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Self-Assessment Questions

Psychiatry

Psychiatric Aspects of Seizures: Review Questions

W. Curt LaFrance Jr, MD

Dr. LaFrance is a clinical research fellow, Brown Medical School; and a staff neurologist and psychiatrist at Rhode Island Hospital, Providence, RI.




Choose the single best answer for each question.

Questions 1 and 2 refer to the following case study.

A 32-year-old single white woman with a history of learning disability is seen for evaluation of paroxysms. She underwent cleft palate repair at birth, which required revision at age 30 years. Subsequent to a second adult repair 4 months ago, she developed what she describes as “whole-body shaking with frothing at the mouth from the anesthesia” following the surgery. The paroxysmal events lasted approximately 10 minutes and consisted of rhythmic bilateral arm and leg movements, with variable cognizance during and after the events. She required 1 minute to return to her cognitive baseline. Over the course of the next 4 months, the events occurred 1 to 4 times per week, and most were preceded by a frontal headache. The events were minimally responsive to lorazepam 1 mg, which was administered each time she was brought to the emergency department.
   The patient has no history of psychiatric problems or abuse but does note having a “nervous stomach.” She takes no illicit drugs. She has been on a medical leave of absence from her job as a food service assistant since her most recent surgery. Her mental status examination reveals slight palatal dysarthria and mild anxiety but is otherwise unremarkable. Results of neurologic examination are largely normal, except for mild incoordination on tandem gait maneuvers.

1. The case patient has repeated episodes of generalized shaking with lapses of consciousness and is partially amnestic of the events. Which of the following is the provisional primary diagnosis for this patient?
  1. Munchausen syndrome
  2. Panic disorder without agoraphobia
  3. Partial complex epilepsy with secondary generalization
  4. Prolonged QT syndrome
  5. Psychogenic nonepileptic seizures (NES)
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2. Results of a computed tomographic scan of the patient’s head are normal. Which of the following is the most appropriate diagnostic study to obtain next?
  1. Magnetic resonance imaging of the brain
  2. Neuropsychological battery
  3. Routine electroencephalography
  4. Video electroencephalography
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3. Measurement of which of the following values is useful in distinguishing NES from epileptic seizures?

  1. Cerebrospinal fluid protein level
  2. Leukocyte count
  3. Serum amylase level
  4. Serum creatine kinase level
  5. Serum prolactin level
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4. NES occur in which of the following groups?

  1. Preadolescent, predominantly males
  2. 20- to 40-year-old, predominantly males
  3. Middle aged, predominantly females
  4. Across all ages, in both genders
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5. Which of the following is the best treatment for patients with NES?

  1. Unknown
  2. Administration of antiepileptic drugs
  3. Administration of anxiolytic drugs
  4. Psychodynamic psychotherapy
  5. Combined pharmacotherapy and psychotherapy
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