Quantitative EEG Findings in Patients With Psychogenic Nonepileptic Seizures.

Objective. Psychogenic nonepileptic seizures (PNES), is one of the clinical manifestations of conversion disorder that epileptiform discharges do not accompany. Factors capable of increasing susceptibility to these seizures have not been adequately investigated yet. This study aims to investigate the quantitative electroencephalography (QEEG) findings for PNES by evaluating the resting EEG spectral power changes during the periods between seizures. Methods. Thirty-nine patients (29 females, 10 males) diagnosed with PNES (group 1) and 47 patients (23 females, 24 males) without any psychiatric diagnosis (group 2) were included in the study. The patients underwent a psychiatric examination at their first visit, were diagnosed and their EEGs were recorded. Using fast Fourier transformation (FFT), spectral power analysis was calculated for delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (15-30 Hz), high-beta (25-30 Hz), gamma-1 (31-40 Hz), gamma-2 (41-50 Hz), and gamma (30-80 Hz) frequency bands. Results. Six separate EEG band power, namely (C3-high beta, C3-gamma, C3-gamma-1, C3-gamma-2, P3-gamma, P3 gamma-1), were found to be higher in the patients diagnosed with PNES than in the control group. Conclusion. Our findings show that PNES correlate with high-frequency oscillations on central motor and somatosensory cortices.

Dissociative Aggression Triggered by Headache.

Headache is generally perceived as a negative symptom focused on oneself. However, there are reports suggesting that patients suffering from pain, especially headache, can be aggressive. The precise nature of the link between headache and aggression is not known. Here, we describe a homicidal attack, triggered by headache, in a middle-aged man. The patient's background and the characteristics of the attack suggested a dissociative behavior. The case shows that headache may be a trigger for homicidal behavior. Case-control studies are needed to determine the prevalence of aggressive tendencies in patients with headache.

Special Report on the Impact of the COVID-19 Pandemic on Clinical EEG and Research and Consensus Recommendations for the Safe Use of EEG.

INTRODUCTION: The global COVID-19 pandemic has affected the economy, daily life, and mental/physical health. The latter includes the use of electroencephalography (EEG) in clinical practice and research. We report a survey of the impact of COVID-19 on the use of clinical EEG in practice and research in several countries, and the recommendations of an international panel of experts for the safe application of EEG during and after this pandemic. METHODS: Fifteen clinicians from 8 different countries and 25 researchers from 13 different countries reported the impact of COVID-19 on their EEG activities, the procedures implemented in response to the COVID-19 pandemic, and precautions planned or already implemented during the reopening of EEG activities. RESULTS: Of the 15 clinical centers responding, 11 reported a total stoppage of all EEG activities, while 4 reduced the number of tests per day. In research settings, all 25 laboratories reported a complete stoppage of activity, with 7 laboratories reopening to some extent since initial closure. In both settings, recommended precautions for restarting or continuing EEG recording included strict hygienic rules, social distance, and assessment for infection symptoms among staff and patients/participants. CONCLUSIONS: The COVID-19 pandemic interfered with the use of EEG recordings in clinical practice and even more in clinical research. We suggest updated best practices to allow safe EEG recordings in both research and clinical settings. The continued use of EEG is important in those with psychiatric diseases, particularly in times of social alarm such as the COVID-19 pandemic.

Psychiatry to dermatology; panic disorder.

OBJECTIVE: Anxiety is commonly observed together with skin diseases and can aggravate them, while skin diseases can increase anxiety. The relationship of skin diseases observed in panic disorder with quantitative electroencephalography (QEEG) findings has not been investigated yet. The aim of this study is to compare the absolute alpha and delta power of panic disorder patients with and without skin disease. METHODS: 246 panic disorder patients, 19 of whom had skin disease and 227 of whom did not have skin disease, were included in the study. Panic disorder severity scale (PDSS) scores of patients were recorded, and QEEG recording was performed. Absolute alpha and delta power and PDSS scores were compared between the two groups. RESULTS: It was found that the absolute delta power in the left hemisphere was lower and PDSS scores were higher in the patients with skin diseases compared to the control group. In the patients with skin disease, decreased delta power in the left hemisphere may cause impairment in the processing of positive emotions and may cause trait anxiety. CONCLUSION: Trait anxiety may increase susceptibility to skin diseases by disrupting cutaneous homeostasis resulting from the prolonged sympathetic nervous system activation.

Prediction of treatment resistance in obsessive compulsive disorder patients based on EEG complexity as a biomarker.

OBJECTIVE: This study aimed to identify an Electroencephalography (EEG) complexity biomarker that could predict treatment resistance in Obsessive compulsive disorder (OCD) patients. Additionally, the statistical differences between EEG complexity values in treatment-resistant and treatment-responsive patients were determined. Moreover, the existence of correlations between EEG complexity and Yale-Brown Obsessive Compulsive Scale (YBOCS) score were evaluated. METHODS: EEG data for 29 treatment-resistant and 28 treatment-responsive OCD patients were retrospectively evaluated. Approximate entropy (ApEn) method was used to extract the EEG complexity from both whole EEG data and filtered EEG data, according to 4 common frequency bands, namely delta, theta, alpha, and beta. The random forests method was used to classify ApEn complexity. RESULTS: ApEn complexity extracted from beta band EEG segments discriminated treatment-responsive and treatment-resistant OCD patients with an accuracy of 89.66% (sensitivity: 89.44%; specificity: 90.64%). Beta band EEG complexity was lower in the treatment-resistant patients and the severity of OCD, as measured by YBOCS score, was inversely correlated with complexity values. CONCLUSIONS: The results indicate that, EEG complexity could be considered a biomarker for predicting treatment response in OCD patients. SIGNIFICANCE: The prediction of treatment response in OCD patients might help clinicians devise and administer individualized treatment plans.

Predictive Value of Slow and Fast EEG Oscillations for Methylphenidate Response in ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder and is characterized by symptoms of inattention and/or hyperactivity and impulsivity. In the current study, we obtained quantitative EEG (QEEG) recordings of 51 children aged between 6 and 12 years before the initiation of methylphenidate treatment. The relationship between changes in the scores of ADHD symptoms and initial QEEG features (power/power ratios values) were assessed. In addition, the children were classified as responder and nonresponder according to the ratio of their response to the medication (>25% improvement after medication). Logistic regression analyses were performed to analyze the accuracy of QEEG features for predicting responders. The findings indicate that patients with increased delta power at F8, theta power at Fz, F4, C3, Cz, T5, and gamma power at T6 and decreased beta powers at F8 and P3 showed more improvement in ADHD hyperactivity symptoms. In addition, increased delta/beta power ratio at F8 and theta/beta power ratio at F8, F3, Fz, F4, C3, Cz, P3, and T5 showed negative correlations with Conners' score difference of hyperactivity as well. This means, those with greater theta/beta and delta/beta powers showed more improvement in hyperactivity following medication. Theta power at Cz and T5 and theta/beta power ratios at C3, Cz, and T5 have significantly classified responders and nonresponders according to the logistic binary regression analysis. The results show that slow and fast oscillations may have predictive value for treatment response in ADHD. Future studies should seek for more sensitive biomarkers.

Simultaneous EEG/fMRI analysis of the resonance phenomena in steady-state visual evoked responses.

The stability of the steady-state visual evoked potentials (SSVEPs) across trials and subjects makes them a suitable tool for the investigation of the visual system. The reproducible pattern of the frequency characteristics of SSVEPs shows a global amplitude maximum around 10 Hz and additional local maxima around 20 and 40 Hz, which have been argued to represent resonant behavior of damped neuronal oscillators. Simultaneous electroencephalogram/functional magnetic resonance imaging (EEG/fMRI) measurement allows testing of the resonance hypothesis about the frequency-selective increases in SSVEP amplitudes in human subjects, because the total synaptic activity that is represented in the fMRI-Blood Oxygen Level Dependent (fMRI-BOLD) response would not increase but get synchronized at the resonance frequency. For this purpose, 40 healthy volunteers were visually stimulated with flickering light at systematically varying frequencies between 6 and 46 Hz, and the correlations between SSVEP amplitudes and the BOLD responses were computed. The SSVEP frequency characteristics of all subjects showed 3 frequency ranges with an amplitude maximum in each of them, which roughly correspond to alpha, beta and gamma bands of the EEG. The correlation maps between BOLD responses and SSVEP amplitude changes across the different stimulation frequencies within each frequency band showed no significant correlation in the alpha range, while significant correlations were obtained in the primary visual area for the beta and gamma bands. This non-linear relationship between the surface recorded SSVEP amplitudes and the BOLD responses of the visual cortex at stimulation frequencies around the alpha band supports the view that a resonance at the tuning frequency of the thalamo-cortical alpha oscillator in the visual system is responsible for the global amplitude maximum of the SSVEP around 10 Hz. Information gained from the SSVEP/fMRI analyses in the present study might be extrapolated to the EEG/fMRI analysis of the transient event-related potentials (ERPs) in terms of expecting more reliable and consistent correlations between EEG and fMRI responses, when the analyses are carried out on evoked or induced oscillations (spectral perturbations) in separate frequency bands instead of the time-domain ERP peaks.

The attitudes of preclinical and clinical Turkish medical students toward suicide attempters.

BACKGROUND: Interest in studies of stigma toward patients with mental disorders is growing. Research on the attitudes of medical students toward suicide attempters does not exist; although as medical personnel, they will encounter suicide attempters in emergency rooms. AIMS: We aimed to investigate the attitudes of preclinical and clinical medical students toward suicide attempters and to compare their attitudes with nonmedical students. METHODS: Participants were asked to fill out questionnaires those were searching the attitudes toward suicide attempters. These questionnaires used a social distance scale, skillfulness assessment scale, and dangerousness scale. RESULTS: More than 73% of students had a negative attitude toward "renting a room of their home to a suicide attempter." More than 90% would not want "a suicide attempter to supervise their children for few hours." Significantly more preclinical than clinical students would not want their children to marry a suicide attempter. CONCLUSIONS: Social distance, skillfulness, and attitudes concerning the dangerousness of suicide attempters are problematic for medical students and need educational intervention.

Electroconvulsive therapy for bipolar depressive and mixed episode with high suicide risk after epilepsy surgery.

Mood disturbance is a common comorbid condition of temporal lobe epilepsy before and after surgery. Suicide is more frequent in patients with epilepsy than in the general population. As suicide is a major issue in both epileptic and depressive patients, it is critical to treat aggressively any psychiatric illness with suicidal ideation. We describe two patients who, after temporal lobe surgery, developed a serious bipolar disorder that necessitated electroconvulsive therapy (ECT), despite better seizure control. Unfortunately they were not able to commit to a regular treatment plan with their psychiatrists to prevent a suicide. These patients underwent a course of ECT treatments. After the ECT regimen, acute suicidal intent remitted and was replaced by chronic suicidal ideation without active intent or plan. The patients were then able to commit to a treatment plan regarding their medications and control visits. These cases represent the safe utilization of ECT as a rapid and effective treatment option for bipolar disorder with suicide ideation following epilepsy surgery. Patients and parents should be advised about possible psychiatric disturbances and suicide risk after epilepsy surgery, especially in the presence of a temporal lobe epilepsy, even when seizure control is achieved postoperatively.

Gender effect on attitudes towards the mentally ill: a survey of Turkish university students.

UNLABELLED: This study investigates gender-associated characteristics of attitudes towards the mentally ill in a large sample of Turkish university students. Factors associated with gender variation were also analyzed. MATERIALS AND METHODS: Student's t-test and linear regression analyses of the results of a vignette-based opinion survey conducted on a sample of final-year Turkish university students (n=700) were performed. The survey consisted of the following: the "Dangerousness Scale:' "Characteristics Scale," "Skill Assessment Scale:" "Social Distance Scale:" "Affective Reaction Scale" and a socio-demographic questionnaire. RESULTS: The results showed a statistically significant difference between female and male respondents with regard to their answers to the questions on the "Dangerousness Scale," "Characteristics Scale" and the "Skill Assessment Scale" In all of these three scales, female respondents showed a less stigmatizing attitude than the male respondents. This gender effect continued after controlling for the subjects' age and family income. In female respondents, parents' level of education and a more positive attitude about treatment of mental illness predicted less stigmatizing attitudes towards mental illness. CONCLUSIONS: The findings suggest that gender difference in this sample has an impact on the stigmatization phenomenon in an independent fashion. A more positive view of female university students towards the mentally ill might be due to their comparatively optimistic attitudes about the treatability of mental illnesses. The observed gender difference seems to be accentuated by the fact that female students' parents' level of education was higher than that of their male counterparts.

EEG correlates of startle reflex with reactivity to eye opening in psychiatric disorders: preliminary results.

Previous studies have shown alterations of eyeblink reflex in patients with various psychiatric disorders. It has previously been demonstrated by our group that EEG measures of the reactivity to eye opening could effectively predict patient-reported startle response in patients with acute stress reaction. In our present study, EEG spectral power analysis and eyeblink electrical startle responses were acquired from a total of 39 patients diagnosed with various psychiatric disorders: 7 patients with schizophrenia, 10 patients with major depressive disorder (MDD), 10 patients with panic disorder, 5 patients with posttraumatic stress disorder (PTSD) and 7 patients with generalized anxiety disorder (GAD). EEG percent power data of each frequency band (delta, theta, alpha, beta) obtained from the 19 leads under open or closed eyelid conditions were used to calculate the arithmetical difference between eyes-open and eyes-closed states as representative of "EEG reactivity to eye opening". Data was analyzed separately for each diagnostic group. For all of the disorders, right-sided R2c (contralateral secondary component) latency was the single eyeblink startle measure that was found to be significantly correlated with EEG reactivity to eye opening. The correlation was most significant for right temporal theta frequency in schizophrenia, right temporal theta frequency in MDD, left central beta frequency in panic disorder, left parietotemporal delta frequency in PTSD and right occipital alpha frequency in GAD. Findings showed a newly identified pattern that has potential scientific and clinical value with respect to psychiatric medicine.

A stigmatizating attitude towards psychiatric illnesses is associated with narcissistic personality traits.

UNLABELLED: This study investigates the personality characteristics of individuals who have stigmatizing attitudes towards people with mental illness. MATERIAL AND METHOD: 700 final-year university students completed the "Dangerousness Scale,' the "Affective Reaction Scale" and 88 items of the "Defense Style Questionnaire" (DSQ). RESULTS: The results showed that there is a strongly positive correlation between the use of narcissistic defenses and the tendency to stigmatize. In contrast, those with mature defenses have a strong tendency not to stigmatize. CONCLUSIONS: The findings suggest that personality traits should be considered in efforts to understand stigmatization.