Faculty Bibliography

Psychogenic seizures (PSs) convincingly mimic seizure phenomena but with no underlying epileptic activity. However, not much is known about their neurophysiological basis. We had the rare opportunity to analyze intracranial brain recordings of PSs occurring besides epileptic seizures (ESs), which identified distinct frequency changes over the parietal cortex. For further validation, we applied topographic frequency analysis to two other patients who presented PSs and ESs during long-term monitoring. The analysis revealed a power decrease in the theta band at the posterior parietal cortex in all three patients during PSs but not during ESs. These changes may reflect disturbed self-referential processing associated with some PSs.

This article discusses the interactions with so-called "difficult" parents, who often suffer from mental illness that has never been treated. The article offers recommendations to decode the emotional communication of such parents who doubt their own ability to care for their children as well as that of the pediatrician's. A clinical case is presented of a mother who "can't take it anymore" with her three-year-old son, in order to focus in greater depth on improving interactions with the physician. The authors strongly recommend assessment of what parents say about their child as well as of first-hand observations of parent-child interactions. Approaches to help the pediatrician better evaluate parental distress and associated risks to the child, while maintaining the parent-pediatrician alliance, are discussed.

This article describes the authors' clinical experience of integrating psychodynamic therapeutic approaches in the care of medically ill children and their families. A case report of a boy with severe, chronic liver disease requiring a double organ transplant is described as an illustration of how such approaches cannot only improve quality of life and functioning but may also be life saving. The authors describe original research investigating how parents' traumatic stress and related interference with children's emotional regulation can compromise their ability to make meaning of their experience, thus posing a risk for adherence to the prescribed medical regimen.

This study tested whether mothers with interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) vs healthy controls (HC) would show greater limbic and less frontocortical activity when viewing young children during separation compared to quiet play. Mothers of 20 children (12-42 months) participated: 11 IPV-PTSD mothers and 9 HC with no PTSD. During fMRI, mothers watched epochs of play and separation from their own and unfamiliar children. The study focused on comparison of PTSD mothers vs HC viewing children in separation vs play, and viewing own vs unfamiliar children in separation. Both groups showed distinct patterns of brain activation in response to viewing children in separation vs play. PTSD mothers showed greater limbic and less frontocortical activity (BA10) than HC. PTSD mothers also reported feeling more stressed than HC when watching own and unfamiliar children during separation. Their self-reported stress was associated with greater limbic and less frontocortical activity. Both groups also showed distinct patterns of brain activation in response to viewing their own vs unfamiliar children during separation. PTSD mothers' may not have access to frontocortical regulation of limbic response upon seeing own and unfamiliar children in separation. This converges with previously reported associations of maternal IPV-PTSD and atypical caregiving behavior following separation.

This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS), related to maternal report of interpersonal violence, mediates the effects of such violence on (a) child PTSS as well as on (b) child externalizing and internalizing symptoms. Study participants were mothers (N = 77) and children 18 to 48 months recruited from community pediatric clinics. Data were analyzed continuously via bivariate correlations and then multiple linear regression. Post hoc Sobel tests were performed to confirm mediation. Paternal violence accounted for 15% of the variance of child PTSS on the PCIP-OR (beta = .39, p