Progesterone, neurosteroids, and the hormonal basis of catamenial epilepsy.
Progesterone, neurosteroids, and the hormonal basis of catamenial epilepsy.
复制标题
黄体酮、神经类固醇和经期癫痫的激素基础。
DOI：
10.1002/ana.10534
复制
发表时间：
2003
影响因子：
11.2
通讯作者：
Rogawski,MichaelA
中科院分区：
文献类型：
--
作者：
Rogawski,MichaelA
Why do they occur? Some people express emotions physically. PNES (and their cousin disorders) are products of a number of factors. 1, 5 The first derives from the ways patients interact with those around them. This could be particularly (but not uniquely) important in people with inadequate coping skills or whose maladaptive behaviors have been reinforced. A second group of factors pertains to internal or internalized conflicts. These might be important for patients with affective disorders, panic attacks, anxiety, obsessivecompulsive disorders, conversion or somatization disorders, posttraumatic stress disorders, or sexual or physical abuse. For personal reasons, some patients may misinterpret normal physiological phenomena. 5 Another group includes patients who have psychoses or are schizophrenic. Still another includes those with what used to be called personality disorders, with problems including borderline personality, malingering, or factitious disorder. In practice, these groupings are not distinct from one another: how you organize and perceive yourself and your experiences, and how flexible, pleasant, and open you are in your interactions6 derive from what you are, both inside and out. Patients with PNES are not always distinctly different from the rest of us. Formal psychiatric disorders may not be present. 7, 8 Patients’ personalities can be variants, even if extreme variants, of normal. 6 When this occurs, patients’ similarities to ourselves may make empathic diagnosis and treatment more difficult. 9 How should we treat? First, explain the diagnosis to the patient courteously and tactfully. The manner for describing PNES should be no different from describing epilepsy, or lupus. If the diagnosis is uncertain, say so. Consider with the patient why the episodes might be occurring. Sometimes that is enough; symptoms stop. 1 More often patients need more treatment, but studies have shown that treatment is often unsuccessful, especially in patients with psychiatric diagnoses. 7, 8, 10
