Latency of epileptic and psychogenic nonepileptic seizures / Latencia de las crisis epilépticas y psicógenas no epilépticas

Abstract Background Due to their semiological similarities, psychogenic nonepileptic seizures (PNESs) can occasionally hardly be differentiated from epileptic seizures (ESs), and long-term video-electroencephalographic monitoring (VEM) is needed for the differential diagnosis. Objective To investigate the time of the first clinical event and its distribution on the days of VEM in ES and PNES patients. Methods In total, a consecutive series of 48 PNES and 51 ES patients matched for gender and age were retrospectively and consecutively evaluated. The time distribution of the seizures during the day was noted. Seizure latency was determined as the time in hours from the start of the video-electroencephalographic recording to the first clinical event. Results The seizure latency was significantly shorter in PNES patients compared to ES patients (p < 0.001). Seventy-two percent of PNES patients and 49.1% of ES patients had their first seizure in the 24 hours of video-EEG recording (p = 0.023). Recording longer than 48 hours was required for 12.5% of PNES patients and 37.3% of ES patients (p = 0.006). While ESs were almost evenly distributed throughout the day, most PNESs occurred during the evening hours (p = 0.011). Conclusion We observed that the PNESs appeared earlier than the ESs in the VEM and were concentrated during daylight hours. Although not strictly reliable, seizure latency can contribute to the differential diagnosis of ES and PNES.

Resumen Antecedentes Debido a sus similitudes semiológicas, las crisis no epilépticas psicógenas (CNEP) en ocasiones apenas se pueden diferenciar de las crisis epilépticas (CE), y se necesita una monitorización video-electroencefalográfica (EEG) prolongada para el diagnóstico diferencial. Objectivo Investigar el momento del primer evento clínico y su distribución en los días de monitorización video-EEG en pacientes con CE y CNEP. Métodos Se evaluó retrospectivamente a una serie consecutiva de 48 pacientes con CNEP y 51 con ES emparejados por sexo y edad. Se anotó la distribución temporal de las incautaciones durante el día. La latencia de las crisis se determinó como el tiempo en horas desde el inicio de la grabación del video-EEG hasta el primer evento clínico. Resultados La latencia de las crisis fue significativamente menor en los pacientes con CNEP en comparación con los pacientes con CE (p < 0,001). El 72% de los pacientes con CNEP y el 49,1% de los pacientes con CE tuvieron su primera crisis en las 24 horas de registro del video-EEG (p = 0,023). Se requirió un registro de más de 48 horas para el 12,5% de los pacientes con CNEP y el 37,3% de los pacientes con CE (p = 0,006). Mientras que las CE se distribuyeron casi uniformemente a lo largo del día, la mayoría de las CNEP ocurrieron durante las horas después del anochecer (p = 0,011). Conclusión Observamos que las CNEPs aparecieron antes que las CEs en la monitorización video-EEG, y se agruparon durante las horas del día. Aunque no es estrictamente confiable, la latencia de las crisis puede contribuir al diagnóstico diferencial de ES y CNEP.

Frequency and economic burden of psychogenic non-epileptic seizures in patients applying for disability benefits due to epilepsy / Frequência e impacto econômico das crises psicogênicas não epilépticas em pacientes requerentes de aposentadoria por invalidez devido a epilepsia

Abstract Background Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures and are often misdiagnosed as epilepsy. Objective To investigate the frequency of PNES and to calculate the economic burden of the patients who admitted to video-electroencephalographicmonitoring (VEM) to obtain a diagnosis of epilepsy in order to apply for disability retirement. Methods The present retrospective study included 134 patients who required disability reports between 2013 and 2019 and had their definite diagnoses after VEM. Following VEM, the patients were divided into three groups: epilepsy, PNES, and epilepsy + PNES. Results In total, 22.4% (n = 30) of the patients were diagnosed with PNES, 21.6% (n = 29) with PNES and epilepsy, and 56% (n = 75), with epilepsy. The frequency of PNES among all patients was of 44% (n = 59). In patients with PNES alone, the annual cost of using anti-seizure medication was of 160.67 ± 94.04 dollars; for psychostimulant drugs, it was of 148.3 ± 72.48 dollars a year; and the mean direct cost for diagnostic procedures was of 582.9 ± 330.0 (range: 103.52-1601.3) dollars. Conclusions Although it is challenging to determine the qualitative and quantitative total cost in these patient groups, early diagnosis and sociopsychological support will reduce the additional financial burden on the health system and increase the quality of life of the patients.

Resumo Antecedentes As crises psicogênicas não epilépticas (CPNE) se assemelham a crises epilépticas, e muitas vezes são diagnosticadas erroneamente como epilepsia. Objetivo Investigar a frequência de CPNE e calcular o impacto econômico dos pacientes internados para serem submetidos a monitoramento videoencefalográfico (MVE) para obter um diagnóstico de epilepsia e requerer aposentadoria por invalidez. Métodos Este estudo retrospectivo incluiu 134 pacientes que solicitaram laudo médico de incapacidade entre 2013 e 2019, e obtiveram seus diagnósticos definitivos após serem submetidos a MEV. Os pacientes foram divididos em três grupos: epilepsia, CPNE, e epilepsia + CPNE. Resultados Após o MEV, 22,4% (n = 30) dos pacientes foram diagnosticados com CPNE, 21,6% (n = 29), com CPNE + epilepsia, e 56%, com epilepsia. A frequência de CPNE entre todos os pacientes foi de 44% (n = 59). Em pacientes somente com CPNE, o custo anual do uso de anticonvulsivantes foi de US$ 160,67 ± 94,04; para os psicoestimulantes, o custo anual foi de US$ 148,3 ± 72,48; e a média do custo direto de procedimentos diagnósticos foi de US$ 582,9 ± 330,0 (variação: 103,52-1601,3). Conclusões Embora seja um desafio determinar o custo total qualitativo e quantitativo nesses grupos de pacientes, o diagnóstico precoce e o apoio sociopsicológico reduzirão o impacto financeiro adicional ao sistema de saúde e aumentarão a qualidade de vida dos pacientes.

Calidad de vida en pacientes con epilepsia y crisis no epilépticas psicógenas: una revisión sistemática / Quality of life in patients with epilepsy and psychogenic nonepileptic seizures: a systematic review

Resumen Se han revisado artículos que estudiaron la calidad de vida en las personas con crisis no epilépticas psicógenas (CNEP) y crisis epilépticas. Se siguió la guía PRISMA y, previo a la búsqueda, se realizó un protocolo publicado en PROSPERO. Se incluyeron estudios aleatorizados y no aleatorizados, de tipo cuantitativo o mixtos, de corte transversal o longitudinal, escritos en lengua inglesa o española publicados hasta el año 2020, y cuyos participantes fueran mayores de 16 años. Luego de filtrar los resultados según los criterios de selección, se incluyeron 11 artículos y una tesis doctoral cuyos años de publicación datan de 1998 a 2020. En su mayoría, se informaba que las personas con CNEP tenían menor calidad de vida, asociadas a presencia de psicopatología, así como también a la toma de medicación antiepiléptica, factores sociodemográficos y relacionados con las crisis (frecuencia, severidad y duración de enfermedad), funcionamiento familiar, trauma y somatización.

Abstract Psychogenic non epileptic seizures (PNES) are disruptive changes in behaviour, thought, or emotion that resemble an epileptic seizure, but without paroxysmal neuronal discharge detectable by electroencephalography (EEG), and are not caused by another medical condition. On the other hand, epileptic seizures (ES) are defined as clinical events that reflect the presence of hypersynchronous discharges of neurons located in the cerebral cortex, which have the particularity of starting and ending abruptly. The diagnosis of epilepsy is made when an epileptic seizure was experienced and there is a risk of having another. The objective of this paper is to present the results of a systematic review of articles that have studied quality of life in people with PNES and ES. This review has been performed following the PRISMA guide (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Prior to the beginning of the search, a protocol was carried out and it is published for consultation in the International prospective register of systematic reviews (PROSPERO). The review includes randomized and non-randomized, quantitative or mixed, cross-sectional or longitudinal studies, published in English or Spanish until 2020. In addition, participants had to be over 16 years old. PNES diagnosis must have been confirmed by video-electroencephalography (VEEG) or a similar procedure-which is considered the gold standard for the diagnosis of PNES.

Research progress of precise differential diagnosis of psychogenic non-epilepsy seizures and epilepsy / 中华神经科杂志

Psychogenic non-epilepsy seizures (PNES) are defined as paroxysms with clinical symptoms similar to epilepsy without epileptiform discharges. It is often misdiagnosed as epilepsy. Misdiagnosis not only delays the time for patients with PNES to get correct diagnoses and treatments, but also may increase the risk of adverse effects from improper use of antiseizure medications. The diagnostic method of PNES is video electroencephalogram monitoring, but there is no consensus on the optimal duration of monitoring. At the same time, the use of diverse physiological signals, brain imaging, laboratory examination, and the application of machine learning provide new perceptions for the precise identification of PNES and epilepsy. This article reviewed the progress of precise differential diagnosis between PNES and epilepsy.

Successfully Treated Psychogenic Non-Epileptic Seizure with Shigyakusan and Hangebyakujutsutemmato / 日本東洋医学雑誌

We report a case of loss of consciousness multiple times with and without focal to bilateral tonic-clonic seizure-like episodes that we diagnosed as psychogenic non-epileptic seizures, and successfully treated with shigyakusan and hangebyakujutsutemmato. The patient did not have fullness and discomfort in the chest and hypochondrium (kyokyokuman), nor spasmodic bilateral rectus abdominis in an interictal state. On the other hand, she had extremely cold limbs, especially feet and hands, with fingers being flexion and rigid under the status of loss of consciousness even without tonic-clonic seizure-like episodes in the ictal state. After being warmed and loosened, her consciousness level slowly recovered. She had headaches frequently in a non-ictal state, too. We identified that she had qi deficiency (kikyo), qi depression (kiutsu), fluid retention (suitai) and qi counter flow (kigyaku) in the interictal state, while kiutsu and kigyaku were extremely strong in the ictal state. In this case, the combined use of shigyakusan and hangebyakujutsutemmato was useful, considering that the patient had two different locations of disease (byoi) that required treatment.

Ekbom Syndrome associated with Lewy Body Dementia: A case report / Síndrome de ekbom associada à demência com corpos de lewy: um relato de caso

ABSTRACT Ekbom Syndrome, also known as parasitosis delusion or psychogenic parasitosis, is a rare condition in which patients present with a fixed belief of being infested by parasites, vermin or small insects, along with tactile hallucinations (such as pruritus or sensations of the parasites crawling over or under the skin). The syndrome may occur idiopathically or be associated with other medical conditions and drug use. This case report describes the occurrence of Ekbom syndrome in a patient diagnosed with Lewy Body Dementia (LBD), a neurodegenerative disease that commonly presents with sensory perception and thought disorders and other neuropsychiatric symptoms. Although visual hallucination is considered a core diagnostic criterion, other modalities of psychiatric symptoms can also occur posing a further challenge for correct diagnosis. Proper recognition allows early diagnosis and adequate treatment, preventing hazardous antipsychotic use in these patients.

RESUMO A síndrome de Ekbom, também conhecida como delírio parasitário ou parasitose psicogênica, é uma condição rara na qual os pacientes apresentam crença fixa de estarem infestados por parasitas, vermes ou insetos, acompanhada de alucinações táteis (como prurido ou sensação dos parasitas andando sobre ou sob a pele). A síndrome pode ocorrer de forma idiopática ou associada a outras condições médicas ou uso de drogas. Este relato de caso descreve a ocorrência da síndrome de Ekbom em um paciente diagnosticado com Demência com corpos de Lewy (DCL), uma doença degenerativa que comumente se apresenta com desordens de sensopercepção e pensamento, e outros sintomas neuropsiquiátricos. A alucinação visual é considerada um dos critérios diagnósticos nucleares, entretanto outras modalidades de sintomas psiquiátricos podem ocorrer criando desafios adicionais ao diagnóstico correto. O reconhecimento apropriado permite o diagnóstico precoce e tratamento adequado, prevenindo o uso arriscado de antipsicóticos nesses pacientes.

La experiencia de pacientes con crisis no epilépticas psicógenas: marcos interpretativos y de acción / A experiência de pacientes com crises não epiléticas psicogênicas: marcos interpretativos e de ação / The experience of patients with psychogenic non epileptic seizures: interpretative and action framework / L´expérience des patients atteints de crise psychogène non épileptique: cadres dinterprétation et daction

Resumen La perspectiva del paciente se presenta como algo importante a tener en cuenta para la comprensión del padecimiento y para lograr un tratamiento efectivo. El objetivo de la presente investigación es indagar las trayectorias terapéuticas y las experiencias durante el recorrido terapéutico de pacientes con Crisis No Epilépticas Psicógenas (CNEP) pertenecientes a un Hospital General de la Ciudad Autónoma de Buenos Aires. Se realizaron entrevistas semiestructuradas a diez pacientes diagnosticados con CNEP. Para el análisis de los datos se utilizó una metodología cualitativa basada en los principios del análisis temático. Se ha identificado una categoría central: Itinerarios terapéuticos dentro del sistema etnomédico y tres subcategorías: (1) Diagnósticos Recibidos; (2) Recursos del sistema etnomédico y (3) Evaluaciones de los recursos utilizados. La dificultad de arribar a un diagnóstico y un tratamiento que permitiera mejorar las CNEP, así como el uso de distintas medicinas, fue destacada por la totalidad de los pacientes.

Resumo A perspectiva do paciente se apresenta como algo importante a levar em conta para a compreensão do sofrimento e para se alcançar um tratamento eficaz. O objetivo desta pesquisa é investigar as trajetórias terapêuticas e as experiências durante a jornada terapêutica de pacientes com crise não epilética psicogênica (CNEP) de um Hospital Geral da Cidade Autônoma de Buenos Aires. Entrevistas semiestruturadas foram realizadas com dez pacientes com diagnóstico de CNEP. Para a análise dos dados, utilizou-se metodologia qualitativa baseada nos princípios da análise temática. Uma categoria central foi identificada: Itinerários terapêuticos dentro do sistema etnomédico; e três subcategorias: (1) Diagnósticos recebidos; (2) Recursos do sistema etnomédico; e (3) Avaliações dos recursos utilizados. A dificuldade de se chegar a um diagnóstico e a um tratamento que permitisse melhorar a CNEP, bem como o uso de diferentes medicamentos, foi destacada por todos os pacientes.

Abstract The patient's perspective is essential to understand their condition and to achieve an effective treatment. The objective of this paper is to investigate the therapeutic trajectories and experiences of patients with Psychogenic Non-Epileptic Crisis (PNES) under treatment in a General Hospital of the Autonomous City of Buenos Aires. Semi-structured interviews were conducted with ten patients diagnosed with PNES. For data analysis, a qualitative methodology based on thematic analysis was adopted. A central category has been identified: Therapeutic Itineraries within the Ethnomedical System, and three subcategories: (1) Diagnoses received; (2) Resources of the ethnomedical system; and (3) Evaluation of the resources used. The difficulty of finding a diagnosis, a treatment to improve PNES, and proper medicine were highlighted by all the patients.

Résumé Le point de vue du patient est présenté comme quelque chose d'important à prendre en compte afin de comprendre la maladie et d'obtenir un traitement efficace. L'objectif de cette recherche est d'analyser les trajectoires thérapeutiques et les expériences au cours du parcours thérapeutique des patients atteints de Crise Psychogénique Non Épileptique (CPNE) dans un hôpital général de la ville de Buenos Aires. Des entretiens semi-structurés ont été menés auprès de 10 patients diagnostiqués avec une CPNE. Pour l'analyse des données, une méthodologie qualitative basée sur les principes de l'analyse thématique a été utilisée. Une catégorie centrale a été identifiée : Les itinéraires thérapeutiques au sein du système ethno-médical et trois sous-catégories : (1) Diagnostics reçus ; (2) Ressources du système ethno-médical ; et (3) Évaluations des ressources utilisées. La difficulté d'arriver à un diagnostic et à un traitement permettant d'améliorer la CPNE, ainsi que l'utilisation de médicaments différents, a été soulignée par l'ensemble des patients.

A Case of Unrecognized Psychogenic Polydipsia

@#Psychogenic polydipsia is prevalent among people with schizophrenia. Although its pathophysiology is relatively unknown, it causes life threatening complications due to acute or severe hyponatraemia.. This report illustrates a patient with schizophrenia who had unrecognized psychogenic polydipsia and developed severe complication. It also highlights the clinical salience of its management.

Pseudoseizures with urinary incontinence in a child with Neuromyelitis optica: a rare association

Background: Paroxysmal non epileptic events or pseudoseizures are common seizure mimics in children. But occasionally PNES events can present or coexist along with organic neurological disorders complicating the clinical scenario posing great challenges for diagnostic and therapeutic implications. Unusual symptomatology in PNES like frothing, tongue bite or urinary incontinence can be seen in PNES. Here, we present a rare case of pseudoseizures with urinary incontinence in a child with Neuromyelitis optica which posed a challenge for diagnosis and proper management with a favourable clinical outcome. A 14 years old girl who was known diagnosed case of Neuromyelitis optica on treatment with oral steroids presented with a history of repeated attacks of involuntary movements affecting all four limbs preceded by a feeling of fear and pain and these events were associated with urinary incontinence. Electroencephalogram and magnetic resonance imaging were performed on the patient. Ictal video EEG confirmed the diagnosis of pseudoseizures. Neuropsychological evaluation was performed which revealed multiple psychological stressors. Repeated counseling sessions and psychotherapy provided significant improvement in the form of remission of pseudoseizures.

Beyond prosody: foreign accent syndrome in a spanish-speaking patient. case report

ABSTRACT Introduction: Foreign accent syndrome (FAS) is a rare speech disorder. It is becoming increasingly common to find reports of cases about alterations different from the suprasegmental aspects of speech, although these reports are not frequent in Spanish-speaking patients. Case presentation: 48-year-old female patient from Colombia diagnosed with FAS, segmental and suprasegmental speech alterations, and changes in cognitive domains (executive functions and language). The woman also presented with motor and affective changes. Brain imaging studies ruled out structural involvement and follow-up at one year did not show significant changes in speech. Discussion: This case presents the neurological, neuropsychological and speech features of a Spanish-speaking patient with FAS. Greater alteration in vowels than in consonants, alteration in pronunciation time, variation in rhythm and intonation of words and phrases, decrease of time between syllables, and insertion of vowels are common elements between this patient and other cases of FAS in non-Spanish speaking subjects. Conclusions: FAS is essentially a speech alteration; however, it can be accompanied by other physical and psychological signs. This case report allows recognizing the essential components for the definition, diagnosis and intervention of this syndrome.

RESUMEN Introducción. El síndrome de acento extranjero (FAS por su sigla en inglés) es un trastorno infrecuente del habla. Cada vez es más usual encontrar reportes de casos con alteraciones diferentes a los aspectos suprasegmentales del habla; estos no son frecuentes para pacientes hispanohablantes. Presentación del caso. Paciente femenino, colombiana, de 48 años de edad, con FAS y alteraciones segmentales y suprasegmentales del habla y en dominios cognoscitivos (funciones ejecutivas y lenguaje). La mujer también presentó cambios motores y afectivos. Las imágenes cerebrales descartaron compromiso estructural y el seguimiento a un año no evidenció cambios significativos en el habla. Discusión. El caso presenta las características neurológicas, neuropsicológicas y del habla de una paciente hispanohablante con FAS. La mayor alteración en vocales, la alteración en el tiempo de pronunciación, la variación en el ritmo y entonación en palabras y frases, la disminución en el tiempo entre sílaba y sílaba y la inserción de vocales son elementos que esta paciente comparte con otros casos de FAS en sujetos no hispanohablantes. Conclusiones. El FAS se constituye esencialmente por alteración del habla; sin embargo, puede acompañarse de otros signos físicos y psicológicos. El presente reporte de caso permite reconocer los componentes esenciales para la definición, diagnóstico e intervención de este síndrome.

Interesting case of sudden unilateral blindness in a teenager: role of psychological intervention in psychogenic visual loss

Visual loss complaints are commonly encountered by treating physicians, neurologist and ophthalmologists. More specifically a presentation of non-organic (psychogenic) blindness is less frequently seen but does exist and requires proper evaluation and specific skills for it to be properly managed. This case is of a 19 years old male who presented with acute monocular blindness post trauma whom he also had past psychiatric history. Post thorough assessment, no organic cause was identified, and a diagnosis of psychogenic blindness was made. Psychological therapy was beneficial in aiding return of his vision.

Why was Nichinto Effective, Although Rikkunshito and Shohangekabukuryoto were Ineffective? / 日本東洋医学雑誌

A female with persistent emesis after eating was successfully treated with nichinto, although neither various western-style medicines nor Chinese herbal medicines including rikkunshito or shohangekabukuryoto were effective. Considering the constituent crude drugs, we believe riki (moving of qi) medicine is potent against vomiting associated with psychological factors, while hoki (rising of qi) medicine would be extra crude drug in the absence of hikyo (deficiency of digestive function).

A Case of Lower Back with Extremity Pain Successfully Treated with Kanzobushito / 日本東洋医学雑誌

We report a case of lower back with extremities pain, whose cause could not be established in the medical sense nor relieved by analgesic drugs, was successfully treated with kanzobushito. The patient was a 69-­year-old male. Because of extremity pain of his lower left back, he could not move by himself and was transported to our hospital by an ambulance. Having persistent pain, he could not turn over or stretch his left leg and anal­gesic drugs and sacral nerve blocks were ineffective. We administered kanzobushito referring to the phrase “pain that gets worse as someone approaches” in the Shokanron. After administering kanzobushito, his pain was reduced remarkably and he could sit down on the bed. And his activities of daily living improved immedi­ately. Thus, kanzobushito may be useful for severe pain and should be administered to neuropathic pain compli­cated with psychogenic factors referring to coldness, severe pain and abnormality of qi (irritable).

Brain magnetic resonance imaging in exploring the central neurophysiological mechanisms of penile erection: Progress in studies / 中华男科学杂志

Previous studies have found that penile erection is not only dependent on the peripheral nervous and vascular systems, but also controlled by the central nervous system. Some brain regions are responsible for promoting and suppressing penile erection, respectively. Studies on the brain functions showed both activation and inactivation of the brain regions when receiving sexual stimulation, and those on the brain structure of ED patients revealed atrophy of the gray matter structure and abnormal connection of the white matter fibers. In addition, abnormal connections within emotional, cognitive and default and salience networks were found in patients with psychogenic ED. This article reviews the brain MRI-based studies on the central neurophysiological mechanisms of penile erection, aiming to gain a deeper insight into human neurophysiological mechanisms of the neural circuits controlling erectile function.

Modelos conceptuales y explicativos sobre las crisis no epilépticas psicógenas (CNEP) / Conceptual and explanatory models of Psychogenic Non-Epileptic Seizures (PNES)

Las Crisis No Epilépticas Psicógenas (CNEP) son episodios similares a las crisis epilépticas, pero a diferencia de éstas, no son causadas por la actividad eléctrica anómala del cerebro. Se diagnostican una vez descartadas otras causas fisiopatológicas. El objetivo de este artículo es presentar la conceptualización actual de este fenómeno. Para ello, en primer lugar realizaremos una historización del fenómeno, relacionándolo con la categoría de histeria; segundo lugar, describiremos las clasificaciones propuestas por las distintas ediciones del Manual Diagnóstico y Estadístico de los trastornos mentales, destacando su última versión (DSM-V); finalmente, introduciremos las corrientes actuales que explican este fenómeno, las cuales toman el rol de la disociación como categoría central que explica tanto el diagnóstico así como los objetivos de tratamiento para las CNEP. La categoría disociación es la clave para entender la dirección en la que se está avanzando en psicopatalogía, la búsqueda de los procesos psicológicos específicos subyacentes para entender el mecanismo que lleva a producir tanto las CNEP como otros cuadros de psicopatológicos.

Psychogenic Non Epileptic Crises (CNEP) have been a challenge to diagnostic and explanation for the mental health field. They are diagnosed after discard out other pathophysiological causes of the crisis. They are similar to epileptic seizures, but unlike these, they are not caused by electrical activity in the brain. In order to present the current conceptualization of this phenomenon, we propose in first place to describe its historical development, second, the current classification of the Diagnostic and Statistical Manual (DSM-V), third, to introduce the present currents that explain this phenomenon by taking the role of dissociation as a central category that explains the diagnosis and the treatment objectives for the CNEP. The dissociation category is the key to understand the direction in which progress is being made in psychopathology, the search for the specific underlying psychological processes to understand the mechanism that leads to producing both the CNEP and other psychopathological frames.

Psychogenic Hiccups – a case report

Hiccups are a common occurrence which may be many a time organic in nature. We present herewith thecase of a 20 year old girl that presented with hiccups of a psychogenic in nature. The patient’s case isdiscussed as the patient responded to a combination of medical and psychological interventions.

Cognitive Behavior Therapy for Psychogenic Cough in Children : a case series

Introduction: Cough is the most common presenting symptom in pediatric primary care settings. Coughcan impact a child's activity level and ability to sleep, play or attend school and is often a source ofparental anxiety. However, an etiology of cough is not always easily identified even after a thoroughsystematic investigation and psychological and neurological conditions are in the differential diagnosis.Psychogenic cough is diagnosed in cases without a clear pulmonary or extrapulmonary etiology in thepresence of some suggestive clinical characteristics and/or an association with psychological issue.Psychogenic cough has been reported to be the second most common cause of chronic cough in children ofage 6-16 years.Methodology: The present paper highlights four case reports of children who presented with symptoms ofpsychogenic cough in the OPD of CNBC hospital, Delhi.The presenting nature of the symptoms alongwith the underlying psychological factors have been discussed. Cognitive Behavioural techniques likedistraction and cognitive restructuring interventions with the children along with family interventions wereused.Conclusions: All the children showed significant improvement at the end of therapy. Three month followup showed that the results were maintained. Cognitive Behavioural approaches are found to be effective inmanaging psychogenic cough and the present paper highlights the process of cognitive behaviouralmanagement of psychogenic cough in children.Key words: cognitive behavior therapy, cough,

Sexual function of undergraduate women: a comparative study between Brazil and Italy / La función sexual de universitarias: estudio comparativo entre Brasil e Italia / Função sexual de universitárias: estudo comparativo entre Brasil e Itália

ABSTRACT Objective: to evaluate the sexual function of Italian and Brazilian nursing students using the Female Sexual Function Index (FSFI), to estimate the prevalence of sexual dysfunctions and related factors. Method: this is a cross-sectional study involving 84 Brazilian and 128 Italian undergraduate. For the evaluation of sexual function, the Female Sexual Function Index (FSFI) questionnaire was used. Results: Italian women presented significantly higher sexual dysfunction index (n=78/60.9%) than the Brazilian women (n=32/38.1%) (p=0.00). Only the "desire" and "excitation" domains showed no difference between groups. Younger, single and without a steady relationship women had a higher rate of sexual dysfunction (p<0.05). Conclusion: the high rate of sexual dysfunction in a young public suggests the need for more research to increase knowledge about the influence of psychosocial and related factors on female sexual function, directing care towards the promotion of sexual and reproductive health.

RESUMEN Objetivo: evaluar la función sexual de académicas italianas y brasileñas de enfermería utilizando el Female Sexual Function Index (FSFI), estimar el predominio de las disfunciones sexuales y los factores relacionados. Método: estudio transversal, de lo cual participaron 212 universitarias, siendo 84 brasileñas y 128 italianas. Para evaluar la función sexual, se utilizó el cuestionario Female Sexual Function Index(FSFI). Resultados: Las italianas presentaron índice de disfunción sexual significativamente superior (n=78/60,9%) en comparación con el de las brasileñas (n=32/38,1%) (p=0,00). Sólo los dominios "deseo" y "excitación" no presentaron diferencia entre los grupos. Las mujeres más jóvenes, solteras y sin relación estable presentaron un índice de disfunción sexual más alto (p<0,05). Conclusión: el elevado índice de disfunción sexual en un público tan joven sugiere la necesidad de realizar más investigaciones que incrementen el conocimiento sobre la influencia de los factores psicosociales y relacionales en la función sexual femenina, dirigiendo el cuidado para la promoción de la salud sexual y reproductiva.

RESUMO Objetivo: avaliar a função sexual de acadêmicas de enfermagem italianas e brasileiras utilizando o Female Sexual Function Index (FSFI), estimar a prevalência das disfunções sexuais e os fatores relacionados. Método: estudo transversal, o qual participaram 212 universitárias, sendo 84 brasileiras e 128 italianas. Para a avaliação da função sexual, empregou-se o questionário Female Sexual Function Index (FSFI). Resultados: As italianas apresentaram índice de disfunção sexual significativamente superior (n=78/60,9%) do que as brasileiras (n=32/38,1%) (p=0,00). Apenas os domínios "desejo" e "excitação" não apresentaram diferença entre os grupos. As mulheres mais jovens, solteiras e sem relacionamento estável apresentaram índice de disfunção sexual maior (p<0,05). Conclusão: o elevado índice de disfunção sexual em um público tão jovem sugere a necessidade da realização de mais investigações que incrementem o conhecimento sobre a influência dos fatores psicossociais e relacionais na função sexual feminina, direcionando o cuidado para a promoção da saúde sexual e reprodutiva.

Distonía psicógena / Psychogenic dystonia

RESUMEN La distonía psicógena (funcional) es una condición que representa un reto para el clínico, desde su terminología confusa hasta el tratamiento integral. Este fenómeno se presenta en pacientes con ausencia de una enfermedad neurológica o condición secundaria que explique cabalmente dicha presentación y generalmente con una comorbilidad psiquiátrica marcada.

SUMMARY Psychogenic (functional) dystonia represent a huge challenge to the clinician. Nowadays there is a discussion between which term fit most to this condition (psychogenic vs. functional) but so far a consensus has not been reach. This phenomenon is present in absence of any neurological condition or identifiable secondary cause and usually is accompanied with an important psychiatric comorbidity.

Distonía psicógena / Psychogenic dystonia

La distonía psicógena (funcional) es una condición que representa un reto para el clínico, desde su terminología confusa hasta el tratamiento integral. Este fenómeno se presenta en pacientes con ausencia de una enfermedad neurológica o condición secundaria que explique cabalmente dicha presentación y generalmente con una comorbilidad psiquiátrica marcada.

SUMMARY Psychogenic (functional) dystonia represent a huge challenge to the clinician. Nowadays there is a discussion between which term fit most to this condition (psychogenic vs. functional) but so far a consensus has not been reach. This phenomenon is present in absence of any neurological condition or identifiable secondary cause and usually is accompanied with an important psychiatric comorbidity.