Standard Electroencephalography in Clinical Psychiatry

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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.

Standard Electroencephalography in Clinical Psychiatry

Standard Electroencephalography in Clinical Psychiatry

Contents List of Contributors ix Preface xi

1 Historical Review of Electroencephalography in Psychiatry 1

Nash Boutros Introduction 1 The early pre-clinical era 1

Early history of human electroencephalography 3

Electroencephalography in psychiatry today 5

References 5

2 Physiologic Basis of the EEG Signal 7

Paola Bucci and Silvana Galderisi Membrane potentials 7

Excitatory and inhibitory postsynaptic potentials 8

Nonsynaptic intercellular events contributing to the EEG signal 8

Factors determining polarity and other characteristics of the surface EEG waveforms 8

Brain structures involved in the genesis of EEG rhythms 10 References 12

3 EEG Recording and Analysis 13

Oliver Pogarell Techniques and technical background 13

References 30

4 Normal EEG Patterns and Waveforms 33

Paola Bucci, Armida Mucci and Silvana Galderisi Introduction 33

Normal EEG patterns in the waking adult 35

References 54

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5 Abnormal Patterns 59

Oliver Pogarell Introduction 59

Detection of artefacts 60

Abnormal patterns 60

Focal alterations 68

References 76

6 The Role of EEG in the Diagnostic Work Up in Psychiatry: Nonconvulsive Status Epilepticus, Frontal Lobe Seizures, Non-Epileptic Seizures 77

Silvana Riggio Nonconvulsive status 77

Psychogenic non-epileptic seizures 81

Frontal lobe seizures 85

References 88

7 EEG in Childhood Psychiatric Disorders 91

Mary W. Roberts and Nash Boutros Introduction 91

Attention deficit disorder 92 Autistic spectrum disorders 100

References 108 8 EEG in Psychoses, Mood Disorders and Catatonia 113

Nash Boutros, Silvana Galderisi, Oliver Pogarell and Felix Segmiller Introduction 113

EEG in psychoses 114

EEG in mood disorders 123

EEG findings in catatonia 124

References 129

9 Standard EEG in Personality and Anxiety Disorders 133

Nash Boutros Introduction 133 EEG in aggression and impulse dyscontrol 133

Panic attacks 138

Borderline personality disorder 142

References 144

10 EEG in Delirium and Dementia 147

Sophia Wang and Silvana Riggio Introduction: Epidemiology of delirium and dementia 147

Clinical diagnosis in delirium 149

EEG work up in delirium 150

Metabolic causes of delirium 151

Infectious causes of delirium 154

Clinical diagnosis and EEG work up in dementia 155

Conclusion 158 References 159

11 Effects of Psychotropic Drugs on EEG 163

Silvana Galderisi and Armida Mucci Introduction 163

The role of EEG assessment of drug-induced CNS toxicity in psychiatric patients 163

Antipsychotic drugs 164

Lithium 166

Other mood stabilisers 167

Anxiolytics 168

Antidepressants 169

Recreational drugs 169

Case vignette 170

References 171

12 Certification and Training in EEG and Clinical Neurophysiology 173

Nash Boutros and Silvana Galderisi Clinical neurophysiology board certification 173

Index 179

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.

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