Antipsychotics and Identity: The Adverse Effect No One is Talking About.

People who take antipsychotics, and people who are prescribed antipsychotics without taking them, experience effects which are not frequently discussed: effects on their identity and sense of self. Qualitative research indicates the relationship between taking APs and identity is multilayered, and changeable. Taking APs can restore people to their earlier, pre-symptom sense of self. Being prescribed and taking APs can also, on the other hand, be experienced as damaging, erasing and dulling people's sense of who they are. This complexity deserves exploration in clinical practice, which we believe is currently not done routinely. More work is needed to understand whether, and how, the relationship between identity and APs is being addressed. We outline the importance of having discussions in a clinical space around identity, and a sense of agency, on the grounds that true recovery-oriented care, which enacts shared decision-making principles, demands it. Further, we argue that it will allow for better therapeutic alliance and trust to be forged between clinician and client, ultimately leading to better care.

Effects of increased grazing intensity during the early and late grazing periods on the welfare of spring-calving, pasture-based dairy cows.

The objective of this study was to identify potential effects of increased grazing intensity, characterized by differing pasture availability and stocking rate, on indicators of welfare during both early and late grazing periods. Seventy spring-calving, pasture-based Holstein-Friesian and cross-bred dairy cows, averaging 35 ± 16 d in milk on the first day of data collection, were assigned to 3 treatments (20-26 cows/treatment) representing a range in grazing intensity: LO (high pasture availability, 980 kg DM/ha opening cover, 2.75 cows/ha, 90:10% pasture:concentrate diet), MOD (medium pasture availability, 720 kg DM/ha opening cover, 2.75 cows/ha, 90:10% pasture:concentrate diet), and HI (low pasture availability, 570 kg DM/ha opening cover, 3.25 cows/ha, 80:20% pasture:concentrate diet); representative of current, best practice and proposed production levels respectively for this system. Welfare indicators were locomotion score, digital dermatitis and white line disease, rumen fill, ocular and nasal discharge, integument damage to the neck-back and hock regions, and lying time. Data were collected during a 5-wk early grazing period in spring (EG) and a 7-wk late grazing period in autumn (LG). Average daily lying time was recorded for 8 to 10 focal cows per treatment. Results demonstrated only minor treatment effects. Cows on MOD [odds ratio (OR) = 3.11] and HI (OR = 1.95) were more likely to display nasal discharge compared with LO. Cows on MOD tended to have more damage to the skin on the neck-back region than LO (OR = 4.26). Total locomotion score (maximum = 25) was greater on LOW (7.1 ± 0.20) compared with HI (6.5 ± 0.19). Average lame cow prevalence for EG and LG respectively was 15.3 ± 3.12% and 39.2 ± 3.00% (LO), 20.0 ± 2.58% and 24.2 ± 5.69% (MOD), and 14.9 ± 4.79% and 17.0 ± 3.44% (HI). Cows on HI were less likely to have impaired walking speed than either LO (OR = 0.24) or MOD (OR = 0.29). Cows on both HI (OR = 0.36) and MOD (OR = 0.40) were less likely to display impaired abduction or adduction compared with those on LO. An interaction between treatment and period revealed longer lying times for cows on LO (10.6 h/d ± 0.39) compared with both MOD and HI (8.7 ± 0.43 and 8.4 ± 0.41 h/d) during EG only. The greatest effects were across grazing periods, with all indicators except rumen fill and locomotion score demonstrating improvements from EG to LG. This suggests cows were able to cope well with increasing levels of grazing intensity, and that regardless of treatment, a greater number of days on pasture led to improvements in welfare indicators.

Risk factors associated with indicators of dairy cow welfare during the housing period in Irish, spring-calving, hybrid pasture-based systems.

In a dairy production system where cows are grazing for a large portion of their lactation, little attention has been afforded to investigating multiple indicators of welfare for risk factors associated with the housing period. Yet regardless of the length of the housing period, cows still experience the positive and negative welfare impacts of both indoor and outdoor environments in a hybrid system. Thus, the objective of this study was to identify risk factors for indicators of dairy cow welfare during the housing period in a spring-calving, hybrid pasture-based system. Herd-level scores for seven indicators of welfare (locomotion, body condition, ocular and nasal discharge, integument damage, tail injury and human avoidance response) were collected from 82 Irish dairy farms during the housing period (October - February). Data were analysed using multiple beta regression or zero-inflated beta regression to identify associations between these welfare indicators and measured herd-level housing, resource and management factors. Thirty-six unique risk factors were associated with one or more welfare indicators (P < 0.05). Analyses identified two risk factors for body condition < 3.0 and four for body condition > 3.5, the target range during the housing period. Four risk factors were identified for each of ocular discharge, nasal discharge and avoidance response of > 1 m from human approach. Six risk factors each were associated with the proportion of lame cows and integument damage to the head-neck-back or hindquarter regions. The greatest number of risk factors, 12, were associated with tail injury (broken, lacerated or incomplete tails). Risk factors associated with multiple indicators of welfare were cow comfort index (tail lacerations and hindquarter integument damage), cubicle width (broken and incomplete tails), shed floor slipperiness (lameness and head-neck-back integument damage), shed light-level (tail lacerations, avoidance response and below target body condition), shed passage width (broken tails and head-neck-back integument damage) and presence (incomplete tails) or absence (broken tails) of a collecting yard backing gate. With the large number of risk factors associated with tail injury, continued research is necessary to identify causes and determine prevention methods to contribute to improved overall welfare of dairy cows. Housing features meeting recommended guidelines from the literature were frequently associated with greater negative indicators of welfare. In light of this, housing guidelines may benefit from regular re-evaluation to ensure facilities meet the welfare needs of cows during the housing period.

Hoof lesions in partly housed pasture-based dairy cows.

Lameness is a symptom of a painful disorder affecting the limbs, which impacts dairy cow welfare and productivity. Lameness is primarily caused by hoof lesions. The prevalence of different lesion types can differ depending on environmental conditions and farm management practices. The aims of this observational study were to establish the cow-level and herd-level lesion prevalence during both housing and grazing periods in a partly housed, pasture-based system, establish the prevalence of lesions always associated with pain ("alarm" lesion), identify the lesions associated with a higher lameness score, determine relationships between lesions, and identify risk factors for digital dermatitis. On 98 farms during the grazing period and on 74 of the same farms during the housing period, every cow was lameness scored (0-3 lameness scoring scale), and the hind hooves of lame cows (score 2 and 3) were examined (maximum 20 cows per visit) and the prevalence of each lesion type recorded. To gather data on potential predictors for the risk factor analysis, a questionnaire with the farmer was conducted on lameness management practices and infrastructure measurements were taken at each visit. Cow-level data were also collected (e.g., parity, breed, milk yield, and so on). Noninfectious lesions were found to be more prevalent than infectious lesions in this system type. The most prevalent lesion types during both grazing and housing periods were white line separation, sole hemorrhages and overgrown claws; all remaining lesions had a cow-level prevalence of less than 15%. The cow-level prevalence of alarm lesions was 19% during the grazing period and 25% during the housing period; the most prevalent alarm lesion was sole ulcers during both periods. We found significantly more foreign bodies within the hoof sole (grazing = 14%, housing = 7%) and overgrown claws (grazing = 71%, housing = 55%) during the grazing period compared with the housing period. Cows with foul of the foot, sole ulcer, white line abscess, toe necrosis or an amputated claw had higher odds of being more severely lame, compared with mildly lame. The strongest correlation between lesions were between toe necrosis and digital dermatitis (r = 0.40), overgrown claws and corkscrew claws (r = 0.33), and interdigital hyperplasia and digital dermatitis (r = 0.31) at herd level. At the cow level, the strongest correlation was between overgrown claws and corkscrew claws (r = 0.27), and digital dermatitis and heel erosion (r = 0.22). The farmers' perception of the presence of digital dermatitis (and lameness) was significantly correlated with the actual presence of digital dermatitis recorded. Additional risk factors for the presence of digital dermatitis were cow track and verge width near the collecting yard, and stone presence on the cow tracks. Results from this study help further our understanding of the causes of lameness in partly housed, pasture-based dairy cows, and can be used to guide prevention and treatment protocols.

Lameness prevalence and management practices on Irish pasture-based dairy farms.

BACKGROUND: Lameness is a painful disease, which negatively impacts dairy cow production and welfare. The aim of this observational study was to determine herd lameness prevalence, describe current lameness management practices and identify the presence of established risk factors for lameness on Irish pasture-based dairy farms. Farms were visited once during grazing (99 farms) and again during housing (85 farms). Lameness scoring was carried out at each visit (AHDB 0-3 scale); cows were classified as lame if they scored two or three. Farm management practices and infrastructure characteristics were evaluated via farmer questionnaires and direct measurements of farm infrastructure. RESULTS: Median herd-level lameness prevalence was 7.9% (interquartile range = 5.6 - 13.0) during grazing and 9.1% (interquartile range = 4.9 - 12.0) during housing; 10.9% of cows were lame at a single visit and 3.5% were lame at both visits (chronically lame or had a repeat episode of lameness). Fifty-seven percent of farmers were not familiar with lameness scoring and only one farm carried out lameness scoring. Only 22% of farmers kept records of lame cows detected, and 15% had a lameness herd health plan. Twenty-eight percent of farmers waited more than 48 h to treat a lame cow, and 21% waited for more than one cow to be identified as lame before treating. Six percent of farmers carried out routine trimming and 31% regularly footbathed (> 12 times per year). Twelve percent put severely lame cows in a closer paddock and 8% stated that they used pain relief to treat severely lame cows. Over 50% of farms had at least one cow track measurement that was classified as rough or very rough, and cow tracks were commonly narrow for the herd size. On 6% of farms, all cubicle beds were bare concrete (no matting or bedding) and on a further 6% of farms, there was a combination of cubicles with and without matting or bedding. On 56% of farms, all pens contained less than 1.1 cubicles per cow and on 28% of farms, a proportion of pens contained less than 1.1 cubicles per cow. CONCLUSIONS: Overall, this study identified infrastructure and management practices which could be improved upon. The comparatively low lameness prevalence demonstrated, compared to fully housed systems, also highlights the benefits of a pasture-based system for animal welfare; however, there remains scope for improvement.

Risk factors associated with the welfare of grazing dairy cows in spring-calving, hybrid pasture-based systems.

Large-scale investigation of risk factors for multiple welfare indicators in hybrid pasture-based dairy systems is scarce. Our objective was to identify grazing season welfare risk factors on spring-calving, hybrid pasture-based dairy farms where cows experience periods of both grazing and housing. Herd-level data were collected from visits to 93 farms in the primary dairy producing counties of Ireland. Zero-inflated beta regression analysis was used to assess potential associations between categorical management and resource factors, and commonly measured animal-based welfare indicators: locomotion, body condition, nasal and ocular discharge, tail injury, integument damage, and avoidance behaviour. To account for small sample size due to elimination of farms with missing data, analyses were conducted on both a dataset of complete cases, and a dataset where missing values had been substituted for the most common response through single imputation. Resulting risk factors from both methods of analysis were compared for each indicator. Analyses identified 14 risk factors associated with one or more welfare indicators. The proportion of lame cows was positively associated with a previous housing period of four months or more compared to three months, all cubicles being outside recommended lengths and repairing roadways every two to three years compared to either yearly or more than every four years to never. The proportion of cows below minimum target grazing body condition score of 2.75 was negatively associated with participation in elective herd disease-testing in the past year. The proportion of cows with tail lacerations was positively associated with using a single breeding method, not employing part-time staff and not using brisket boards in cubicles. Previous housing period length was significantly associated with the proportion of cows with integument damage, although the direction of association was unclear. Moderate to severe nasal discharge was positively associated with collecting yard holding times of ≤ 60 min compared to > 90 min. Ocular discharge was negatively associated with manual health record-keeping and a collecting yard below the recommended area of 1.4 m2/cow. The proportion of cows with an avoidance response distance > 1 m was positively associated with herding cows without a dog present and having no additional full-time staff. Multiple risk factors were related to the housing period, suggesting that potential carry-over effects of housing management on welfare persist into the grazing period. This emphasizes the need for research to consider both housing and grazing periods in the management of welfare in hybrid pasture-based systems.

Cow- and herd-level risk factors for lameness in partly housed pasture-based dairy cows.

Lameness in dairy cows is a major animal welfare concern and has substantial economic impact through reduced production and fertility. Previous risk factor analyses have focused on housed systems, rather than those where cows were grazed for the majority of the year and housed only for the winter period. Therefore, the aim of this observational study was to identify a robust set of cow-level and herd-level risk factors for lameness in a pasture-based system, based on predictors from the housing and grazing periods. Ninety-nine farms were visited during the grazing period (April 2019-September 2019), and 85 farms were revisited during the housing period (October 2019-February 2020). At each visit, all lactating cows were scored for lameness (0 = good mobility, 1 = imperfect mobility, 2 = impaired mobility, 3 = severely impaired mobility), and potential herd-level risk factors were recorded through questionnaires and infrastructure measurements. Routine cow-level management data were also collected. Important risk factors for lameness were derived though triangulation of results from elastic net regression, and from logistic regression model selection using modified Bayesian information criterion. Both selection methods were implemented using bootstrapping. This novel approach has not previously been used in a cow-level or herd-level risk factor analysis in dairy cows, to the authors' knowledge. The binary outcome variable was lameness status, whereby cows with a lameness score of 0 or 1 were classed as non-lame and cows with a score of 2 or 3 were classed as lame. Cow-level risk factors for increased lameness prevalence were age and genetic predicted transmitting ability for lameness. Herd-level risk factors included farm and herd size, stones in paddock gateways, slats on cow tracks near the collecting yard, a sharper turn at the parlor exit, presence of digital dermatitis on the farm, and the farmers' perception of whether lameness was a problem on the farm. This large-scale study identified the most important associations between risk factors and lameness, based on the entire year (grazing and housing periods), providing a focus for future randomized clinical trials.

HIV and Pneumocystis Jiroveci Pneumonia (PJP) Managed With Extracorporeal Membrane Oxygenation (ECMO).

Presentation A 40-year-old Irish female presented with a new diagnosis of HIV, advanced immunosuppression and severe respiratory failure. Diagnosis Patient was subsequently diagnosed with Pneumocystis jiroveci Pneumonia (PJP). Treatment The patient was treated for HIV and PJP and required mechanical ventilation. She continued to deteriorate and veno-venous Extracorporeal Membrane Oxygenation (V-V ECMO) was deployed in her management after 18 days of mechanical ventilation. Conclusion HIV presenting with extensive pneumonia secondary to PJP and advanced immunosuppression is still a treatable condition. All available respiratory support including ECMO should be considered for patients even if they have been on mechanical ventilation for more than 7 days.

What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components.

AIMS: Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. METHODS: We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. RESULTS: The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. CONCLUSIONS: Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.

Optimisation of the zinc sulphate turbidity test for the determination of immune status.

Failure of passive transfer of maternal immunity occurs in calves that fail to absorb sufficient immunoglobulins from ingested colostrum. The zinc sulphate turbidity test has been developed to test bovine neonates for this failure. The specificity of this test has been shown to be less than ideal. The objective was to examine how parameters of the zinc sulphate turbidity test may be manipulated in order to improve its diagnostic accuracy. One hundred and five blood samples were taken from calves of dairy cows receiving various rates of colostrum feeding. The zinc sulphate turbidity test was carried out multiple times on each sample, varying the solution strength, time of reaction and wavelength of light used and the results compared with those of a radial immunodiffusion test, which is the reference method for measuring immunoglobulin concentration in serum. Reducing the time over which the reaction occurs, or increasing the wavelength of light used to read the turbidity, resulted in decreased specificity without improving sensitivity. Increasing the concentration of the zinc sulphate solution used in the test was shown to improve the specificity without decreasing sensitivity. Examination of the cut-off points suggested that a lower cut-off point would improve the performance.

Effect of feeding colostrum at different volumes and subsequent number of transition milk feeds on the serum immunoglobulin G concentration and health status of dairy calves.

Transfer of sufficient IgG to the newborn calf via colostrum is vital to provide it with adequate immunological protection and resistance to disease. The objectives of the present study were to compare serum IgG concentration and health parameters of calves (1) fed different volumes of colostrum [7, 8.5, or 10% of body weight (BW)] within 2h of birth and (2) given 0, 2, or 4 subsequent feedings of transition milk (i.e., milkings 2 to 6 postcalving). Ninety-nine dairy calves were fed 7, 8.5, or 10% of BW in colostrum within 2h of birth and given 0, 2, or 4 subsequent feedings of transition milk. The concentration of IgG in the serum of calves was measured at 24, 48, 72, and 642 h of age by an ELISA. The apparent efficiency of absorption for IgG was determined. Health scores were assigned to calves twice per week and all episodes of disease were recorded. The effect of experimental treatment on calf serum IgG concentration differed by the age of the calf. Calves fed 8.5% of BW in colostrum had a greater mean serum IgG concentration than calves fed 7 or 10% of BW at 24, 48, and 72 h of age. At 642 h of age, serum IgG concentrations of calves fed 8.5% of BW (24.2g/L) and calves fed 10% of BW (21.6g/L) did not differ, although the serum IgG concentration of calves fed 8.5% of BW was still greater than that of calves fed 7% of BW (20.7 g/L). No difference in serum IgG concentration existed between calves fed 7% of BW and those fed 10% of BW at any age. No significant effect of number of subsequent feedings of transition milk on calf serum IgG concentration was detected. The apparent efficiency of absorption of calves fed 8.5% of BW in colostrum (38%) was greater than calves fed 7% of BW in colostrum (26%) and tended to be greater than in calves fed 10% of BW (29%). Calves fed further feedings of transition milk after the initial feeding of colostrum had a lower odds (0.62; 95% confidence interval: 0.41 to 0.93) of being assigned a worse eye/ear score (i.e., a more copious ocular discharge or pronounced ear droop) and a lower odds (0.5; 95% confidence interval: 0.32 to 0.79) of being assigned a worse nasal score (i.e., a more copious and purulent nasal discharge) during the study period relative to calves that received no further feedings of transition milk. In conclusion, calves fed 8.5% of BW in colostrum within 2h of birth achieved a greater concentration of IgG in serum in the first 3 d of life than calves fed either 7 or 10% of BW. Feeding calves transition milk subsequently reduced their odds of being assigned a worse eye/ear and nasal score.

Does iodine supplementation of the prepartum dairy cow diet affect serum immunoglobulin G concentration, iodine, and health status of the calf?

Absorption of adequate IgG from colostrum is critical to provide the newborn calf with adequate immunological protection and resistance to disease. Excessive iodine supplementation of the prepartum ewe reduces IgG absorption of her offspring; it is possible that excessive iodine supplementation of the prepartum dairy cow may similarly impair the ability of the calf to acquire immunological protection. The objectives of this study were to determine whether the iodine status, health status, and ability of calves to absorb IgG from colostrum were affected by prepartum iodine supplementation strategies of their dams. Dairy cows (n=127) received one of the following levels of iodine supplementation precalving: 15mg of iodine/kg of dietary dry matter (DM) (HI); no additional iodine supplementation (MI); 5mg/kg of dietary DM (SI); and 15mg of iodine/kg of DM for the first 3.5wk of the precalving period and no additional supplementation for the second 3.5wk (HMI). Calves were assigned to 1 of 6 experimental treatments, based on the prepartum iodine supplementation treatment of their dam and the precalving treatment group of the cows from which the colostrum fed was obtained: (1) HI_HI: born to HI dams, fed HI colostrum (i.e., colostrum produced by cows in the HI group); (2) MI_MI: born to MI dams, fed MI colostrum; (3) SI_SI: born to SI dams, fed SI colostrum; (4) HI_MI: born to HI dams, fed MI colostrum; (5) MI_HI: born to MI dams, fed HI colostrum; and (6) HMI_HMI: born to HMI dams, fed HMI colostrum. Concentration of calf serum IgG and plasma inorganic iodine (PII) was measured at 0 and 24h of age. Apparent efficiency of absorption for IgG was determined. Health scores were assigned to calves twice weekly and all episodes of disease were recorded. Cow experimental treatment group affected calf PII at 0h of age; the PII of calves born to HI dams (987.2µg/L) was greater than that of calves born to MI dams (510.1µg/L), SI (585.2µg/L), and HMI dams (692.9µg/L). Calf experimental treatment group affected calf PII at 24h of age; the PII of HI_HI (1,259.2µg/L) and HI_MI (1,177.8µg/L) calves was greater than MI_MI (240.7µg/L), SI_SI (302.2µg/L), HMI_HMI (320.7µg/L), and MI_HI (216.3µg/L) calves. No effect of experimental treatment was observed on the concentration of IgG measured in calf serum at 24h of age, or on apparent efficiency of absorption. Experimental treatment had no effect on the likelihood of a calf being assigned a worse nasal, eye and ear, cough, or fecal score within the study period, nor did it affect the probability of a calf receiving treatment for a disease a greater number of times. Prepartum iodine supplementation of cows at 15mg/kg of DM increased the iodine levels in their calves at birth and 24h of age, but did not affect their ability to absorb IgG from colostrum. Supplementation with iodine above the minimum requirements established by the National Research Council was unnecessary to ensure appropriate iodine levels in calves at birth.

Factors associated with the concentration of immunoglobulin G in the colostrum of dairy cows.

Transfer of sufficient immunoglobulin G (IgG) to the neonatal calf via colostrum is vital to provide the calf with immunological protection and resistance against disease. The objective of the present study was to determine the factors associated with both colostral IgG concentration and colostral weight in Irish dairy cows. Fresh colostrum samples were collected from 704 dairy cows of varying breed and parity from four Irish research farms between January and December 2011; colostral weight was recorded and the IgG concentration was determined using an ELISA method. The mean IgG concentration in the colostrum was 112 g/l (s.d. = 51 g/l) and ranged from 13 to 256 g/l. In total, 96% of the samples in this study contained >50 g/l IgG, which is considered to be indicative of high-quality colostrum. Mean colostral weight was 6.7 kg (s.d. = 3.6 kg) with a range of 0.1 to 24 kg. Factors associated with both colostral IgG concentration and colostral weight were determined using a fixed effects multiple regression model. Parity, time interval from calving to next milking, month of calving, colostral weight and herd were all independently associated with IgG concentration. IgG concentration decreased (P < 0.01) by 1.7 (s.e. = 0.6) g/l per kg increase in the colostral weight. Older parity cows, cows that had a shorter time interval from calving to milking, and cows that calved earlier in spring or in the autumn produced colostrum with higher IgG concentration. Parity (P < 0.001), time interval from calving to milking (P < 0.01), weight of the calf at birth (P < 0.05), colostral IgG concentration (P < 0.01) and herd were all independently associated with colostral weight at the first milking. Younger parity cows, cows milked earlier post-calving, and cows with lighter calves produced less colostrum. In general, colostrum quality of cows in this study was higher than in many previous studies; possible reasons include use of a relatively low-yielding cow type that produces low weight of colostrum, short calving to colostrum collection interval and grass-based nutritional management. The results of this study indicate that colostral IgG concentration can be maximised by reducing the time interval between calving and collection of colostrum.

Experience with continuous ambulatory EEG monitoring.

The value of continuous ambulatory EEG monitoring in the management of patients with seizures was assessed. Eighty-seven patients were studied over a two-year period, and 198 recordings were made. In six patients data from the monitor record changed management significantly by suggesting a diagnosis other than that made clinically and by routine EEG. In a further 33 patients data strongly supporting the clinical diagnoses were obtained. In 47 patients no positive diagnostic data were obtained, and in one patient the data could not be reconciled with the clinical picture. The ambulatory EEG was particularly useful for detecting nocturnal fits, such as tonic seizures, and for differentiating genuine seizures from pseudoseizures. Limitations of the instrument include the presence of only four channels and some distortion and degradation of the EEG signal. In spite of these problems, the instrument was found to be a valuable aid in the evaluation of patients with seizures.