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      As crises não-epilépticas psicogênicas como manifestações clínicas do transtorno de estresse pós-traumático Translated title: Psychogenic nonepileptic seizures as clinical manifestations of posttraumatic stress disorder

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          Abstract

          As crises não epilépticas psicogênicas (CNEP) ainda são pouco entendidas. Como não existem critérios clínicos positivos para as CNEP, não há consenso sobre sua definição, assim como não se tem clareza em relação à nosologia de base, à fisiopatologia e ao tratamento apropriado. As CNEP manifestam-se principalmente por sintomas conversivos e dissociativos, os quais estão ligados historicamente a uma doença considerada de origem traumática, a histeria. Recentemente, observou-se que pacientes com CNEP apresentam taxas elevadas de experiências traumáticas, em particular abuso na infância, e de transtorno de estresse pós-traumático (TEPT). Estes achados sugerem que a CNEP pode ocorrer como expressão clínica de um padrão de TEPT cuja característica central é a predominância de fenômenos dissociativos e conversivos. Algumas evidências levantam a possibilidade de que este subtipo de TEPT dissociativo/conversivo seja resultante de maus cuidados parentais e disfunção familiar na infância, os quais estão associados a - e, portanto podem causar - sintomas somatoformes, incluindo as CNEP. Limitações metodológicas impedem a confirmação destas hipóteses, sendo necessários desenhos de pesquisa mais fortes, tais como prospectivos e de caso-controle.

          Translated abstract

          Psychogenic nonepileptic seizures (PNES) are still poorly understood. Because there are no positive clinical criteria for PNES, there is no consensus about its definition, nor clarity about the underlying nosology, pathophysiology, or the suitable treatment. PNES most commonly occur in the form of conversion and dissociative symptoms, which are historically linked to a trauma-related disease called hysteria. Recently, it has been observed that PNES patients show high rates of traumatic experiences, in particular childhood abuse, and posttraumatic stress disorder (PTSD). This suggests that PNES may arise as a clinical expression of a PTSD pattern whose cardinal feature is the predominance of dissociative and conversion phenomena. Emerging evidence also raise the possibility that the dissociative/conversion subtype of PTSD may occur as a result of poor parental care and family dysfunction, which are associated with - and may therefore cause - somatoform symptoms, including PNES. Methodological limitations do not permit the confirmation of these hypotheses. Stronger research designs are needed, such as prospective and case-control studies.

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          Pierre Janet and the breakdown of adaptation in psychological trauma.

          In this reappraisal of the work of Pierre Janet at the centenary of the publication of L'automatisme psychologique, the authors review his investigations into the mental processes that transform traumatic experiences into psychopathology. Janet was the first to systematically study dissociation as the crucial psychological process with which the organism reacts to overwhelming experiences and show that traumatic memories may be expressed as sensory perceptions, affect states, and behavioral reenactments. Janet provided a broad framework that unifies into a larger perspective the various approaches to psychological functioning which have developed along independent lines in this century. Today his integrated approach may help clarify the interrelationships among such diverse topics as memory processes, state-dependent learning, dissociative reactions, and posttraumatic psychopathology.
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                Author and article information

                Contributors
                Role: ND
                Journal
                jecn
                Journal of Epilepsy and Clinical Neurophysiology
                J. epilepsy clin. neurophysiol.
                Liga Brasileira de Epilepsia (LBE) (Porto Alegre )
                1980-5365
                December 2007
                : 13
                : 4 suppl 1
                : 32-35
                Affiliations
                [1 ] Universidade Federal do Rio de Janeiro Brazil
                Article
                S1676-26492007000500007
                10.1590/S1676-26492007000500007
                fe7143e4-fcc5-4a4b-b9c6-41b21aaa9896

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1676-2649&lng=en
                Categories
                CLINICAL NEUROLOGY
                NEUROSCIENCES
                PHYSIOLOGY

                Neurology,Anatomy & Physiology,Neurosciences
                transtorno de estresse pós-traumático,somatoform disorders,childhood abuse,dissociative disorders,abuso na infância,transtornos dissociativos,transtornos somatomorfos,crises não-epilépticas psicogênicas,psychogenic nonepileptic seizures,posttraumatic stress disorder

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