[Paroxysmal psychological disorders--a diagnostic trap].

UNLABELLED Paroxismatic psychical disorders, as attacks of panic and anxiety, de-realization, de-personalization, false reconescense phenomena and other are, represent the diagnostic problem. The possibility of mistake is significant, and wrong diagnosis has medical and social implications. The aim was to point out the methodology of the work with these patients. METHOD From the group of patients with resistant epilepsies, we have separated five patients, which are very instructive. Three of them have been on anti-epileptics for 2.5 up to 4 years (partial complex attacks), two on psycho-pharmacies and one on psycho-therapy (as pseudo-attacks). The complete history of the disease have been taken with all patients, together with simultaneous consultations with psychiatrist, laboratory and cardiology status, EEG registrations, and with three patients the whole-night poly-somnogram (Vrapce), CT and MRI of the brain. RESULTS Three patients with "resistant epilepsy" did not have epilepsy, but were psychiatric cases, although two patients were partial complex epilepsies (pseudo-attacks before). DISCUSSION The diagnosis of paroxysmal psychic disorders has to be all-inclusive. It has to have included maximal diagnostic criteria for the epilepsy, together with obligatory consultation (synchronal) with psychiatrist. Some characteristics of epileptic attacks may be the direction-signs: they are short, repeating more or less on stereotype way, accompanied with automatisms, and especially important are post-attack conditions (conditions of confusion). If paroxysms are of less sharp borders, last longer, less stereotype, and especially if there is no post-ictal shows, more probably are psychiatric cases. CONCLUSION 1. For the exact diagnosis of paroxysm, the overall consideration, the close cooperation between epileptologist and psychiatrist are needed, 2. The maximal diagnostic criteria for epilepsy are conditio sine qua non.