Author: Gretchen Hinson, M.D.
- PNES vs. epilepsy: postictal state is diagnostic of an epileptic seizure (sonorous respirations and/or confusion, lasting typically 20-30 minutes); Epileptiform seizures show decrease in convulsion frequency, but increase in convulsion amplitude while PNES convulsions demonstrate episodic convulsion amplitudes; and epileptiform seizures usually do not pause.
- PNES is a form of conversion disorder and can be associated with underlying personality disorder; however there are patients with epilepsy that also can have PNES which complicates the diagnosis and treatment.
- Patients that are malingering may have flailing movements and might talk during the episodes – both not typical of epileptic seizures or PNES.
- Treatment for PNES is with psychotropic medications and psychotherapy as opposed to antiepileptic medications
Avbersek, A; Sisodiya, S. (2010). Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?. Journal of neurology, neurosurgery, and psychiatry. 81(7):719-25.
Devinsky, O; Gazzola, D; LaFrance, W. Curt (2011). Differentiating between nonepileptic and epileptic seizures. Nature Reviews. Neurology. 7 (4): 210?220.
Lesser, RP. (2003). Treatment and Outcome of Psychogenic Nonepileptic Seizures. Epilepsy Currents. 3(6):198-200. doi:10.1046/j.1535-7597.2003.03601.x.
Pillaia, JA; Hautab SR. (2012). Patients with epilepsy and psychogenic non-epileptic seizures: An inpatient video-EEG monitoring study. Seizure. 21(1): 24-27.
Author: Dylan Luyten, MD
- Johannes Hoffer coined term Nostalgia in 1688 in his medical dissertation.
- Nostalgia was a formal medical diagnosis, and one that dates back to 17th century when soldiers had longing for home and melancholy with a constellation of symptoms including lethargy, sadness, disturbed sleep, heart palpitations, GI complaints, and/or skin findings for which the only cure was to return home.
- In the civil war, over 5000 soldiers were given medical leave for nostalgia.
- Always remember to view your patient in the appropriate context (psychosocial, cultural, historical, etc.)
Beck, J. (2013, August 14). When Nostalgia Was a Disease. Retrieved March 08, 2018, from https://www.theatlantic.com/health/archive/2013/08/when-nostalgia-was-a-disease/278648/
Podcast #221: Walking Corpse Syndrome
Author: Erik Verzemnieks, M.D.
- Walking Corpse Syndrome (aka Cotard Delusion) is a very rare psychiatric disorder that leads to the belief that one is a “walking corpse”.
- Often co-presents with depression, schizophrenia, and starvation.
- Responds to ECT.
Run Time: 4 minutes
Author: Dr. Michael Hunt
- Ketamine is a dissociative anesthetic that can be used for sedation, anesthesia, or to calm down agitated patients.
- Can be given IV at 1-2 mg per kilo or IM at 4-5 mg per kilo every ten minutes and will last anywhere from five to thirty minutes depending on administration.
- Complications include laryngospasm (1%), increased IC pressure, increased ocular pressure, rash (15%), and acute psychosis.
Link to Podcast: http://medicalminute.madewithopinion.com/ketamine/