Posttraumatic stress disorder caused by the misattribution of seizure-related experiential responses.

Patients with temporal lobe seizures sometimes experience what John Hughlings Jackson described as "dreamy states" during seizure onset. These phenomena may be characterized by a re-experiencing of past events, feelings of familiarity (déjà vu), and hallucinations. In previous reports, patients have been aware of the illusory nature of their experiences. Here, however, the case of a patient with a documented 37-year history of temporal lobe epilepsy who is not aware is described. Fifteen years ago, the patient saw visions of traumatic autobiographical events that he had never previously recalled. He believed them to be veridical memories from his childhood, although evidence from his family suggests that they were not. The patient's psychological reaction to the "recovery" of these traumatic "memories" was severe enough to qualify as posttraumatic stress disorder (PTSD). To our knowledge, this is the first report of PTSD caused by the misattribution of mental states that accompany a seizure.

The use of duloxetine in chronic bulimia nervosa: a case report.

Selective serotonin reuptake inhibitors are routinely prescribed as off-label treatments for bulimia nervosa. There is, however, a paucity of literature addressing the efficacy of the serotonin norepinephrine reuptake inhibitors in the pharmacologic management of this disorder. This article describes a clinical situation in which duloxetine, a serotonin norepinephrine reuptake inhibitor, effectively treated a patient with long-standing bulimia nervosa, purging type, and comorbid generalized anxiety disorder.