Standard Electroencephalography in Clinical Psychiatry E-Book

Nash N. Boutros

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 273

Veröffentlichungsjahr: 2011

Beschreibung

This book provides a concise overview of the possible clinical applications of standard EEG in clinical psychiatry. After a short history, the book describes the physiologic basis of the EEG signal, then reviews the principles of EEG in terms of technical backgrounds and requirements, EEG recording and signal analysis, with plentiful illustrations of the most frequent biological or technical artefacts. Normal EEG patterns and waveforms for easy reference are clearly presented, before the detailed description of abnormal patterns.

With the basic information in hand, the reader progresses to an account of the role of EEG in the diagnostic work up in psychiatry, covering nonconvulsive status epilepticus, frontal lobe seizures and non-epileptic seizures. The clinical application of EEG in both childhood and adult disorders follows, including many case vignettes. The effects of psychotropic drugs on EEG are highlighted.

The book closes with a discussion of currently available certification venues for Clinical Neurophysiology along with limitations of each venue. It calls for the development of training guidelines and certification processes specific to Psychiatric Electrophysiology.

The material is clearly presented throughout, with plenty of figures, tables with summaries of relevant findings, flow diagrams for diagnostic work-up, boxes with learning points, and short lists of key references.

We fully expect the book will become the standard teaching source for psychiatry residents and fellows, as well as a useful resource for practising psychiatrists and clinical psychologists.

Praise for the book:

"This distinguished group of editors has put together chapters that represent an excellent practical handbook on electroencephalography in clinical psychiatry, now a very important topic. I highly recommend it not only to psychiatrists, but also to anyone interested in neuroscience."
John R. Hughes, DM (Oxon), MD, PhD, Professor of Neurology, University of Illinois Medical Center, at Chicago, Illinois, USA

Leseprobe

Contents

Cover

Series

Title Page

Copyright

List of Contributors

Preface

Chapter 1: Historical Review of Electroencephalography in Psychiatry

Introduction

The early pre-clinical era

Early history of human electroencephalography

Electroencephalography in psychiatry today

Chapter 2: Physiologic Basis of the EEG Signal

Membrane potentials

Excitatory and inhibitory postsynaptic potentials

Nonsynaptic intercellular events contributing to the EEG signal

Factors determining polarity and other characteristics of the surface EEG waveforms

Brain structures involved in the genesis of EEG rhythms

Chapter 3: EEG Recording and Analysis

Techniques and technical background

Chapter 4: Normal EEG Patterns and Waveforms

Introduction

Normal EEG patterns in the waking adult

Chapter 5: Abnormal Patterns

Introduction

Detection of artefacts

Abnormal patterns

Focal alterations

Chapter 6: The Role of EEG in the Diagnostic Work Up in Psychiatry: Nonconvulsive Status Epilepticus, Frontal Lobe Seizures, Non-Epileptic Seizures

Nonconvulsive status

Psychogenic non-epileptic seizures

Frontal lobe seizures

Chapter 7: EEG in Childhood Psychiatric Disorders

Introduction

Attention deficit disorder

Autistic spectrum disorders

Chapter 8: EEG in Psychoses, Mood Disorders and Catatonia

Introduction

EEG in psychoses

EEG in mood disorders

EEG findings in catatonia

Chapter 9: Standard EEG in Personality and Anxiety Disorders

Introduction

EEG in aggression and impulse dyscontrol

Panic attacks

Borderline personality disorder

Chapter 10: EEG in Delirium and Dementia

Introduction: Epidemiology of delirium and dementia

Clinical diagnosis in delirium

EEG work up in delirium

Metabolic causes of delirium

Infectious causes of delirium

Clinical diagnosis and EEG work up in dementia

Conclusion

Chapter 11: Effects of Psychotropic Drugs on EEG

Introduction

The role of EEG assessment of drug-induced CNS toxicity in psychiatric patients

Antipsychotic drugs

Lithium

Other mood stabilisers

Anxiolytics

Antidepressants

Recreational drugs

Case vignette

Chapter 12: Certification and Training in EEG and Clinical Neurophysiology

Clinical neurophysiology board certification

Index

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Intellectual Disability Psychiatry: A practical handbookEdited by Angela Hassiotis, Diana Andrea Barron and Ian HallEdited by Angela Hassiotis, Diana Andrea Barron and Ian Hall 9780470742518

The Child and Adolescent Psychiatry Handbook: An evidence-based approachCharlotte Boyce, Darren Cutinha, Renee Barton and Eilis Kennedy 9780470745670

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Library of Congress Cataloging-in-Publication Data

Standard electroencephalography in clinical psychiatry : a practical handbook / Nash Boutros… [et al.]. p. cm. Includes index. Summary: “This book provides a concise overview of the possible clinical applications of standard EEG in clinical psychiatry. It starts with a short history then describes the physiologic basis of the EEG signal. The material is clearly presented throughout, with figures, tables with summaries of relevant findings, flow diagrams for diagnostic work-up, boxes with learning points, and short lists of key references” – Provided by publisher. Summary: “This book provides a concise overview of the possible clinical applications of standard EEG in clinical psychiatry” – Provided by publisher. ISBN 978-0-470-74782-7 (pbk.) 1. Electroencephalography. 2. Psychiatry. 3. Mental illness–Diagnosis. I. Boutros, Nashaat N. RC386.6.E43S73 2011 616.8′047547–dc22 2010047247

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: eBook 9780470974629; Wiley Online Library 9780470974612; ePub 9780470974940

List of Contributors

Nash Boutros, MD Professor of Psychiatry and Neurology, Wayne State University, School of Medicine. 2751 E, Jefferson, Detroit, MI 48207, USA

Paola Bucci, MD, PhD Assistant Professor of Psychiatry, Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 8018 Naples, Italy

Silvana Galderisi, MD, PhD Full Professor of Psychiatry, Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 8018 Naples, Italy

Armida Mucci, MD, PhD Assistant Professor of Psychiatry, Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie, 8018 Naples, Italy

James J. Peters, VAMC New York, NY 10029, USA

Oliver Pogarell, MD Associate Professor, Neurologist, Psychiatrist, Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Nussbaumstr. 7, D-80336 Munich, Germany

Silvana Riggio, MD Professor of Psychiatry and Neurology, Mount Sinai School of Medicine and James J. Peters VAMC, New York, NY, USA

Mary Roberts, MD Clinical Associate Professor of Psychiatry, Wayne State University, School of Medicine, 2751 E. Jefferson, Detroit, MI, 48207, USA

Felix Segmiller, MD Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University of Munich, Nussbaumstr. 7, D-80336 Munich, Germany

Sophia Wang, MD Psychiatry Department, Mount Sinai School of Medicine, New York, NY, USA

Preface

Electroencephalography (EEG) is an important, non-invasive functional method for the investigation of electrical activity in the brain. EEG alone, or at times in combination with video EEG monitoring, is a very useful tool in the differential diagnosis of psychiatric and/or neurological presentations. It can also be useful for monitoring and helping to evaluate the clinical or therapeutic course of psychiatric disorders and to guide treatment plans.

The idea of a practical handbook on Standard Electroencephalography in Clinical Psychiatry was originally conceived by Dr N. Boutros following many discussions amongst members of the EEG and Clinical Neurosciences Society. These discussions concerned the relative roles of the standard (visually inspected) EEG (EEG) and the quantified EEG (QEEG) in clinical psychiatry. They resulted in the firm conclusion that both techniques are important and that they are complementary. While a number of texts addressing QEEG applications in psychiatry have been published in recent years, the last book addressing EEG in psychiatry was that by John R. Hughes and William P. Wilson [1] from 1983. We therefore started to compile this book, which integrates our combined knowledge and will serve as a comprehensive and practical guide to assist psychiatrists in clinical decision making using EEG.

This book was envisioned as a practical guide to assist psychiatrists in clinical decision making using EEG. It reviews the basics of a normal and abnormal EEG exam, the value and the limitations of EEG testing and its clinical indications. Specific clinical pitfalls and pearls, that are `red flags', in the EEG assessment are stressed throughout the book.

Despite the fact that we have had the ability to record brain electrical potential since 1924 and that this work was spearheaded by Dr Berger, a psychiatrist, to this day the significance of some EEG changes present in psychiatric patients remains poorly understood. The scalp-recorded visually inspected standard EEG is an under-utilised tool in the assessment of patients with a psychiatric diagnosis: failure to utilise this tool may contribute to a delay in making an accurate diagnosis and initiating appropriate therapy. The EEG is an essential tool in the differential diagnosis of neurological versus psychiatric disorders, especially when performed in correlation with the clinical manifestations and when special techniques such as video monitoring recording are used.

The goals of this book are to provide a brief historical perspective of EEG in psychiatric practice; to provide an understanding of the physiologic bases of the EEG signal and of the basic elements of EEG recording; to review normal and abnormal EEG patterns; and to provide the psychiatrist with a clear understanding of both the value and limitations of EEG testing and its clinical indications in the diagnostic work up as it applies to psychiatric patients.

There is detailed coverage of the role of EEG in:

1. the evaluation of non epileptic seizures;

2. the differential diagnosis of the behavioural manifestations of seizures of frontal lobe origin;

3. the differential diagnosis of nonconvulsive status epilepticus;

4. the evaluation of childhood psychiatric disorders;

5. the assessment of the patient with psychosis, mood disorders and catatonia;

6. the assessment of personality disorders and anxiety disorders;

7. the differential diagnosis of delirium versus dementia and its differentiation from a primary mood, anxiety or psychotic disorder.

After an historical review, Chapters 2 and 3 provide a synopsis of the physiologic bases of the EEG and its recording and analysis methodology. Chapters 4 and 5 then summarise the most important normal and abnormal EEG patterns. These chapters are not meant to be comprehensive: the interested reader is referred to the many available EEG atlases.

Chapter 6 emphasises the potential of the EEG in the evaluation of behavioural manifestations in order to help reach a clinical diagnosis and develop an appropriate treatment strategy. The following chapters address the application of this technique in specific groups of disorders, starting with developmental disorders, that is ADHD, autism, conduct disorders and learning disabilities even in the absence of seizures. Helpful guidelines are provided for when to use an EEG in the evaluation of these entities.

Chapter 8 discusses possible EEG findings in the evaluation of psychosis, mood disorders and catatonia with particular reference to their prognostic implications and addresses the differential diagnosis with general medical conditions. This is followed by chapters on personality disorders and anxiety disorders and on delirium and dementia.

Chapter 11 describes the effects of psychotropics drugs on the EEG. It includes a discussion of data indicating the usefulness of EEG in the diagnosis of drug-induced CNS side effects or toxicity.

The final chapter highlights the need for training guidelines and certification processes specific to Neuropsychiatric Electrophysiology and the issues involved in developing training programmes and certification.

Throughout the book, the authors provide specific illustrations of the different EEG patterns and review various technical artefacts. These illustrations will enable the reader to have a clear understanding of both the value and limitations of EEG testing and its clinical indications. Helpful clinical vignettes, together with well designed summary tables and flow diagrams, support the application of EEG in the differential diagnosis of psychiatric and neurological illnesses. An overall goal of the volume is to make the point that EEG abnormalities (whether focal or diffuse slowing, abnormal background rhythms, or epileptiform activity) represent important findings that must be taken into consideration when formulating a biopsychosocial understanding of an individual patient.

Reference

1. John, R. Hughes and William P. Wilson (1983) EEG and Evoked Potentials in Psychiatry and Behavioral Neurology, Butterworth-Heinemann.

The Editors July 2010

1

Historical Review of Electroencephalography in Psychiatry

Nash Boutros

School of Medicine, Wayne State University, Jefferson, Detroit, MI, USA

Introduction

The very beginning of the field of human electroencephalography (EEG) emerged directly from the field of psychiatry. Its founder, Hans Berger, was a biologically orientated psychiatrist with strong interests in the relationships between mind and body (Figure 1.1) [1]. In 1924, after years of frustrating failed experiments, his overwhelming dedication and persistence finally resulted in the first non-invasive scalp EEG recordings from humans and in 1929 he launched nearly a decade of landmark publications (all in psychiatric journals) that essentially laid down the very foundation of this new field.

Figure 1.1 Hans Berger.

Recent decades have seen a substantial resurgence of interest in biological psychiatry and perhaps this will permit greater utilisation of those strengths of EEG already known to exist as well as those that appear to hold substantial promise pending further research. Berger, if he were alive today, would surely be pleased.