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146 Cards in this Set

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What are Somatic Stress
Disorders?

They are a related set of syndromes characterized
more by disability, symptoms, and suffering, than
by objective pathology

functional somatic syndromes, somatic stress disorders, illnesses of unknown origin; medically unexplained symptoms are other names for....

Somatic stress disorders

Somatic stress disorders include

1. Fibromyalgia
2. Chronic Fatigue Syndrome
3. Pseudoseizure in epilepsy
4. Silicone breast implant illness
5. Gulf War Unexplained illness
6. Toxic mould and Sick Building Syndrome
7. Idiopathic Environmental Intolerance (IEI) (Multiple chemical sensitivity)
8. Psychologically-based aspects of the post concussion syndrome

How do Individuals with Somatic Stress Disorders tend to view themselves?

These patients tend to view themselves as
severely disabled

What do individuals with Somatic Stress
Disorders tend to do (hint: Centrelink)?

They often apply for disability payments

In somatic stress disorders:

Demonstrable pathology vs. degree of disability?

The degree of disability is often out of proportion to that seen with patients with demonstrable pathology e.g. patients with heart disease, amputations, cancer or
rheumatoid arthritis.

The reported frequency of neurological symptoms in healthy
Controls:

Fatigue?


(Paniak et al, 2002) _ Fatigue 33%; headaches 58%; forgetfulness 58%; poor concentration 35%

Fatigue 33%

The reported frequency of neurological symptoms in healthy Controls:

Headaches and forgetfulness?

58%

The reported frequency of neurological symptoms in healthy
Controls:

Poor concentration?

Poor concentration 35%

Reported frequency of pain in community dwellers?

Common!!

Pain 37%, back pain 32%; headache 25%; chest pain 25%; arm or leg pain 24%; abdominal pain 24%

People who view themselves as able bodied do not allow pain and neurological symptoms to...

Disable them.

Some people see common symptoms as signs of _______ ______.

Some people see common symptoms as signs of serious illness;

Situation is made worse by the oft noted social isolation of these folk which means they do not get significant other feedback on the complaint

What are “fashionable diseases”?

Who coined the Term?

What are they characterized by? (8)

Ford coined the term. (Think Ford models = fashionable)

1. Vague,
2. subjective,
3. multisystem complaints
4. a lack of objective laboratory findings
5. quasi-scientific explanations,
6. overlap of one fashionable diagnosis with
another,
7. symptoms which are consistent with depression
or anxiety or both
8. denial of psychosocial distress or attribution of it to the illness

What do patients with “fashionable diseases” tend to do? (3)

1. Rejects psychological explanations for their
symptoms
2. Prefers biomedical and somatic explanations
3. They seek out healthcare professionals who share their belief systems and who are likely to recommend alternative medical treatments or explanations

MILLER noted:

If damage in structure X is known to produce a
decline on test T it is tempting to argue that any
new subject, or group of subjects, having a
relatively poor performance on T must have a lesion at X. In fact the logical status of this argument is
the same as reasoning that because a horse meets
the test of being a large animal with four legs then
any newly encountered large animal with four legs
must be a horse. The newly encountered specimen
could of course be a cow or a hippopotamus and still meet the same test. Similarly new subjects who do badly on T may do so for reasons other than having a lesion at X (p 131).

If damage in structure X is known to produce a
decline on test T it is tempting to argue that any
new subject, or group of subjects, having a
relatively poor performance on T must have a lesion at X. In fact the logical status of this argument is
the same as reasoning that because a horse meets
the test of being a large animal with four legs then
any newly encountered large animal with four legs
must be a horse. The newly encountered specimen
could of course be a cow or a hippopotamus and still meet the same test. Similarly new subjects who do badly on T may do so for reasons other than having a lesion at X (p 131).

Miller = Damage to structure X person.

What is the key feature of factitious disorder?

Physical or psychological symptoms are intentionally produced to assume sick role; conscious/voluntary symptom production

What are the three types of factitious disorder?

1. With predominantly psychological signs and
symptoms
2. With predominantly physical signs and
symptoms
3. With combined psychological and physical
signs and symptoms

What is the key feature of Somatoform Disorders?

Key Feature: Presenting complaint cannot
be explained by any known medical
condition; unconscious/involuntary
symptom production

What are the types of somatoform disorders? (6)

1 Conversion Disorder
2. Somatoform Pain Disorder
3. Hypochondriasis
4. Somatization Disorder
5. Body Dysmorphic Syndrome
6. Undifferentiated Somatoform Disorder

What is the key feature of conversion disorder?

Key Feature: Patient complains of isolated
symptoms that seem to have no physical
cause, e.g., blindness, deafness, stocking
anaesthesia

What are the criteria for conversion disorder? (4)

Criteria
1. Symptoms are preceded by stressors
2. Symptoms are not intentionally feigned or produced
3. No neurological, medical, substance abuse or cultural
explanation
4. Must cause marked distress

What is the key feature of hypochondriasis?

Key feature: Excessive preoccupation with
fear of disease or strong belief in having
disease due to false interpretation of a
trivial symptom

What are the key criteria for hypochondriasis?

1. Unwarranted fear or idea persists despite reassurance
2. Clinically significant distress
3. Not restricted to appearance
4. Not of delusional intensity

What is the key features of pan disorder?

1. Chronic, unexplained pain in one or more anatomical
sites of sufficient severity to warrant clinical
attention.

2. The pain causes clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.

3. Psychological factors play an important role in onset,
exacerbation, or maintenance of the pain.

4. Symptom or deficit is not intentionally produced.

5. The pain is not better accounted for by a Mood,
Anxiety, or Psychotic Disorder

What is malingering?

The intentional production of false or grossly
exaggerated physical and/or psychological symptoms for external incentives such as obtaining monetary compensation or avoiding criminal prosecution (American Psychiatric Association, DSM-IV-TR, 2000; Rogers, 1997).

The notion of malingering occurs with a view to presenting oneself as ________ than one is with the view to a demonstrable and predictable ____.

The notion of malingering occurs with a view to
presenting oneself as worse than one is with a view to
a demonstrable and predictable gain.

What are the two types of gain?

Gain has generally been divided into primary versus
secondary gain in the psychoanalytic tradition.

What is primary gain?

Primary gain is considered to represent the reduction
in anxiety and relief generated by the unconscious
emotional conflict.

What is secondary gain?

Secondary gain describes the psychosocial benefit of
the sick role including such things as release from
unpleasant responsibility, increased personal
attention and sympathy and financial reward?

The distinction between primary and secondary gain has been described as somewhat _________.

Cullum, Heaton and Grant (1991) propose that
the distinction between primary and secondary
gain is somewhat artificial and prefer the
notion of merely gain irrespective of whether
the benefit is conscious or unconscious

SSDs are not due to ___________.

SSDs are due to malingering

What percentage of the patients seen by neurologists have co morbid psychiatric disorders?

Half of the patients seen by neurologists have co morbid psychiatric disorders.

Fink et al (2003) questioned 198 consecutive patients referred to a neurologist for the first time and found that 61% had at least one medically unexplained symptom and 33.8% met criteria for one of the somatoform disorders

What percentage of new patients referred to neurologists fulfil criteria for somatoform disorder?

33% (up to 1/3!)

Worse, 70% of neurologists do not recognize common psychiatric conditions such as somatoform disorders (Bridges & Goldberg, 1984; Fink et al, 2005)

Which disorder results in more disability and unemployment than any other psychiatric diagnosis? (Thomassen et al, 2003)

Somatotization disorder

Somatization disorder is ____ times more common in women.

5 times more common

Somatic Stress Disorders and
Neuropsychology:

ALL somatic stress disorders except X are associated with neuropsychological abnormalities.

Idiopathic Environmental Intolerance (IEI)

With SSD, Subjective cognitive impairment is _______;

Subjective cognitive impairment is INVALID;
remember the hippopotamus

Cognitive abnormalities do not of themselves signify
neurologic disease but ____ _________ and perhaps
_______ are altered by stress.

Cognitive abnormalities do not of themselves signify
neurologic disease but brain chemistry and perhaps
structure are altered by stress

Cognitive complaints are often an index of _______ __________ communicated in a different language from the complaints typically associated with depression and anxiety”

Cognitive complaints are often an index of EMOTIONAL DISTRESS communicated in a different language from the complaints typically associated with depression and anxiety.

(i.e., masked anxiety and depression)

Individuals with SSD tend to ____ diagnose.

Self-diagnose.

They tend to ______ their symptoms and turn to the internet to …….?

They tend to AMPLIFY their symptoms and turn to the internet to research and complete questionnaires on their symptoms.

They believe their illness is _____ but not _____.

They believe their illness is serious by not fatal.

What do they think about mainstream medicine?

They have skepticism with mainstream medicine but this is not so surprising as experts mostly believe that these conditions are either of disputed origin or surrogates for psychological disorders.

They tend to shop for doctors who ____

They shop for doctors who BELIEVE.

They reject _________ explanations and prefer _________ explanations for their difficulties.

They reject psychological explanations and prefer biomedical explanations for their difficulties.

(secondary gain an issue)

Individuals with SSD are so tuned into their bodes that they tend to view _______ as abnormal

Individuals with SSD are so tuned into their bodes that they tend to view NORMAL as abnormal.

Sick role and disability:

What % of cases of Fibromyalgia in the US are on disability payments?

27.

What is the stance of SSD’s on self-help groups?

Self-help groups++

What is the media’s role in SSD’s?

Sensationalized media coverage, e.g., Gulf War, silicone breast implants.

SSDs tend to be ___________ conditions:

Overlapping.

Healthcare professionals are often pressured by misguided patients to ____________ physical illness

We can be pressured by misguided patients to
over diagnose physical illness.

Advocacy groups often pressure name changes for disorders despite objective evidence. Give an example:

The name change of CFS to chronic immune
dysfunction syndrome occurred due to the
intervention of advocacy groups, despite the
lack of evidence of immune dysfunction in the
condition.

We can be pressured by misguided patients to overdiagnose physical illness.

Shorter’s historical view- 1

Historical eras and culture shape the ____ and
_______.

Historical eras and culture shape the mind and
symptoms

Shorter’s historical view- 1

The ________ considers some symptoms legitimate and
others illegitimate

The CULTURE considers some symptoms legitimate and others illegitimate.

Shorter’s historical view- 1

As symptom legitimacy changes, what happens?

As symptom legitimacy changes, people produce
different symptoms

Shorter’s historical view- 1
Pervasive _________ dictates the shape of symptoms

Pervasive zeitgeist dictates the shape of symptoms

Shorter’s historical view- 1

For example, If glove anaesthesia or paralysis will not produce the desired outcome (i.e. the secondary gain) then….

If glove anaesthesia or paralysis will not produce the
desired outcome (i.e. the secondary gain) then more
intangible symptoms e.g. headache, pain or fatigue
may be more effective

Shorter’s historical view- 2
_
What is happening to the Medical authority’s influence?

It’s declining

Shorter’s historical view- 2

What two things are increasing in influence?

Media (including the internet) and support groups are increasing in influence

Shorter’s historical view- 2

Social isolation is increasing and this may
increase idiosyncratic explanations of
__________

Social isolation is increasing and this may increase idiosyncratic explanations of symptoms.

Shorter’s historical view- 2

What can normal symptoms such as fatigue be viewed as?

Normal symptoms such as fatigue can
become viewed as disease

Shorter’s historical view- 2

Who do individuals with SSDs pick as friends and treatment providers?

They pick friends and clinicians that agree with them.

Somatic stress disorders:
Are associated with neuropsychological with neuropsychological symptoms and findings?

YES THEY ARE.

Somatic stress disorders:

Are emotional abnormalities may be greater or lesser than cognitive ones?

Emotional abnormalities may be greater than
cognitive ones!

Somatic stress disorders:

Stress and psychiatric can cause what sort of abnormalities?

Stress and psychiatric illness can cause NEUROCHEMICAL ABNORMALITIES, medical illness and unexplained illnesses

Somatic stress disorders:

What may not be reported by patients with SSDs?

Stressors

Somatic stress disorders:

What is common with regard to reporting of symptoms?

Amplification is common

Somatic stress disorders:

“ Organic” vs. “Psychiatric” distinction is
_________.

“Organic” vs. “Psychiatric” distinction is outdated.

NB: Many psychiatric disorders are increasingly looking more and more organic.

Patients with SSDs may present with May present illusory mental health deny what two things?

Deny emotional problems and history

What does emotional suppression result in? (2)

Adverse immune system effects.
Adverse cardiovascular effects.

Are there are genetic differences in reactivity to stress?

Yes

Will everyone subjected to an intensely stressful life experience develop PTSD? What percentage will?

No. Only 10% will.

What is the nocebo effect?

The nocebo effect occurs when a subject has a negative response to a treatment that is known to be inert.

What two things play an important role in the nocebo effect?

Conditioning and expectation play an important role in the nocebo response

Most investigators agree that the size of the placebo effect is about how big?

1/3 of any treatment effect

In general…the more invasive the therapy….

the stronger the placebo effect.

What is pseudoneurologic disease? (hysteria)

Neurologic symptoms without objective evidence of neurologic disease.

Is pseudoneurologic disease often associated with cognitive deficits?

Yes

Did Slater show that hysteria often over diagnosed?

Yes

What is the best model of pseudoneurological illness?

Nonepileptic seizures (NES)

Nonepileptic seizures (NES) are diagnosed when:

1. Neurological disease has been ruled out

Intensive EEG video telemetry monitoring is necessary because episodes usually not observed and NES and ES seizures often appear similar.

Psychological methods useful for description and to identify persons at risk, but cannot be used for
diagnosis

Neuropsychological functioning in NON epileptic seizures. Do deficits persist?

YES. Neuropsychological deficits persist

What are non epileptic seizures commonly associated with?

Associated with psychiatric illness- usually
psychogenic in origin

What percentage of individuals with non epileptic seizures have a psychiatric history?

30%

How are individuals with non epileptic seizures in terms of providing history?

They are BAD historians and deny verifiable stressors

Can you you distinguish between actual seizure groups non epileptic seizure groups based on neuropsychological findings?

NO. Cannot distinguish between the two seizures groups.

The MMPI-2 is about ___% accurate in differentiating ES from NES

MMPI-2 about 70% accurate in differentiating ES from NES

MMPI: What subscales would we expect to be elevated in NES groups relative to ES?

DODRILL

1. Conversion V profiles
2, hypochondriasis
3. hysteria

Actual Seizures groups consistently 10 points lower on hypochondriasis and hysteria scales (striking difference)

Binder’s group found that epileptic and non
epileptic seizure patients did not differ on
most neurocognitive variables except the
______

Portland Digit Recognition Test (a test of effort). But not in the range of malingering!!

Somebody has NES and they complete an MMPI-2. What pattern of results would you expect to see as compared to someone who experiences actual seizures?

NES score about 10 points higher on hypochondriasis and hysteria

Non epileptic patients not typically in malingering range on ____.

Non epileptic patients ARE NOT typically in
malingering range on PDRT.

Classification of seizure type
with multiple predictors:

What are the best three predictors of NES?

1. MMPI-2 hysteria
2. routine EEG
3. And brief chronicity

MMPI-2 data and anecdotal evidence leads to the
conclusion that many of NES patients lack _______ and try to deny _________ problems, preferring physical explanations for their illness

MMPI-2 data and anecdotal evidence leads to the
conclusion that many of these patients lack
insight and try to deny psychological problems,
preferring physical explanations for their illness.

Fortunately, some are willing to accept a
psychological explanation.

How is fibromyalgia diagnosed?

Diagnosis based on report of pain to at least 11
of 18 trigger points in response to 4 kg of pressure. Sites must be bilateral and both above and below the waist

What are the two problems with diagnosing fibromyalgia? (2)

Problems in diagnosis with examiner and
patient reliability

Is fibromyalgia is associated with mild neuropsychological deficits?

YES. Think CN (RAVLT poor and psychiatrically disturbed)

1. mild neuropsychological deficits
2. psychiatric illness

Fibromyalgia aetiology is _____

What are the two hypotheses?

Unproven.

1. ?Psychiatric
2. Abnormal illness behaviour

Various neuroendocrine and gate control theory
hypotheses have been advanced

Pain and neuroendocrine findings in fibromyalgia are often associated with _______ _______.

Pain and neuroendocrine findings in fibromyalgia are often associated with PSYCHIATRIC ILLNESS.

People diagnosed with fibromyalgia often have a history of what? (think CN)

Abuse.

Read:

“The only relevant feature of the illness suffered
by these people is that they feel too wretched to
go to work…disability determination for
Fibromyalgia is nothing more than a testing of the
veracity of the claimant.” (Hadler, 1997)

What does this mean?

Have to validity test.

US criteria for chronic fatigue syndrome include chronic disabling fatigue and at least 4 of 8 other features. What are they?

1. muscle ache
2. joint pains
3. subjective cognitive problems
4. sore throat,
5. new headache
6. non-restorative sleep
7. post exertion malaise
8. swollen lymph glands.

Crowe’s CFS study found that medically confirmed CFS patients performed poorly on what test?

The RAVLT.

The supports the notion that there is central nervous system compromise.

CFS is associated with _______ cognitive deficits and what two types of disorders?

Associated with acquired cognitive deficits and
affective and anxiety disorders.

Subjective cognitive impairment is usually great than _______ impairments.

Subjective cognitive impairment>objective.

CFS and depression?

Often different than depression (Jason)

Neuropsychological Profile of CFS?

Where is the deficit (1) and what’s preserved (2)?

1. Complex information processing deficit

2. Preservation of intellect and complex
problem solving


Subjective>objective findings (Tiersky et al; DiPino & Kane)

Idiopathic Environmental
Intolerance (IEI) is otherwise known as?

What is it associated with?

Also known as Multiple Chemical Sensitivity

It is associated with psychiatric disease

What characterizes Idiopathic Environmental Intolerance (IEI)?

Characterized by allergic like sensitivity to various
common chemical odours such as common cleansers,
gasoline and perfume (odours rather than
neurotoxins: Bolla, 2000)

What are some of Idiopathic Environmental Intolerance (IEI) often reported symptoms (4)

Symptoms include
1. fatigue
2. confusion
3. dizziness
4. respiratory problems

IEI and cognitive function vs. controls? (SPARK)

SAME.

Systematic studies indicate no differences from
controls in cognitive function (Sparks, 2000).

Laboratory provocation in MCS with those chemicals
identified as incitants yielded extremely low
________ and __________(Staudenmayer et al, 1993)

Laboratory provocation in MCS with those chemicals
identified as incitants yielded extremely low
sensitivity and specificity (Staudenmayer et al, 1993).

There is a strong association between IEI and…

Strong association between IEI and psychiatric illness.

Classical conditioning but can occur without history of a US causing UCR

Individuals with IEI have what sort of belief system?

An ILLNESS belief system

It is possible that CFS, FM, IEI are all

All one condition.

There is significant symptom and diagnostic overlap

It is said that the same patient will receive a FM
diagnosis from a rheumatologist and a CFS diagnosis from an internist, (and probably a diagnosis of depression or anxiety from a psychiatrist) and many patients carry 2-3 of these labels

What may be the most objective finding regarding the differences between CFS, FM, IEI?

Neuropsychological findings may be the most
objective abnormality, but NO EVIDENCE that there
is a neurologic disease in the classical sense.

Subjective cognitive impairment is weakly _________ of objective findings and is more related to ________.

Subjective cognitive impairment is WEAKLY predictive of objective findings and is more related to DISTRESS.

Accuracy of self report-1
_

What is the “Good old days” phenomenon?

Pre-morbid health is overestimated AFTER injury.

Lees-Haley et al (1997) gathered data on a total of 446 subjects (comprising 131 litigating and 315 non-litigating adults from five locations across the United States) and noted that the litigating clients consistently reported themselves to be hyper-normal before their injury.

These differences applied to areas as diverse as life in general, concentration, memory, level of depression, level of anxiety, level of alcohol abuse, work or school performance, level of irritability, level of headache, level of confusion, level of self esteem, fatigue, level of sexual functioning, quality of their marriage and the relationship to their children. Only level of drug abuse did not differ between the forensic group and the controls.

Empirical evidence that adults who were sexually
abused or otherwise traumatized during
childhood or earlier in adulthood may ____ __ _______ abuse/trauma when directly asked

Empirical evidence that adults who were sexually
abused or otherwise traumatized during
childhood or earlier in adulthood may FAIL TO REPORT abuse/trauma when directly asked

Gulf War trauma reported more _________ at 2 years than 1 month after return in the same cohort (Southwick et al, 1997)

Gulf War trauma reported more FREQUENTLY at 2
years than 1 month after return in the same
cohort (Southwick et al, 1997)

30-40% ______ for physical and sexual abuse when
assessed 15 years later with file evidence from
childhood.

30-40% denial for physical and sexual abuse when
assessed 15 years later with file evidence from
childhood

Accuracy of self report-3

Post-encoding effects and events can influence the _________ of memory (i.e. reconsolidation)

Post-encoding effects and events can
influence the ACCURACY of memory (i.e.
reconsolidation).

Academic, athletic, military achievements
distorted by some.

Well documented stressors, medical and
mental health history imperfectly recalled
(Harlow & Linet; 1989; Simon & Von Korff,
1995)

What is the level of overlap between self report
of depression in structured interview and
in a self report instrument administered a
year later?

NO SIGNIFICANT overlap between self report
of depression in structured interview and
in a self report instrument administered a
year later.

Results were “disheartening…wherever
possible, use of records of past depression
is to be strongly preferred over a reliance
on respondent recall” (Coyne et al, 2001)

1008 New Zealand 18 years olds who had
participated in a longitudinal study had
inaccurate recollections of items such as
family conflict at various ages as reported
earlier by mother, self report of hyperactivity, self report of depression.
(Henry et al., 1994)

Given the unreliability of self-report, you should always….

Seek to obtain comprehensive records.

- For some reason these folk may well have
suffered significant stressful life events and
for whatever reason may not recognize these
(repression/denial???)

- Disclosure is healthy
- Disclosure of trauma must be titrated –too
much disclosure can be traumatic for some
people

Somatic Stress Disorders and Neuropsychology

SSD’s are associated with neuropsychological _________

Associated with neuropsychological ABNORMALITIES.

In SSDs, subjective cognitive impairment is not ______

Subjective cognitive impairment is NOT VALID.

In SSDs, self-report may be ________.

Self report history may be INACCURATE

Cognitive abnormalities do not signify ______ ______ but brain chemistry and perhaps structure can be altered by stress.

Cognitive abnormalities do not signify NEUROLOGIC DISEASE but brain chemistry and perhaps structure
can be altered by stress.

The pattern of neuropsychological deficits does not
allow for classification as “_______” or “_______”

Pattern of neuropsychological deficits does not
allow for classification as “organic” or “functional”

AVOID ENDORSING ORGANIC ACCOUNTS OF ILLNESS.

Epstein et al’s model does not use labels such as _______ or medical labels that ________.

1. Don’t use labels such as somatoform
2. Don’t use medical labels that pathologize

He prefers symptom descriptors as labels.

Employ the biopsychosocial model in case conceptualization as all illnesses involve
physical symptoms, social relationships,
emotions.

Epstein argues that you need to empathize with the patient’s experience, validating the experience without ________ the diagnosis/pathology.

Epstein argues that you need to empathize with the patient’s experience, validating the experience without endorsing the diagnosis/pathology.

In terms of working with SSD patients, it’s best to have only ___ treating clinician.

One treating clinician.

MINIMIZE LEVEL OF CLINICIAN INVOLVEMENT.

After appropriate work up and diagnosis, further diagnostic testing __________ ______ ______,

After appropriate work up and diagnosis, further diagnostic testing should be minimized

Is it better to say “there is no neurological/neuropsychological
problem” or that “you condition is purely
psychiatric/psychological”?

Say neither.

In SSD, they symptoms are real but are associated with….?

The symptoms are “real” but are associative with maladaptive coping patterns

SSDs are common syndromes and you will see them.

Be sure to avoid endorsing organic accounts of these conditions.

What else should you recommend in terms of treatment?

Recommend appropriate psychological
intervention minimizing the level of clinician
involvement

What two factors can have a PROFOUND effect on functional outcome following mTBI? (2)

1. Psychological factors
2. Subjective cognitive factors

Neuroanatomical and neurochemical changes in SSD

What's altered? (2)

1. Brain chemistry
2. Structure are altered by stress

Cognitive abnormalities do not themselves signify neurological disease.... BUT.....

but chemistry and perhaps structure due to stress.

The danger of placing someone on the DSP is that they will become....

Sick role dependent.

Is intensive EEG monitoring monitoring necessary in NES diagnostic workup? If yes, why? (2)

1. Intensive EEG video telemetry monitoring is necessary because episodes usually not observed and NES and ES seizures often appear similar.

2. Psychological methods useful for description and to identify persons at risk, but cannot be used for diagnosis.

Do patients presented with NES have neuropsychological deficits?

YES!!

Scores above ____ on MMPI2 hypochondriasis and hysteria are associated with NES

Scores about 79!

Actual seizure groups are 10 points lower than pseudoseizure groups.

THREE BEST PREDICTORS OF PSEUDO SEIZURE?

1. MMPI-2 Hysteria
2. ROUTINE EEG
3. BRIEF CHRONICITY.

in terms of psychological interventions, the focus should be on ___________ the level of clinician involvement.

in terms of psychological interventions, the focus should be on minimising the level of clinician involvement.

Don't assume all cognitive change is due to neurological...

injury (e.g., TBI).

Key points to lecture (4)

 Don’t assume that all cognitive change is due to neurological injury
 Do your best to corroborate the history if possible
 Avoid endorsing organic accounts of these conditions
 Recommend appropriate psychological intervention minimizing the level of clinician involvement