Psychogenic Nonepileptic Seizures—High Mortality Rate is a ‘Wake-up Call’ | Chapter 11 | Medical Science: Recent Advances and Applications Vol. 4

Patients with epilepsy have an elevated mortality rate compared to the general population, and now studies are showing a comparable death ratio in patients diagnosed with psychogenic nonepileptic seizures. The latter is a top differential diagnosis for epilepsy, and the unexpected mortality rate in these patients underscores the importance of an accurate diagnosis. Experts have called for more studies to elucidate this finding, but the explanation is already available, embedded in the existing data. To illustrate, a review of the diagnostic practice in epilepsy monitoring units, of the studies examining mortality in PNES and epilepsy patients, and of the general clinical literature on the two populations was conducted. The analysis reveals that the scalp EEG test result, which distinguishes a psychogenic from an epileptic seizure, is highly fallible; that the clinical profiles of the PNES and epilepsy patient populations are virtually identical; and that both are dying of natural and non-natural causes including sudden unexpected death associated with confirmed or suspected seizure activity. The recent data showing a similar mortality rate simply constitutes more confirmatory evidence that the PNES population consists largely of patients with drug-resistant scalp EEG-negative epileptic seizures. To reduce the morbidity and mortality in these patients, they must be given access to treatments for epilepsy.

 

Author (s) Details

Catherine A. Carlson
Minnesota Judicial Branch, Psychological Services Division, Minneapolis, MN 55487, USA.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v4/5130

 

Reconceptualizing Conversion Disorder: A Rational-Choice Theory of Neurosis Perspective | Chapter 7 | Disease and Health Research: New Insights Vol. 11

Conversion disorder remains enigmatic, with its understanding further complicated by the declining influence of psychoanalysis and emerging neurological insights suggesting biological underpinnings. Prevalent rates of this disorder vary widely across cultures and the population studied. Existing theories struggle to explain the efficacy of diverse interventions, such as psychoanalysis, behavior therapy, drug therapy, and religious therapy. This article reviews research and clinical evidence on the development and treatment of conversion disorder, proposing that this seemingly incompatible evidence can be integrated within a new framework: the Rational-Choice Theory of Neurosis (RCTN). RCTN builds on Freud's framework, introducing a new concept of repression and replacing the unconscious with self-deception while suggesting that neurotic disorders are rational behaviors. Repression is seen as a conscious coping mechanism which deliberately eliminates threatening stimuli from attention through the employment of distractive maneuvers. RCTN has already proven its integrative approach due to its ability to account for the differential efficacy of various therapeutic methods pertaining to neurosis, such as behavior therapy, religious therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy and drugs, using one set of theoretical principals. This integration offers fresh insights into the condition and could enhance therapeutic approaches, making it a valuable contribution to the field.

 

Author (s) Details

 

Yacov Rofe
Department of Social Sciences and Health, Bar-Ilan University, Ramat-Gan, Israel.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrni/v11/1471