Looking for research on the efficacy of self-care for art therapists. I know it works for me, and how important it is for me, even though I'm not a full-fledged art therapist. I work as an activities director and apply principles to art activities I facilitate with patients. In the course of the activities, or afterward, the patients often rely on me as a sounding board, or for support. I find it is hard to let go of, and must let my unconscious response be expressed through art. But has there been any research?
Hi Anne,
I don't know if there has been any systematic research in the area. Most has been anecdotal based on common sense. I am sure that you have run across the same "research" that I have. This is just one example of the types of books that I am running across:
Malinowski, A. J. (2014). Self-Care for the Mental Health Practitioner: The Theory, Research, and Practice of Preventing and Addressing the Occupational Hazards of the Profession. London: Jessica Kingsley Publishers.
Here is an article that is not just about art therapists:
Hansson, A., Hillerås, P., & Forsell, Y. (2005). What kind of self-care strategies do people report using and is there an association with well-being?. Social Indicators Research, 73(1), 133-139. doi:10.1007/s11205-004-0995-3
A graduate student at EVMS did a heuristic on art for self-care and she might be willing to share her results. Her email is: [email protected]
I hope this helps.
Lisa Hinz
I have information I can post here - which I have as I am training as a psychotherapist - however is not specifically about art therapy per se - would you still be interested. Best wishes
Hi
Try this, hope it helps. It has since been published in Public Health.
Martyn
Thank you all, I will follow all of your leads! Dr. Queen, thank for the research you shared, more specific to an underlying question which is; am I really helping? Am I doing any good? Dr. Hinz I have requested the article by Hansson. Thank you much!
Hi,
I did a little research. I could acessed by my University many periodics.
I found 27 publications. I hope that help you.
Luiz
27 Resultados para Portal de Periodicos
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Visual art making for therapist growth and self-care
Harter, S.L.
Journal of Constructivist Psychology, April 2007, Vol.20(2), pp.167-182 [Periódico revisado por pares]Scopus (Elsevier B.V)
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Provision and practice of art therapy for people with schizophrenia: results of a national survey
Patterson, Sue ; Debate, James ; Anju, Soni ; Waller, Diane ; Crawford, Mike J
Journal of mental health (Abingdon, England), August 2011, Vol.20(4), pp.328-35 [Periódico revisado por pares]Art therapy has been recommended as a treatment for people with psychosis. However, little is known about the availability, organisation or delivery of art therapy within NHS settings. To describe the availability, structure and content of art therapy for people with schizophrenia provided by NHS services in England. A survey of art therapists working in a randomly selected sample of half of all mental health Trusts in England. Not all mental health Trusts employ art therapists. Those which do employ few therapists, typically on a sessional basis who work across a variety of inpatient and community-based settings. Most art therapists report that their practice is underpinned by psychodynamically grounded understandings of psychosis. However, rather than seek to explore underlying dynamics, art therapists typically adopt a non-directive approach encouraging patients to use image making to express feelings and reflect on these in a concrete way to develop self-understanding. While three-quarters of respondents reported that their work was valued by colleagues, less than half considered art therapy well understood by colleagues or integrated with other services. People diagnosed with schizophrenia have limited access to art therapy in NHS settings. Further research is needed to understand the experience and outcomes of art therapy to support its meaningful integration within the spectrum of care required to meet the needs of people with schizophrenia. MEDLINE/PubMed (U.S. National Library of Medicine)
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Theater for, by and with fibromyalgia patients – Evaluation of emotional expression using video interpretation
Horwitz, E. Bojner ; Kowalski, J. ; Anderberg, U.M.
The Arts in Psychotherapy, 2010, Vol.37(1), pp.13-19 [Periódico revisado por pares]The healing function of theater is reflected in all human cultures. Today, therapists and scientists work with psychodrama and drama therapy, often describing theater as the art form closest to life itself. In a unique cooperation between professional actors and a dance movement therapist/pain researcher, patients with fibromyalgia have first been trained in body and voice expression and thereafter acted out a drama onstage together with professional actors. A video interpretation technique was used to help patients interpret their own emotional expressions towards other actors and evaluate their perceived pain and self-rated health. The results of this feasibility study show that the variation of emotional expression from video interpretation is dependent upon whether or not the patient acts with an actor. The intensity of emotional expression increases significantly when acting together with a professional actor. The results also show an increase in self-rated health and a decrease in pain after 3 months of using this theater-based technique. A correlation between strong emotional expression and decreased pain was also observed. However, when patients did not actively participate in a theater play, their self-estimated pain was not significantly decreased. In this study, the cross-fertilization of culture/expressive arts and health care is presented as a new resource for pain treatment. In particular there may be a link between intense emotional expressions when acting with professional actors and decreased perceptions of pain. The paper also discusses the potential therapeutic value of working with professional actors in the treatment of other pain patients. Hopefully, this theater-related method can contribute to developing collaboration between actors and creative art therapists and stimulate controlled studies of evidence-based science. ScienceDirect (Elsevier B.V.)
and better self-perceived health. In this study... pain and health Patients evaluated their self... emotional expression.
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Theater for, by and with fibromyalgia patients - Evaluation of emotional expression using video interpretation.(Clinical report)
Horwitz, E. Bojner ; Kowalski, J. ; Anderberg, U. M.
The Arts in Psychotherapy, Feb, 2010, Vol.37(1), p.13(7) [Periódico revisado por pares]To link to full-text access for this article, visit this link: http://dx.doi.org.ez54.periodicos.capes.gov.br/10.1016/j.aip.2009.11.003 Byline: E. Bojner Horwitz (a), J. Kowalski (b), U.M. Anderberg (a) Keywords: Cultural health; Dance/movement therapy; Emotional expression; Fibromyalgia; Theater related method; Video interpretation Abstract: The healing function of theater is reflected in all human cultures. Today, therapists and scientists work with psychodrama and drama therapy, often describing theater as the art form closest to life itself. In a unique cooperation between professional actors and a dance movement therapist/pain researcher, patients with fibromyalgia have first been trained in body and voice expression and thereafter acted out a drama onstage together with professional actors. A video interpretation technique was used to help patients interpret their own emotional expressions towards other actors and evaluate their perceived pain and self-rated health. The results of this feasibility study show that the variation of emotional expression from video interpretation is dependent upon whether or not the patient acts with an actor. The intensity of emotional expression increases significantly when acting together with a professional actor. The results also show an increase in self-rated health and a decrease in pain after 3 months of using this theater-based technique. A correlation between strong emotional expression and decreased pain was also observed. However, when patients did not actively participate in a theater play, their self-estimated pain was not significantly decreased. In this study, the cross-fertilization of culture/expressive arts and health care is presented as a new resource for pain treatment. In particular there may be a link between intense emotional expressions when acting with professional actors and decreased perceptions of pain. The paper also discusses the potential therapeutic value of working with professional actors in the treatment of other pain patients. Hopefully, this theater-related method can contribute to developing collaboration between actors and creative art therapists and stimulate controlled studies of evidence-based science. Author Affiliation: (a) Department of Public Health and Caring Sciences, Social Medicine, Uppsala University, Box 564, SE 751 22 Uppsala, Sweden (b) Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, SE 141 86 Stockholm, Sweden Cengage Learning, Inc.
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Self-Awareness Enhancement through Learning and Function (SELF): A Theoretically Based Guideline for Practice
Dirette, Diane
The British Journal of Occupational Therapy, 2010, Vol.73(7), pp.309-318 [Periódico revisado por pares]Introduction: Impaired self-awareness is a significant barrier to successful rehabilitation. This paper presents a new guideline for practice, entitled Self-awareness Enhancement through Learning and Function (SELF). Description: The SELF is a newly developed guideline for practice, which incorporates the latest theoretical information from neuroscience, psychology and computer science regarding self-awareness, learning, cognition and care giving, with evidence of the importance of participation in occupation. The SELF provides clear evaluation and treatment postulates using therapeutic alliance, occupation, belief perspectives, brain education and compensatory strategies to improve self-awareness. Discussion: The current approach to the treatment of impaired self-awareness focuses on testing and performance feedback. This approach does not have evidence to support its effectiveness and there is some evidence that the approach actually contributes to emotional distress and increased denial of deficits. Conclusion: The SELF integrates the art and the science of occupational therapy to foster self-awareness in an empathetic and dignified manner. Occupational therapists are uniquely qualified, and should be leaders, in the integration of personal factors, environmental elements and occupations to improve self-awareness. The SELF provides occupational therapists with guidelines for using these interrelationships to restore self-awareness in a manner that builds confidence and skills. SAGE Publications
therapists with a new conceptualisation of self-awareness, which provides a... regarding self-awareness, learning, cognition and care giving, with evidence
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Massage for Low-back Pain
Farber, Katrina ; Wieland, L. Susan
Explore: The Journal of Science and Healing, May-June 2016, Vol.12(3), pp.215-217 [Periódico revisado por pares]Furlan AD, GiraldoM, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev 2015, Issue 9. Art. No.: CD001929. DOI: 10.1002/14651858.CD001929.pub3.BackgroundLow back pain (LPB) is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70–80% of adults at some time in their lives. Massage therapy has the potential to minimize pain and speed return to normal function. ObjectivesTo assess the effects of massage therapy for people with non-specific LBP. Search MethodsWe searched PubMed to August 2014, and the following databases to July 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Index to Chiropractic Literature, and Proquest Dissertation Abstracts.We also checked reference lists. There were no language restrictions used. Selection CriteriaWe included only randomized controlled trials of adults with non-specific LBP classified as acute, sub-acute, or chronic. Massage was defined as soft-tissue manipulation using the hands or amechanical device.We grouped the comparison groups into two types: inactive controls (sham therapy, waiting list, or no treatment), and active controls (manipulation, mobilization, TENS, acupuncture, traction, relaxation, physical therapy, and exercises or self-care education). Data Collection and AnalysisWe used standard Cochrane methodological procedures and followed CBN guidelines. Two independent authors performed article selection, data extraction, and critical appraisal. Main ResultsIn total we included 25 trials (3096 participants) in this review update. The majority was funded by not-for-profit organizations. One trial included participants with acute LBP, and the remaining trials included people with sub-acute or chronic LBP (CLBP). In three trials massage was done with a mechanical device, and the remaining trials used only the hands. The most common type of bias in these studies was performance and measurement bias because it is difficult to blind participants, massage therapists and the measuring outcomes. We judged the quality of the evidence to be “low” to “very low,” and the main reasons for downgrading the evidence were risk of bias and imprecision. There was no suggestion of publication bias. For acute LBP, massage was found to be better than inactive controls for pain (SMD = −1.24, 95% CI: −1.85 to −.64; participants = 51; studies = 1) in the short-term, but not for function (SMD = −.50, 95% CI: −1.06 to .06; participants = 51; studies = 1). For sub-acute and chronic LBP, massage was better than inactive controls for pain (SMD = −.75, 95% CI: −.90 to −.60; participants = 761; studies = 7) and function (SMD = −.72, 95% CI: −1.05 to −.39; 725 participants; 6 studies) in the short-term, but not in the long-term; however, when compared to active controls, massage was better for pain, both in the short (SMD = −.37, 95% CI: −.62 to −.13; participants = 964; studies = 12) and long-term follow-up (SMD = −.40, 95% CI: −.80 to −.01; participants = 757; studies = 5), but no differences were found for function (both in the short and longterm). There were no reports of serious adverse events in any of these trials. Increased pain intensity was the most common adverse event reported in 1.5–25% of the participants. Authors׳ ConclusionsWe have very little confidence that massage is an effective treatment for LBP. Acute, sub-acute, and chronic LBP had improvements in pain outcomes with massage only in the short-term follow-up. Functional improvement was observed in participants with sub-acute and chronic LBP when compared with inactive controls, but only for the short-term follow-up. There were only minor adverse effects with massage. ScienceDirect (Elsevier B.V.)
pain, massage compared to inactive controls such as usual care or a waiting list...
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Distance art groups for women with breast cancer: guidelines and recommendations
Collie, Kate ; Bottorff, Joan L ; Long, Bonita C ; Conati, Cristina
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, August 2006, Vol.14(8), pp.849-58 [Periódico revisado por pares]To overcome barriers that prevent women with breast cancer from attending support groups, innovative formats and modes of delivery both need to be considered. The present study was part of an interdisciplinary program of research in which researchers from counseling psychology, psycho-oncology, nursing, computer science, and fine arts have explored art making as an innovative format and telehealth as a mode of delivery. For this study, we conducted focus groups and interviews with 25 people with expertise about breast cancer, art, art therapy, and distance delivery of mental health services to generate guidelines for distance art-based psychosocial support services to women with breast cancer. A qualitative analysis of the focus group and interview data yielded guidelines for developers and facilitators of distance art groups for women with breast cancer pertaining to (a) emotional expression, (b) emotional support, (c) emotional safety, and (d) accommodating individual differences, plus special considerations for art therapy groups. Further research is needed pertaining to the use of computers, involvement of art therapists, and screening out vulnerable clients. MEDLINE/PubMed (U.S. National Library of Medicine)
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ELEMENTS: the design of an interactive virtual environment for movement rehabilitation of traumatic brain injury patients
Duckworth, J 2010
This exegesis details the development of an interactive art work titled Elements designed to assist upper limb movement rehabilitation for patients recovering from traumatic brain injury. Enhancing physical rehabilitative processes in the early stages following a brain injury is one of the great challenges facing therapists. Elements enables physical user interaction that may present new opportunities for treatment.
One of the key problems identified in the neuro-scientific field is that developers of interactive computer systems for movement rehabilitation are often constrained to the use of conventional desktop interfaces. These interfaces often fall short of fostering natural user interaction that translates into the relearning of body movement for patients, particularly in ways that reinforce the embodied relationship between the sensory world of the human body and the predictable effects of bodily movement in relation to the surrounding environment. Interactive multimedia environments that can correlate a patient’s sense of embodiment may assist in the acquisition of movement skills that transfer to the real world. The central theme of my exegesis will address these concerns by analysing contemporary theories of embodied interaction as a foundation to design Elements.
Designing interactive computer environments for traumatic brain injured patients is, however, a challenging issue. Patients frequently exhibit impaired upper limb function which severely affects activities for daily living and self-care. Elements responds to this level of disability by providing the patient with an intuitive tabletop computer environment that affords basic gestural control.
As part of a multidisciplinary project team, I designed the user interfaces, interactive multimedia environments, and audiovisual feedback (visual, haptic and auditory) used to help the patients relearn movement skills.
The physical design of the Elements environment consists of a horizontal tabletop graphics display, a stereoscopic computer video tracking system, tangible user interfaces, and a suite of seven interactive software applications. Each application provides the patients with a task geared toward the patient reaching, grasping, lifting, moving, and placing the tangible user interfaces on the display. Audiovisual computer feedback is used by patients to refine their movements online and over time. Patients can manipulate the feedback to create unique aesthetic outcomes in real time. The system design provides tactility, texture, and audiovisual feedback to entice patients to explore their own movement capabilities in externally directed and self-directed ways.
This exegesis contributes to the larger research agenda of embodied interaction. My original contribution to knowledge is Elements, an interactive artwork that may enable patients to relearn movement skills, raise their level of self-esteem, sense of achievement, and behavioural skills RMIT University
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A foot in the door: art therapy in the nursing home
Ferguson, W J ; Goosman, E
American journal of art therapy, August 1991, Vol.30(1), pp.2-3 [Periódico revisado por pares]Inclusion of art therapy in the residential nursing home and a day-care facility had positive effects on the elderly. Socialization, self-esteem, and memory retrieval were enhanced by the art experience. In addition, the staff and administrators of both the nursing home and day-care facility found art therapy to be valuable and arranged to continue the program. The funding agent for the pilot project was particularly interested in supporting a program that included an educational component, and the university recognized this program as an excellent training opportunity. The five art therapy interns gained experience in working with a population that will need increased professional services in the future, and the successful addition of part-time art therapists at the two pilot agencies will assure a continuation of intern training sites for art therapy students interested in gerontology. By developing sites for art therapy interns, we have opened the door to a method which will not only train professionals to work with older adults but will also offer job sharing between nursing homes. It has been suggested by the administrator of the nursing home in the program that we investigate the possibility of one art therapist serving two or three nursing homes on a part-time/full-time employment basis. Programs would then be affordable at most sites, and thus more people would be able to benefit from art therapy. MEDLINE/PubMed (U.S. National Library of Medicine)
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Stakeholder views on a recovery-oriented psychiatric rehabilitation art therapy program in a rural Australian mental health service: a qualitative description
De Vecchi, N ; Kenny, A ; Kidd, S
International Journal Of Mental Health Systems, 2015 Mar 10, Vol.9 [Periódico revisado por pares]Web of Science
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ELEMENTS: the design of an interactive virtual environment for movement rehabilitation of traumatic brain injury patients
Duckworth, J 2010
Theses http://researchbank.rmit.edu.au/view/rmit:4912This exegesis details the development of an interactive art work titled Elements designed to assist upper limb movement rehabilitation for patients recovering from traumatic brain injury. Enhancing physical rehabilitative processes in the early stages following a brain injury is one of the great challenges facing therapists. Elements enables physical user interaction that may present new opportunities for treatment.
One of the key problems identified in the neuro-scientific field is that developers of interactive computer systems for movement rehabilitation are often constrained to the use of conventional desktop interfaces. These interfaces often fall short of fostering natural user interaction that translates into the relearning of body movement for patients, particularly in ways that reinforce the embodied relationship between the sensory world of the human body and the predictable effects of bodily movement in relation to the surrounding environment. Interactive multimedia environments that can correlate a patient’s sense of embodiment may assist in the acquisition of movement skills that transfer to the real world. The central theme of my exegesis will address these concerns by analysing contemporary theories of embodied interaction as a foundation to design Elements.
Designing interactive computer environments for traumatic brain injured patients is, however, a challenging issue. Patients frequently exhibit impaired upper limb function which severely affects activities for daily living and self-care. Elements responds to this level of disability by providing the patient with an intuitive tabletop computer environment that affords basic gestural control.
As part of a multidisciplinary project team, I designed the user interfaces, interactive multimedia environments, and audiovisual feedback (visual, haptic and auditory) used to help the patients relearn movement skills.
The physical design of the Elements environment consists of a horizontal tabletop graphics display, a stereoscopic computer video tracking system, tangible user interfaces, and a suite of seven interactive software applications. Each application provides the patients with a task geared toward the patient reaching, grasping, lifting, moving, and placing the tangible user interfaces on the display. Audiovisual computer feedback is used by patients to refine their movements online and over time. Patients can manipulate the feedback to create unique aesthetic outcomes in real time. The system design provides tactility, texture, and audiovisual feedback to entice patients to explore their own movement capabilities in externally directed and self-directed ways.
This exegesis contributes to the larger research agenda of embodied interaction. My original contribution to knowledge is Elements, an interactive artwork that may enable patients to relearn movement skills, raise their level of self-esteem, sense of achievement, and behavioural skills National Library of Australia (Trove)
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Arts therapies for young offenders in secure care -- A practice-based research
Smeijsters, Henk ; Kil, Julie ; Kurstjens, Han ; Welten, Jaap ; Willemars, Gemmy
The Arts in Psychotherapy, Feb, 2011, Vol.38(1), p.41(11) [Periódico revisado por pares]To link to full-text access for this article, visit this link: http://dx.doi.org.ez54.periodicos.capes.gov.br/10.1016/j.aip.2010.10.005 Byline: Henk Smeijsters, Julie Kil, Han Kurstjens, Jaap Welten, Gemmy Willemars Keywords: Drama therapy; Music therapy; Art therapy; Dance-movement therapy; Young offenders; Constructivistic research; Practice-based evidence Abstract: a[paragraph] Best practices for all arts therapies working with juvenile offenders in the area of disturbed self-image, emotions, interaction and cognition. a[paragraph] Best practices that can be used in regular practice. a[paragraph] Best practices that are based on tacit knowledge, practice based evidence and evidence based practice. a[paragraph] One valuable aspect of this study is that it has led to arts therapists from various different institutions and with different backgrounds talking to one another and developing their work. Because so much knowledge taken from practice, theory, and research is integrated by the professionals themselves, there is strong commitment to actual application of the interventions. It is also important that independent experts are involved in discussion of the usefulness and the effect of arts therapies. Arts therapists and experts with a variety of theoretical perspectives exchange views and assist one another in developing the intervention and accounting for its effect. Author Affiliation: KenVaK Research Centre, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN Heerlen, The Netherlands Cengage Learning, Inc.
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The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes
Gunnarsson, A. Birgitta ; Eklund, Mona
Australian Occupational Therapy Journal, 2009, Vol.56(3), pp.167-176 [Periódico revisado por pares]Background/aim: The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health‐related factors, with clients going through a TTM intervention. Methods: Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self‐rating instruments, targeting therapeutic alliance (HAq‐II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health‐related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist‐90‐R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention. Results: A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self‐mastery. According to the therapists’ ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health‐related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction. Conclusions: The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance. John Wiley & Sons, Inc.
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A Pilot RCT of Psychodynamic Group Art Therapy for Patients in Acute Psychotic Episodes: Feasibility, Impact on Symptoms and Mentalising Capacity
Montag, Christiane ; Haase, Laura ; Seidel, Dorothea ; Bayerl, Martin ; Gallinat, Jürgen ; Herrmann, Uwe ; Dannecker, Karin
PLoS One, Nov 2014, Vol.9(11), p.e112348 [Periódico revisado por pares] This pilot study aimed to evaluate the feasibility of an assessor-blind, randomised controlled trial of psychodynamic art therapy for the treatment of patients with schizophrenia, and to generate preliminary data on the efficacy of this intervention during acute psychotic episodes. Fifty-eight inpatients with DSM-diagnoses of schizophrenia were randomised to either 12 twice-weekly sessions of psychodynamic group art therapy plus treatment as usual or to standard treatment alone. Primary outcome criteria were positive and negative psychotic and depressive symptoms as well as global assessment of functioning. Secondary outcomes were mentalising function, estimated with the Reading the mind in the eyes test and the Levels of emotional awareness scale, self-efficacy, locus of control, quality of life and satisfaction with care. Assessments were made at baseline, at post-treatment and at 12 weeks' follow-up. At 12 weeks, 55% of patients randomised to art therapy, and 66% of patients receiving treatment as usual were examined. In the per-protocol sample, art therapy was associated with a significantly greater mean reduction of positive symptoms and improved psychosocial functioning at post-treatment and follow-up, and with a greater mean reduction of negative symptoms at follow-up compared to standard treatment. The significant reduction of positive symptoms at post-treatment was maintained in an attempted intention-to-treat analysis. There were no group differences regarding depressive symptoms. Of secondary outcome parameters, patients in the art therapy group showed a significant improvement in levels of emotional awareness, and particularly in their ability to reflect about others' emotional mental states. This is one of the first randomised controlled trials on psychodynamic group art therapy for patients with acute psychotic episodes receiving hospital treatment. Results prove the feasibility of trials on art therapy during acute psychotic episodes and justify further research to substantiate preliminary positive results regarding symptom reduction and the recovery of mentalising function. Trial Registration ClinicalTrials.gov NCT01622166 © ProQuest LLC All rights reserved Medical Database ProQuest Pharma Collection Health & Medical Collection Nursing & Allied Health Database ProQuest Agriculture Journals ProQuest Public Health Aquatic Science Journals ProQuest Nursing & Allied Health Source ProQuest Agricultural Science Collection ProQuest Aquatic Science Collection ProQuest Atmospheric Science Collection ProQuest Biological Science Collection ProQuest Central ProQuest Earth Science Collection ProQuest Engineering Collection ProQuest Environmental Science Collection ProQuest Advanced Technologies & Aerospace Collection ProQuest Hospital Collection ProQuest Materials Science Collection ProQuest Natural Science Collection ProQuest Technology Collection ProQuest SciTech Collection ProQuest Health & Medical Complete ProQuest Medical Library Advanced Technologies & Aerospace Database Agricultural & Environmental Science Database Biological Science Database Earth, Atmospheric & Aquatic Science Database Materials Science & Engineering Database Natural Science Collection ProQuest Central (new) SciTech Premium Collection Technology Collection Health Research Premium Collection
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What Play Therapists Do within the Therapeutic Relationship of Humanistic/Non-Directive Play Therapy
Robinson, Sally
Pastoral Care in Education, 2011, Vol.29(3), p.207-220 [Periódico revisado por pares]Play therapists are increasingly being employed in schools, yet there is confusion among many health, education and social care practitioners about the role of play therapists. This paper explains how play therapists position themselves and what they do through an examination of the therapeutic relationship between the therapist and child. It discusses the core conditions of congruence, acceptance and empathy with reference to recent research. Play therapists vary their practice in terms of verbal or non-verbal interaction, the tools in their playroom and how they physically place themselves. This paper argues for placing an emphasis on the non-verbal mirroring of the child, the incorporation of expressive media such as paint, clay and sand into the play room and the positioning of the therapist within the play space. ERIC (U.S. Dept. of Education)
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I just want to melt away : 'treatment' of women with eating issues : a critical feminist informed view of art therapy and the exploration of an alternative approach
Edwards, Claire 2005
This thesis, which includes a dual case study, explores the clinical use of art therapy with women with eating issues from a feminist perspective. It provides a critique of the existing art therapy literature, and suggests alternative approaches which may be incorporated into an art therapy intervention, to increase its relevance to this client group. It demonstrates the need for flexibility and creativity on the part of the art therapist, particularly with regard to the provision of structure and containment. It offers an example of qualitative research methods which were easily incorporated into clinical practice, as a means to introducing clients’ voices into art therapy narratives as well as evaluating practice. These research methods are suggested for future art therapy research projects. This study found that a short term feminist informed art therapy intervention was able to meet its goals of increasing clients’ self awareness and insight into their eating issues. The use of art therapy was found to be one of the strategies which contributed to the success of this intervention. Other important aspects included: the adoption of a feminist model; the use of journalling; a flexible approach; a concern with what lay beneath the eating issue; and a focus on self-care and nurture. National Library of Australia (Trove)
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Arts therapies for young offenders in secure care—A practice-based research
Smeijsters, Henk ; Kil, Julie ; Kurstjens, Han ; Welten, Jaap ; Willemars, Gemmy
The Arts in Psychotherapy, 2011, Vol.38(1), pp.41-51 [Periódico revisado por pares]Research highlights ▶ Best practices for all arts therapies working with juvenile offenders in the area of disturbed self-image, emotions, interaction and cognition. ▶ Best practices that can be used in regular practice. ▶ Best practices that are based on tacit knowledge, practice based evidence and evidence based practice. ▶ One valuable aspect of this study is that it has led to arts therapists from various different institutions and with different backgrounds talking to one another and developing their work. Because so much knowledge taken from practice, theory, and research is integrated by the professionals themselves, there is strong commitment to actual application of the interventions. It is also important that independent experts are involved in discussion of the usefulness and the effect of arts therapies. Arts therapists and experts with a variety of theoretical perspectives exchange views and assist one another in developing the intervention and accounting for its effect. This article describes the results of the first phase of a research project to develop, implement, evaluate, and improve arts therapies interventions for young offenders in secure care. By means of a naturalistic/constructivistic research methodology in combination with grounded therapy methodology, practice-based evidence has been generated. Core problems of young offenders that are connected to delinquency have been described and arts therapies interventions have been developed that can be used to change these core problems. Core problems are problems with self-image, with expressing and discharging emotions, the inability to resolve interpersonal problems and finally, negative cognitions. In co-creation with practitioners, interventions have been developed for drama therapy, music therapy, art therapy and dance-movement therapy. A treatment theory has been developed that explains the working of arts therapies by means of the first author's theory of analogy. This theory explains arts therapies by means of the equality between forms of expression in art and the core self consciousness as described by Damasio and the vitality affects within the core self as described by Stern. ScienceDirect (Elsevier B.V.)
core self. In the art process, the clients can express... core self. In the art process, the clients can express...
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Staff perceptions of complementary and alternative therapy integration into a child and adolescent psychiatry program
Kennedy, Heather ; Reed, Katherine ; Wamboldt, Marianne Z.
The Arts in Psychotherapy, February 2014, Vol.41(1), pp.21-26 [Periódico revisado por pares]•Complementary and alternative therapies benefit youth in psychiatric hospital programs.•Art, music, dance/movement, and yoga therapies provide coping skills, relaxation, and stress relief to patients.•Integrating complementary and alternative therapies can also benefit psychiatric staff. Art, music, yoga, and dance/movement therapies have been researched individually, mostly in adults, but few studies explain the impact of integrating these therapies into the treatment of children with psychiatric illnesses. Given the financial constraints of current healthcare, as well as limitations of verbal and medical therapies, it is important to document the added value of integrating complementary therapies, including creative arts therapies, into childhood mental health and treatment. The present study looked to evaluate views of clinical professionals (n=23) (i.e. psychiatrists, psychologists, and social workers), nurses (n=17) and milieu staff (mental health counselors; n=56) within the Psychiatry Department of a large children's hospital on the perceived benefits of integrating Complementary and Alternative Medicine (CAM) therapies within inpatient and day treatment programs. The majority of respondents (96% of clinicians, 100% of nurses, and 82% of milieu staff) reported that CAM positively impacted patient care. Staff indicated that sessions facilitated by masters level creative arts therapists or yoga therapists helped patients by increasing self esteem, increasing motor coordination and body control, providing relaxation, teaching coping skills, decreasing acting out behaviors, developing patient's awareness of emotions or underlying issues, and helping to broach difficult topics or issues for the first time. Milieu staff who participated in CAM groups alongside patients also received personal and professional benefits. ScienceDirect (Elsevier B.V.)
learning difficulties and on self concept; moderate... learning difficulties and on self concept; moderate... subjective experiences such as self-concept
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Atraumatic restorative treatment (ART): the Tanzanian experience
Mandari, G. J. ; Matee, M. I. N.
International Dental Journal, 2006, Vol.56(2), pp.71-76 [Periódico revisado por pares]: Atraumatic Restorative Treatment (ART), which involves the use of hand instruments, is a relatively inexpensive, non‐sophisticated, tooth conservative technique that offers the opportunity for restorative work in remote areas without electricity. The objectives of this survey were to evaluate the experience of dental practitioners with ART and the impact of the technique on oral health care in Tanzania, where ART was pioneered. : Dental officers (DOs), assistant dental officers (ADOs) and dental therapists (DTs) from different parts of the Tanzania mainland participated in a cross‐sectional study that gathered information using a self‐administered structured questionnaire. : Only 41 (35%) of the 117 respondents were practising ART with only 6.5% of them doing so either “most of the time” or “always”. Practising ART was significantly associated with the cadre of the dental practitioner, being higher among ADOs (50%) than DOs (37%) and DTs (20%), and with ART training, but was not related to either working experience or material availability. : To date, ART has made little impact on oral health care delivery in Tanzania, where dental extractions still account for over 90% of all forms of dental treatment, and restorative work for less than 5%. Several problems in providing ART were noted, such as limited practical training and practice in ART, scarce resources, and lack of advocacy. : An increased involvement and support for ART from the Ministry of Health and professional organisations, and public education of ART is called for. John Wiley & Sons, Inc.
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Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme
Kool, Nienke ; Van Meijel, Berno ; Koekkoek, Bauke ; Van Der Bijl, Jaap ; Kerkhof, Ad
BMC Psychiatry, 2014, Vol.14, p.64-64 [Periódico revisado por pares]Background Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme. Methods Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r . Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively. Results Of the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert. Conclusion A specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here. U.S. National Library of Medicine (NIH/NLM)
communicate with and care for patients who self-harm... (N = 8): seven mental health care experts in self... care effectively for patients who self-harm a .
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Stakeholder views on a recovery-oriented psychiatric rehabilitation art therapy program in a rural Australian mental health service: a qualitative description.(Research)(Report)
De Vecchi, Nadia ; Kenny, Amanda ; Kidd, Susan
International Journal of Mental Health Systems, March 10, 2015, Vol.9, p.11 [Periódico revisado por pares]Background Recovery-oriented care is a guiding principle for mental health services in Australia, and internationally. Recovery-oriented psychiatric rehabilitation supports people experiencing mental illness to pursue a meaningful life. In Australia, people with unremitting mental illness and psychosocial disability are often detained for months or years in secure extended care facilities. Psychiatric services have struggled to provide rehabilitation options for residents of these facilities. Researchers have argued that art participation can support recovery in inpatient populations. This study addressed the research question: Is there a role for the creative arts in the delivery of recovery-oriented psychiatric rehabilitation for people with enduring mental illness and significant psychosocial disability detained in a secure extended care unit? Methods The study had two major aims: to explore the experiences of consumers detained in a rural Australian secure extended care unit of an art therapy project, and to examine the views of nurse managers and an art therapist on recovery-oriented rehabilitation programs with regard to the art therapy project. A qualitative descriptive design guided the study, and a thematic network approach guided data analysis. Ethics approval was granted from the local ethics committee (AU/1/9E5D07). Data were collected from three stakeholders groups. Five consumers participated in a focus group; six managers and the art therapist from the project participated in individual interviews. Results The findings indicate that consumer participants benefitted from art participation and wanted more access to rehabilitation-focussed programs. Consumer participants identified that art making provided a forum for sharing, self-expression, and relationships that built confidence, absent in the regular rehabilitation program. Nurse manager and the art therapist participants agreed that art participation was a recovery-oriented rehabilitation tool, however, systemic barriers thwarted its provision. Conclusions The transformation of mental health services towards a recovery orientation requires commitment from service leaders to provide evidence-based programs. Psychiatric rehabilitation programs based on local need should be included in public mental health services. This study supports the use of art-based rehabilitation programs for people detained in rural secure extended care facilities. Introducing these programs into clinical practice settings can improve the consumer experience and support organisational culture change towards a recovery orientation. Cengage Learning, Inc.
epistemologies of duty of care and risk management with consumer autonomy and self-determination. Often risk management is more clearly supported by law and
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Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme.(Research article)(Author abstract)
Kool, Nienke ; Van Meijel, Berno ; Koekkoek, Bauke ; Van Der Bijl, Jaap ; Kerkhof, Ad
BMC Psychiatry, March 4, 2014, Vol.14, p.64 [Periódico revisado por pares]Background Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme. Methods Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively. Results Of the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert. Conclusion A specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here. Cengage Learning, Inc.
care of patients who self-harm. A nursing intervention... ): seven mental health care experts in self-harm and one... care staff are confronted with
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Concise arm and hand rehabilitation approach in stroke (CARAS): a practical and evidence-based framework for clinical rehabilitation management
Franck, Johan A. ; Halfens, Jos
Open Journal of Occupational Therapy, 2015, Vol.3(4) [Periódico revisado por pares]The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF) and arm-hand skill performance (ASHP) in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS) is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARA.S is based on four constructs: (a) stratification according to the severity of arm-hand impairment (using the Utrecht Arm/Hand -Test [UAT ]), (b) the individual's rehabilitation goals and concomitant potential rehabilitation outcomes, (c) principles of self-efficacy, and (d) possibilities to systematically incorporate (new) technology and new evidence-based training elements swiftly. The framework encompasses three programs aimed at treating either the severely (UAT 0-1), moderately (UAT 2-3), or mildly (UAT 4-7) impaired arm-hand. Program themes are: taking care of the limb and prevention of complications (Program 1), task-oriented gross motor grip performance (Program 2), and functional AHSP training (Program 3). Each program is preceded and followed by an assessment. Training modularity facilitates rapid interchange/adaptation of sub-elements. Proof-of-principle in clinical rehabilitation has been established. The CARAS facilitates rapid structured design and provision of state-of-the-art AHF and ASHP treatment in stroke patients. Keywords arm, hand, self-efficacy, stroke, therapy, task-oriented training Cengage Learning, Inc.
enhancing self-efficacy in diabetes education: a... using self-efficacy principles, which could also... ). Therapists can incorporate principles of self...
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A biblioterápia klinikai alkalmazásáról
Tóth, Anita
Könyvtári Figyelő, 2016, Vol.26(1), p.14It is a special priority of bibliotherapy to deal with those who stay hospitalized for a long time or are subjected to frequent and monotonous treatment. This target group obviously includes health care professionals serving these groups as well as the families of patients. In Hungary today clinical bibliotherapy is exercised mainly in psychiatric institutions. Earlier, bibliotherapy was classified as a kind of sociotherapy and aimed at developing social and verbal skills and educating people how to spend their free time usefully. Bibliotherapy interpreted as psychotherapy with art has, however, got deeper-rooted and longer-term therapeutic objectives. Therapists need the same abilities -- independent of locations and target groups -- as in the case of developing bibliotherapy groups: to assist participants to formulate their fears, to strengthen their self-knowledge, and to help their rehabilitation by processing well-selected texts at the sessions. © ProQuest LLC All rights reserved Library & Information Science Abstracts (LISA) Library and Information Science Abstracts (LISA) Library & Information Science Collection Social Science Premium Collection
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Proceedings of the 20th Annual Conference of the Japanese Association for Adolescent Psychotherapy, 16 November 2002, Tokyo, Japan
Psychiatry and Clinical Neurosciences, 2003, Vol.57(5), pp.S37-S42 [Periódico revisado por pares]Inpatient treatment of obsessive–compulsive disorder in a child and adolescent psychiatry ward M. USAMI National Center of Neurology and Psychiatry, Kohnodai Hospital, Chiba, Japan This is a case report of a 13‐year‐old‐boy (2nd grade in junior high school). His father had poor communication; his mother was a very fragile woman. The boy had been overprotected by his parents, as long as he responded to their expectations. He did not have any other siblings. He played well with his friends since he was young, and did not have problems until the 1st term (from April to July) of 1st grade in junior high school. However, in September he started to have difficulties going well with his friends, and going to school. He spent most of his time in his room, and began to repeat checking and hand‐washing frequently. Even at midnight, he forced his mother to touch the shutter from outside of the house for many times. He also ritually repeated to touch his mother's body, after he licked his hands, for over an hour. He became violent, when his parents tried to stop him. In April, year X, his parents visited our hospital for the first time. From then, his mother could not tolerate her son's coerciveness any longer. His father explained to the boy that ‘your mother has been hospitalized’, and she started to live in the next room to the boy's without making any noise. After 3 months he noticed that his mother was not hospitalized, and he got very excited. He was admitted to our hospital with his family and relatives, in October, year X. At the initial stage of hospitalization he showed distrust and doubt towards the therapist and hospital. He had little communication with other boys and did not express his feelings. Therefore, there was a period of time where he seemed to wonder whether he could trust the treatment staff or not. During his interviews with his therapist he repeated only ‘I’m okay’ and did not show much emotional communication. For the boy, exposing himself was equivalent to showing his vulnerability and incompleteness. Therefore, the therapist considered that he was trying to denying his feelings to avoid this. The therapist set goals for considering his own feelings positively and expressing them appropriately. Also, the therapist carried out behavioral restrictions towards him. He hardly had any emotional communication with the staff, and his peer relationship in the ward was superficial. Therefore, he gradually had difficulty spending his time at the end of December On the following day in which he and the therapist decided to return to his house for the first time, he went out of the ward a few days before without permission. From thereon it was possible for him to share feelings such as hostility and aggression, dependence and kindness with the therapist. The therapist changed his role from an invasive one to a more protective one. Then, his unsociability gradually faded. He also developed good peer relationships with other boys in the ward and began to express himself feeling appropriately. He was also able to establish appropriate relations with his parents at home, and friends of his neighborhood began to have normal peer relationships again. During childhood and adolescence, boys with obsessive–compulsive disorder are known to have features such as poor insight and often involving their mothers. We would like to present this case, through our understanding of dynamic psychiatry throughout his hospitalization, and also on the other therapies that were performed. Psychotherapy with a graduate student that discontinued after only three sessions: Was it enough for this client? N. KATSUKI Sophia University, Tokyo, Japan Before and after the psychotherapy, SWT was administrated in this case. Comparing these two drawings, the therapist was provided with some ideas of what kind of internal change had taken place inside this client. Referring to the changes observed, we would like to review the purposes and the ways of the psychotherapy, as well as the adequacy of the limited number of the sessions (vis‐a‐vis result attained.) Also we will discuss later if any other effective ways could be available within the capacities of the consulting system/the clinic in the university. Ms. S Age 24 years. (i) awkwardness in the relationship with the laboratory colleagues; (ii) symptoms of sweating, vomiting and quivering; and (iii) anxiety regarding continuing study and job hunting. > c/o PTSD. At the therapy room in the clinic, placed at the university, 50 min‐session; once a week; paralleled with the medical treatment. (1) Since she was expelled from the study team in the previous year, it has become extremely difficult for her to attend the laboratory (lab) due to the aforementioned symptoms. She had a feeling of being neglected by the others. When the therapist suggested that she compose her mental confusions in the past by attending the therapy room, she seemed to be looking forward to it, although she said that she could remember only a few. (2) She reported that she overdosed on sedatives, as she could not stop irritating. She was getting tough with her family, also she slashed the mattress of her bed with a knife for many times. She complained that people neither understood nor appreciated her properly. and she said that she wanted revenge on the leader of the lab by punishing him one way or other. (3) Looking back the previous session, she said ‘I had been mentally mixed up at that time, but I feel that now I can handle myself, as I stopped the medication after consulting the psychiatrist. According to what she said, when she disclosed the occurrences in the lab to her mother, she felt to be understood properly by her mother and felt so relieved. and she also reported that she had been sewing up the mattress which she slashed before, without any reason. She added, “ although I don’t even know what it means, I feel that this work is so meaningful to me, somehow”. Finally, she told that she had already made her mind to cope with the situation by herself from now on, although it might result in a flinch from the real solution. Situations being the above, the session was closed. By the remarkable changes observed between the two drawings, the meanings of this psychotherapy and its closure to the client would be contemplated. Question of how school counselors should deal with separation attendant on students’ graduation: On a case in which the separation was not worked through C. ASAHARA Sophia University, Tokyo, Japan Although time limited relationship is one of the important characteristics in school counseling, the question of separation attendant on it has not been much discussed based on specific cases. This study focuses on the question of separation through looking at a particular case, in which the separation was not worked through, and halfway relationship continued even after the student's graduation and the counselor's resignation. I was a part time school counselor at a junior high school in Tokyo. The client was a 14‐year‐old female student, who could not go to her classroom, and spent a few hours in a sick bay when she came to school. She was in the final grade and there was only half a year left before graduation when we first met, and we started to see each other within a very loose structure. As her personality was hyper‐vigilant and defensive, it took almost 2 months before I could feel that she was nearer. Her graduation was the first occasion of separation. On that occasion, I found that there had been a discrepancy between our expectations; while I took it for granted that our relationship would end with the graduation, she expected to see me even after she graduated, and she actually came up to see me once in a while during the next year. A year later, we faced another occasion of separation, that was my resignation. Although I worried about her, all I have done for her was to hand a leaflet of a counseling office, where I work as a part time counselor. Again I could not refer to her feelings or show any concrete directions such as making a fixed arrangement. After an occasional correspondence for the next 10 months (about 2 years after her graduation), she contacted me at the counseling office asking for a constant counseling. Why could I not deal with both occasions? and how did that affect the client thereafter? There were two occasions of separation. At the time of the client's graduation, I seemed to be enmeshed in the way of separation that is peculiar to the school setting. In general in therapeutic relationship, mourning work between counselor and client is regarded as being quite important. At school, however, separation attendant on graduation is usually taken for granted and mourning work for any personal relationship tends to be neglected. Graduation ceremony is a big event but it is not about mourning over one's personal relationships but separation from school. That may be why I did not appreciate how the client counted on our relationship. At the time of my resignation I was too worried about working through a change from very loose structure which is peculiar to the school setting to a usual therapeutic structure (fees are charged, and time, place are fixed). That is why I did nothing but give her a leaflet. In this way, we never talked about her complex feelings such as sadness or loneliness, which she was supposed to experience on separation. Looking at the aforementioned process from the client's viewpoint, it can be easily imagined that she could not accept the fact of separation just because she graduated. and later, she was forced to be in double‐bind situation, in which she was accepted superficially (handed a leaflet), while no concrete possibility was proposed concerning our relationship (she could never see me unless she tries to contact me.) As a result, she was left alone and at a loss whether she could count on me or not. The halfway situation or her suspense was reflected in her letter, in which she appeared to be just chatting at first sight, but between the lines there was something more implying her sufferings. Above discussion suggests that in some case, we should not neglect the mourning work even in a school setting. To whom or how it is done is the next theme we should explore and discuss in the future. For now, we should at least be conscious about the question of separation in school setting. Study of the process of psychotherapy with intervals for months M. TERASHIMA Bunkyo Gakuin University, Tokyo, Japan This is a report on the process of psychotherapy of an adolescent girl who showed manic and depressive state. At the time of a depressed state, she could not go to a college and withdrew into home, and the severe regressive situation was shown. Her therapy began at the age of 20 and she wanted to know what her problem was. The process of treatment went on for 4 years but she stopped coming to sessions for several months because of failure of the therapist. She repeated the same thing twice. After going through these intervals the client began to remember and started to talk about her childhood – suffering abusive force from her father– with vivid impressions. They once were hard for her to accept, but she began to establish the consistent figure of herself from past to present. In this case, it could be thought that the intervals of the sessions had a certain role, with which the client controlled the structure of treatment, instead of an attack against the therapist. Her object relation, which is going to control an object offensively, was reflected in these phenomena. That is, it can be said that the ambivalence about dependency – difficult to depend but desirous of the object – was expressed. Discontinuation of the sessions was the product of the compromise formation brought about the ambivalence of the client, and while continuing to receive this ambivalence in the treatment, the client started to realize discontinuance of her memories and then advanced integration of her self‐image. For the young client with conflict to dependence such as her, an interval does not destroy the process of treatment but in some cases it could be considered as a therapeutic element. In the intervals the client could assimilate the matter by herself, that acquired by the sessions. Psychotherapy for a schizoid woman who presented eccentric speech and behaviour M. OGASAWARA Osaka University Graduate School of Medicine, Osaka, Japan A case of a 27‐year‐old woman at the beginning of therapy. She had been having a wish for death since she was in kindergarten and she had been feeling strong resistance to do the same as others after school attendance. She had a history of ablutomania from the age of 10–15, but the symptom disappeared naturally. and she said that she had been eliminated from groups that she tried to enter. After graduating a junior college, she changed jobs several times without getting a full‐time position. Scolded by her boy friend for her coming home too late one day, she showed confusion such as excitement, self‐injury or terror. She consulted a psychiatrist in a certain general hospital, but she presented there eccentric behaviours such as tense facial expression, stiffness of her whole body, or involuntary movement of limbs. and because she felt on bad terms with the psychiatrist and she had come to cause convulsion attacks in the examination room, she was introduced to our hospital. Every session of this psychotherapy was held once a week and for approximately 60 min at a time. She sometimes presented various eccentric attitudes, for example overturning to the floor with screaming (1), going down on her knees when entrance at the door (5), entering with a knife in her mouth and hitting the wall suddenly (7), stiffening herself just outside the door without entering the examination room (9), taking out a knife abruptly and putting it on her neck (40), exclaiming with convulsion responding to every talk from the therapist (41), or stiffening her face and biting herself in the right forearm suddenly (52). She also repeated self‐injuries or convulsion attacks outside of the examination room in the early period of the therapy. Throughout the therapy she showed hypersensitivity for interpersonal relations, anxiety about dependence, terror for self‐assertion, and avoidance for confrontation to her emotional problems. Two years and 6 months have passed since the beginning of this therapy. She ceased self‐injury approximately 1 year and 6 months before and her sense of obscure terror has been gradually reduced to some extent. Her non‐verbal wariness and aggression to the therapist made the sessions full of tension and the therapist felt a sense of heaviness every time. In contrast, she could not express aggression verbally to the therapist, and when the therapist tried to identify her aggression she denied it. Her anxiety, that she will be thoroughly counterattacked to self‐disintegration if she shows aggression to other persons, seems to be so immeasurably strong that she is compelled to deny her own aggression. Interpretations and confrontations by the therapist make her protective, and occasionally she shows stronger resistance in the shape of denial of her problems or conversion symptoms (astasia, aphonia, or involuntary movements) but she never expresses verbal aggression to the therapist. and the therapist feels much difficulty to share sympathy with her, and she expresses distrust against sympathetic approach of the therapist. However, her obvious disturbance that she expresses when she feels the therapist is not sympathetic shows her desire for sympathy. Thus, because she has both strong distrust and desire for sympathy, she is in a porcupine dilemma, which is characteristic of schizoid patients as to whether to lengthen or to shorten the distance between herself and the therapist. This attitude seems to have been derived from experience she might have had during her babyhood and childhood that she felt terror to be counterattacked and deserted when she showed irritation to her mother. In fact, existence of severe problems of the relationship between herself and her mother in her babyhood and childhood can be guessed from her statement. Although she has been repeating experiences to be excluded from other people, she shows no attitude to construct interpersonal relationship actively. On the contrary, by regarding herself to be a victim or devaluating other persons she externalizes responsibility that she herself should assume essentially. The reason must be that her disintegration anxiety is evoked if she recognizes that she herself has problems; that is, that negative things exist inside of her. Therefore, she seems to be inhibited to get depressive position and obliged to remain mainly in a paranoid–schizoid position. As for the pathological level, she seems to have borderline personality organization because of frequent use of mechanisms to externalize fantastically her inner responsibility. For her high ability to avoid confronting her emotional problems making the most of her verbal ability, every intervention of the therapist is invalidated. So, it seems very difficult for her to recognize her own problems through verbal interpretations or confrontation by the therapist, for the present. In general, it is impossible to confront self problems without containing negative emotions inside of the self, but her ability seemed to be insufficient. So, to point out her problems is considered to be very likely to result in her confusion caused by persecution anxiety. Although the therapy may attain the stage on which verbal interpretation and confrontation work better some day, the therapist is compelled to aim at promoting her ability to hold negative emotion inside of herself for the time being. For the purpose, the therapist is required to endure the situation in which she brings emotion that makes the therapist feel negative counter‐transference and her process to experience that the therapeutic relation itself would not collapse by holding negative emotion. On supportive psychotherapy with a male adolescent Y. TERASHIMA Kitasato University Health Care Center, Kanagawa, Japan Adolescent cases sometimes show dramatic improvements as a consequence of psychotherapy. The author describes how psychotherapy can support an adolescent and how theraputic achievements can be made. Two and a half years of treatment sessions with a male adolescent patient are presented. The patient was a 19‐year‐old man, living with his family. He had 5 years of experience living abroad with his family and he was a preparatory school student when he came to a mental clinic for help. He was suffering from not being able to sleep well, from difficulties concerning keeping his attention on one thing, and from fear of going to distant places. He could barely leave his room, and imagined the consequence of overdosing or jumping out of a window. He claimed that his life was doomed because his family moved from a town that was familiar to him. At the first phase of psychotherapy that lasted for approximately 1 year, the patient seldom responded to the therapist. The patient was basically silent. He told the therapist that the town he lives in now feels cold or that he wants to become a writer. However, these comments were made without any kind of explanation and the therapist felt it very difficult to understand what the patient was trying to say. The sessions continued on a regular basis. However, the therapist felt very useless and fatigued. Problems with the patient and his family were also present at this phase of psychotherapy. He felt unpleasant at home and felt it was useless to expect anything from his parents. These feelings were naturally transferred to the therapist and were interpreted. However, interpretation seemed to make no changes in the forms of the patient's transference. The second phase of psychotherapy began suddenly. The patient kept saying that he did not know what to talk about. However, after a brief comment made by the therapist on the author of the book he was reading, the patient told the therapist that it was unexpected that the therapist knew anything of his favorite writer. After this almost first interaction between the patient and the therapist, the patient started to show dramatic changes. The patient started to bring his favorite rock CDs to sessions where they were played and the patient and the therapist both made comments on how they felt about the music. He also started asking questions concerning the therapist. It seemed that the patient finally started to want to know the therapist. He started communicating. The patient was sometimes silent but that did not last long. The therapist no longer felt so useless and emotional interaction, which never took place in the first phase, now became dominant. The third phase happened rapidly and lasted for approximately 10 months. Conversations on music, art, literature and movies were made possible and the therapist seldom felt difficulties on following the patient's line of thought. He started to go to schools and it was difficult at first but he started adjusting to the environment of his new part‐time jobs. By the end of the school year, he was qualified for the entrance to a prestigious university. The patient's problems had vanished except for some sleeping difficulties, and he did not wish to continue the psychotherapy sessions. The therapist's departure from the clinic added to this and the therapy was terminated. The patient at first reminded the therapist of severe psychological disturbances but the patient showed remarkable progress. Three points can be considered to have played important roles in the therapy presented. The first and the most important is the interpretation by behavior. The patient showed strong parental transference to the therapist and this led the therapist to feel useless and to feel fatigue. Content analysis and here‐and‐now analysis seemed to have played only a small part in the therapy. However, the therapist tried to keep in contact with the patient, although not so elegant, but tried to show that the therapist may not be useless. This was done by maintaining the framework of the therapy and by consulting the parents when it was considered necessary. Second point is the role that the therapist intentionally took as a model or target of introjection. With the help of behavioral interpretation that showed the therapist and others that it may not be useless, the patient started to introject what seemed to be useful to his well being. It can be considered that this role took some part in the patient going out and to adjust to the new environment. Last, fortune of mach must be considered. The patient and the therapist had much in common. It was very fortunate that the therapist knew anything about the patient's favorite writer. The therapist had some experience abroad when he was young. Although it is a matter of luck that the two had things in common, it can be said that the congeniality between the patient and the therapist played an important role in the successful termination of the therapy. From the physical complaint to the verbal appeal of A's recovery process to regain her self‐confidence C. ITOKAWA and S. KAZUKAWA Toyama Mental Health Center, Toyama, Japan This is one of the cases at Toyama Mental Health Center about a client here, we will henceforth refer to her simply as ‘A’. A was a second grade high school student. We worked with her until her high school graduation using our center's full functions; counseling, medical examination and the course for autogenic training (AT). She started her counseling by telling us that the reason for her frequent absences from school began because of stomach pains when she was under a lot of stress for 2 years of junior high school, from 2nd grade to 3rd grade. Due to a lack of self confidence and a constant fear of the people around her, she was unable to use the transportation. She would spend a large amount of time at the school infirmary because she suffered from self‐diagnosed hypochondriac symptoms such as nausea, diarrhea and a palpitation. She continued that she might not be able to have the self‐confidence to sit still to consult me on her feelings in one of our sessions. A therapist advised her to take the psychiatric examination and the use of AT and she actually saw the medical doctor. In counseling (sessions), she eventually started to talk about the abuse that started just after her entering of junior high school; she approached the school nurse but was unable to tell her own parents because she did not trust them. In doing so, she lost the rest of her confidence, affecting the way she looked at herself and thought of how others did. At school she behaved cheerfully and teachers often accused her of idleness as they regarded this girl's absences along with her brightly dyed hair and heavy make‐up as her negligent laziness. I, as her therapist, contacted some of the school's staff and let them know of her situation in detail. As the scolding from the teachers decreased, we recognized the improvement of her situation. In order to recover from the missed academic exposure due to her long absence, she started to study by herself. In a couple of months her physical condition improved gradually, saying ‘These days I have been doing well by myself, haven’t I?’ and one year later, her improved mental condition enabled her to go up to Tokyo for a concert and furthermore even to enjoy a short part‐time job. She continued the session and the medical examination dually (in tangent) including the consultation about disbelief to the teachers, grade promotion, relationships between friends and physical conditions. Her story concentrated on the fact that she had not grown up with sufficiently warm and compassionate treatment and she could not gain any mental refuge in neither her family nor her school, or even her friends. Her prospects for the future had changed from the short‐ranged one with no difficulty to the ambitious challenge: she aimed to try for her favorite major and hoped to go out of her prefecture. But she almost had to give up her own plan because the school forced her to change her course as they recommended. (because of the school's opposition with her own choice). So without the trust of the teachers combined with her low self‐esteem she almost gave up her hopes and with them her forward momentum. In this situation as the therapist, I showed her great compassion and discussed the anger towards the school authorities, while encouraging this girl by persuading her that she should have enough self‐confidence by herself. Through such sessions, she was sure that if she continued studying to improve her own academic ability by herself she could recognize the true meaning of striving forward. and eventually, she received her parents’ support who had seemed to be indifferent to her. At last she could pass the university's entrance exams for the school that she had yearned to attend. That girl ‘A’ visited our center 1 month later to show us her vivid face. I saw a bright smile on her face. It was shining so brightly. John Wiley & Sons, Inc.
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The use of Kinetic Family Drawings to identify diabetic children with previously unidentified family distress
Peterson, Linda ; Scott, Barbara ; Artman, Henry ; Affinito, Meg ; Holt, Mari Peterson, Linda (correspondence author)
Trauma and Loss: Research and Interventions, Mar 2002, Vol.2(1), pp.21-32The objective of this paper is to examine the usefulness of Kinetic Family Drawings (KFD) to help identify diabetic children with family distress. Drawings were evaluated using the Peterson/Hardin screening tool, and the subjects included 57 children with Type I diabetes, 8 to 14 years. The use of the Peterson/Hardin Screening of 57 children's drawings revealed indications of possible family distress in 10% and 14% of the children using qualitative and quantitative criteria, respectively. For the children who had a physician's assessment of family stress (32 out of the sample of 57), the use of the screening tool and picture analysis alone identified an additional 5 children at risk. Younger children (8 to 10.5 years in this study) had the most indicators of family distress on the KFD. Factors such as gender or the presence of a diabetic family member did not affect findings. The art indicators for this population were similar to those identified in other studies of children with diabetes. The study concluded that the use of drawings in children with Diabetes Mellitus can provide additional evidence to therapists regarding children with possible family distress who might not otherwise be identified in routine medical care. The drawing may be most useful for screening younger children because they are more able to communicate through drawings than by interview. After the age of 11, drawing is less sensitive for data retrieval, as older children are more self-conscious about drawing and they express well in words. [Author Abstract] © ProQuest LLC All rights reserved PILOTS: Published International Literature on Traumatic Stress ProQuest Social Sciences Premium Collection ProQuest Sociology Collection
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Abstracts from the 2008 Annual Meeting of the American Epilepsy Society
Epilepsia, Oct, 2008, Vol.49(s7), p.1(498) [Periódico revisado por pares]To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org.ez54.periodicos.capes.gov.br/10.1111/j.1528-1167.2008.01871.x Abstract: Saturday, December 6, 2008Poster Session 11:00 p.m.-6:00 p.m.Clinical Neurophysiology Nicholas S. Abend*,[dagger], Dennis Dlugos*,[dagger], S. Herman[dagger], A. Topjian[double dagger],s., M. Donnelly*, R. Ichord*,[dagger], M. Helfaer[double dagger],s., V. Nadkarni[double dagger],s. and R. Clancy*,[dagger]*Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA; [dagger]Neurology, The University of Pennsylvania School of Medicine, Philadelphia, PA; [double dagger]Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA and s.Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA Rationale: The incidence and characteristics of acute seizures in children undergoing therapeutic hypothermia following pulseless cardiac arrest (CA) are unknown. Since a high proportion of seizures may be subclinical, diagnosis requires continuous electroencephalography (EEG). We hypothesized that (i) EEG seizures are common during therapeutic hypothermia following CA and (ii) the background patterns would evolve during hypothermia and re-warming, and (iii) the background abnormalities would be associated with survival and short-term outcome. Methods: As part of a feasibility study of therapeutic hypothermia in children, we performed a prospective, pilot, observational study of 10 consecutive children undergoing continuous EEG monitoring during epochs of hypothermia (24 hrs), re-warming (12-24 hours), and an additional 24 hrs. EEG seizures were identified and the background during each epoch was described in a standardized manner. A standardized neurological exam was performed on day 5-7 to provide a cerebral injury score (CIS), rated from normal to profoundly abnormal. Results: Ten patients were studied from March to December 2007 with a mean age 19.9 [+ or -] 17.5 mo (range 2.2-51.2 mo). EEG monitoring began within 4 hours of hypothermia initiation in all. Over 720 hours of EEG were reviewed. Electrographic seizures occurred in 5/10 (50%) patients and began during the second 12 hours of hypothermia in 3 and during re-warming in 2. Most seizures were subclinical and electrographically generalized. Eight patients with initially mild/moderate EEG background abnormalities (discontinuity, slowing, attenuation) improved during warming; 2 patients with initially severe background abnormalities (burst suppression) had EEG worsening (longer duration suppression and status epilepticus). Background abnormalities did not predict seizures. Of the two patients with severe background abnormalities, one survivor had a severely abnormal CIS and one died. Of the eight patients with initial mild/moderate background abnormalities, 2 survivors did not have a CIS, 3 had a mild/moderate CIS, and 2 had a severe CIS (1 died). Thus, 1 of 2 (50%) with severe background abnormalities died while 1 of 8 (13%) with mild/moderate background abnormalities died. Also, death or severe CIS occurred in 2 of 2 (100%) with severely abnormal EEG background but only 2 of 6 (33%) with mild/moderate background abnormalities. Conclusions: Seizures occurred in half of those undergoing therapeutic hypothermia after CA and were mostly subclinical and generalized. The EEG background may improve or worsen during hypothermia and re-warming, suggesting that the earliest EEG results may not be useful for prognostication. However, the trend suggests more severe abnormalities are associated with worse survival and short term outcome. Further study correlating continuous EEG background patterns with short- and long-term outcomes in children treated with therapeutic hypothermia is warranted. Abstract: Juan P. Appendino*, P. McNamara[dagger], M. Keyzers[dagger] and Cecil Hahn**Neurology, The Hospital for Sick Children, Toronto, ON, Canada and [dagger]Neonatology, The Hospital for Sick Children, Toronto, ON, Canada Rationale: Introduction: Amplitude integrated EEG has become a commonly-used bedside monitoring tool in many neonatal intensive care units (NICUs). aEEG has been used to predict neurodevelopmental outcome, diagnose clinical and subclinical seizures and evaluate cerebral recovery after hypoxic-ischemic insults. However, the impact of aEEG use on neonatal neurological care remains unclear. Objective: To investigate the relationship between introduction of aEEG at a single tertiary care hospital NICU and the: Frequency and timing of conventional EEG recordings. Frequency of neurology consultation. Frequency of diagnosis of neonatal seizures. Methods: This was a retrospective observational study conducted at The Hospital for Sick Children, Toronto, Canada. The study population included all patients admitted to the NICU over a six-year period from July 2001 to June 2007. The sample was divided into two epochs: Epoch 1 (July 2001 to June 2004), during which only conventional EEG was available. Epoch 2 (July 2004 to June 2007), during which both aEEG and conventional EEG were available. The frequency and timing of conventional EEG and aEEG recordings, neurology consultation and diagnosis of neonatal seizures were obtained. Data was abstracted from a Health Records database, NICU aEEG database and Neurophysiology EEG database. Statistical comparisons were made using Fisher's exact test. Results: A total of 2219 neonates were admitted during Epoch 1, and 2202 during Epoch 2. The rates of neurological diagnoses, length of stay and mortality did not differ between Epochs 1 and 2. The percentage of admitted neonates receiving conventional EEG recordings did not differ between Epoch 1 (18.0%) and Epoch 2 (18.5%). The percentage of neonates receiving aEEG recordings during Epoch 2 (18.4%) approached that of conventional EEGs. The percentage of conventional EEG recordings initiated after-hours did not change following introduction of aEEG (Epoch 1: 7%, Epoch 2: 11%; p = 0.08). However, far more aEEGs (74%) were initiated after-hours. Following the introduction of aEEG, there was a significant reduction in the rate of repeated EEGs from 30% in Epoch 1 to 20% in Epoch 2 (p = 0.003). In addition, there was a 5% decline in the percentage of newborns diagnosed with seizures (Epoch 1: 36%, Epoch 2: 31%; p = 0.047). However, the number of Neurology consultations to the NICU did not change (Epoch 1: 14.7%, Epoch 2: 12.4%; p = 0.20). Conclusions: aEEG monitoring has become common practice in this NICU, with usage now approaching that of conventional EEG. Whereas most conventional EEGs were initiated during the daytime, most aEEGs were initiated after-hours, reflecting the 24/7 in-house availability of required personnel. The introduction of aEEG was associated with a significant reduction in the rate of repeated EEGs and, unexpectedly, a small but significant reduction in the percentage of newborns diagnosed with seizures. This was a population level study; the impact of aEEG on individual patient care and outcomes remains to be determined. Abstract: Radwa Badawy*,[dagger], N. Pillay[double dagger],s., Nathalie Jette[double dagger],s., Adnan I. Al-Sarawi[double dagger], S. Wiebe[double dagger],s. and Paolo Federico[double dagger],s.*Department of Neurology, University of Melbourne, Mebourne, VIC, Australia; [dagger]Brain Research Institute, University of Melbourne, Melbourne, VIC, Australia; [double dagger]Departments of Clinical Neurosciences and Radiology, University of Calgary, Calgary, AB, Canada and s.Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada Rationale: Guidelines for optimum EEG recording and video telemetry are well established and most laboratories follow standardized protocols to ensure accurate data acquisition and clinical interpretation. On the other hand, the process of reviewing video-EEG monitoring (VEM) data varies from centre to centre. Many centers review the entire VEM dataset, while others implement a sampled approach, whereby a set amount of VEM data is reviewed per hour of recording (typically 5-10 min per hour), together with the data recorded in relation to events identified by button presses or by seizure or spike detection programs. This study was designed to compare continuous versus sampled reviewing of VEM data to validate whether the diagnostic yield would be different. Methods: VEM data acquired from 50 consecutive patients admitted to the seizure monitoring unit were reviewed by two independent electroencephalographers, one using the continuous review method, and the other sampling the first 5 minutes of each hour together with events identified by button presses and by automated seizure detection function. The patients were monitored for periods ranging between 3-21 days. The reviewers were asked to complete an identical data form summarizing the following information in three areas: i) demographic data, 2) interictal discharge location, frequency of occurrence, and 3) seizures or other clinical event types, quantity, location of onset, and certainty of classification (ordinal scale of 0-7; 0 = not certain, 7 = extremely certain). Descriptive statistics were obtained for the variables of interest. Overall agreement between reviewers was calculated using the Kappa statistic except when comparing the total number of clinical events between the two review methods in which case Pearson's correlation coefficient was used. Results: Fifty patients were studied (31 females, 44 right handed) whose seizures began at the age of 19.1 [+ or -] 12.83 years of age. There was poor agreement on the frequency of occurrence of interictal discharges ([kappa]= 0.44) with continuous review of VEM yielding a greater quantity of interictal discharges. Better agreement was seen for the side of the discharge (K = 0.87) but less for the specific lobe (K = 0.68). The total number of clinical events identified were similar between the two review methods (Pearson's coefficient = 0.92). The electroclinical diagnoses were similar between the groups (K = 0.72) with better agreement for the side of onset (K = 0.80), and perfect agreement for those patients with focal onset seizures (K = 1.00). Conclusions: This study demonstrates that sampled review of VEM data can yield datasets that are similar to those produced by continuous review. However, there was poor agreement for the quantification of interictal discharges and seizures. Only a moderately good correlation was seen between electroclinical diagnoses. Thus, using this particular method of comparison in our clinical setting, continuous VEM more comprehensively captured the information of interest. Our findings require replication in different settings, including a larger patient population. Abstract: Noel Baker[dagger],* and D. M. Treiman**Barrow Neurological Institute, Phoenix, AZ and [dagger]Neurology, Swedish Neuroscience Institute, Seattle, WA Rationale: The performance of surface EEG can be challenging in patients who are unable to cooperate with the procedure. We present one year's experience of the performance of EEG under general anesthesia with sevoflurane. Methods: All EEGs were performed at the Barrow Neurological Institute between 5/30/07 and 5/30/08. A similar protocol was used throughout, consisting of sevoflurane alone to a mean alveolar concentration (MAC) of 7-8% sufficient to produce unconsciousness. Surface EEG electrodes were then applied using the international 10-20 system of electrode placement. The EEG was then recorded as the anesthesia was turned off, oxygen applied, and the MAC dropped to zero. The recordings were then evaluated by staff epileptologists. Results: A total of 45 studies were performed. None of the patients was neurologically normal and all had some degree of encephalopathy. There were 29 males (64%) and 16 females (36%) ranging in age from 2 to 17 years, with one female of 22 years. 22 studies (49%) were read as normal, with normal defined as: lack of asymmetry or epileptiform discharges (EPDs) and a normal mix and distribution of frequencies once the sevoflurane MAC had reached zero and the anesthesia effect of background slowing and increased beta rhythms had resolved. 23 studies (51%) were read as abnormal. 21 of these (91%)showed EPDs, both with and without focal slowing. 1 showed focal slowing alone, and another showed diffuse background slowing. 21 patients (47%) had an established diagnosis of epilepsy at the time of the study. The studies of 8 (38%) of these patients were normal and 13 (62%) were abnormal. All of the abnormals had EPDs. 24 patients (53%) did not have a pre-existing diagnosis. The studies of 14 of these patients (58%) were normal and 10 (42%)were abnormal. 8 of these abnormal studies showed EPDs, with the remaining 2 showing either focal or diffuse background slowing. 33 studies (73%) were ordered by pediatric neurologists and 12 (27%) were ordered by pediatricians. Of those ordered by neurologists, 20 (61%) were abnormal, while of those ordered by pediatricians 3 (25%) were abnormal due to EPDs. 2 of the neurologist-ordered abnormal studies demonstrated either focal or diffuse background slowing without EPDs. All of the patients tolerated the procedure well and were discharged home in good condition without complications. Conclusions: 1. This method of performing an EEG under general anesthesia with sevoflurane produces readable results which allow for the identification of epileptiform discharges and focal or diffuse slowing. 2. The yield of epileptiform abnormalities was higher in those patients with established diagnoses of epilepsy than in those without. 3. No complications occurred. 4. EEG under general anesthesia with sevoflurane is a safe and effective method of acquiring data on encephalopathic and uncooperative patients. Results * In 2 of these studies, the abnormality consisted of either focal or diffuse background slowing Patient Demographics Abstract: Maysaa M. Basha*, Sandeep Mittal[dagger], D. R. Fuerst*, I. Zitron[dagger], Mahmoud Rayes* and Aashit K. Shah**Neurology, Wayne State University, Detroit, MI and [dagger]Neurosurgery, Karmanos Cancer Institute, Wayne State University, Detroit, MI Rationale: Refractory epilepsy is frequently seen in adults with primary brain tumors. Lesionectomy alone may be inadequate in achieving seizure freedom. In addition to ictal EEG, quantitative interictal EEG analysis may help to further define the epileptogenic zone in patients with tumor-related epilepsy. Methods: Nine consecutive patients who underwent 2-stage surgery for resection of tumor and epileptogenic zone were studied. Chronic invasive EEG was recorded over 4-6 days using hippocampal depth electrodes and/or subdural grids (40 to 96 electrodes per patient). Two to four 10-minute interictal awake EEG samples taken [greater than or equal to] 6 hours from the last clinical seizure were analyzed using automatic spike detection software (Stellate Systems) and reviewed by a single EEGer. Artifacts identified as spikes were discarded whereas spikes missed by the software were included. These corrected files were used to calculate average spike frequency for each electrode (n = 618). Each electrode was labeled by its ictal activity as "seizure onset" (electrographic involvement at the earliest point in seizure, n = 56); "seizure spread" (involvement of the electrode within 10 seconds of seizure onset, n = 85); or "neither" (n = 477). Similarly, electrode location was blindly identified as "tumoral" (within or overlying tumor, n = 154), "peritumoral" (adjacent to tumor, n = 104), or "non-tumoral" (n = 360) based on preoperative and post-implantation MRI and/or CT scans. For each patient, the mean ([mu]) and standard deviation ([sigma]) of spike frequency at all electrode sites was calculated, and then used to transform the raw spike frequency to a z-score (Xi-[mu]/[sigma]) at each electrode. This standardization process yielded 618 electrodes with a z-transformed spike frequency that can be treated independently. Data were analyzed with independent groups ANOVA, with spike frequency forming the dependent measure, and electrode location and ictal activity forming the independent measures. Significant results were further analyzed using Tukey's pairwise comparison procedure. Results: There was an effect of electrode location (F(2,615) = 9.06, p < 0.0001) with "tumoral" electrodes showing greater interictal spiking than electrodes labeled as "neither". Spike frequency at "peritumoral" electrodes fell midway between the two, but not significantly different from either. There was also an effect of ictal activity (F(2,615) = 18.78, p < 0.0001), with "seizure onset" and "seizure spread" electrodes showing greater interictal spike frequency than "neither" electrodes. Spiking at "seizure onset" electrodes was higher than at "seizure spread" without reaching statistical significance. Conclusions: Interictal spike frequency appears to be spatially related to tumor location. In addition, the interictal spiking correlates positively to the ictal onset and spread regions. Thus, interictal electrophysiology may assist in better defining the epileptogenic zone in patients with tumor-related refractory epilepsy. Abstract: Selim Benbadis, Shirley Chen and M. Melo Neurology, University of South Florida, Tampa, FL Rationale: Accurately diagnosing seizures in the critically ill patient can be particularly challenging, given the high incidence of altered sensorium in this patient population. The purpose of this study was to analyze what conditions mimic seizures in the intensive care unit (ICU) setting. Methods: We retrospectively reviewed all bedside video-EEGs obtained in the adult ICU setting (age 18 or greater) from January 1, 2007 to April 30, 2008. All ICU patients whose reason for EEG was "possible seizures" had a video recording in addition to the EEG. Only those that had clinical events captured on video were analyzed. Results: A total of 41 video-EEGs were obtained. Eleven (27%) had epileptic seizures: 5 (45%) focal clonic, 2 (18%) myoclonic, 1 focal tonic, 1 focal status epilepticus, 1 generalized clonic, and 1 generalized tonic clonic. Thirty (73%) had non-epileptic events. Eleven (37%) had slow semi-purposeful movements, 9 of which involved one or more extremities, and 2 involved brief truncal flexion. Ten (33%) had tremor-like movements, involving the jaw, lip, one or more extremities, or were generalized. Four (13%) had myoclonic jerks. Three (10%) had transient eye movements. Two (7%) had repetitive mouth movements described as suckling or puckering. Two (7%) had head nodding or banging. Two (7%) had psychogenic nonepileptic attacks. One (3%) had abdominal fluttering which was attributed to artifact from artificial ventilation. Conclusions: Seizure mimics in the ICU are diverse, and different from the usual differential diagnosis of seizures seen in ambulatory patients. The majority are tremors and semi-purposeful movements likely related to discomfort. Abstract: Margo Block, W. Mueller and Manoj Raghavan Comprehensive Epilepsy Program, Medical College of Wisconsin, Milwaukee, WI Rationale: Paroxysmal high frequency oscillations (HFOs) in the interictal intracranial EEG has been the subject of recent attention as markers of epileptogenic cortex. HFOs may occur simultaneously, independently, or at times with consistent propagation across subdural recording sites. We sought to determine if the propagation patterns of interictal HFOs, when observed, predict the propagation of seizures. Methods: We reviewed all adult intracranial EEG studies performed at the Medical College of Wisconsin's Comprehensive Epilepsy Program between January 2007 and May 2008. EEG sampling rate was 500 Hz in all but two patients where it was 1000 Hz. Intracranial EEG records were reviewed at a sensitivity of >20 uV/mm with the low frequency filter set at 53 Hz, and high frequency cut-off at 120 Hz. Localization of HFOs and their propagation patterns, as well as ictal onset and propagation was performed by visual analysis. Results: A total of 26 intracranial EEG studies were screened. Nine patients with mesial temporal sclerosis and four patients with no ictal data to allow definition of ictal propagation patterns were excluded. We identified 13 patients with neocortical seizure onsets. Ictal onset zones were identified in the lateral temporal (3), frontal (3), temporo-parietal (2), temporo-occipital (1), and fronto-temporal (4) neocortices. Multichannel HFOs were noted in all 13 patients. Frequency of the HFOs encountered ranged from 60-120 Hz (mean 93.5 Hz, SD 16.9 Hz). In 7 of 13 patients (53%) a consistent HFO propagation pattern was present, with propagation across lobar boundaries or within a lobe. Propagation time was always less than 200 ms. In 6 of 7 patients (85%) with a consistent HFO propagation pattern, ictal onset zone was predicted by the subdural electrodes with the leading HFOs, and ictal spread by electrodes showing HFO propagation. In one of these patients, only one of two different ictal patterns that were observed was predicted by HFO propagation. In these 6 patients, HFO and ictal propagation pattern was interlobar in 4 cases, and intra- plus inter-lobar in 2 cases. Frequencies of the leading HFOs were identical to those of the propagated HFOs in 4 of these patients, but in two patients the leading HFOs were lower in frequency compared to the propagated activity. Amplitudes of the HFOs showed no consistent relationship between areas of seizure onset and propagation. Conclusions: Our observations suggest that seizure spread patterns may be predicted by propagation patterns of interictal high frequency oscillations. Although our observations are limited to frequencies < 120 Hz, they appear to argue against the notion that higher frequency HFOs are more localizing of ictal onset zones. Instead, they support the view that the location of leading HFOs may be more predictive of ictal onset zones than HFO amplitude or frequency. Abstract: Laura Cantonetti*, C. Buttinelli*, G. Rossi-Fedele Matri*, M. Piccioli[dagger], M. Caporro*, M. Ferraldeschi*, P. Tisei*, Pasquale Parisi[double dagger], A. Luchetti[double dagger], L. Conti[dagger], C. Cerminaras., R. Terenzi[paragraph] and D. Kasteleijn-Nolst Trenite[parallel]*Department of Neurology, "Sant'Andrea" Hospital, "Sapienza" University, Rome, Italy, Rome, Italy; [dagger]San Filippo Neri Hospital, Rome, Italy; [double dagger]Department of Pediatrics, "Sant'Andrea Hospital", Sapienza University, Rome, Italy; s."Tor Vergata" Hospital, "Tor Vergata" University, Rome, Italy; [paragraph]"Villa San Pietro" Hospital, Rome, Italy and [parallel]Department of Genetics, "UMCU" Hospital, Utrecht University, Utrecht, Netherlands Rationale: Epileptic seizures have been triggered by cartoons containing scenes with flickering colours, and especially long-wavelength red has been demonstrated to be the most provocative colour. However, studies (Sternberg & Patry,1979; Parra et al. 2008) and clinical practice have shown that individual differences in sensitivity to colour exist. In genetic studies the PPR is used as an endo-phenotype, but the role of colour might be helpful in identifying sub-endo-phenotypes. The purpose of our study is to determine whether per patient a fingerprint could be made by ranking the sensitivity to the different primary colours (red, orange, yellow, green and blue). Methods: In 11 consecutive photosensitive patients (6 female, 5 male; age range: 12-72 years) and in 11 control patients (5 female, 6 male; age range: 14-46 years) a standardised 21-channel EEG has been recorded, with extensive Photic stimulation (IPS) of separate trains of flashes (5 sec each) with a Grass photo-stimulator PS33. The lamp was placed at 30 cm distance and besides normal white diffuse light standard coloured Grass filters were used in front of the lamp. Both lower and upper thresholds of the photosensitivity ranges have been determined separately for white light and all colours. This method allowed us to determine possible differences in sensitivity to the various colours, in a safe way. The colours were tested in random order. Results: None of the control patients were sensitive to any colour nor white light. Nine patients showed a PPR at all colours, one patient at all colours except the yellow one and one other patient exclusively at red. Orange (5 patients) and yellow (4 patients) were the most provocative colour, and green and blue the least. The spectrum of color sensitivity differed among the patients although two patients showed the same pattern as well as a father and daughter. Conclusions: Although orange, yellow and red are the most provocative colours in the patients tested, indeed individual differences in sensitivity to different colours and especially in its ranking order were found. The standardised use of five coloured filters in front of a photostimulator in patients sensitive to white flickering light can probably be helpful in delineating further epilepsy phenotypes. Family studies need to be performed to confirm this. Abstract: Rohit R. Das*, Brendan P. Lucey*, Patricio S. Espinosa*, S. Chou[dagger], A. A. Zamani[double dagger], E. B. Bromfield* and Jong Woo Lee**Neurology, Division of Epilepsy, Brigham and Women's Hospital, Boston, MA; [dagger]Neurology, Division of Cerebrovascular Diseases and Neurocritical Care, Brigham and Women's Hospital, Boston, MA and [double dagger]Radiology, Division of Neuroradiology, Brigham and Women's Hospital, Boston, MA Rationale: 1) To investigate the feasibility and safety of conductive plastic electrodes (CPEs, Ives EEG Solutions, Ontario, Canada) in patients undergoing continuous video-electroencephalographic (EEG) monitoring and 2) to assess the quality of brain MRI and cranial CT imaging obtained during such monitoring Methods: We evaluated consecutive ICU patients between January 1 1 and May 15, 2008, who were monitored, using CPEs. Results: A total of 24 patients were monitored. Indications for EEG monitoring in these patients included vascular causes of altered mental status, including strokes and hemorrhages (11 patients), uncontrolled seizures (6), brain tumors (3), cerebral infections including encephalitis (3) and metabolic encephalopathy (1). Impedance did not differ from standard gold cup leads. A total of 12 brain MRIs and 11 head CTs were performed on 14 patients. One patient had three MRIs, 2 had multiple CTs and 4 had both MRIs and CT scans. Six scans were obtained beyond normal working hours. All patients had good quality anatomical images without artifact, and without any signs or symptoms that raised safety concerns. CPEs provided interpretable and relevant EEG recordings for patients in the ICU. Seizures were recorded in 8/24 patients. Conclusions: In this study we investigated the use and safety of CPE electrodes in ICU EEG monitoring. These CT and MRI compatible electrodes produced no significant radiographic artifacts. Recording quality of the EEG was comparable to standard gold electrodes. The use of CPE electrodes allowed for noninterruptible EEG recording and facilitated emergent neuroimaging, particularly off hours, as EEG electrodes did not need to be removed. Abstract: Marco de Curtis*, Vadym Gnatkovsky*, S. Dylgjeri*, L. Castana[dagger], L. Tassi[dagger], R. Mai[dagger], L. Nobili[dagger], G. Lo Russo[dagger] and S. Francione[dagger]*Unit of Epileptology and Experimental Neurophysiology, Fondazione Istituto Neurologico, Milano, Italy and [dagger]Epilepsy Surgery Unit Claudio Munari, Ospedale Niguarda Ca'Granda, Milano, Italy Rationale: Approximately half of the patients with a diagnosis of pharmaco-resistant epilepsy are potential candidates for epilepsy surgery. Successful epilepsy surgery may substantially reduce or eliminate epilepsy and the associated disability. In 30-40% of drug-resistant patients with focal epilepsy the cerebral areas responsible for seizure generation can only be defined by intracranial recordings with intracerebral or subdural electrodes. The correct pre-surgical identification of the epileptogenic zone with intracranial recordings has a direct impact on post-surgical outcome. For this purpose, an accurate analysis of ictal and interictal activity during and between seizures is required. At present, the identification of the epileptic zone is based on visual inspection of the intracranial electroencephalographic (EEG) patterns. One of the principal impediments to computer-driven analysis of intracranial signals is the complexity and the quantity of data recorded during pre-surgical stereo-EEG sessions. Methods: We selected a population of patients with extra-temporal neocortical dysplasias that showed similar ictal patterns and performed retrospectively a computer-assisted detection of the cortical region involved in seizures. Results: Reproducible ictal patterns observed in more then 10 seizures per patient were evaluated. Fast activity at 20-40 Hz was typically observed at the onset of seizures and during interictal paroxysms. During seizures, this pattern was followed by the appearance of faster activity (40-100 Hz) of lower voltage, coupled with a very slow wave deflection. Seizure termination was associated with a recovery of fast activity at 20-40 Hz that in most cases evolved into high amplitude bursts separated by brief EEG flattenings. Fast activities were further analyzed in the same group of patients. Stereo-EEG data were exported in ASCII or binary form and imported to a program developed in LabView for elaboration. Data evaluation algorithms were mainly based on the time, frequency and spatial domain analysis. Prevalent frequency was evaluated by Fourier transformation and further integral algorithms. As a final representation of the area that generated the typical ictal patterns, 3-D matrix of the measurements obtained from each recording channels were constructed based on magnetic resonance (MR) coordinates to obtain a visual representation and the spatial distribution of the analysed parameters. Conclusions: The study was sponsored by a Mariani Foundation grant 50-06. Abstract: Tissiana M. De Haes, L. K. Silva, Tonicarlo R. Velasco, D. V. Pachito, H. H. Sander, M. M. Bianchin, C. M. Lourenco, Regina M. Fernandes and A. C. Sakamoto Neurology, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil Rationale: Congenital Central Hypoventilation Syndrome (CCHS) is a rare condition characterized by dysfunction of autonomic respiratory control, more dramatic during NREM sleep, associated to a mutation in the gene PHOX2B, with variable outcome including death in more severe cases. Methods: We report the history of a 22 year-old female with refractory complex partial seizures since age 6, admitted to the Video-EEG (VEEG) Monitoring Unit of our Epilepsy Surgery Center for pre-surgical evaluation, in January, 2008. Results: VEEG showed interictal sharp waves over the right temporo-parietal region and seizures originated in both temporal lobes, confirmed by invasive study with bifronto-temporal strips. After a generalized tonic-clonic seizure, the patient had a prolonged apnea requiring intubation and continued having apneas with oxigen dessaturation, mainly during slow wave sleep, after extubation. A past history of neonatal central apnea leading to mechanical ventilation along the first weeks of life came up at this point. She was then submitted to a polissomnography, which showed 195 episodes of central apnea (27/hour), maximal dessaturation of 63%, with no obstructive sleep apnea. DNA investigation in blood samples of the patient and her sister with similar history of early onset respiratory distress showed a mutation in the gene PHOX2B. She was diagnosed as CCHS and treated with BiPAP during sleep. Treatment with Benzodiazepines was interrupted and Carbamazepine dose reduced. She has no longer had epileptic seizures and has shown significant improvement in attention, humor and scholar skills, as well as in polysomnographic parameters. Conclusions: The association between respiratory sleep disorders and worsening of epileptic seizures has been previously described. We report the association of CCHS, leading to initial diagnosis of refractory epilepsy, which became easily controlled after adequate treatment for the respiratory sleep disorder. Supported by FAEPA Abstract: Dawn Eliashiv*, Naomi K. Lin*, Evgeny Tsimerinov* and Jeffrey M. Chung*,[dagger]*Neurology, Cedars Sinai Medical Center, Los Angeles, CA and [dagger]Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA Rationale: Refractory status epilepticus (RSE) is commonly encountered in tertiary care settings, requiring intubation, anticonvulsant drips, and EEG monitoring. RSE is defined as SE unresponsive to two standard anticonvulsant medications. Some of these patients that present with SE have a negative seizure history. Goal is immediate cessation of seizures, and prevention of breakthrough seizures. Previous studies have focused on the management of RSE with continuous infusion of midazolam, propofol, or pentobarbital. There is scant data, however, on clinical neurological examination of patients in burst suppression, as most of the neurological examination is obscured by these medications. Andrefsky et al. examined six patients on pentobarbital drip and found that ciliospinal reflex can be elicited in patients with reactive or unreactive pupils (J. Neurosurg 90:644-646, 1999). We wanted to determine the effect of pentobarbital on pupillary size and reactivity as we obseved a patient with pentobarbital induced coma and reversible pupillary changes. Methods: We studied eight consecutive patients who were placed in burst suppression from July, 2007 through April, 2008. All patients were directly examined, treated, and monitored with continuous EEG. Patient age ranged from three to 85. Six patients were treated for RSE; four patients had convulsive and nonconvulsive status epilepticus, while two had exclusively nonconvulsive status epilepticus. The etiology of refractory status epilepticus included stroke), encephalitis, tumor, and CNS degenerative disease . Two patients were placed in burst suppression for elevated intracranial pressure. All patients were placed in burst suppression or complete suppression. Six patients were treated with iv pentobarbital with or without midazolam, propofol, or fentanyl. Two patients were treated with propofol only. All patients also received routine anticonvulsant medications. Results: During burst suppression or complete suppression, 5/6 patients treated with pentobarbital demonstrated fixed, unreactive pupils at some point during their coma. Two patients who were in burst suppression with propofol alone had reactive pupils. Ancillary tests including funduscopic exam, radiological imaging, intracranial pressure monitoring demonstrated that the patients with fixed, unreactive pupils did not have cerebral herniation or elevated intracranial pressure to explain the pupillary findings. Conclusions: Pentobarbital may cause pupils to be fixed when patients are in burst suppression. This finding is not necessarily related to pentobarbital dosage or the underlying etiology of the status epilepticus. Upon pentobarbital withdrawl, the pupillary changes reverse. This finding has not been specifically described. When fixed, unreactive pupils are encountered in drug induced burst suppression,pentobarbital induced pupillary changes should be considered. In the future, a multicenter trial of patients with pentobarbital induced burst suppression utilizing sophisticated infrared video pupillometry would be helpful in confirming our findings. Abstract: Andrew Evans*, J. K. Hong*, T. J. Long*, B. Rubery[dagger] and Cormac A. O'Donovan**Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC and [dagger]Cardiology, Wake Forest Medical Center, Winston-Salem, NC Rationale: Ictal asystole occurs in a small percentage of epilepsy patients and is thought to possibly play a role in SUDEP. Pacemaker implantation has been performed to prevent the occurrence of malignant bradyarrhythmia in those cases diagnosed with ictal asystole. Prolonged EKG monitoring has been recommended in cases of unexplained epilepsy to determine if a cardiac cause may be found. The reverse case for using EEG monitoring to diagnose idiopathic cardiac arrhythmias seems limited to neonatal cases where epilepsy is highly suspected. We report a case of recurrent asystole in an intensive care patient treated with pacemaker prior to seizures being diagnosed. Methods: A 59 year old female with peritoneal carcinomatosis with no history of seizures was admitted for intraabdominal chemotherapy. Hospital course was complicated by critical illness of sepsis, renal failure, respiratory failure, and asystolic pauses of 5 to 10 seconds duration occurring several times per day. Neurology was consulted for intermittent left sided hemiplegia, spells of altered mental status and asymmetric pupils. Her spells were characterized by bilateral arm raising and tachypnea, followed by bradycardia. Due to lack of definitive diagnosis,VEEG monitoring was instituted. Results: VEEG was performed for 2 days. During this time period, 15 electrographic seizures were identified. Clinically, the events were preceded by tachypnea followed by low amplitude head and neck clonic activity. Prior to the seizure the patient averaged a heart rate of 85 beats per minute. Within 10 seconds of EEG seizure onset, the EKG showed a slowing of the heart rate to 60 beats per minute prior to programmed pacemaker activation to control heart rate. After electrographic seizure cessation, the intrinsic heart rate returns to normal sinus rhythm and a rate of 85-100. EEG demonstrated left temporal spikes and focal slow activity as ictal pattern. Pacemaker activation did not appear to affect the slowing on EEG of which hypoperfusion may be a component in addition to ictal activity. Treatment of seizures with antiepileptic medication resulted in no further episodes of asystole, bradycardia or pacemaker activation. Conclusions: Unexplained asystole may be due to undiagnosed seizures and treated inadvertently or empirically with pacemakers. Treatment with antiepileptic drugs may be sufficient in these cases. This case further highlights the important cerebral influences on cardiac rhythm. We observed the occurrence of seizure induced aystole in critically ill patients which has usually been reported in epilepsy patients during VEEG. Prospective studies in ICU patients may help to better explain the pathophysiology of unexplained cardiac dysfunction. Abstract: Yujian Guo and L. D. Uber-Zak Neurology, Loma Linda University Medical Center, Loma Linda, CA Rationale: Patients in status epilepticus are often treated with pharmacologic coma using a number of agents including pentobarbital. Status epilepticus patterns can be controversial. We report on six cases that emerged from pentobarbital coma with a pattern of atypical triphasic waves which could be mistaken for a more refractory status epilepticus pattern. Methods: This was a retrospective case series of patients who were placed in pentobarbital coma for refractory status epilepticus. The pattern of interest was identified in these six patients. A chart review was undertaken to determine if any other factors were common to all of the patients and if any other factor was responsible for this pattern. Results: All six cases showed an atypical triphasic wave pattern on emergence. Two cases showed the same pattern on emergence from repeated rounds of pentobarbital coma. All patients were on antiepileptic drugs (AEDs) in addition to pentobarbital. No other drug was common to every patient other than the pentobarbital be it an AED or other medication. Laboratory tests did not reveal evidence of liver enzyme elevations, elevated ammonia or elevated BUN/creatinine in all patients. All of the patients were in partial status going into pentobarbital coma. All of the patients successfully had the status epilepticus terminated and survived the status epilepticus. However, one patient was withdrawn from care by her family later in the hospital stay for poor prognosis based on her overall condition. No other cause could be found other than the pentobarbital and the pattern typically disappeared within several days of totally discontinuing pentobarbital. Conclusions: This pattern of atypical triphasic waves needs to be appreciated neurologists and epileptologists. Misinterpretation of this pattern could lead to overtreating a patient and placing the patient back in pentobarbital coma before allowing the pattern to disappear. This would lead to unending futility with each emergence from pentobarbital coma. Thus the patient may be mistakenly labeled as having refractory status epilepticus leading to the withdraw of care when this is a reversible and self limited, medication emergence pattern associated with discontinuation of pentobarbital during the treatment of status epilepticus. Abstract: Jean Isnard*, M. Guenot[dagger], Michel Magnin[double dagger], P. Derambures., H. Catenoix*, F. Mauguiere* and L. Garcia-Larrea[double dagger]*Functional Neurology and Epileptology, HCL, Lyon, France; [dagger]Functional Neurosurgery, HCL, Lyon, France; [double dagger]U879 - Central Integration of Pain, INSERM, Lyon, France and s.Clinical Neurophysiology, CHRU Lille, Lille, France Rationale: Painful somatosensory seizures are some of the most rarely observed partial seizures and their physiopathogenesis remains poorly understood. We report the case of a patient presenting pure painful somatosensory seizures, in whom a SEEG exploration: localized the epileptic zone (EZ) in the insular cortex; showed the functional organization of the cortical systems involved in the perception of pain. Methods: A 22-year-old patient consulted for presurgical evaluation for drug-resistant epilepsy. For the preceding 2 months he had had painful, recurrent partial simple seizures several times a week. These were dysesthetic hallucinations of a burning sensation or tearing of soft tissues over a more or less extended area of the left hemibody. Extremely intense, the pain seemed to continue for the first 15 seconds and then pulsated and progressively decreased over the following 2 min. MRI of the brain detected a 2-cm claustral spherical lesion, suggesting cortical dysplasia (CD) next to the right posterior insular cortex. The clinical exam, EEG, and FdG-PET scan were not contributive. SEEG exploration was planned using ten electrodes implanted in the insular-perisylvian and parietal area of the right hemisphere. Results: The seizure began as a high-frequency, low-amplitude discharge confined to the insular lesion for approximately 15 sec. This discharge was then interrupted and, over several dozen seconds, replaced with high repetitive spikes always collected by the intralesional contacts as well as in the middle part of the cingular gyrus and the parietal operculum, i.e. the secondary somato senitive cortex (SII). The passage from the first to the second period of the seizure was marked by the transformation from continuous to pulsating pain. Throughout the discharge, the cingular and SII spikes were repeated with a perfectly stable delay lasting 30 msec compared to the insular spikes. Conclusions: In this case, the painful seizures were associated with a critical discharge beginning in the insular cortex. Secondly, the paroxystic activities propagated from the insula to the secondary somatosensory areas and to the mid-cingular gyrus, precisely the structures that have been identified in functional imaging studies investigating nociception in humans. The pain in this case was produced by the pathological activation of the physiological network involved in nociception. Invasive presurgical evaluation of partial epilepsy with painful seizures should attempt to arrange electrodes in direct contact with the insulo-operculo-cingular cortices or risk mistaking the localization of the EZ. Abstract: Elisabeth Landre, d. Toussaint, l. Allouche, f. Chassoux, Baris Turak and b. Devaux neurosurgery, Sainte-Anne hospital, Paris, France Rationale: To demonstrate the place of Video-Stereoelectroencephalo-graphy for defining the electrical pattern and the semiology of the insular epileptic seizures. Methods: Nine patients (5 women and 4 men; age: 14 to 39 years, mean 24) were evaluated using Video-Stereoelectroencephalography (VSEEG) for partial refractory epilepsy with the hypothesis of insular seizures. There were 3 cases of Taylor's dysplasia (diagnosis after surgery) and the remaining 6 patients were considered cryptogenic. MRI was considered as normal in 7 patients and demonstrated a thickening of the insular cortex in 2 of the 3 cases of cortical dysplasia. In all cases PET-scan showed a predominant insular hypometabolism. For each case 1 to 4 electrodes targeted insular cortex and frontal and temporal lobes were also investigated in 6 cases, the frontal lobe also in 1 case and the frontal and the parietal lobes also in 2 cases. Results: Symptoms associated with the initial fast insular discharge were thoracic, abdominal or genital sensation (3 cases), paresthesia of the controlateral upper limb or cheek or inside the mouth (3 cases), throat tightening with a feeling of suffocation (3 cases), vertigo or cephalic sensation (3 cases). Discharge spread was frontal in 4 cases with agitated gesticulation, temporal in 3 cases associated with oroalimentary automatisms and to the inferior central region in 2 cases with tonic posture of the controlateral upper limb. Conclusions: These observations confirm the involvement of insular cortex in generating known electro-clinical seizures patterns and emphasize the importance of considering the insula as a possible seizure onset zone in similar cases. Abstract: Maciej Markowski, C. Plummer and G. R. Ghearing Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA Rationale: Ictal vocalizations, which are defined as production of sound without speech quality, are frequent in frontal lobe seizures, while verbalizations are less common. We report a case of right orbitofrontal seizures presenting with buccal pseudovoice (Donald Duck like speech). Our patient was successfully treated with resection of the right orbitofrontal epiletogenic focus. Clinicians should be aware that even bizarre and complex verbalizations may occur in frontal lobe seizures. Methods: A 40 year old male without significant past medical history started having paroxysmal episodes at the age of 18. The seizures included vocalization that contained obscene words and clearly understandable complex phrases produced with buccal pseudovoice. He failed multiple antiepileptic medications, and was deemed a candidate for epileptic surgery. Results: The initial evaluation in our Epilepsy Monitoring Unit (EMU), which included intracranial EEG (iEEG), ictal SPECT, and PET, localized the seizure foci to the right frontal operculum and the right superior temporal gyrus. Following resection of these areas in October 2005, the patient remained seizure-free for six months. Thereafter seizures of identical semiology reappeared. During his second EMU evaluation in 2007, both SPECT and MEG failed to localize a discrete seizure focus. Multiple clinical events were captured on iEEG with onset localized to the right orbitofrontal area that was resected in January 2008. Our patient remains seizure-free. Conclusions: Our patient exhibited very unusual ictal verbalizations that included clearly understandable curse words produced in buccal pseudovoice. The production of buccal pseudovoice is taught by speech therapists to patients who undergo laryngectomy. Perhaps the most famous example of a buccal pseudovoice is the distinctively angry voice of the cartoon character Donald Duck supplied by Clarence Nash. Our patient was able to produce buccal pseudovoice interictally. Ictal vocalizations occur in up to 50% of frontal lobe seizures, while ictal verbalizations are less frequent. In some frontal lobe series ictal vocalizations lateralized more often to the left. In our patient, however, the seizure onset zone was mapped to the right orbitofrontal region. Abstract: Michael Quach, Richard C. Burgess and E. E. Altay Cleveland Clinic Foundation, Cleveland, OH Rationale: Historically, the frequencies believed to be relevant EEG have been limited to less than 100 Hz. Recently, multiple studies have implicated higher frequency activities (>100 Hz) in both normal brain function and epilepsy. In particular, high frequency oscillations (HFO) in the range of 100-250 Hz and very-high frequency oscillations (VHFO) in the range of 250-500 Hz have been found and are thought to be a marker for epileptogenicity. The objective of this pilot study was to determine the feasibility of recording HFOs and VHFOs in neocortical epilepsy using subdural macroelectrodes. Methods: Three neocortical epilepsy patients were examined with invasive EEG using subdural macroelectrodes at a sampling rate of 2000 Hz without filters. One additional patient was recorded at 1000 Hz sampling rate. 63 macroelectrodes were used in each patient and seizures were recorded, ranging from 1-4 per patient. EEG was manually examined from one minute before ictal onset until one minute after the end of the EEG seizure, and divided into "pre-ictal", "early ictal", and "ictal propagation". A one-minute sample of interictal EEG was also examined to assess the presence of interictal activity. High-pass filters of 100 Hz and 200 Hz were used to identify HFOs, which were then compared to EEG findings with conventional filter settings (LF 1.6, HF 70) to determine thei... Cengage Learning, Inc.
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Hi
Attached for a starting point. Robber has written a lot about the therapist and therapeutic alliance. Best wishes
Thank you Maureen Mitchell! And Oh my goodness much appreciated Luiz Nolasco de Rezende Junior!
Not exactly what youre looking for, but this might be useful to you.
www.tandfonline.com/eprint/ZyvHddg4NmRHhfgPW7ih/full
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