Min, Adestro & Vazzoler-Mendonça | More Epilepsy Into Psychology | E-BOOK 2019

ENGLISH V e r sion : MORE EPILEPSY INTO PSYCHOLOGY

Organização da tradução para o inglês:

Adriana Vazzoler-Mendonça

MORE EPILEPSY INTO PSYCHOLOGY

MAIS EPILEPSIA NA PSICOLOGIA Li Li Min Sueli Adestro (Orgs.)

Adriana Vazzoler-Mendonça (Organização da Tradução para o Inglês)

ADCiência Divulgação Científica Campinas 2019

Copyright © 2018, Li Li Min, Sueli Adestro (Orgs.).

Direitos Reservados. Os direitos de todos os textos e ilustrações contidos neste livro são reservados a seus autores e organizadores da obra, e estão registrados e protegidos pelas leis do direito autoral, sendo preservada obrigatoriamente sua referência bibliográfica.

Editores Responsáveis Li Li Min Sueli Adestro Diagramação e Arte Alline Camargo Revisão Sueli Adestro Alline Camargo Tradução e Revisão da Versão em Inglês Adriana Vazzoler-Mendonça

Ficha Catalográfica (Câmara Brasileira do Livro, SP, Brasil) Mais Epilepsia na Psicologia: Li Li Min, Sueli Adestro (Orgs.).

Org. Trad. Adriana Vazzoler-Mendonça. Campinas: ADCiência Divulgação Científica, 2018.

113p.

ISBN: 978-85-69736-08-0.

1. Epilepsia. 2. Psicologia. I. Li, Li Min. II. Adestro, Sueli. III. Título.

CDD: 610.150

ADCiência Divulgação Científica Campinas, São Paulo www.adciencia.com.br E-mail: adciencia@gmail.com

SUMMARY 15

Editorial | Dr. Li Li Min

- Section I -

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1. Epilepsy and Neurofeedback: The Technology Applied to Clinical Intervention - Priscila Camile Barioni Salgado

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2. Management of Psychoeducational Group in Cognitive Behavioural Therapy - Karina Kelly Borges & Fernando José da Silva

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3. The Roles of Organizational Psychologists in the Inclusion of Professionals with Epilepsy in the Workplace - Adriana Vazzoler-Mendonça

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4. Anxiety Disorders in Patients with Epilepsy - Karina B. Batista

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5. Social Representations of the Causes of Epilepsy According to Psychologists - Ester Maria Horta de Paula, Cláudio José Cobianchi & Júlio César Cruz Collares-da-Rocha

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6. The Importance of the Psychotherapy Process in the Resignification of Being Diagnosed with Epilepsy: The View of Gestalt Therapy - Valquíria Gonçalves Ferreira Silva

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7. The Psychoeducation for Teachers of Children With Epilepsy - Denise Almeida Wendland

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8. Should Epilepsy Be Disclosed? Perceptions of Stigma in Patients with Epilepsy - Carolinne Yuri Tagami

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9. Epilepsy and ADHD: The Importance of NeuroLearnment for Classroom Management - Ana Paula Rabello Chaves

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10. Contributions of Positive Psychology to the Psychological Well-being and Quality of Life of Epileptics - Aline Boschi Neves

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11. School and Educational Psychology: Orientation about Epilepsy in School - Vilma Bastos Machado

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12. Epilepsy in School: The Behaviors, Emotions and Much More than Seizures Involved - Thais Pilon Ferro

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13. Dimensions of Sexuality in Epilepsy - Sueli Adestro

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14. Epilepsy and Employability: Barriers to Overcome - Maíra Frizzi da Cunha Bergo

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- Section II -

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15. Epilepsy and Autism: A Comorbidity Case - Veviane Spergue

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16. Absence Seizures: Intervention in Elementary School Students - Ádrinne Uchôa

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INVITED AUTHORS • Adriana Vazzoler-Mendonça Psychologist graduated from Anhanguera Educational, Campinas, SP, Brazil, and Architect and City Planner graduated from Catholic University of Campinas, SP, Brazil. Former professor of graduate programs. Founder and director of Kaleidoscopio Neurofeedback, Psychology and Coaching Clinic. She is a researcher in the field of talent and giftedness, and works as an author and a counselor/mentor for gifted and talented people.

• Ádrinne Uchôa Psychologist graduated from United Metropolitan Colleges (FMU), with certifications in Neuropsychology and Systematic Clinical Training from Araraquara University, SP, Brazil. Studied Neurosciences as part of an extension program at the Federal University of ABC, in Santo André, SP, Brazil. Works in education as an entrepreneur.

• Aline Boschi Neves Psychologist graduated from the University of Marília, SP, Brazil; graduate studies in Strategic People Management at the Getúlio Vargas Foundation, SP, Brazil; trained in Behavioral Therapy at ITCR, Campinas, SP, Brazil; master’s degree in Psychology as a Science and a Profession as part of the stricto sensu Graduate Studies Program at the Catholic University of Campinas (PUC), SP, Brazil.

• Ana Paula Rabello Chaves Specialist in Clinical Psychology and Neuropsychology, working with cognitivebehavioural approach since 1999, and a consultant in educational training and management. Researcher in the field of neurosciences and learning. Educational coordinator and full professor of the Neurolearning Certification program of UnyLeya, as well as of the Neuropsychology Applied to Education certification program at Euroamerican University Center (Unieuro), both in Brasilia, DF, Brazil. She is accredited by the Brazilian Association of Dyslexia (ABD/SP), São Paulo, SP, Brazil.

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• Carolinne Yuri Tagami Undergraduate student of Psychology at the University of Sorocaba (UNISO), SP, Brazil. Undergraduate research student at University of Campinas, Medical Science College (FCM), SP, Brazil, and a volunteer at Health Care for Patients with Epilepsy (ASPE).

• Cláudio José Cobianchi Psychologist who holds a master’s degree in Social Psychology from Catholic University of São Paulo, SP, Brazil, and Mental Health certification from Sedes Sapientiae Institute, São Paulo, SP, Brazil. Adjunct professor at Cruzeiro do Sul University, São Paulo, SP, Brazil.

• Denise Almeida Wendland Psychologist with a certification in Neuropsychology Applied to Pediatric Neurology from the Medical Science College of University of Campinas (UNICAMP), SP, Brazil. Professor of graduate programs at IESCAMP and Max Planck colleges in Campinas, SP, Brazil. Works as an Educational Psychologist and a Clinical Psychologist.

• Ester Maria Horta Psychologist with a certification in Neuropsychology from the Psychology Department of the University of São Paulo (USP), SP, Brazil. Clinical Neuropsychologist and supervisor of the Black Women Therapy Circle Project.

Works with pediatric neuropsychological assessment and Social Psychology.

• Fernando José da Silva Psychologist graduated from Paulista University (UNIP), São Paulo, SP, Brazil.

Presently attending the Hospital/Health Psychology certification program at the São José do Rio Preto College of Medicine (FAMERP), São José do Rio Preto, SP, Brazil.

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• Julio Cesar Cruz Collares-da-Rocha Psychologist with a master’s and doctor’s degree from the Psychology Graduate Program of Federal University of Rio de Janeiro (UFRJ), RJ, Brazil. Adjunct professor of master’s and undergraduate psychology programs of the Catholic University of Petrópolis, RJ, Brazil.

• Karina B. Batista Undergraduate student of Psychology at the Federal University of Rio de Janeiro (UFRJ), RJ, Brazil, and an intern in Clinic Research at the UFRJ Institute of Psychiatry. In receipt of a student grant for research into Brain Plasticity and Functional Magnetic Resonance Imaging from the D’Or Institute of Research and Learning (IDOR), Rio de Janeiro, RJ, Brazil.

• Karina Kelly Borges Psychologist with a Neuropsychology certification from University of Campinas (UNICAMP), SP, Brazil. Master’s and doctor’s degree in Health Sciences from the College of Medicine of São José do Rio Preto (FAMERP), SP, Brazil. Researcher at FAMEP’s Medicine and Health Laboratory.Visiting lecturer of FAMERP’s Psychology Undergraduate Program. Founding partner of the Institute of Psychology, Education, Behavior and Health (IPECS), in São José do Rio Preto, SP, Brazil. IPECS Coordinator of the Clinical Neuropsychology, Clinical Neuropsychopedagogy and Cognitive Rehabilitation programs.

• Maíra Frizzi da Cunha Bergo Holds a Psychology degree from Catholic University of Campinas (PUC), SP, Brazil, and has conducted research and published articles in the area of psychological interventions and processes of human development. She researches Neuroscience at the University of Campinas (UNICAMP), SP, Brazil, focusing on professionals with epilepsy, their employment and employability.

She is also a volunteer at the non-profit organization Health Care for People with Epilepsy (ASPE).

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• Priscila Camile Barioni Salgado Clinical psychologist, neurotherapist, professor and clinical supervisor at the Anhanguera/Kroton College. Post-doctoral studies in Biomedical Sciences at University of Campinas (UNICAMP), SP, Brazil. Founding partner of MindSelf – Psychology and Neurofeedback Clinic.

• Sueli Adestro Psychologist, holds a master’s degree in Philosophy of Psychology and Psychoanalysis from University of Campinas (UNICAMP), SP, Brazil. Bachelor in Philosophy with certifications in Ethics, Teaching in Higher Education and Human Sexuality from UNICAMP. Specialist in Scientific Dissemination in the Neurosciences and Health from UNICAMP. She is a supervisor in Lacanian psychoanalysis, psychopedagogy, and works with scientific dissemination and books publishing.

• Thaís Pilon Ferro Psychologist graduated from University of São Carlos (UFSCar), SP, Brazil, and attends the master’s degree program in Neurosciences in Faculty of Medical Sciences (FCM) of University of Campinas (UNICAMP), SP, Brazil.

Has a certification in Behavioral Analysis in a Clinical Context from Institute of Therapy by Contingency of Reinforcement (ITCR), in Campinas, SP, Brazil.

Works with and researches Neuroeducation.

• Valquíria Gonçalves Ferreira Silva Psychologist graduated from Santa Catarina Teaching Association (ACE/FGG), SC, Brazil. Certified in Gestalt Therapy Clinical Psychology from the Gestalt Therapy Studies Center of Santa Catarina (CEGSC), Joinville, SC, Brazil.Attends the master’s degree program in Clinical and Health Psychology of Iberoamerican University Foundation (FUNIBER), in Florianópolis, SC, Brazil. She is president of the Brazilian Federation of Epilepsy (EpiBrasil) and coordinator of the Community Clinic of Psychology of CEGSC.

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• Veviane Spergue Psychologist with a certification in Cognitive BehavioralTherapy from the Salesian University of São Paulo (UNISAL), SP, Brazil. Certification in Neuropsychology Applied to Child Neurology from University of Campinas (UNICAMP), SP, Brazil. Founder of the Epilepsy Support Movement in the city of Americana (MAPEA), SP, Brazil and member of the Audit Board of the Brazilian Federation of Epilepsy (EpiBrasil). Works with child, adolescent and adult psychotherapy and neuropsychological assessment. She is also a COGMED Working Memory Training tutor.

• Vilma Bastos Machado Psychologist graduated from São Marcos University (UNIMARCO) in São Paulo, SP, Brazil. Holds a master’s degree in Educational Psychology from Catholic University of Campinas (PUC), SP, Brazil, and is a professor of the Education Program of Higher Education Foundation of Bragança Paulista (FESB), SP, Brazil, lecturing in Principles and Practices of Special and Inclusive Education.

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INVITED TRANSLATORS AND PROOFREADERS • Adriana Vazzoler-Mendonça Holds a Bachelor’s degree in Architecture and City Planning from Catholic University of Campinas and in Psychology from Anhanguera Educational in Campinas, SP, Brazil. She was a partner of Intertrad, a translation company, in the decade of 1990, when she worked as a translator, interpreter and proofreader.

She is currently an author and a scientific researcher.

• Fernanda Braga Earned a degree in Psychology in from São Francisco University (USF) in Itatiba, SP, Brazil, and has worked in International Trade and Logistics for 27 years. She lived in the United States and is currently enrolled in Translator and Interpreter training at Traducenter in Campinas, SP, Brazil.

• Gloria van Donge Holds an Arts Degree from the University of Queensland, in Australia, and an Arts Degree in Biblical Studies from Luther Rice Seminary, in Florida, USA. She is the author of The Gifted Kids Book Series, a set of five picture books written especially for gifted and talented children, their families and educators.

• Helena Giordano Is a Brazilian freelance translator and English teacher who was awarded a PostGraduation Certificate in Portuguese/English Translation from Estácio de Sá University, Rio de Janeiro, RJ, Brazil, and earned a BA in Social Service from the Catholic University of Campinas, SP, Brazil. She is a volunteer translator for TED Talks and Global Voices and is currently enrolled in attending to a Translator and Interpreter training at Traducenter, in Campinas, SP, Brazil.

• Johnni Haddan Viana da Silva Is an undergraduate student of English from the Federal University of Ceará, Fortaleza, CE, Brazil, having previously trained as a computer networks technician. He does computer programming and game programming in his free time.

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• Kamila Moreira de Oliveira Is a Brazilian freelance translator and proofreader who is currently earning a Master’s degree in Translation Studies and has a degree in English Linguistics and Literature from the Federal University of Ceará, Fortaleza, CE, Brazil. She has experience in translation from English into Portuguese and she has been working with technical and academic texts since 2012. She is a person who lives with epilepsy.

• Larissa Castro Has a degree in English Linguistics and Literature and has worked as an English teacher for nine years. She has been teaching English online since April and has had translation experience in language pairs of English-Portuguese. She currently lives in Campinas, SP, Brazil.

• Magalie A. Pinney Resides in the USA and works in the Financial Services sector. She received a Communication baccalaureate, cum laude, and is pursuing an M.Ed. in Gifted Studies-Educational Psychology. She is an advocate, chairperson and board member for MAGE, Massachusetts Association for Gifted Education. She serves as an editor and contributor for South Shore Community Magazine.

• Mônica Angela Mazzoni Has a Bachelor degree in Administration with a Foreign Trade specialization and a Diploma in Translation by the Chartered Institute of Linguists. She has worked as an English translator for 25 years winning a Royal Engineering Society award for her work translating science and technology. She lived in London, England, from 1981 to 1993. She is a member of Mensa, an amateur astronomer and a fiber artist in Brasilia, DF, Brazil.

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• Pá Falcão Is a Brazilian game designer and People Development Consultant, living in Sao Paulo, SP, Brazil. She has a degree in Computer Science and a post-graduate degree in Cooperative Games. She has written books about games, people and business development in Portuguese and English. She is an International Speaker, including TEDx Talks, and a professor in several universities in Brazil.

• Patrício Costa Is an undergraduate student of English at the Federal University of Ceará, Fortaleza, CE, Brazil, and a bass player in his spare time. He has an interest in electronic games and polyglotism, having been a participant of Poliglotar, the largest polyglots conference in Brazil.

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EPILEPSY WINS… FREEDOM BEGINS

By redesigning our identities, we admit the restlessness of silence, the shape of institutionalized words within a deep mark of morality, stigma and prejudice.

This is a (inverse) self-esteem approach, because we are afraid of the archaeology of our physical and mental mysteries.

Neuroscience, as a producer of knowledge about the brain, educates us to confirm our awareness of a (pseudo) truth, entrusted with the study of a treatable chronic disease.

But, we create characters that hide in the shadows and we add something more to the weight of epilepsy.

We try to reveal through symbols the content that makes us believe in the appropriation of a “being-in-itself,” within a worldview that is more coherent with the reality of “being-a-person-with-epilepsy”.

The Organizers

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EDITORIAL

Back in 1994 during my fellowship in Queen Square, I was called to read the EEG recording during the Wada test that consists of isolating the function of a cerebral hemisphere through a selective injection of amytal sodium in the carotid circulation. Along with me was the neuropsychologist, Pam Thompson, who in those few minutes of the effect of the medication, was making her assessment. That information was added to other data for the decision of surgical treatment for patients with refractory epilepsy.

At the Montreal Neurological Institute, the presence of neuropsychologists was also noted.Yes, I remember that in one of our corridor conversations, Brenda Milner mentioned that they were like little spiders: “we occupy the spaces here and there, building little networks.” The context, in fact, was about the occupation of spaces, which always seems to generate animosity.

This symbolic meaning, as I had understood it, evokes the fundamental role of Psychology and its professional – the psychologist – in the knowledge network of Neuroscience and its practical application.They are professionals who boost neuroscience development oriented to convenience.

During these years of my journey around the world researching epilepsy, I had the pleasure of working with excellent psychologists, developing bold and challenging research projects or working in the direct assistance of patients.The unfolding of this journey has brought points of reflection on the issue of the labor market and school inclusion, in numerous difficulties, from interpersonal relationships to learning difficulties.And, when I least expect it, I look around and I remember those words above. Well… There are psychologists everywhere.

Discussing these facts with Sueli Adestro, my producer and a Lacanian, has contributed to reaching this line of thought – hahaha – of course! Epilepsy is a common, severe, deadly disease and despite having a clear cerebral origin, supernatural beliefs persist. Epilepsy brings serious impacts on patients’ life quality and imposes psychic suffering in a portion of them and their relatives.

Thus it is very natural that psychologists find themselves working in this field.

Yes, natural! However, in other conversations in the small circle of 15

psychologists, we have seen that epilepsy is not often discussed during the academic training of Psychology professionals. Big-Bang! That was the beginning of the conception of this book, with a title that declares our intentions – More Epilepsy into Psychology. It is a showcase that exposes the multifaceted universe of epilepsy under the gaze of the psychologist whose goal is to disseminate epilepsy as a realistic and practical model to be used by Psychology in the process of formation and professional improvement.To this end, we have called on psychologists close to our circle of interaction to contribute with their opinions and we extend this invitation to YOU through Psychology to enter into this universe in which I am sure you will feel at home.

The book, More Epilepsy into Psychology, is composed of 15 chapters, divided into two parts: the first one has the articles and the second the case studies. In this edition, the authors have discussed numerous topics such as positive psychology, Gestalt-therapy, analytical psychology, neurofeedback…

However, we can observe a greater focus on the cognitive-behavioral field with an approach to learning deficits and school cognitive disorders which builds a network of interaction with professionals of Psychopedagogy and Neuropsychopedagogy. This is not a coincidence considering that at the moment ASPE (Medical Care for People with Epilepsy)¹ and BRAINN (Brazilian Institute of Neuroscience and Neurotechnology) have been going through with the development of this topic in Neuroeducation through its own event – NeuroEdu – now in its fifth consecutive year.

Paraphrasing the neuroscientists of the past: Epilepsy is a window to unravel brain functioning and, as we understand it, we broaden the understanding of ourselves. More Epilepsy into Psychology is a multi-dimensional mosaic of adverse situations associated with epilepsy. By entering into this universe of psychic suffering and mechanisms for its overcoming, we hope that each reader can create their own insights in this tangled puzzle of our psyche. Here’s to good reading!

Li Li Min

Professor of Neurology at University of Campinas – UNICAMP

¹ - ASPE: Assistência à Saúde de Pacientes com Epilepsia.

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SECTION I

LITERATURE REVIEW: EPILEPSY IN PSYCHOLOGY

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1 Epilepsy and Neurofeedback: The Technology Applied to Clinical Intervention Priscila Camile Barioni Salgado

The invitation to write a chapter of a book that would bring more of the psychological approach to epilepsy was received with great joy, as it actually is a matter psychologists should research deeper. People with epilepsy are not only affected by seizure occurrences, but also feel those effects in all areas of their lives, at all times.

The impacts are revealed in the professional, family, affective-sexual, social and emotional areas; in other words, in the quality of life and well-being in broad and general ways. In addition, the perception of having the seizures controlled or not is more important to the person’s quality of life than the frequency of seizures themselves.

Before beginning with the theme of this chapter, I would like to present my work and studies’ trajectory, which led me to the neurofeedback. Shortly after getting my degree in Psychology, I started my Master’s degree in the Department of Neurology at UNICAMP (University of Campinas, Brazil) and researched the relationship between the perception of seizure management and the quality of life in adult patients with epilepsy. At that time, we identified the impairments those people were subject to, mainly in their professional lives.

We also identified how the perception of the frequency and intensity of seizures could be different from their actual frequency and intensity, thus confirming the importance of psychology in epilepsy. The perception of seizure control (regardless of whether the person has based on medical criteria, controlled the seizures or not) seems to be the most important variable in determining for better or worse the psychological, physical and social well18

being levels of people with epilepsy.

At the doctoral level, I focused on researching the implications of biopsychosocial variables in people with temporal lobe epilepsy who underwent epilepsy surgery. At that time, we observed that the surgery had a very positive response in the quality of life for those patients, even when there was no complete remission of the seizures.

The main reasons that led patients to undergo surgery were to be happy, to be able to work, to be less concerned about their condition and to reduce medication.

After surgery, patients evaluated themselves as normal people, more capable of caring for themselves and their family, more accepted and less stigmatized. In the post-doc period, we researched anxiety and depression, which are the most frequently comorbidities presented in epilepsy. We verified how they interfere in people’s lives and related them to the neurological and psychological makeup of the epilepsy condition.

At that point, my concern was to understand how people with epilepsy could develop a more autonomous life, despite their epileptic seizures. How could they develop a sense of self-control, an appropriation of their choices and responsibilities, even when the seizures brought the subliminal warning that, as they occurred, everything could get out of control?

This sense of lack of control during the seizures should not be expanded to all areas of these people’s lives and there should be a way for them to feel safer, despite the epileptic seizures. Psychophysiology, biofeedback, and neurofeedback research brought me answers in this direction and led me to develop some work in the area, finding relief for people seeking help for various complaints, besides epilepsy.

Hence, in this chapter I propose some concepts and techniques which have seldom been studied, or never even not studied at all during the psychologists’ graduate school years, although they are components of our mastery and competence, and represent a modality of complementary work to psychotherapeutic and drug treatments. Thereunto, I summarize the concepts of Psychophysiology, Biofeedback and Neurofeedback.

I will briefly report the history of neurofeedback and epilepsy studies and their main results, as well as explain the methodology beyond the technique.

It is an introduction to a relatively new area of knowledge, with a lot of potential for development, work and research. Here is the invitation for more psychologists to delve into the studies of psychophysiology and biofeedback.

Psychophysiology is an area of knowledge that studies the interrelationship between psychological and physiological processes, in other words, the relation between behavior and its neurophysiological bases. Here, 19

therefore, we have the first basic premise that any change in the physiological state is accompanied by a change in the mental state, conscious or unconscious and, conversely, any change in mental state, conscious or unconscious, is accompanied by a change in the physiological state.

This interrelation will always be individual, dynamic and bidirectional.

More simply, what I am saying here is that our emotions affect the functioning of our brain, just as the functioning of our brain affects our emotions.

Biofeedback is a technique used to understand psychophysiological processes. Through the human-machine interface, the individual physiological responses are monitored and, from a feedback mechanism, the person becomes able to learn to modulate and self-regulate the responses. Biofeedback training feeds back signals from the central nervous system (neurofeedback) and peripheral nervous system. This occurs when electrodes are attached to a person and monitor their physiological responses. Those responses are sent to a computer, which processes the data. Self-regulation occurs when, viewing their responses in real time via an interface on the computer screen (when feedback occurs), the person learns to modify it. Biofeedback is widely used to measure and teach how to increase attention and cognition potentials, as well as stress management skills in challenging or assessment situations.

It is a technique that teaches individuals to monitor, understand and change their physiology.That happens because when we are able to observe our physiology and receive a reinforcement that feeds back into our psychological or mental process, we are then in a better position to change it. The key word for any biofeedback process is self-regulation, in other words, the competence that individuals develop to control their physical and mental processes for a healthier functioning.

All biofeedback processes are based on the positive operant conditioning theory, proposed by Skinner in 1950. According to his theory, behavior consequences influence the tendency to repeat the behavior in the future. The consequences in the case of biofeedback training are positive reinforcements that the subject receives in the form of sound or visual signals every time he reaches a functional level of physiological response of the central or peripheral nervous system. According to Skinner’s theory, we tend to increase behavior whenever we have a positive consequence, just as we learn how to behave in advance to achieve the positive consequence.

Neurofeedback,also known as the“Biofeedback Electroencephalogram�, is a biofeedback modality that uses brain electrical activity (central nervous system) as its measure of self-regulation. Its general objective is to stimulate the natural abilities of the brain, regenerating and developing its potentialities, correcting and improving its functions.

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The first step in neurofeedback treatment is the evaluation by a quantitative electroencephalographic study (electrodes positioned according to the international system 10/20) during resting state with eyes closed, open and task execution status such as reading , memorization, calculations. The obtained data will present the type of wave emitted in different areas of the brain in different conditions.The analysis to obtain wave frequencies is performed using specific software through the fast Fourier transformation, which breaks down EEG tracing into wave frequency during the recorded period of time.

The most common frequencies are: delta (<4Hz), theta (4-8Hz), alpha (8-12Hz) and beta (12-38Hz). Other wave appointments are found in specific studies, as in the case of studies with epilepsy, which we will see later.

Each wave frequency has different characteristics and predominates more in different situations and periods of life. Different frequencies in distinct regions are associated with different behaviors.

When the electrical activity is dysfunctional, a personalized treatment protocol will be developed. The treatment itself consists of activities that the practitioner develops in front of a computer.

As the person develops the activities, the brain waves are monitored through electroencephalographic sensors.The person receives a reinforcement whenever expected wavelengths for the type of activity being performed are reached, thus enabling brain learning and self-regulation. The neurofeedback process occurs by molding, in other words, the physiological responses that approach the pre-established threshold from the initial evaluation, are successively reinforced, providing gradual modulation of expected patterns.

Conditioning occurs naturally and feedback (consequent positive stimulus) leads to the increase of conditioned physiological responses.

Studies involving neurofeedback and epilepsy began in the 1970s, when Barry Stearman published a series of papers on the modulation of sensory motor rhythm (SMR) in cats. The SMR are waves in the range between 12 and 20Hz that occur in the sensorimotor region. The differentiation of this rhythm occurred from the discovery that this frequency, in the central region, is associated with the thalamus, alertness and increases when there is suppression of the movement. Those studies demonstrated that cats, through operant conditioning, could control the occurrence of the waves to receive positive reinforcement (food). In addition, it had been observed in subsequent studies that cats that had trained SMR were more resistant to having seizures when induced to them. The findings of these early studies were extended to the clinical context when it was discovered that it is possible to recondition and train brain wave patterns. Studies involving people with epilepsy generally evaluated more severe, out-of-control, and drug-resistant patients. However, 21

even in this group of patients, Stearman’s research found that neurofeedback training significantly reduced the number of seizures, often reducing the use of medication.

Since those early studies involving neurofeedback and epilepsy, a number of new studies have been developed yielding consistent results on improved seizure control, mainly through SMR wave training. Despite the significant improvement in patients produced in the short term with the use of neurofeedback, this technique is still not widely accepted and disseminated in academic and medical circles.

One of the reasons is that it is contrary to the pharmaceutical industry, when proposing a non-invasive technique that can reduce crises and medication use. The other is that there are currently a number of distinct molds for brain assessment and training. The practice of neurofeedback requires training and knowledge of the concepts of operant conditioning, psychophysiology, neuropathology and clinical management. The cerebral efficiency, when achieved, intensifies the psychological development and promotes life quality improvement. Psychologists must be prepared to understand the human being in a unique way and to awaken the development of brain and mind.

REFERENCES - Dias, A. M. (2010). Tendências do neurofeedback em psicologia: revisão sistemática. Psicol. estud., 15(4): 811-820. Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S141373722010000400017&lng=en&nrm=iso - Egner, T., & Sterman, M. B. (2006). Neurofeedback treatment of epilepsy: from basic rationale to practical application. Expert Rev Neurotherapeutics, 6(2): 247-257.

- Lubar, J. F., & Bahler, W. W. (1976). Behavioral Management of Epileptic Seizures Following EEG Biofeedback Training of the Sensorimotor Rhythm. Biofeedback and Self- Regulation, 1(1): 77-104.

- Salgado, P. C. B., Fernandes, P. T., & Cendes, F. (2008). Pre-surgery expectations and post-surgery life-changing validation process. Epileptic Disorders 10: 290-296.

- Salgado, P. C. B., & Cendes, F. (2009). Life adjustment after surgical treatment for temporal lobe epilepsy. Journal of Epilepsy and Clinical Neurophysiology, 15: 71-75.

- Salgado, P. C. B., & Cendes, F. (2009). The effects of epileptic seizures upon quality of life. Journal of Epilepsy and Clinical Neurophysiology, 15: 111-114.

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- Salgado, P. C. B.,Yasuda, CL., & Cendes, F. (2010). Neuroimaging changes in mesial temporal lobe epilepsy are magnified in the presence of depression. Epilepsy & Behavior 19: 422-427.

- Salgado, P. C. B., Nogueira, M. H.,Yasuda, C. L., & Cendes, F. (2012). Screening symptoms of depression and suicidal ideation in people with epilepsy using the Beck depression inventory. Journal of Epilepsy and Clinical Neurophysiology, 18: 85-91.

- Sterman, M. B., MacDonald, L. R., & Stone, R. K. (1974). Biofeedback training of the sensorimotor electroencephalogram rhythm in man: effects on epilepsy. Epilepsia. 15: 395-416.

- Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencephalography, 31 (1), 45- 55.

- Sterman, M. B.; & Egner, T. (2006). Foundation and Practice of Neurofeedback for the Treatment of Epilepsy. Applied Psychophysiology and Biofeedback, 31 (1), 21-31.

- Tan, G., Thornby, J., Hammond, D. C., Strehl, U., Canady, B., Arnemann, K., & Kaiser, D. A. (2009).

Meta-Analysis of EEG Biofeedback in Treating Epilepsy. Clinical EEG and Neuroscience, 40 (3): 173-179.

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2 Management of Psychoeducational Group in Cognitive Behavioural Therapy Karina Kelly Borges & Fernando JosĂŠ da Silva

The incidence of psychological disturbances is greater in people with epilepsy than in the general population. It is estimated that 20-30% of patients with epilepsy show psychiatric comorbidities; and it is predominantly substantially higher in those with epilepsy resistant to the antiepileptic drug.

The profound physical, psychological, and social consequences of epilepsy can impact quality of life due to a number of reasons, including medication side effects, cognitive disorders, and unpredictability of the crisis, its stigmatizing nature, academic decline, and work difficulties (Michaelis et al. 2018)

While physicians focus on minimizing disease symptoms and side effects, a primary role of mental and behavioral health (i.e., psychologists, psychiatrists, neuropsychologists, and social workers) may be related to optimizing quality of life by providing psychiatric treatments based on evidence. Psychological treatments tend to be complex, that is, several intervention components can be incorporated into various therapeutic approaches (e.g., psychoeducation and skills training).

Next, here are some important considerations during clinical treatment in patients with epilepsy: 1. Performing symptom screenings helps in identifying them and demonstrates the benefits in the psychological treatment of epileptics in the clinical / hospital environment

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2. Patients must complete mental health exams as part of routine clinical care. Each epilepsy visit should include at least one clinical question about mental health and quality of life. Screening is encouraged in the diagnosis of epilepsy, before and after the antiepileptic drugs initiation or alterations, and at timed intervals.

3. The interview should be conducted, mainly for children, with several caregivers. The difficulty of identifying cognitive delays and maladaptive behaviours needs these other perspectives.

4. A measure of psychological functioning should be administered before the initiation of anticonvulsant drugs and during the course of treatment, considering standardized assessments.

5. Carry out an evidence evaluation for psychoeducational interventions (Fountain et al., 2015).

Below are the main terminologies for interventions in patients with epilepsy.

Table 1. Terminology for psychological interventions.

Intervention

Psychological intervention

Objectives To reduce psychological distress (for example, symptoms of anxiety and depression); To improve and assist in dealing with epilepsy and its treatments

Type of therapy used Cognitive behavioral therapy Behavior analysis Acceptance and commitment therapy Motivational Interviewing

Family Management and commitment to affiliation

Activities in which patient or family can perform to have an affect on the frequency of crises or to promote well-being; Activities developed in the community or primary Health Care System.

Motivational interventions Family Therapy

Adherence to intervention

To help patients join counselling and health care services, including the administration of antiepileptic drugs and avoiding risk behavior.

Problem-solving Intention Motivational interventions Family Therapy

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Educational intervention educational/ psychoeducation

To increase knowledge of epilepsy and its treatments and brain function

Group and/or individual therapy

Source: Wagner et al., 2017.

Psychoeducational group for coping with the disease

Cognitive-Behavioural Therapy (CBT) assumes that the way people think and interpret the situation, influence how they feel emotionally and how they behave (Beck, 2013).

The use of Cognitive-BehaviouralTherapy(CBT) is considered important for managing emotional changes, especially for symptoms of depression and anxiety in patients with neurological conditions (Oliveira, Argimon, Irigaray, Moraes & Piccoloto, 2015).

In addition Group CBT, which has been highlighted in research and clinical applications, is used due to its effectiveness and its positive cost-benefit relationship. It is able to attend to a larger number of patients at the same time and at lower cost (Rangé, Pavan-Cândido & Neufeld, 2017). Because of this group interventions have been widely used by health service professionals and programs, and they have the potential to improve the quality of care in this context (Borges, Soares & Rudnicki, 2018).

Several groups have been carried out and developed with different focuses and objectives, such as psychoeducation groups (Rangé, Pavan-Cândido Neufeld, 2017). These are one of the modalities of CBT, which aims to provide information and self-knowledge about the neurobiological, environmental and psychological characteristics of the symptoms and difficulties of individuals, as well as courses and treatments for them. In this way, it is possible to recognize their difficulties, symptoms, thoughts, emotions and behaviours and to identify the interrelationship between them so that they can discuss strategies for change and carry out effective interventions based on psychoeducation techniques and problem solving (Neufeld, 2011).

Psychoeducational content consists of the medical aspects of epilepsy, healthy lifestyle behaviour and health promotion attitudes, development of positive relationships with peers and family, coping, stress management, and skill development. In the group, individuals can share their problems and reflect on them benefiting from the mutual interaction of other members who face similar demands, finding emotional support, suggestions for different lifestyles, and relieving from pressures and fears (Borges, Soares & Rudnicki, 2018).

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The coping strategies are a set of cognitive and behavioural efforts, used to deal with specific internal or external demands, triggered in stressful situations and evaluated as an overload or when it exceeds the individual’s resources (Lazarus & Folkman, 1984).

Psychological interventions can be focused on the development of adaptive coping strategies, so that stress can be minimized due to limitations, challenges and demands related to the disease process as well as contributing to the improvement of individuals’ quality of life (Borges, Soares & Rudnicki, 2018).

Table 2. Measurement instruments used for psychoeducational group.

Measurement Instrument

Description

Hospital Anxiety and Depression Scale (HAD)

It has 14 multiple choice questions, which contains seven items for each of the subscales: anxiety and depression. Considering that for each of these, the score ranges from 0 to 21 (Botega, Bio, Zomignami, Garcia & Pereira, 1995).

Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)

Contains 6 items for the screening of depressive episodes in the Epilepsy. Its cutoff point is > 15 (Oliveira et al., 2011)

Ways of Coping Scale (WOCS)

Questionnaire with 45 items and contains four modes of coping: focused on the problem (18 items), focused on the emotion (15 items), religious practices / fanciful thinking (7 items) and social support search (5 items) (Seidl, Troccoli & Zannon, 2001).

The Medical Outcomes ShortForm Health Survey (SF-36)

Multidimensional questionnaire that has 36 items, with 8 scales: physical functioning, role-physical, pain, general health perception, vitality, social functioning, role-emotional, mental health.Your score can range from 0 to 100, with zero being considered as worse general health and one hundred, better state of health (Ciconelli, Ferraz, Santos, Meinão & Quaresma, 1999).

Source: Prepared by the authors.

The group meets for a duration of 120 minutes each session, held weekly, at a total of 14 sessions and a maximum of 10 participants.

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Table 03. Structure of Psychoeducation Sessions.

Sessions

Objectives

Procedures

1

To evaluate the characteristics of each member of the group to obtain psychometric information.

In addition to offering reception, active listening, validation feelings and stimulate the mutual knowledge among the participants.

Reception; Structure of Sessions; Therapeutic Contract; Application of Inventory (Hospital Anxiety and Depression Scale â&#x20AC;&#x201C;HAD), Neurological Disorders Depression Inventory for Epilepsy- NDDI-E, Scales of Ways of Coping Scale-WOCS, The Medical Outcomes Short-Form Health Survey (SF-36) - and Dynamics: Exercise of Confidence.

2

To provide information and understanding about epilepsy and Depression, in addition to perform activity on empathy.

Psychoeducation: Epilepsy and Depression.

Dynamics: He was caught in his own web

3

To provide information and understanding about Anxiety Stress, in addition to guiding about relaxation technique as strategy to reduce these symptoms.

Psychoeducation: Anxiety and Stress.

Diaphragmatic Relaxation Technique

4

To offer information about food, physical activities, leisure, sleep and relationships to improve the quality of life.

Self-care: Food, Physical Activity, Leisure and Sleep (Sleep Hygiene)

To discuss about the vision of the self, in relation to the potential and difficulties, in addition to dealing with criticism.

Vision of the self: Self-esteem. Pass the Plate Exercise

6

Stimulate cognitive processes

Memory Stimulation

7 to 9

To improve individual functioning in social contexts; To acquire social repertoire assertive and appropriate communication.

Social Skills Training

10 to 12

To Discuss about coping strategies and acquire perception about their own needs, in addition to mobilizing resources to improve and to set realistic goals for maintenance of daily life and use the otherâ&#x20AC;&#x2122;s learning as a form of help.

Coping with the disease Dynamics: The Exchange of a Secret; Tell about the Word and Complete the Sentence; and get rid of Difficulties.

5

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13

14

To provide the participant with a reflection on how he wants that his life would be in the future and to raise the awareness of the necessity of doing it now in addition to discussing about their perception of functional pattern and encourage it to assume responsibility for the learning that needs to be acquired.

To reassess the characteristics of each member of the group to obtain psychrometric information of their therapeutic gains. Besides provide and receive the group feedback and promote an atmosphere of trust and personal appreciation.

Perspective of the Future. Dynamics: Project for 20 years’ time

Reapplication of Inventories (Hospital Anxiety and Depression Scale HAD, Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), Ways of Coping Scale- WOCS The Medical Outcomes Short-Form Health Survey –SF-36) Feedback: From the Group to the Therapist.

Dynamics: The Gift of Joy.

REFERENCES - Beck, J. S. (2013). Cognitive- Behavioral Therapy: theory and practice. (2nd ed). Porto Alegre.

Artmed.

- Borges, L. M., Soares, M. R. Z., & Rudnicki, T. (2018). Group work in the context of health psychology. In: Seidl, E. M. F., Miyazaki, M. C. O. S., Ramos-Cerqueira, A. T. A., & Domingos, N. A. M. (Org.), Psychology of Health: Theories, Concepts and Practices. (Cap. 4. pp. 103-132).

Curitiba: Juruá.

- Botega, N. J., Bio, M. R., Zomignani, M. A., Garcia, C. Jr., & Pereira, W. A. B. (1995). Mood disorders among medical in-patients: a validation study of the hospital anxiety and depression scale (HAD), Public Health Jornal, 29(5), 355-363. Recovered from https://www.scielosp.org/article/rsp/1995.v29n5/359-363/. doi: https://dx.doi.org/10.1590/S0034-89101995000500004 - CiconellI, R. M., Ferraz, M. B., Santos, W., Meinão, I., & Quaresma, M. R. (1999). BrazilianPortuguese version of the SF-36. A reliable and valid quality of life outcome measure.

Brazilian Journal of Rheumatology, 39(3) 143-150. Recovered from http://www.ufjf.br/ renato_nunes/files/2014/03/Valida%C3%A7%C3%A3o-do-Question%C3%A1rio-dequalidade-de-Vida-SF-36.pdf - Fountain, N. B.,Van Ness P. C., Bennett A., Absher, J., Patel, A. D., Sheth, K. N., Gloss, D. S., Morita, D. A., & Stecker, M. (2015). Quality improve-ment in neurology: epilepsy update quality easurement set. Neurology. 84(14) 1483-1487. Recovered from http://n.neurology.org/content/84/14/1483.long. doi: https://doi.org/10.1212/WNL.0000000000001448

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- Lazarus, R. S. & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer Publishing Company.

- Michaelis R., Tang,V., Goldstein, L. H., Reuber, M., LaFrance Jr, W. C., Lundgren, T.,& Wagner, J. L. (2018). Psychological treatments for adults and children with epilepsy: Evidence-based recommendations by the International League Against Epilepsy Psychology Task Force. Epilepsy. 59(7), 1282-1302. Recovered from https://onlinelibrary.wiley.com/doi/full/10.1111/ epi.14444. doi: https://doi.org/10.1111/epi.14444 - Neufeld, C. B. (2011). Cognitive-behavioral intervention in socio-educational group. In: Rangé, B. (Org.). Cognitive-behavioural psychotherapies: A dialogue with psychiatry. (2. ed., Cap. 46, pp 737-750). Porto Alegre: Artmed.

- Oliveira, A. C. R., Argimon, I. I. L., Irigaray,T. Q., Moraes, A. A., & Piccoloto, N. M. (2015). CognitiveBehavioral Therapy in Neurological Patients: A Systematic Review. Brazilian Journal of Behavioural and Cognitive Therapy, 17(1), 54-67. Recovered from http://www.usp.br/rbtcc/ index.php/RBTCC/article/view/736/433 - Oliveira, G. N. M,, Araújo-Filho, G. M., Kummer A., Salgado J.V., Portela E. J., Sousa-Pereira S. R., & Teixeira, A. L. (2011) Brazilian version of the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E). Epilepsy & Behavior, 17(2), 49-53. Recovered from http://www.scielo.br/pdf/jecn/v17n2/v17n2a04.pdf. doi: http://dx.doi.org/10.1590/S167626492011000200004 - Rangé, B. P., Pavan-Cândido, C. C., & Neufeld, C. B. (2017). Brief History of Group Therapies and TCCG. In: Neufeld, C. B., & Rangé, B. P. (Org.). Cognitive-Behavioural Therapy in Groups: from Evidence to Practice, (Cap. 1. pp 17-32). Porto Alegre: Artmed.

- Seidl, E. M. F., Tróccoli, B. T., & Zannon, C. M. L. C. (2001). Factorial Analysis of a Coping Measure.

Psychology: science and profession, 17(3), 225-234. Recovered from http://www.scielo.br/ pdf/ptp/v17n3/8812.pdf. doi: http://dx.doi.org/10.1590/S0102-37722001000300004 - Wagner, J. L., Modi A. C., Johnson E. K., Shegog, C., Escoffery, C., Bamps,Y., Austin, J. K., Schultz, R. J., MapelLentz, S., & Smith, G. (2017). Self-management interventions in pediatric epilepsy: what is the level of evidence? Epilepsy, 58(7), 743–754. https://onlinelibrary.wiley.com/doi/ full/10.1111/epi.13711. doi: https://doi.org/10.1111/epi.13711.

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3 The Roles of Organizational Psychologists in the Inclusion of Professionals with Epilepsy in the Workplace Adriana Vazzoler-Mendonça

This paper has been conceived to inform psychology students about some variables concerning problems people with epilepsy encounter in their work lives and how the roles of Organizational Psychologists fit into the inclusion process.

In 2010, the World Health Organization estimated that there were 40 million people with epilepsy in the world in all age categories from childhood to elderly (WHO, 2010). The prevalence of epilepsy in Brazil is 0.14% of the population between 16 to 64 years old. Each year 44 more people with epilepsy are added per each 100 thousands of inhabitants, based on Borges et al (2004).

According to the interview carried out by Salgado and Souza (2002), the area where most people are affected by the disease is in their jobs. It is estimated that 50% of patients with epilepsy find it hard to get a job, and unemployment or underemployment are the two most important challenges faced by people with epilepsy (Masland, 1985; Guldvog et al, 1991; Boer, 1995 apud Salgado and Souza, 2002).

Feelings of Inadequacy - Sawmilling of Subjectivity and Sawmilling of Objectivity

When diagnosed with the disease, the worker is labeled as an “epileptic” by social stigma, which is a form of prejudice suggesting a discriminating attitude, 31

as alerted by Fernandes and Li (2006). Thus, according to the authors, besides the physical unease, they suffer from physical, psychological, social and spiritual consequences of the stigma.

Concerning the subjective aspects, the Organizational Psychologist must be attentive to the emotional consequences of feelings of inadequacy that might arise in people with epilepsy. The term Feelings of Inadequacy (FI) was defined by Torres (2006, p.14) as “the beginning of a form of existence in which a state of difference or uniqueness of traits is noticed independently from the reactions started by this acknowledgement.” According to Torres (2011), this feeling is due to an incorrect but inevitable comparison. Torres explains that the term “inadequate” suggests that there must be a correct, good or “adequate” form as opposed to “inadequate” which is wrong, bad and ill.Within the biopsychosociospiritual context, FI might become a source of existential anguish for a person with epilepsy. This may cause even more damage than the convulsive crises or seizures which characterize the illness.

Based on FI, the person might want to change, to become different and healed. This desire has been described by Torres (2008) as Sawmilling of Subjectivity (SS) that can be a painful process which is not very fruitful either.

One form of SS is to try to hide epilepsy (Fernandes and Li, 2006). By realizing that there are other external variables, the person might make an effort to change the world, the work environment and change others in a movement called Sawmilling of Objectivity (SO) (Torres, 2008). Thus FI might come together with violence against oneself (SS), against the world (SO) or it might distance the person from real inclusion.

Inclusion

If on the one hand there is a professional with epilepsy who has feelings and needs, there is also a company representing the society and the world with all sorts of barriers for him or her. In regard to people with disabilities and their inclusion in school and work, the Brazilian Law (13.146/2015) for Inclusion of Persons with Disabilities is turning into an important legal milestone. It is promoting deep considerations over our culture, society, ethics, autonomy and citizenship, and the process of empowerment for people with disabilities.

Nonetheless, people with epilepsy are not protected by this law, that says in its second article that a disabled person is defined as “someone who has a long term constraint of physical, mental, intellectual or sensorial nature, or someone who is obstructed from full and effective participation in the society in equal conditions with other members of the society” (Brazil, 2015). There is 32

still no law in Brazil to include people with chronic diseases such as epilepsy, HIV-AIDS, cancer, multiple sclerosis, lupus, only to mention a few of them, either for academic life or for professional activities. The Article 93 of Quota Act 8213/1991 establishes a quota of 2% to 5% of vacancy for companies that have more than 100 employees (Brazil, 1991). It does not even consider people with chronic diseases as a target audience to be protected for support, adaptation, accommodations to enable their active participation in the society as citizens who support families or for personal fulfillment.

Supported Employment is for Anyone Who Needs It

Facing this problem, the Organizational Psychologist can make use of Supported Employment (SE) which is a methodology that has been consolidated in many countries for decades (ANEA, 2016). In Brazil, it seeks to establish itself as a feasible alternative for real inclusion of a group of people traditionally excluded from labor activities in the labor market. This group is composed of people with significant disabilities due to social deficiencies or vulnerabilities whose inclusion demands mobilization of family, the employer, coworkers, the technical team which attends the person (doctors, psychologists, occupational therapists, lawyers, etc.) and the professional himself respecting and recognizing his choices, interests, strengths and needs for support (Betti and Sassaki, 2014).

In Brazil, National Association of Supported Employment (ANEA, 2016) gathers together professionals, institutions, employers, researchers, clients, relatives and anyone concerned about developing methods of SE and inserting people with significant difficulties in the competitive labor market.

Initially designed for workers with intellectual impairments, disabilities or handicaps, SE soon proved that it could be applied to workers with all kinds of disabilities such as physical, sensorial, global development disorders as well as socially excluded people such as egresses from the prison system, transgender people, refugees, chemical dependents in recovery, people with esthetic deformation and other situations which make their insertions difficult in society and the labor market, and their continuation of the activity. It can also be used for people with epilepsy and other chronic diseases. According to Betti and Sassaki (2014), SE considers, a priori, everyone as employable as long as required conditions are provided for them. Therefore SE may help anyone who needs it by allowing any specific group access to work.

Based on these principles, it is important to analyze how SE can support people with epilepsy in finding a job as well as staying in their jobs, if they want to. As far as professional capacitation is concerned, SE postulates that 33

the best way to include a worker is by means of education and capacitation activities. Thus, for the inclusion of a person with disabilities, first of all, the worker is hired for a work vacancy, and then, based on the job description, and within the organizational, social and cultural context, he or she must get the specific training required to develop competences with more assertiveness (Betti and Sassaki, 2014; Sassaki, 2014).Therefore the professional with epilepsy should first be hired and then leveraged in the best way, providing him support, accommodations and adaptations, as well as development of competences and career planning.

The SE methodology proposed by Betti and Sassaki (2014) is divided into 3 phases. Phase 1 is dedicated to the discovery of a vocational profile, where the SE consultant seeks to discover the desires, talents and competencies of the worker based on his or her interviews, as well as on interviews with his family members, colleagues, managers, neighbors, friends that can talk about him with certainty and explain about his strengths and also about where he needs adaptations. In this phase, degrees of professional disability caused by epilepsy is also defined based on instruments of assessment, such as inventory and scales, as well as knowledge and capabilities and ascertainable results of the worker himself. In phase 2 a job is developed. The SE consultant goes to the marketplace to search for companies that might be interested in the profile of his client. The job must be aligned with what he or she desires, be compatible with his or her vocational profile and with the degree of his work capacity.This phase might result in hiring the professional for an existing position or creating a personalized job that suits both the professional and the firm. In phase 3, a post placement follow up is carried out by SE consultant for a necessary period of time, with as many sessions as needed to ensure that both parties are developing what has been established beforehand. This avoids undesirable deviations aiming at the inclusion of the professional based upon the initial agreement.

If SE was designed to assist a group of people excluded from the labor market due to severe impairment, disabilities or handicaps (Betti and Sassaki, 2014; Sassaki, 2014), then, for people with epilepsy, there would be merit for offering an SE consultant as a follow up measure. For professionals who cannot work or cannot persist in their jobs on their own due to emotional, social and cognitive difficulties and their symptoms, SE might end up further jeopardizing the mental health of the person. So the typical strategy is for the Organizational Psychologist to hire an SE consultant to assist in cases where professionals with epilepsy are already working in a company to keep their jobs or to be promoted, transferred or is in danger of being dismissed. Dismissal of a professional should not be considered by an SE consultant, an Organizational 34

Psychologist or by the employee as an option. It may be better to offer the possibility for re-employment in a job which makes more sense, brings more satisfaction and fulfillment and includes the person in a better group in which he or she wants to belong.

What a Professional with Epilepsy Can Do for Himself and for the Cause

For an inclusion process to be successful everyone must do one’s part and people with epilepsy are no exception. His inclusion in the labor environment requires his commitment and effort. The Organizational Psychologist could act as a bridge between the management and the employees, as proposed by Pless and Maak (2004) They purport an inclusive work environment and constructive relationships based on values such as understanding, validation, confidence and integrity in the pursuit of continuity of business with sustainability of the system and quality of life for their workers.

Sassaki (2007, p.8) believes that “no result regarding people with disability should be generated without complete participation of people with disability”.This is the basis of the motto “Nothing about us without us” created in 1986 in South Africa by William Rowland and adopted in many parts of the world by movements of people with disabilities or other kinds of special needs for which support is demanded (Sassaki, 2007). The same principle applies to people with epilepsy so that they are responsible for their own inclusion at school, work or any other social activities.

In this context, the Organizational Psychologist is responsible for acting as a facilitator for these processes to convene the subjects to participate as main actors, promoting actions that, according to Fernandes and Li (2006), aim at the reduction of stigma of epilepsy and can improve the relationship of everyone involved: 1. Create an information campaign aimed at the internal community such as shareholders, managers, colleagues, subordinates, HR, work physicians as well as the ecosystem where the company belongs - society, suppliers, clients etc; 2. Certify that employees with epilepsy should have adequate medical supervision, psychotherapy, support group as well as the support group for relatives and friends; 3. Provide access to continuous education programs to update healthcare professionals as well as providing access to managers and employees of HR that work directly with people development.

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Conclusion

Labor activity has a fundamental role in human development and insertion of people in the society where they live. Therefore it is important to include workers with any kind of disability, high abilities and giftedness, global development disorder, autism spectrum disorder, learning disorder and chronic diseases.

Nevertheless, the progress of the past few years in Brazil are the result of coercive actions - that foresee sanctions against companies that do not comply with Quota Law and that are dissonant to rules of diversity, inclusion, accessibility and Human Rights - due to the social conscience expansion.

To stop being considered invisible, the professional with epilepsy should make himself visible based on protagonist actions in favor of his needs. This effort may be managed by the Organizational Psychologist by legitimizing his actions in company or community environment, aiding him in the management of his FI which will naturally increase empathy for himself and for others, resulting in less stress and more satisfactory relationships.

Endowed with a holistic and integrative vision, the Organizational Psychologist is invited to assume the role of the conductor in the process of inclusion for the professional with epilepsy, orchestrating this performance with other professionals inside and outside the organization, giving voice and giving placement to the person, and adding knowledge in search for transdisciplinarity.

REFERENCES - ANEA, National Association of Supported Employment. Retrieved from http://www.aneabrasil.org.br/.

- Betti, A. P. & Sassaki, R. K. (2014) Perspectivas do Emprego Apoiado. Revista DI, Sao Paulo, n. 6, p.12-18, 2014. Retrieved from https://pt.calameo.com/read/0013472529726bb417588.

- Borges, M. A. et al. (2004) Urban prevalence of epilepsy: populational study in Sao Jose do Rio Preto, a medium-sized city in Brazil. Arq. Neuro-Psiquiatr., Sao Paulo , v. 62, n. 2a, p. 199204, June. Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004282X2004000200002&lng=en&nrm=iso.

- Brasil (2015). Law number 13.146, de 6/07/2015 deals with Brazilian Law regarding people with disabilities. Retrieved from http://www.planalto.gov.br/ccivil_03/_Ato2015-2018/2015/ Lei/L13146.htm.

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- Brazil (1991). Laws and Decrees. Law number 8.213 de 24/07/1991. Retrieved from http://www.planalto.gov.br/ccivil_03/leis/L8213cons.htm.

- Fernandes, P.T. & Li, L. M. (2006) Percepção de estigma na epilepsia. J. epilepsy clin. neurophysiol., Porto Alegre, v. 12, n. 4, p. 207-218, Dec. Retrieved from http://www.scielo.br/scielo. php?script=sci_arttext&pid=S1676-26492006000700005&lng=en&nrm=iso.

- Pless, N. M. & Maak, T. (2004) Building an Inclusive Diversity Culture: Principles, Processes and Practice. Journal of Business Ethics, vol. 54, no. 2, pp. 129–147. Retrieved from http:// diversity.cofc.edu/journal-articles/building-an-inclusive-diversity-culture.

- Salgado, P. C. B. & Souza, E.A. P. de. (2002) Impacto da epilepsia no trabalho: avaliação da qualidade de vida. Arq. Neuro-Psiquiatr., Sao Paulo, v. 60, n. 2B, p. 442-445, June. Retrieved from http:// www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2002000300019&lng=en&n rm=iso.

- Sassaki, R. K. (2014) Inclusão laboral mediante emprego apoiado. Revista Nacional de Reabilitação (Revista Reação), Edition n. 99, pp. 12-13, July/August. Retrieved from http://revistareacao. com.br/wp-content/uploads/2018/05/ED99.pdf.

- Sassaki, R. K. (2007). Nada sobre nós, sem nós: da integração à inclusão – Parte 1 Revista Nacional de Reabilitação (Revista Reação), year X, n. 57, Jul./Aug., pp. 8-16.

- Torres, A. R. R. (2008). Sentimento de Inadequação: Estudo Fenomenológico-Existencial, 153 p.

Dissertation (Master in Psychology), Catholic Pontifical University of Campinas, CampinasSP. - Torres, A. R. R. (2011). Sentimento de Inadequação, prática psicológica e contemporaneidade In: Angerami,V. A. (org.). Psicoterapia e Brasilidade. Sao Paulo, Cortez.

- WHO World Health Organization (2010). Mental health and development: targeting people with mental health conditions as a vulnerable group, 2010, 108p, ISBN: 9789241563949.

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4 Anxiety Disorders in Patients with Epilepsy Karina B. Batista Epidemiology

Anxiety disorders are highly prevalent, problematic comorbidities in people with epilepsy which are still sparsely understood and often undetected (Gandy et al., 2015). Although anxiety represents a substantial burden for those with epilepsy, it has received much less attention compared to depression and other comorbidities (Pham et al., 2017).

A Canadian study carried out by Pham et al., 2017 evidenced that subjects with anxiety reported more serious epilepsy seizures in comparison with subjects who had no anxiety and that the degree of deficiency associated with convulsions was higher among anxious subjects as opposed to nonanxious subjects. Not surprisingly, the anxiety was associated with epilepsy factors including seriousness of epilepsy, degree of incapacity associated with convulsions and side effects.

It is extremely important to understand the patientâ&#x20AC;&#x2122;s point of view regarding the disease since it can influence the development of a pathological anxiety. Scott, 2017 and colleagues found that patients who reported anxiety seemed more likely to overestimate the threat and consequences of epilepsyrelated diseases and risks. Because of this perception, participants displayed avoidant behaviors that interfered more and unnecessarily keeping them away from their social life and other activities. For some this involved withdrawal and isolation because of the fear of a negative judgement by others. In addition the fear of injury or seizures in certain situations resulted in agoraphobic behaviors. It is well documented that adults with epilepsy display high levels of anxiety, depression and suicide, indicating the negative initial impact of anxiety 38

(Stafstrom, Seidenberg, & Hermann, 2016). Depression is quite common among adults with epilepsy. However, anxiety disorders have attracted more attention in recent years, since anxiety and depression are frequently a mutual occurrence (Jones, 2014). In both anxiety and depression models, we observed that negative beliefs related to uncontrollability and the danger of preoccupation were the largest contributions (Fisher & Noble, 2017).

Mula, 2013 says that panic disorder (PD) seems to have a prevalence ranging from 5% to 10% among patients with epilepsy whereas generalized anxiety disorder (GAD) ranges between 3% to 12% in selected sample populations. Social anxiety seems to have prevalence rates ranging from 3% to 7%; posttraumatic anxiety disorder (PTSD) is reported in about 1% of patients; and obsessive-compulsive disorder (OCD) is reported in about 1% to 5% of patients.

In addition it is important to pay attention to the prevalence of such symptoms among children and adolescents. In particular children with epilepsy are at significant risk of developing disorders which in turn may impair the development of social skills, academic achievement, and quality of life. The most commonly reported psychiatric comorbidities in pediatric epilepsy are attention deficit hyperactivity disorder (ADHD), depression, and anxiety (Jones, 2014).

A study involving epileptic children carried out by Stafstrom et al in 2016 found that several recent-onset anxiety disorders were identified among children with epilepsy. Children with the disease in this sample population displayed higher rates of specific phobia (44% vs. 15.8%), separation anxiety (32% vs. 1.6%), social phobia (24% vs. 8.2%) and generalized anxiety disorder (20% vs. 1.1%) when compared with rates reported in the National Comorbidity Survey-Adolescent Supplement (NCS-A). This finding indicates that the rates of anxiety disorders are probably higher in children with epilepsy compared to young people in the general population.

Neurobiology

In terms of neurobiological perspectives on the development of anxiety in the context of epilepsy, there are shared pathogenic mechanisms including disruption of neurotransmitters serotonin, norepinephrine, glutamate and gamma-aminobutyric acid (GABA); inflammatory process of the central nervous system; neuroendocrine disorders; similar brain regions; and brain circuits in both disorders. This includes the amygdala and hippocampus (Jones, 2014).

39

Among a proportion of patients with focal epilepsy, the same regions involved for example, the amygdala and the hippocampus, also play a key role in the neurobiology of anxiety. The amygdala is key to the experience of fear.

It mediates endocrine and autonomic responses through the exit to the hypothalamus, and avoidance behavior through the exit to the periaqueductal gray. In addition, the hippocampus mediates the revival of fear and its affective component. The activation of these circuits is the main hypothesis for anxiety symptoms and the reduction of excessive output from these neurons is the main treatment target. This mechanism has several similarities with the typical excessive explosion of epileptic neurons thereby explaining the effects of antiepileptic agents (such as benzodiazepines or antiepileptic drugs) (Mula, 2013).

The study by Stafstrom et al., 2016 has found the following: significantly larger volumes of the left amygdala were found in the Epilepsy + Anxiety group; children with epilepsy and anxiety displayed a significantly thinner cortex in the left medial orbitofrontal region (compared to children with epilepsy but without anxiety). In this sample, Stafstrom noticed that children with a recent onset of epilepsy and anxiety had a significantly thinner cortex in the left frontal medial orbital, lateral right and in the right frontal regions considered part of the anterior prefrontal cortex. The prefrontal cortex has been implicated as a key player in the anxiety system particularly because it inhibits or modulates the pathway to the amygdala resulting in an extinction response.This reduction in cortical acuity may indicate that the prefrontal cortex is not developing similarly in comparison with healthy controls and children with epilepsy and without anxiety. Children with recent-onset epilepsy and anxiety were more likely to have focal epilepsy compared to children with epilepsy and without anxiety. However, significant cortical and subcortical findings were not associated with syndrome differences (focal vs. generalized) suggesting that such neurobiological differences are associated with anxiety and not with the epileptic syndrome.

In patients with temporal lobe epilepsy, ictal fear is often associated with epileptic discharges of the mesial temporal lobe â&#x20AC;&#x201C; ictal fear usually begins when the patient is still conscious, has a short duration of 0.5 to 2 minutes and is accompanied by other psychic auras, such as dĂŠjĂ vu and other hallucinatory phenomena but is not preceded by anticipatory anxiety as observed in panic attacks (Yacubian & Kochen, 2014). Magnetic resonance imaging also evidenced a link between atrophy of the amygdala and seizure focus in people displaying ictal fear (Stafstrom et al., 2016). Moreover, the unpredictability of the seizures and the sense of vulnerability associated with distorted thought patterns of risk overestimation and damage from seizures could theoretically increase the risk 40

of developing anxiety disorders (Mule, 2013).

Treatment

Treatments for anxiety disorders in epilepsy range from therapy to drugs. However, literature shows what tends to be more effective and in which way it should be used. Mule, 2013 says that cognitive-behavioral therapy (CBT) should be the first choice treatment for patients with epilepsy but not the only one (Table 1). A study by Scott et al., 2018 concluded that those who reported clinical levels of anxiety appeared to prioritize risk prevention therefore the adverse effects of the symptoms persisted. Since epilepsy is inherently unpredictable, individuals predisposed to low tolerance to uncertainty seemed to have a particular risk of developing anxiety in the context of their epilepsy.

This conclusion shows the importance of cognitive-behavioral therapy which uses treatment strategies such as confronting the situations feared by patients so that their fear is allowed to diminish gradually.

Still on Table 1, one can verify that the use of CBT is controversial in the treatment of some disorders. This is because a number of studies show it to be effective while others do not support this affirmation. Therefore, there is no certainty regarding the use of CBT in these cases.

Table 01. Treatment of anxiety disorders in epilepsy.

Disorder

Acute treatment

Long-term treatment

Panic Disorder

First Choice: SSRI * + CBT** Second Choice: TCAs*** + CBT

First Choice: SSRI + CBT or CBT (only)

Generalized Anxiety Disorder

First choice: Pregabalin Second choice: paroxetine, venlafaxine, imipramine CBT (controversial)

First choice: Pregabalin Second choice: paroxetine, venlafaxine, imipramine CBT (controversial)

Social Anxiety Disorder

First Choice: SSRI. CBT (controversial)

First Choice: SSRI. CBT (controversial)

Posttraumatic Stress Disorder

First Choice: SSRI. CBT (controversial)

First Choice: SSRI. CBT (controversial)

Compulsive-Obsessive Disorder

First Choice: CBT Second Choice: CBT + Sertraline Third Choice: CBT + Clomipramine

First Choice: CBT Second Choice: CBT + Sertraline Third Choice: CBT + Clomipramine

* Serotonin reuptake inhibitor. | ** Cognitive-Behavioral Therapy. *** Tricyclic antidepressants.

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Conclusion

There are few original studies involving effective treatments for anxiety disorders specifically geared to patients with epilepsy.

One research possibility would be to examine whether metacognitive beliefs predict that people with recent-onset epilepsy adjust to or experience persistent emotional distress (Fisher & Noble, 2017).

According to Mule 2013, clinical practice still depends strongly on the experience of individuals. In addition, anxiety disorders are still undertreated and poorly diagnosed. Therefore, it seems evident that research is urgently required to examine the nature of anxiety symptoms in epilepsy, and how they may differ from the nature of anxiety in primary anxiety disorders and anxiety symptoms found in other central nervous system disorders.

REFERENCES - Fisher, P. L., & Noble,A. J. (2017).Anxiety and depression in people with epilepsy:The contribution of metacognitive beliefs. Seizure, 50, 153–159. Retrieved from https://doi.org/10.1016/j. seizure.2017.06.012 - Gandy, M., Sharpe, L., Perry, K. N., Miller, L., Thayer, Z., Boserio, J., & Mohamed, A. (2015). Anxiety in epilepsy: A neglected disorder. Journal of Psychosomatic Research, 78(2), 149–155.

Retrieved from https://doi. org/10.1016/j.jpsychores.2014.12.002 - Jones, J. E. (2014). Treating anxiety disorders in children and adolescents with epilepsy: What do we know? Epilepsy and Behavior, 39, 137–142. Retrieved from https://doi.org/10.1016/j. yebeh.2014.06.021 - Pham, T., Sauro, K. M., Patten, S. B., Wiebe, S., Fiest, K. M., Bulloch, A. G. M., & Jetté, N. (2017). The prevalence of anxiety and associated factors in persons with epilepsy. Epilepsia, 58(8), e107–e110. Retrieved from https://doi.org/10.1111/epi.13817 - Scott, A. J., Sharpe, L., Hunt, C., & Gandy, M. (2017). Anxiety and depressive disorders in people with epilepsy: A meta-analysis. Epilepsia, 58(6), 973–982. Retrieved from https://doi. org/10.1111/epi.13769 - Scott,A. J., Sharpe, L.,Thayer, Z., Miller, L.A.,Wong,T., Parratt, K., & Nikpour,A. (2018).A qualitative examination and theoretical model of anxiety in adults with epilepsy. Epilepsy and Behavior, 85, 95–104. Retrieved from https://doi.org/10.1016/j.yebeh.2018.05.023 - Stafstrom, C. E., Seidenberg, M., & Hermann, B. P. (2016). NIH Public Access, 56(2), 283–290.

Retrieved from https://doi.org/10.1111/epi.12832.Children - Yacubian, E. M. T., & Kochen, S. (2014). Crises epilépticas Crises epilépticas, 97.

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5 Social Representations of the Causes of Epilepsy According to Psychologists Ester Maria Horta de Paula, Cláudio José Cobianchi & Julio Cesar Cruz Collares-da-Rocha

Epilepsy is a common condition that afflicts approximately 50 million people around the world (World Health Organization [WHO], 2018). The causes of epileptic crises involve factors such as individual predisposition, epileptogenic injury and biochemical alterations. The causes of epilepsy, however, involve “genetic and perinatal factors, developmental disorders, infectious diseases, toxic factors, trauma or physical agents, vascular, metabolic and nutrition disorders, degenerative and hereditary diseases” (Guerreiro, Guerreiro, Cendes and Lopes-Cendes, 2000, p. 5).

Within the interdisciplinary team involved in the diagnosis of epilepsy, the psychologist is one of the figures who acts, among other activities, in the neuropsychological evaluation. He composes the list of investigative procedures derived from its etiology (Wilson, Baxendale, Barr, Hamed, Langfitt, Samson, Watanabe, Baker, Helmstaedter, Hermann and Smith, 2015). In spite of the participation of Psychology in the diagnosis and treatment of epilepsy, we believe that some psychologists might not be aware of the factors which cause this condition.

The aim of this research was to get to know the social representation of the causes of epilepsy among psychologists. Serge Moscovici, who created the Social Representation Theory (SRT) from Durkheim’s concept of collective representation (Moscovici, 2012). Jodelet (2001, p. 22) defined social representations (SR) as “a form of knowledge, socially elaborated and shared, with a practical objective, that contributes to the construction of a common 43

reality to a social set.”

Amongst the research conducted in SR about epilepsy, Moreira and Souza Filho (2003) investigated the SR of the person who has epilepsy and identified that the discourse of such an individual was inserted into a stereotyped behavior, saturated by prejudice and discrimination which, according to the authors, would be the reflection of individual and collective thinking. Moreira and Morya (2003) realized a comparative study between the social representation of epilepsy and of AIDS, and interpreted that in both of them there is the notion of biological contamination and forms of social contamination, emerging ideas of estrangement and isolation of the individuals who have these diseases.

Method

This was an exploratory and qualitative research.The participants were 40 male and female psychologists, from the metropolitan region of São Paulo, who had no experience in clinical care with patients who have epilepsy. They were contacted via snowball method. The questionnaire used in this research consisted of one question about the possible causes of epilepsy, followed by information about the characterization of the participants. Data collection took place between September-November 2007, individually, when each participant signed an informed consent and then answered the questionnaire. The first question went through a content analysis (Bardin, 2011) and the following went through a descriptive analysis (frequency and percentage).

Results

The characterization of the participants showed that 32 (80%) of them were female; 17 (42.5%) had a graduate degree; 15 (37.5%) had 1 to 5 years of experience; and 31 (77%) reported clinical experience as predominant.

The content analysis for the SR of the causes of epilepsy resulted in the subsequent themes, followed by examples: (1) Organic aspects in general: when organic aspects in general were mentioned as causes of epilepsy. Example: “I believe it is the ingestion of contaminated food”; (2) Neurological aspects: when the causes of epilepsy were associated to neurological/cerebral factors.

Example: “I believe it is a neurological factor, where when there is a crisis, there is a discharge of energy”; (3) Heredity/Genetics: when the causes of epilepsy where associated to genetics or heredity. Example: “Genetic (heredity)”; 44

(4) Interaction of organic and psychological variables: when the interaction of psychological/emotional and organic factors were mentioned. Example: “Something organic that might be triggered even by emotional issues”; (5) Mental and/or psychiatric disorders: when mental or psychiatric disorders were listed as causes of epilepsy. Example: “Issues related to mental disorders”; (6) Uncertain: when there was uncertainty about the causes of epilepsy. Example: “I think the real causes weren’t defined yet but it is possible that they are multifactorial”; and (7) Without knowledge: when the participant informed they did not know the possible causes of epilepsy. Example: “I’m not certain of the causes.”

Discussion

In the SR of the causes of epilepsy, the participants mentioned contents ranging from organic aspects to mental disorders as well as presented doubts about the possible causes. In this respect, Moreira and Souza Filho (2003) observed in their study that the diversity of the contents related to the causes of epilepsy were relative to the individual aspects of each subject as we could also recognize in the group under discussion.

Fernandes and Li (2006) pointed out that the lack of information about epilepsy is one of the factors which contribute to the perpetuation of the stigma in society, and that it is present in most people, especially in regards to the definition of epilepsy, its causes, existent kinds of treatment, and procedures during crisis.

Final Considerations

The aim of this research was to get to know what would be the social representations of the cause of epilepsy according to psychologists.The content analysis allowed us to identify that the participants have a dispersed knowledge about the causes of epilepsy, and that it would indicate that we are facing a common sense about the subject and not a specialized/reified knowledge. Such a result emphasizes the need for the approach to epilepsy to be more widely taught in Psychology training, so that the professionals can understand this disease from a specialized/reified point of view and even contribute to the reduction of the social stigma that still exists.

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REFERENCES - Bardin, L. (2011). Análise de conteúdo. São Paulo: Edições 70.

- Fernandes, P. T., & LI, M. L. (2006). Percepção de estigma na epilepsia. Journal of Epilepsy and Clinical Neurophysiology, 12(4), 207-218. doi: 10.1590/S1676-26492006000700005 - Guerreiro, C. A. M., Guerreiro, M. M., Cendes, F., & Lopes-Cendes, I. (2000). Considerações Gerais. In C. A. M. Guerreiro, M. M. Guerreiro, F. Cendes, & I. Lopes-Cendes, (Eds.), Epilepsia (pp. 1-10). São Paulo: Lemos.

- Jodelet, D. (2001). Representações sociais: um domínio em expansão. In D. Jodelet. (Ed.), As representações sociais (pp. 17-44). Rio de Janeiro: EDUERJ. - Moreira, A. S. P., & Moriya, T. M. (2003). Aspectos psicossociais da epilepsia e da AIDS: representações sociais intergrupos. In A. S. P. Moreira & J. C. Jesuíno, (Eds.), Representações sociais: teoria e prática (pp. 205-213). João Pessoa: UFPB. - Moreira, A. S. P., & Souza Filho, E. A. (2003). Representação social da epilepsia e intergrupalidade.

In A. S. P. Moreira & J. C. Jesuíno (Eds.). Representações sociais: teoria e prática (pp. 189212). João Pessoa: UFPB. - Moscovici, S. (2012). A psicanálise, sua imagem e seu público. Petrópolis:Vozes.

- Wilson, S. J., Baxendale, S., Barr, W., Hamed, S., Langfitt, J., Samson, S., Watanabe, M., Baker, G. A., Helmstaedter, C., Hermann, B. P., & Smith, M. (2015). Indications and expectations for neuropsychological assessment in routine epilepsy care: Report of the ILAE Neuropsychology Task Force, Diagnostic Methods Commission, 2013–2017. Epilepsia, 56(5), 674-681. doi: 10.1111/epi.12962 - World Health Organization (2018, February 8). Epilepsy. Retrieved from: http://www.who.int/en/ news-room/fact-sheets/detail/epilepsy.

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6 The Importance of the Psychotherapy Process in the Resignification of Being Diagnosed with Epilepsy: The View of Gestalt Therapy Valquíria Gonçalves Ferreira Silva Introduction

The process of identifying poor health or illness is not easy, since it involves not only the existence or non-existence of symptoms, but also the ways in which each of them manifests according to the occurrence of a particular disease. In 1946, the World Health Organization defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease.” This definition has been under discussion lately. Currently there are several theoretical approaches required in order to understand disease or health as an individual process which cannot be explained by mere concepts alone.

Receiving the diagnosis of a chronic condition is difficult for the patient and when it comes to epilepsy, we know that this is a moment marked by much anguish. This is because epilepsy is still an unknown condition to many people and is marked by a high degree of prejudice.

The main objective of this chapter suggests that the psychotherapy process according to the view of Gestalt therapy can be a valuable resource to help epileptics give new meanings to their treatment, their ways of responding to it and how they see themselves in the face of epilepsy. Since we could not find journal articles or books with case studies cases which describe the use of Gestalt therapy with epileptics, we chose references which discuss Gestalt therapy used for other diseases and disorders such as renal failure, bipolarity, 47

dementia, and other conditions instead.

Some Concepts of Gestalt Therapy

The theoretical background of this topic was the process of psychotherapy involved with Gestalt therapy. Gestalt therapy is a psychological approach created by Frederick Perls that bases its view of humankind on phenomenology, humanism, and existentialism.

According to Ribeiro (1985, p. 29), “Gestalt therapy stands alongside humanistic psychotherapies, which means that it contains and promotes the idea of man as the center, as a positive value, capable of self-managing and regulating.” For this approach, the human being is the focus of all attention, and it aims to make the person reestablish contact with themselves and with the world.

The need to understand the individual from their subjectivity and singularity emerges due to the influence of Existentialism. Ginger and Ginger (1995, p. 36) emphasize that: [Everything that concerns how the man experiences, assumes, guides, and directs his existence can be considered ‘existential’. . . The notion of responsibility of each individual who actively participates in the construction of his/her existential project and attributes an original meaning to what happens and to the surrounding world, creating, inevitably, each day, his/ her relative freedom.]

Therefore, it can be said that each individual is seen as unique, and thus emerges the need to always take into account the particularities and possibilities of growth and development of each one.

Ginger and Ginger (1995) claim that due to the influence of phenomenology the how is more important than the why. That is the reason why Gestalt therapy seeks the essence of the phenomenon through phenomenological reduction and not the explanation of the reasons why a given behavior happens.

Ribeiro (2011) argues that Gestalt therapy bases its worldview in holism. According to it, people and the world follow three principles: everything is a whole; everything changes; everything is related to everything. According to this view, the man is a being in constant evolution and in relation to it. As such what changes in a context will make a difference in other related parts.

The author also highlights that the world and life are constituted by circles or 48

gestalt, where there is a constant movement of closures and openings of cycles.

The concept of self-regulation from Gestalt therapy is based on Kurt Goldstein’s organismic theory. In this theory, the human being is seen as a whole, and self-regulation is the way by which the organism manages to interact and adapt itself to the world, respecting its limits and the individuality of each person. That way, “an organism gets deregulated when strength and abilities for which it is not prepared are demanded of it.” (Ribeiro, 2006, p. 67) Due to its holistic view and to the concept of self-regulation, Gestalt therapy understands the man as a biopsychosocial being, in which there is total interaction between environment, body, and mind.

The main objective of the process of psychotherapy from Gestalt therapy is for the client to become aware of themselves and of their actions.

This awareness is not only about knowing something. it has to go beyond that, making a complete involvement of the client beyond simply understanding why.

Perls (1988, pp. 77-78) emphasizes that: [The ‘becoming aware’ provides the patient with the understanding of his own skills and abilities, of his sensory, motor, and intellectual equipment . . . It is not about the consciousness . . . the ‘becoming aware’ provides something more to the consciousness . . . That is because the ‘awareness’ develops only in the present. It opens possibilities to the action.]

Epilepsy

Epilepsy is a chronic condition characterized by recurrent epileptic seizures, resulting from the hyper excitability and/or hyper synchronism of brain neurons. Due to its high incidence, nowadays many researchers consider epilepsy as the most common brain disorder. It is believed that people with epilepsy make up 1 to 2% of the world population (Oliveira, Parreiras, & Doretto, 2007).

The treatment of epilepsy is usually conducted with antiepileptic drugs aimed at preventing the occurrence of seizures. The choice of medication is realized individually, considering the type of seizure, the efficiency of the medication, and the side effects (Yacubian, 2006).

Most people can achieve total or partial decrease or total control of the seizures with the regular use of medication. Epilepsy might require treatment for many years and sometimes during the person’s entire life, thus needing involvement from the person with epilepsy throughout treatment and constant medical supervision.

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Studies have pointed out that people with epilepsy might have lower quality of life, as there is the need for continuous medication use in addition to the occurrence of seizures (Rizzutti, 2007). This decrease in quality of life might be associated with the side effects of the medication, and mainly to social and psychological issues. Nowadays the treatment of epilepsy is being performed sometimes with a multiprofessional team, in which not only the seizures are treated but also what happens with the person with epilepsy. The person needs to get involved with the treatment not in a mechanical way but rather in a conscious way. However, so far, the involvement of the person with the treatment and the psychological process are not sufficiently explored.

The Relation between Gestalt Therapy and Epilepsy Treatment

In the moment of getting sick, people commonly get desperate and many times become sad, believing that the diagnosed disease will be the end of everything. That is why it is important that the doctor, when diagnosing epilepsy, does not restrict themselves only to the disease. They must also value that specific person and show them that even though the seizure lasts some minutes, they will have time without seizures during which they will be able to enjoy a healthy life (Fonseca & Mariano, 2007).

Yontef (1998, p. 216) claims that “awareness is accompanied by acceptance, namely, the process of knowing one’s own control, the choice and the responsibility by one’s own feeling, and by their behavior”. For this reason, when the process of awareness occurs, the individual becomes responsible for their acts and actions. Since epilepsy usually requires a prolonged treatment, the person with this diagnosis needs to be aware of their role in the treatment, using the medication correctly and accepting the treatment.

In order to the medication be accepted and correctly used by the subjects, it is important that they know the purpose of the treatment and the risks of not using the medication properly. As Rizzutti (2007) states, when the person understands what their medication is intended for and what is its importance, they will be able to understand that using the medication is better than having frequent seizures.

Yontef (1998, p. 236) highlights that awareness “is the means by which the individual manages to regulate themselves.” Since one of the objectives of the process of psychotherapy of Gestalt therapy is self-regulation, the person with epilepsy can, over time, better understand themselves and, as a consequence, have better control of what happens. It is important to highlight that this does not mean to have control of the epileptic seizures to the point of 50

letting them happen or not but rather a way of understanding what can trigger the seizures and thus keep themselves better regulated.

Studies have pointed out that external, psychosocial factors, and even psychiatric disorders (Oliveira, Parreiras, & Doretto, 2007) are associated to the frequency of epileptic seizures. Once the person is aware of these factors, they need to be avoided whenever it is possible, so that the seizures can be better controlled. There is not a way for the person with refractory epilepsy to shield themselves from all the factors that cause seizures yet but with the development of the self-regulation, an adaptation to the treatment might happen. As Ribeiro (2006, p. 41) points out, “self-regulation means to respect the functional totality of the organism, it means to look at yourself and behave as an organized and efficient whole.”

The individuals with epilepsy need to adapt themselves to a new way of life because of the treatment, and might also find difficulties in their social adaptation. This is mainly due to the fact that epilepsy is still a disease fraught with prejudice.

With regard to the difficulties and limitations experienced by individuals because of the disease, Silva and Motta (2012) verified that those individuals completely modified their lives, and now have physical, social, and occupational restrictions. The same authors affirm that the psychologist must act with the objective of lessening the impact that the disease causes in the individual and their relatives, fulfilling their role in the psychic restructuring of people affected by the disease as well as in treatment maintenance.

Perls (1977, p. 96) gives a new concept to the word responsibility.

According to him, responsibility can be understood as “the ability to answer: to have thoughts, reactions, and emotions in a given situation.” This responsibility makes the person have autonomy and respond for themselves and for their acts, thus starting to value themselves. When a significant knowledge of themselves and of the disease that affects them is acquired, the person might become more aware of what they are not allowed to do because of the restrictions of the disease.

When an epileptic seizure happens, some manifestation in the body might occur, such as convulsions and spasms (Fontenelle & Pires, 2006). This occurrence might leave the person embarrassed and even scared of feeling other manifestations in their body. Ribeiro (2006, p. 97) reinforces that “my body is my totality, feeling, thinking, doing, speaking” therefore “these functions are correlated, they have an ontological contractual complicity, one cannot function without the other.” As Gestalt therapy considers the feeling, during the psychotherapy process the person might receive the awareness of their own body and through the contact recognize themselves as a unique being that 51

has limitations, and also qualities.

Final considerations

Being diagnosed with a chronic condition especially epilepsy can bring several consequences however each person will have a reaction and that will depend on how they are psychologically and what social mediations they have.

Most people with epilepsy are not psychologically prepared for this process, since for some of them the treatment might last their entire lifetime.

Since Gestalt therapy is a psychological process based on existentialism, humanism, phenomenology, and holism, its use in people with epilepsy can be very useful. The use of this approach will not treat the disease nor seek explanations of why it happened, but attention will be given to the person as a whole and all their specificities and particularities. Gestalt therapy, through its methodology of awareness, can provide the person the perception of themselves, their body, their feelings, and their context as a whole, thus having a better control of the imminence of a seizure to be able to manage themselves to avoid as well as to better deal with it once it is over.

Through a psychological process that considers the person and does not reduce them to a disease, the person with epilepsy can be aware that their life is not only about it, thus expanding their view of the world and of responsibility about their life and actions. When recognizing that life is in constant movement and that the person is always in self-regulation, the person with epilepsy will understand that there is not only a passive role for them to perform in the world.

Within Gestalt psychotherapy, the therapist can to help the person with epilepsy to understand their symptoms in the context of the field of their contact with the environment at the moment, that is, as an interruption in their flux of contact, and consequently promote a process of awareness, causing this flux to return and the closure of open gestalts occurs, be it related to what concerns the epilepsy and its psychosocial consequences or the person’s life in general.

REFERENCES - Fonseca, L. F., & Mariano, S. C. (2007). Humanizando o momento do diagnóstico. In Albuquerque, M. de, & Cukiert, A. Epilepsia e qualidade de vida (pp. 21-26). São Paulo: Alaúde Editorial.

- Fontenelle, L. da C., & Pires, L. de C. (2006). Epidemiologia e definições. In Melo, A. N.,Yacubian,

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E. M. T., & Nunes, M. M. L. Crises epilépticas e epilepsias ao longo da vida: 100 questões práticas (pp. 11-18). São Paulo: Segmento Farma.

- Ginger, S., & Ginger A. (1995). Gestalt: uma terapia de contato. São Paulo: Summus.

- Oliveira, B. L.M. B., Parreiras, M. S., & Doretto, M. C. (2007). Epilepsia e Depressão: Falta diálogo entre a Neurologia e a Psiquiatria? Journal of Epilepsy and Clinical Neurophysiology, 13(3), 109-113. Retrieved from http://www.scielo.br/pdf/jecn/v13n3/a04v13n3.pdf - Perls, F. S. (1977). Gestalt-terapia explicada. São Paulo: Summus.

- Perls, F. S. (1988). A abordagem gestáltica e testemunha ocular da terapia. Rio de Janeiro: Guanabara.

- Ribeiro, J. P. (1985). Gestalt-terapia: refazendo um caminho. São Paulo: Summus.

- Ribeiro, J. P. (2006).Vade-mécum de Gestalt-terapia: conceitos básicos. São Paulo: Summus.

- Ribeiro, J. P. (2011). Conceito de mundo e de pessoa em Gestalt-terapia: revisitando o caminho.

São Paulo: Summus.

- Rizzutti, S. (2007). Impacto do tratamento antiepiléptico na qualidade de vida. In Albuquerque, M. de, & Cukiert, A. Epilepsia e qualidade de vida (pp. 75-108). São Paulo: Alaúde Editorial.

- Silva, R. M., & Motta R. F. (2012). A psicologia e o processo de adoecimento nos pacientes renais crônicos. Disciplinarum Scientia, 13(2), 13-150. Retrieved from: https://www.periodicos. unifra.br/index.php/disciplinarumCH/article/view/1734/1638.

- Yacubian, E. M. T. Tratamento das crises epilépticas e epilepsia. (2006). In Melo, A. N.,Yacubian, E. M. T., & Nunes, M. M. L. Crises epilépticas e epilepsias ao longo da vida: 100 questões práticas (pp. 69-76). São Paulo: Segmento Farma.

- Yontef, G. M. (1998). Processo, diálogo e Awareness – ensaios em gestalt-terapia (E. Stern, Trad.).

São Paulo: Summus.

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7 The Psychoeducation for Teachers of Children with Epilepsy Denise Almeida Wendland Epilepsy in Childhood

Epilepsy is considered a serious and frequent neurological disease (Fernandes et al., 2013; Winckler & Melo, 2016; Castro & Adda, 2012) marked by epileptic seizures that signal changes in the electrical activity of the brain and affect both cerebral hemispheres, taking place by means of excessive and transient neuronal discharges in the cerebral cortex (Winckler & Melo, 2016). It is an early-onset disease since 90% of epileptics can have their first seizure under the age of 20 (Winckler & Melo, 2016) in other words, by school age. Research points out that epilepsy can cause severe cognitive impairment affecting learning (Castro & Adda, 2012; Fluentes et al., 2014; Fernandes & Souza, 2004; Kremer et al., 2017; Nolan et al., 2004) and social interaction (Fernandes & Souza, 2004).

Epilepsy manifests with the excessive and uncontrolled activity of part or the entire nervous system caused by a cerebral bioelectric imbalance or a demonstrable pathology. Epilepsy presents a large variety of manifestations of symptoms and effects. It may manifest as absence seizures, â&#x20AC;&#x153;nervous ticsâ&#x20AC;?, impaired consciousness or behavior, as well as psychological and emotional problems. The early onset of seizures could interfere with the development of the brain, and in the long term, it could affect cognition (Winckler & Melo, 2016).

Therefore, it can cause a range of impairments from intellectual deficits or a mental illness to cognitive, speech and behavioral impairments, or aggression (Oliveira, 1999).

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School Difficulties

In childhood, epilepsy can be a risk factor for school difficulties (Winckler & Melo, 2016, Fluentes et al., 2014, oliveira, 1999, Ciasca & Lima, 2017).

In children, school difficulties may not only be caused by epilepsy but also by a sum of psychological factors such as the quality of education, poor perspective from parents and teachers regarding the child’s performance, low self-esteem and rejection from teachers and colleagues. The physical and psychological detachment generated by stigma and prejudice increases the emotional burden for the epileptic child. It is indispensable that all persons involved, especially psychologists (Oliveira, 1999), neuropsychologists and teachers know the causes and effects of the pathology.

Several studies point out that learning difficulty is the most frequent complaint in teachers’ referrals for child evaluations (Ciasca, 2003; Machado & Proença, 2004; Lima et al., 2006). A study carried out with children referred for multidisciplinary evaluations reported that of 100 referrals, 46% were prompted by learning difficulties, 19% by attention and memory difficulties, and 15% were due to behavior problems (Lima et al., 2006).

Epilepsy is a fundamentally clinical diagnosis, in other words, the diagnostic is based on information offered by the patient or the person accompanying them. In addition, in order to safely diagnose the condition, the doctor may request clinical and neurological examinations, a neuropsychological assessment and supplementary tests. The neuropsychological assessment can help diagnose cognitive impairment, contribute to the understanding of the neurological condition and assist in treatment decisions, with a view to understanding the educational and psychosocial problems related to cognitive impairment (Table 1). It also monitors the effects of medication or of epilepsy on cognition, as well as the impact of cognitive dysfunctions in daily life (Fernandes & Souza, 2004).

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Table 01. Electro clinical syndromes in childhood Types of epilepsy

Age range

Cognitive impairments

Epilepsy Rolandic

Age 3 to 10, peak onset at age 8

Executive Functions Language Memory Learning difficulties in about 20 to 30% of children

Temporal lobe epilepsy

Onset habitually during adulthood, but there may be an initial event in childhood.

Attention Memory Language Executive Functions Visuospatial Abilities Behavior and learning disorders.

Juvenile myoclonic epilepsy

Starting peak between ages 14 and 16 , may vary from age 8 to age 26.

Working memory Executive Functions Deficits in tasks that require answers to verbal questions and complex motor performance

Source: Based on Fluentes et al. (2014).

A neuropsychological assessment is also required if surgery is to be performed to treat epilepsy. Assessments are made before and after the surgical procedure.Therefore, the role of the neuropsychologist is fundamental to the investigation of cognitive components secondary to epilepsy, the antiepileptic medication and the evaluation of cognitive potentials and deficits before and after surgery (Fernandes & Souza, 2004). Demand is on the increase for neuropsychological assessments and they have become popular in clinical practice.

Epilepsy can cause cognitive impacts on brain development. It is up to the neuropsychologist to assess the child to ascertain the cognitive, affective and behavioral potentials and impairments. In addition, they can provide guidance to the family and school since it is vital that the child receives the necessary support, both in the family and school settings. The neuropsychologist can use psychoeducation (Malloy-Diniz et al., 2016), to clarify what epilepsy is and what care must be provided to the student.

Psychoeducation

Psychoeducation is one of the means used in psychotherapy as strategy 56

for change and its objective is to increase knowledge about the patient, the family’s knowledge about the disorder, symptoms and resources that may be available to deal with deficits resulting from the disease, and with the side effects of medications (Cordioli & Giglio, 2008).

The child with epilepsy requires special care so it is important for the educator to know the disease and to receive guidance so as not to be scared in the event of a seizure (Relvas, 2011) and to help students understand what is happening with the child. Fundamental information to educators includes: • Explain that epilepsy is one of the most common neurological diseases in the world. The most common type manifests as convulsions. The epileptic seizure usually lasts a few seconds or minutes. It is a temporary and reversible event. At the end of the seizure, the brain returns to normal functioning. Therefore, it is essential that the educator remains calm.

• Information about what to do when faced with an epileptic seizure the educator must calm down the other children. Remove anything that could hurt the child. Assist the child by turning his body to the side and keeping the head lowered so that the saliva can flow out of the mouth.

Wait until the seizure is over. Once the child is conscious, explain that they have had a seizure. During or after the seizure, contact the family and report the incident. If the seizure lasts longer than five minutes, take the child to the emergency room or call the ambulance service (Matck, 2013). Explain to the class what happened. The educator must prepare the class to accept their colleague without any hostilities. The educator may use children’s books addressing differences as well as group dynamics for integration.

• If the child is slow to learn, the educator can overcome this by using real experiences, encouragement and motivation, praise and reward as well as individual attention. In addition, educators should follow a few principles: accept the child as they are; be patient; give them confidence; find out what skills they have. The educator must be prepared to find a diversified class, adjusting work to the class to enable each student to achieve maximum development (Relvas, 2011).

Conclusions

Epilepsy may manifest in childhood and can cause severe cognitive impairment and affect learning. Educators and school staff should receive adequate information about epilepsy which may be provided by the neuropsychologist through psychoeducation.

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In addition to the neuropsychological evaluation of children with epilepsy, the neuropsychologist can help the educator understand epilepsy, how seizures occur and what cognitive aspects may be impaired thus seek strategies with the educator to overcome such difficulties. We conclude that through psychoeducation it is possible to transmit adequate knowledge favoring the child’s academic performance and reducing prejudice.

REFERENCES - Castro, L. H. M. & Adda, C. C. (2012). Distúrbios cognitivos nas epilepsias. In. Miotto, E. C., Scaff, L. M (Coord.). Neuropsicologia Clínica (pp. 118-126). São Paulo: Roca.

- Ciasca, S.M. (2003) Distúrbios de Aprendizagem: Proposta de Avaliação Interdisciplinar. São Paulo: Casa do Psicólogo.

- Ciasca, S.M & Lima, R.F. (2017). O que são Transtornos de Aprendizagem (TA)? In: Lima, R.F & Silva, C.P (Coord.).Abordagem interdisciplinar dos Transtornos do Neurodesenvolvimento: guia de orientação aos pais e educadores (pp. 29-38). Ribeirão Preto, SP: BookToy - Cordioli, A.V. & Giglio L. (2008). Como atuam as psicoterapias: os agentes de mudança e as principais estratégias e intervenções psicoterápicas. In. Psicoterapias: abordagens atuais (pp.

43-73). Porto Alegre: Artmed.

- Fernandes, C. et. al. (2013). A transdisciplinaridade promove o conhecimento da epilepsia e educação na escola. In. Journal of Epilepsy and Clinical Neurophysiology, 19 (2), 32-37.

Retrieved from: http://bdpi.usp.br/item/002482949.

- Fernandes, P. T. & Souza, E. A. P. (2004). Percepção do Estigma da Epilepsia em professores do ensino fundamental [online]. Rev. Estudos de Psicologia, 9(1), 189-195. Retrieved from: http://www. scielo.br/pdf/epsic/v9n1/22394.pdf.

- Fluentes, D. et. al. (2014) Avaliação Neuropsicológica aplicada às epilepsias. In. Fluentes, D. [et. al] (Coord.). Neuropsicologia. (2ª ed). Porto Alegre: Artmed.

- Kremer, C.A., Souza S. R & Oliveira A. D. (2017). “Meu cérebro é morto”: relato de experiência sobre um caso de Epilepsia. [online] Educa Revista Multidisciplinar em Educação, 4 (9)32 a 47. Porto Velho, Sep/Dec. Retrieved from: http://www.periodicos.unir.br/index.php/ EDUCA/article/ view/2958 - Lima, R.F, Mello, R.J.L, Massoni, I. & Ciasca, S.M. (2006). Dificuldades de Aprendizagem: queixas escolares e diagnósticos em um serviço de Neurologia Infantil [online], 14(4): 185-190. Rev. Neurociências. Oct/Dec. Retrieved from: http://www.revistaneurociencias.com.br

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- Machado, A.M. &Proença, M. (2004). A queixa escolar e o predomínio de uma visão de mundo.

In: Machado, A.M & Proença, M. (Coord.). Psicologia escolar: em busca de novos rumos. São Paulo: Casa doPsicólogo.

- Malloy-Diniz, L.F., Mattos, P., Abreu, N. & Fluentes, D. (2016). O exame neuropsicológico: o que é e para que serve? In: Malloy-Diniz, LF [et.al]. Neuropsicologia: aplicações clínicas (pp. 2134). Porto Alegre: Artmed.

- Matck, M. [et. al]. (2013). Epilepsia. In:Li Li Min [et. al] (Coord.).Tecla Sapiens: Neurociências para todos. Campinas, SP: Curt Nimuendajú.

- Nolan, M.A, Redoblado, M.A & Lah, S. et. al. (2004). Memory function in childhood epilepsy syndromes, (40), 20-7. J. Paediatric Child Health. Retrieved from: https://www.ncbi.nlm.nih. gov/pubmed/14717999.

- Oliveira, M.A.D. (1999). Epilepsia. In: Neurofisiologia do comportamento (pp. 205-220). Canoas: Ed. Ulbra.

- Relvas, M.P. (2011). Neurociências e transtornos de aprendizagem: as múltiplas eficiências para uma educação inclusiva. (5 ed). Rio de Janeiro: Wak. - Winckler, M. I. B & Melo, J. F.V. (2016). Aprendizagem e Epilepsia. In. Rotta, L. O. & Riesgo, R. S. Transtornos de aprendizagem: abordagem Neurobiológica e multidisciplinar (pp.414-426), (2ª ed). Porto Alegre: Artmed.

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8 Should Epilepsy Be Disclosed? Perceptions of Stigma in Patients with Epilepsy Carolinne Yuri Tagami

It is often the case that people with epilepsy do not reveal their condition for fear that it may lead to discrimination and social isolation. It then follows that it is important to understand the feelings epilepsy imprints on individuals. This study was based on answers to three essay questions. “What is epilepsy for you?”;“How do you feel about talking with other people about your epilepsy?”; “What are your impressions on what people think about epilepsy?”

The questions were posed at the Neurology Clinic of the Hospital de Clínicas da Universidade Estadual de Campinas (HC-UNICAMP). Understanding people’s feelings about the condition could lead to the development of strategies to minimize the impacts that stigma has on patients.

Introduction

The Reinforcement Contingency History, or RCH, is an investigation of an individual’s past behaviors and events. It identifies and itemizes aspects of reinforcement repertoires (Guilhardi, 2013). RCH enables us to functionally observe and analyze behaviors and have a better understanding of present aspects.

Challenges faced by persons with epilepsy include fear of revealing the condition, which may be related to each patient’s repertoire, the unpredictability of the seizures and the stigma it carries. Stigma comes from an expectation, a prejudice, or even a mark defined by society (Goffman, 1988).What an individual 60

hears throughout their lifetime can also influence their behavior toward the disclosure of their condition. In this context, we can say that this verbal behavior is an instrument used to highlight the meanings, thoughts, ideas, propositions, emotions, needs and desires that an individual is expressing thus understanding the influences they have had throughout his or her history (Vandenberghe, 2004).

Variations in an individual’s behavior are selected according to their consequences and define whether they are able to disclose their epilepsy. This willingness depends on the individual’s background, life story and previous experience with similar situations. According to Baum (2006), to consider a behavior is not only to look at the actions of a body but at the whole set of relationships that take place internally and externally to the patient.

Self-esteem, self-confidence and responsibility are feelings associated with an individual’s ability to feel free, loved, and to take initiatives (Guilhard, 2002). The absence of these conditions can have a direct influence on people’s lives because of their impact on the behavior and quality of life of both the patient and their family (Jacoby & Austin, 2007). The decision to disclose the diagnosis of the condition is a complex one and carries several characteristics for the person with epilepsy (Benson, 2015). In this case, while the seizures are under control, the individual has the freedom to decide whether to reveal their condition and to decide the most adequate moment and to whom they wish to reveal this information (Troster, 1997). Therefore, it is important to understand situations that can lead to social isolation. Thus, this study investigated the relationship between social verbal behavior, the perception of stigma among people with epilepsy, and what feelings their condition elicits.

Methodology

Qualitative analysis carried out at the Neurology Clinic of Hospital de Clínicas da Universidade Estadual de Campinas (HC-UNI-CAMP). Approved by the Ethics Committee of the College of Medical Sciences. CAAE number: 66963417.3.0000.5404. All selected volunteers filled the informed consent form.

The research was carried out by way of a questionnaire adapted from Troster (1997) consisting of three open-ended questions related to the impact of epilepsy on the individual. In order to enable a qualitative investigation of a person’s perception of epilepsy, the questions were “What is epilepsy for you?”

“How do you feel about talking with other people about your epilepsy?” “What are your impressions on what people think about epilepsy?”

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Criteria for inclusion in this investigation were men and women undergoing treatment at the epilepsy clinic, aged 18-60. Subjects who did not fall within the criteria for inclusion in the investigation were not allowed to participate in the study; neither were patients with comorbidities that could influence data collection, in accordance with clinical recommendations of patients with epilepsy.

Results and Discussion

Participants included 120 persons with epilepsy (55% women), aged 18-70, of whom 29% (35 patients) had their first seizure after the age of 20, 81% (94 patients) had an average of zero to four seizures in the month before the investigation, and 76% (87 patients) considered their epilepsy seizures to be under control.

What is epilepsy for you?

Responses were classified according to nine themes: Undefined; Correct Knowledge; Beliefs; Disease; Metaphor; Negative Feelings; Limiting Feelings; Positive Feelings; and Symptoms.

During the interview, about 26% (32 patients) defined epilepsy as a “disease” associating it with the classification transmitted by their doctor during consultation, or at epilepsy information group meetings held at waiting rooms. In the latter case, we noticed the same repertoire coming from group facilitators. Communication from both information groups and physicians is of paramount importance in the dissemination of information about epilepsy to individuals, enabling the production and proliferation of knowledge about their own condition.

About 19% (23 patients) reported “negative feelings” associated with fear-, prejudice- or sadness-related experiences brought by epilepsy. Some patients say “It’s the saddest thing in the world,” “It mixes up one’s mind,” among other things. About 12% (15 patients) reported “limiting feelings” associated with the disease, which hampers and limits patients.

If prior events occur differently from expected, they may evoke negative and limiting feelings in patients. Guilhardi (2002) associates the feelings of selfesteem, self-confidence and responsibility with an individual’s capacity to feel free, loved and to take initiatives.The absence of any of these feelings can affect individuals in their social interactions in a number of ways. A few examples of limiting patient narratives are “it is something that affects one’s actions”, 62

“something that affects my ability to learn”, “it has put my life to waste,” among other things. Epilepsy-related experiences that evoke feelings in persons with the disease reinforce an individual’s behavior of choosing to conceal their condition, so as not to develop other negative feelings about epilepsy. The environment that surrounds the individual models and upholds this verbal behavior (Skinner, 1969b).

How do you feel about talking with other people about your epilepsy?

This was classified according to ten themes: Does not talk about epilepsy; Embarrassment; Disease; Only to persons who are close; Indifference; Informative; Fear; Prejudice; Sadness; and Good feelings.

According to investigations by Troster (1997) involving willingness to disclose epilepsy, there is no exact probability that a person with epilepsy will or will not disclose their condition.This willingness will depend on the patient’s life history, and whether they have experienced similar situations before. To consider the action of disclosing the disease is not only to consider the body’s actions, but also to look at the whole set of relations that sustains the action.

(BAUM, 2006).

During data collection, it was possible to observe that about 33% (39 patients) were “indifferent” about telling other people that they have epilepsy.

It is something common, especially when 76% (87 patients) have their epilepsy under control, because the perception and stigma involving epilepsy is different when the condition is under control and not apparent to the social community (Troster, 1997). On the other hand, about 19% (23 patients) were affected by feelings of “sadness” which may be justified by the percentage of people who do not have their seizures under control. Their perception of the disease is different from those who have their seizures under control. The behaviors experienced by patients with epilepsy are what determine the existence of negative feelings and the sensations they have.

When there is no feeling of discrimination and epilepsy is under control, the desire to neutralize fears and reveal the condition to spread knowledge about epilepsy and share positive experiences can bring about “good feelings” when revealing their condition to others. About 9% (11 patients) reported this feeling.They reported having “a feeling of encouragement,” of “feeling honest by telling others” and that it “sometimes helps,” among other things.

What are your impressions on what people think about epilepsy?

The last question also received a classification according to ten themes: Undefined, Limitation, Lack of knowledge, Fear, Prejudice, Drug Use, Disease, 63

Beliefs, Contagious and Support.

During the discussion, about 18% (22 patients) were associated with “beliefs” because historically, epilepsy was associated with religious implications where the disease was associated with “demoniacal possession,” “spiritual stuff,” among other things. Stigma comes from an expectation, a prejudice or even a mark defined by society (Goffman, 1988). This mark imposed by society can bring suffering to a patient and may even lead to social isolation.

This condition has an impact on people’s lives by directly affecting the behavior and quality of life not only of persons with epilepsy, but also of their families (Fernandes & Li, 2008). About 17% (21 patients) reported that prejudice is present in their lives. Patients reported this by saying that “not everyone understands what it is so they judge,” “those who have no knowledge of it think it is out of the ordinary, dangerous, that (epileptics) attack people,” among other observations. For Troster (1997), prejudice can be an influencing factor which may lead an individual to disclose their condition or not.

About 12% (15 people) feel limited and believe that epilepsy is restrictive. They report to be “unable to go out and visit friends” or that “people think you are disabled,” among other things. Again, the limiting feeling appears and may exert its influence through verbal behavior, causing individuals to discredit themselves. It then follows that feelings of sadness and fear of the unpredictability of seizures may arise.

Conclusion

The feelings that patients experience in certain situations or when they reveal to other people that they have epilepsy can determine whether a person with epilepsy will disclose their condition on another occasion, when faced with a similar situation. Epileptics experience negative feelings when faced with the discrimination of the contingency of revealing it or not, so the behavior of not revealing their epilepsy is further strengthened.

As we observed in the studies by Troster (1997) in the results of this investigation, there is no correct probability of revealing epilepsy to another person. Social verbal behavior may vary according to what an individual knows about the disease; the situations experienced by the individual; their feelings when faced with certain situations and how people behave verbally about epilepsy. All these situations are contingent on the behavior of reinforcing or not the act of revealing a patient’s condition to others.

The role of psychologists in relation to epileptic patients is to reduce their suffering regarding their condition and the stigma experienced when 64

faced with verbal behavior. We have seen that beliefs, prejudice and all things negative which patients hear and feel can directly affect their perception of their condition, sometimes becoming their truth, when they do not have psychological flexibility. If a patient perceives epilepsy as being negative, feelings of limitation and sadness emerge and these can lead an individual to possible depression and even social isolation.

Acknowledgements

To Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for funding this undergraduate research.To my advisor, Professor Li Li Min, PhD, for his guidance and mentoring the investigation. To Gabriela Salim Spagnol, MSc, for jointly developing and participating in this project, and to all the patients who made themselves available to answer the questionnaire.

REFERENCES - BAUM, W. (2006) Comportamento verbal e linguagem. Compreender o behaviorismo: comportamento, cultura e evolução (pp. 135-163). Porto Alegre: Artmed.

- BENSON, A., O’TOOLE, S., LAMBER,V., GALLAGHER, P. & SHAHWAN, A. (2015) To tell or not to tell: A systematic review of the disclosure practices of children living with epilepsy and their parents. Epilepsy & Behavior. 1(51), 73-92.

- FERNANDES, P.T., NORONHA, A. L. A., SANDER, J.W. & LI, L. M. (2008) Stigma scale of epilepsy: The perception of epilepsy stigma in different cities in Brazil. Arquivos de Neuropsiquiatria.

66(3), 471-6.

- GOFFMAN, E. (1997) Manicômios, Prisões e Conventos. (3rd ed) São Paulo: Perspectiva.

- GUILHARD, H. J. (2002) Autoestima, autoconfiança e responsabilidade. Human behavior. 1(1) 63-98.

- JACOBY, A. & AUSTIN, J. K. (2007) Social stigma for adults and children with epilepsy. Epilepsia.

48(9), 6-7.

- SKINNER, B. F. (1957a) Comportamento verbal. São Paulo: Cultrix.

-SKINNER, B. F. (1969b) Contingências de reforço: uma análise teórica. São Paulo: Abril Cultural.

- TROSTER, H. (1997) Disclose or Conceal? Strategies of Information Management in Persons with Epilepsy. Epilepsia. 38(11),1227–37.

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- VANDENBERGHE, L. (2004) Relatar emoções transforma as emoções relatadas? Um questionamento do paradigma de Pennebaker com implicações para a prevenção de transtorno de estresse pós-traumático. Revista Brasileita de Terapia Comportamental e Cognitiva. 6(1), 39-48.

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9 Epilepsy and ADHD: The Importance of NeuroLearnment for Classroom Management Ana Paula Rabello Chaves “I always do what I cannot do to learn what I do not know.”

(Pablo Picasso)

Throughout the life cycle of the epileptic patient, there is an increasing number of information about cognitive, neuropsychological, neuroeducational and neuropsychiatric aspects. This is in addition to the psychosocial consequences of the social limitations that go beyond the stigma as imposed by the (sometimes) ineffective control of epilepsy. Epidemiological studies in the pediatric field show that chronic diseases, such as epilepsy, cause great harm in the child’s development in relation to their behavior, learning; and future work life (Costa; Maia & Gomes, 2009).

It is worth mentioning that epilepsy comorbidities often cause more damage to the patient’s development and quality of life than epilepsy itself.

Therefore, it is necessary to focus not only on the treatment of epileptic seizures control, but also on the follow-up and more effective therapy of the various comorbidities, which in this way leads to provide and guarantee a better quality of life, being and adequate cognitive ability for him or her.

According to Pimentel and Cysneiros (2017) epilepsy is characterized by a persistent predisposition of the brain to generate bioelectrical discharges that lead to neurobiological, cognitive, psychological and social consequences; such condition affects 65 million people worldwide and is the most common neurological disease in children and adolescents up to 16 years.

Attention Deficit Hyperactivity Disorder (ADHD), Learning Disorder (LD) and Autism Spectrum Disorder (ASD) are the most prevalent 67

comorbidities in children and adolescents with epilepsy (Ferrie et al., 1997; Pimentel & Cysneiros, 2017). ADHD has the characteristic deficit of attention, hyperactivity and/or disorganization and impulsivity. It is classified as: predominantly inattentive, predominantly hyperactive and impulsive, and the combined type; the incidence is 5% to 7% of schoolchildren. (American Psychiatric Association [APA], 2014)

When associated with epilepsy, the prevalence of ADHD increases significantly asthere may be a variation from 8% to 77% depending on the criteria used and the study (Costa & Maia, 1997). The results of the Loutfi (2010) study show the combined type as the most frequent (43.7%), followed by hyperactive (37.5%) and inattentive (18.7%), and in the neuropsychological evaluation there is clear evidence of cognitive impairment (17%) for total IQ and 20% for verbal IQ and executive IQ.This disparity is due to the high complexity of the relationship between ADHD and epilepsy as well as the large number of contributory variables such as type of epilepsy or epileptic syndrome associated with seizure control and epileptiform discharges. (Pimentel & Cysneiros, 2017). Although the relationship of these conditions is poorly understood and considering the great impact on the school, social and psychological performance of human development, it is important to highlight the imminent importance of the study of neurolearnment suggestions for the management of the learning of children and adolescents with an epilepsy scenario of comorbid ADHD.

Attention Deficit and/or Hyperactivity disorder is a neuropsychiatric dysfunction characterized by: disorganization in cognitive planning, difficulty in self-regulation (inhibitory control), attentional process fluctuation and low impulse control; and sometimes excessive motor activity. (Mulas, Meneses, Hernández-Muela, Mattos & Pitarch, 2004)

Such characteristics must be present before 7 years of age and generate clear damages in the daily life of the child and/or adolescent. It is important to point out that those losses must be present in the three scenarios: social relations, family and work/ school.

As far as the school sphere is concerned, epilepsy with its comorbidities is within the scope of special educational needs (SEN). This term refers to children and young people whose needs stem from their high capacity or learning difficulties thus it is associated with learning difficulties and/or disorders and may not necessarily be associated with one or more disability cadres. (Ministério da Educação e Cultura [MEC] & Secretaria de Educação a Distância, Alfabetização, Diversidade e Inclusão [SECADI], 2015)

Thus, special educational needs are presented as manifestations of learning difficulties, difficulties in communication and interaction, high skills or giftedness. This denomination is very broad and may make it difficult to delimit 68

more specifically the concept. In general special educational needs have been classified as follows: Cognitive, linguistic, affective, psychomotor, from praxis and social. (MEC & SECADI, 2015).

By definition learning is the act of taking in knowledge; the action of learning. During this process many factors are involved sometimes directly or indirectly. In the neurobiological view, learning occurs when a given stimulus activates the cortical area of the brain causing changes that also occur in other areas. This is due to the existence of a large number of precisely organized association paths acting in the two directions of the brain (right hemisphere and left hemisphere).(Relvas, 2009 & Chaves, 2017, p.74)

Whereas learning constitutes a change of behavior that generates the acquisition of knowledge, something new, resulting from experience whether by imitation or study, teaching and cognition is the process through which we learn. Cognitive neuroscience opens a direct route to the development of the underlying mental processes of behavior which favor the acquisition and training of executive brain skills (memory, reasoning, judgment, thinking, and language). (Chaves, 2017)

According to Chaves (2017), in order to insert the student with special educational needs into the inclusive environment, one must be open to the different; to the new. It is necessary to realize that the students are not the same and from there to realize that these differences need strategies to be different, also. The pedagogical practice will be focused on the specific attendance that the students present. In this way, neurolearnment plays an important role in the management of classroom regency. This role is played in the development and training of the brain´s executiveabilities in order to sensitize the teacher to rethink his pedagogical practices regarding the understanding of brain functioning.

Cognitive neuroscience/neurobiology explains that the behaviors run through brain biochemistry and neural synapses as well as affective and emotional issues. The teacherâ&#x20AC;&#x2122;s glance in the classroom needs to be directed at the plurality of the singularity. Each student is unique and his/ her learning time is different, both in the elaboration and understanding of information that goes through the biological senses then reaches the brain. In this way one must consider the world of each one; the culture, the region, in short, the various dimensions in which the human is inserted, including the subtle differences of the brain structures. Neurolearnment facilitates the pedagogical work since it favors the knowledge of the brain and its functions. (Chaves, 2017)

The proposal is to look at the whole without losing the specificities of the parts. This approach prioritizes a dialogue between the neurosciences, psychology and education with a view to understanding the learning difficulties 69

that give origin and destination to the teaching and learning processes. (Chaves, 2017)

Applying neuroscience in teacher training with a view to the curriculum adequation/adaptation of students with special educational needs requires careful observation of teachers regarding the profile of each student in question.

Developing and training executive brain skills encompasses specific cognitive functioning interventions, namely: memory, attention, self-control, cognitive flexibility, language, visuoperceptive and visual-spatial deficits. Such training is a set of interventions focused not only on cognitive but also emotional and behavioral issues. For this, the teacher should be attentive to the following questions: • To probe, to “study” the cerebral functioning of the child, adolescent, adult in question; • What limitations exist?

• What learning routes are currently being used?

In the sequence we can assemble a “program” of assertive pedagogical strategies for the training and development of the aforementioned cognitive abilities. It is worth mentioning that the objectives of this training are: • Recovering or restoring impaired cognitive function; • Potentiate brain plasticity or functionally reorganize preserved brain areas; • Compensate cognitive difficulties with alternative means or external aids that allow better functional adaptation; • Improve the environment with assistive technology or other means of adapting to difficulties.

It is worth mentioning that, regardless of the deficits found in the student (lesions, neurodevelopmental disorders), cognitive functions are in the process of development. Thus, we ENABLE, cognitive functions not properly developed.

Here are some suggestions for the proper training of cognitivetechniques: • Repetition of practices and exercises for monitoring and self-regulation of students about their own cognitive processes.

• Establishment of “routine,” “hygiene” study; • Strategies of memorization and organization; • Planning techniques; • Family and school counseling.

These suggestions undergo the coping with difficulties inherent in the 70

school environment and the specificities of each student. It is necessary to seek knowledge, collect structure to attend students with special educational needs and seek a collective solution that serves everyone. With study, reflection and preparation we can act, methodologically, adequately and combat the prejudice that still remains in our schools. As a team we will be able to grow and make progress in methodology, structure and teaching system, so that the student can have a more human and personal service.

To transform behavior is to adopt a posture committed to the diffusion of equality and respect for difference. Day by day, reflect, think, share opinions with your peers and students. The result is a richer world with more capable and supportive people. It is the dream and the hope that motivate the educators to continue to educate. (Chaves, 2017) REFERENCES - American Psychiatric Association. (2014). Manual Diagnóstico e Estatístico de Transtornos Mentais – DSM-5 (Maria Inês Correa Nascimento et al.,Trad.; Rev. técnica: Aristides Volpato Cordioli et al.). Porto Alegre: Artmed.

- Cardoso, C. O., & Fonseca, R. P. (2016). Programa de estimulação neuropsicológica da cognição em escolares: ênfase nas funções executivas – PENcE. São Paulo: BookToy. - Chaves,A. P. R. (2017). Distúrbios/dificuldades de aprendizagem e sugestões de neuroaprendência.

In Chaves, A. P. R. (Org.). A neurobiologia do aprendizado na prática (pp. 69-83). Brasília: Alumnus/Leya.

- Loutfi, K. S. (2010). Transtorno de déficit de atenção e hiperatividade em crianças portadoras de epilepsia. 151f. Dissertation (Master of Health Science) – Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

- Machado da Costa, C. R. C., Maia, H. S., Filho, & Gomes, M. M. (2009). Avaliação clínica e neuropsicológica da atenção e comorbidade com TDAH nas epilepsias da infância: uma revisão sistemática. Journal of Epilepsy and Clinical Neurophysiology, 15(2), 77-82.

- MEC/SECADI. (2015). Política Nacional de Educação Especial na Perspectiva da Educação Inclusiva. Retrieved from: http://portal.mec.gov.br.

- Miotto, E. C. (2015). Reabilitação neuropsicológica e intervenções comportamentais. Rio de Janeiro: Editora Roca.

- Mulas, F., Téllez de Meneses, M., Hernández-Muela, S., Mattos, L., & Pitarch, I. (2004). Transtorno por Déficit de Atención e Hiperactividade y Epilepsia. Revista de Neurologia, 39(2), 192195.

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- Pimentel, L. C., & Cysneiros, R. M. (2017). TDAH nas epilepsias: prevalência e fatores de risco.

Revista Psicologia: Teoria e Prática, 19(2), 200-214.

- Relvas, M. P. (2009). Neurociência e educação: pontencialidades dos gêneros humanos na sala de aula. Rio de Janeiro: Wak Editora.

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10 Contributions of Positive Psychology to the Psychological Well-being and Quality of Life of Epileptics Aline Boschi Neves Introduction

Epilepsy is a serious neurological disorder and usually occurs when there is a brain anomaly, hemorrhages, febrile seizures, head trauma, tumors or infection of the brain. Although some seizures can be triggered by stress and anxiety, epilepsy is not a mental illness. Epilepsy is a brain disorder caused by the brainâ&#x20AC;&#x2122;s predisposition to generate spontaneous and recurrent epileptic seizures, accompanied by neurobiological, cognitive and social consequences (Fisher et al., 2005).

Medication is the treatment of choice in most cases and when removal of the affected part of the brain is possible, surgical intervention can be performed (Fernandes, 2013). In addition to the limitations of the disease itself, people with epilepsy also face stigma and prejudice, which directly influence their quality of life (Hopker, Berberian, Marri, Willig & Torrochi, 2017). The stigmatized person feels rejected, presenting low self-esteem and self-confidence. It can be said that epilepsy brings with it neurobiological, cognitive, psychosocial, social and economic consequences along with loss of self-confidence and self-esteem (Linhares et al., 2014). The reflection of these feelings of devaluation, of shame and fear, arising from negative views of the disease can result in social isolation (Viteva, 2013) and depression (Fernandes, Teixeira & Li, 2006).

Beliefs attached to the disease will also determine susceptibility to depression and anxiety is considered to be the factor that most affects the 73

quality of life of people with epilepsy (Kotwas et al., 2016). Another investigation has stated that social inadequacy and inability may occur due to the perception of negative affections (Zanon, Bastianello, Pacico & Hutz, 2013) and that negative emotions influence the development of chronic pain, heart disease and other pathologies (Silvestre & Vandenberghe, 2013). On the other hand, investigations that focus on positive experiences have shown contributions to prevention, promotion of health, and coping with diseases (Calvetti, Muller & Nunes, 2007; Estrela-Dias & Pais-Ribeiro, 2014).

Therefore, in view of the relevance of emotions to a personâ&#x20AC;&#x2122;s physical, psychological and social well-being, the intervention of positive psychology as support to existing treatments can be of great value to the quality of life of people with epilepsy.

Brief Definition of Positive Psychology

Positive Psychology is a recent scientific movement that is expanding and bringing positive additions to the field of Psychology. Started in 1998 when Martin Seligman, the President of the American Psychological Association, stated that psychology needed to broaden its focus to study not only mental disorders and human suffering, but also the positive aspects of life and of human beings.

The primary interest of Seligman and Csikszentmihalyâ&#x20AC;&#x2122;s (2000) theory is the scientific understanding of positive human forces and experiences and possible interventions to alleviate pain and promote subjective well-being (Park, Peterson & Seligman, 2005). However, positive psychology should not be confused with self-help. Instead, it should be regarded as an extension of Psychology with scientific investigation of positive human characteristics, preventing illness and maintaining levels of happiness and well-being (ScorsoliniComin et al., 2013).

Therefore, Positive Psychology investigations have contributed to a fuller view of human experience, understanding how and under what conditions positive emotions, characteristics and institutions promote flourishing. Flourishing refers to a combination of feeling good and functioning effectively with a high level of psychological well-being (Cintra & Guerra, 2017).

Flourishing or psychological well-being comprises the following domains: positive emotions, engagement, achievement, purpose or meaning and positive relationships (Seligman, 2011).

Research has shown that â&#x20AC;&#x153;individuals who are flourishing (or who have a high level of psychological well-being), learn effectively, work productively, have 74

better social relationships, are more likely to contribute to their community, and have better health and life expectancyâ&#x20AC;? (Huppert & So, 2009, p.1). Focusing on positive experiences can contribute to prevention and health promotion, also helping with disease coping mechanisms (Calvetti et al., 2007).

According to research by Frederickson (2001), positive emotions promote engagement, new learning, and further interpersonal relationships. They also contribute to build the resilience that is essential in overcoming difficult situations and promoting our growth. In other words, when we go through an adverse situation, it becomes possible to know oneâ&#x20AC;&#x2122;s personal strengths and virtues, favoring oneâ&#x20AC;&#x2122;s potentialities and making them stronger and more productive (Paludo & Koller, 2007; Camalionte & Bocallandro, 2017). Therefore, positive psychology can contribute to the well-being of people with epilepsy.

Subjective Well-being as a Component of Positive Psychology

Seligman and Csikszentmihaly (2000) point out that subjective well-being (SWB) refers to what people think and feel about their lives, the subjective judgment of how happy people are with their lives (Diener, Scollon, & Lucas, 2004). Positive psychological interventions are considered a complementary strategy in promoting and treating mental health. The role of positive intervention is to help individuals to build a pleasurable, engaged and meaningful life (Duckworth, Steen, & Seligman, 2005).

One of several exercises that assist in this process is meditation, a practice that offers great benefits, enables the experience of pleasure, peace and serenity (Shapiro, Schwartz & Santerre, 2002), which play an important role in the perception of happiness and can be a protection factor against psychopathologies.Therefore, individuals with higher levels of positive emotion will engage more in thoughts and behaviors that promote their rehabilitation (Dunn & Brody, 2008). Also, they have social relationships, are optimistic, have more success in coping, and feel in control of their lives (Ostir, Markides, Peek, & Goodwin, 2001).

Considering the number of investigations demonstrating that positive affection entails better results in physical and mental health (Pressman & Cohen, 2005; Fredrickson, Tugade, Waugh, & Larkin, 2003), it is necessary to identify and implement intervention strategies that promote the growth of virtuous aspects of human nature without ever devaluing suffering with survivors, family and multidisciplinary team. From these considerations, one realizes how much positive intervention can contribute to prevent and fight stigma, and provide better quality of life for people with epilepsy.

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Using scientifically proven methods and techniques, positive psychology can increase feelings of joy, gratitude, inspiration, hope and generosity. It can also identify talent and virtues that are often overlooked when epilepsy is diagnosed, helping to find more sense, meaning and purpose in one’s life. Finally, as its main focus is on promoting human potential and well-being, positive psychology can be applied in the clinical, institutional and organizational context.

Final Considerations

Despite some limitations imposed by epilepsy, positive psychology can contribute by reducing the focus on difficulties faced, revealing human potential, generating self-acceptance, and improving self-esteem as well as self-confidence.

Consequently, it contributes to improve quality of life and reduce the stigma associated with epilepsy.

Support groups or educational groups must be made available in order to promote the social inclusion of persons with epilepsy by promoting greater adaptation in terms of citizenship, social responsibility, altruism, moderation and tolerance. This requires an optimistic view of human processes. Because it is a recent theory, investigations and further studies on the subject are necessary, especially in Brazil.

The science of and practices in positive psychology are very broad and have not been explained in this chapter. However, its biggest and primary objective is the effective and scientific understanding of how to help individuals, families, institutions and communities to flourish, developing their strengths and virtues, thus achieving well-being. Not only correcting weaknesses, but also finding new ways for the quality of life of people with epilepsy.

REFERENCES - Calvetti, P. U., Muller, M. C., & Nunes, M. L. T. (2007). Psicologia da Saúde e Psicologia Positiva: Perspectivas e Desafios. Psicologia Ciência e Profissão. 27 (4), 706-717.

- Camalionte, L. G., & Boccalandro, M. P. R. (2017). Felicidade e bem-estar na visão da psicologia positiva. Bol. - Academina Paulista de Psicologia. 37 (93), 206-227.

- Cintra, C. L., & Guerra,V. M. (2017). Educação Positiva: A aplicação da Psicologia Positiva a instituições educacionais. Psicologia Escolar e Educacional. 21 (3), 505-514. DOI: http:// dx.doi.org/10.1590/2175-3539/2017/02131119.

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- Diener, E., Napa Scollon, C., & Lucas, R. E. (2003). The evolving concept of subjective well-being: the multifaceted nature of happiness. Advances in Cell Aging and Gerontology, 15, 187-219.

DOI: 10.1016/S1566-3124(03)15007-9.

- Duckworth, A. L., Steen, T. A., & Seligman, M. E. P. (2005). Positive psychology in clinical practice.

Annual Reviews of Clinical Psychology, 1, 629-651. DOI: https://dx.doi. org/10.1146/annurev. clinpsy.1.102803.144154.

- Dunn, D. S., & Brody, C. (2008). Defining the good life following acquired physical disability.

Rehabilitation Psychology, 53, 413-425.

- Estrela-Dias, M., & Pais-Ribeiro, J. (2014). Intervenção psicológica positiva em grupo: forças e virtudes na reabilitação pós-avc. Psicologia, Saúde & Doenças, 15(1), 201-218. DOI: https:// dx.doi. org/10.15309/14psd150117.

- Fernandes, M. J. S. (2013). Epilepsia do lobo temporal: mecanismos e perspectivas. Estudos Avançados, 27(77), 85-98. DOI: https://dx.doi.org/10.1590/S0103-40142013000100007.

- Fernandes, P. T., & Li, L. M. (2006). Percepção de estigma na epilepsia. Journal of Epilepsy and Clinical Neurophysiology, 12(4), 207-218. DOI: https://dx.doi.org/10.1590/S167626492006000700005 - Fisher, R. S., Acevedo, C., Arzimanoglou, A., Bogacz, A., Cross, J. H., Elger, C. E., et al. (2014). ILAE official report: a practical clinical definition of epilepsy. Epilepsia; 55, 475–82.

- Fredrickson, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. (2003). What good are positive emotions in crises?: A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th. Journal of Personality and Social Psychology; 84, 365–376 - Fredrickson, B. L. (2001). Cultivating research on positive emotions. Prevention and Treatment, 3. Retrieved from: http://www.journals.apa.org/prevention/volume3/pre0030007r.html.

- Hopker, C. C., Berberian, A. P., Massi, M., Willig, M. H., & Tonocchi, R. (2017). A pessoa com epilepsia: percepções acerca da doença e implicações na qualidade de vida. CoDAS 29(1):e20150236 DOI: http://dx.doi.org/10.1590/2317-1782/20172015236 - Huppert, F. A., & So, T. C. (2009). What percentage of people in Europe are flourishing and what characterises them? presented at the meeting of the OECD/ISQOLS meeting, July 23/24 2009, Florence - Kotwas, I., McGonigal, A., Trebuchon, A., Bastien-Toniazzo, M., Nagai,Y. & Bartolomei, F. (2016).

Self-control of epileptic seizures by nonpharmacological strategies. Epilepsy Behav 55, 157–64.

- Linhares,V., Meneses, R. F., Pais-Ribeiro, J., Silva, I., Pedro, L.,Vilhena, E., Mendonça, D., Cardoso, H., Martins, A., & Martins-da-Silva, A. (2014). Preditores da qualidade de vida na epilepsia.

Psicologia, Saúde & Doenças, 15(1), 60-76. DOI: http://dx.doi.org/10.15309/14psd150107

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- Ostir, G.V., Markides, K.S., Peek, K., & Goodwin, J. S. (2001).The associations between emotional well-being and the incidence of stroke in older adults. Psychosomatic Medicine, 63, 210–215.

- Paludo, S. S. & Koller, S. H. (2007). Psicologia Positiva: uma nova abordagem para antigas questões.

Paidéia, 17(36), 9-20. DOI: http://dx.doi.org/10.1590/S0103-863X2007000100002 - Park, N., Peterson, C., & Seligman, M. E. P. (2005). Strengths of character and wellbeing among youth. Unpublished manuscript, University of Rhode Island.

- Pressman, S. D., & Cohen, S. (2005). Does Positive Affect Influence Health? Psychological Bulletin, 131, 925-971. DOI: http://dx.doi.org/10.1037/0033-2909.131.6.925.

- Scorsolini-Comin, F., Fontaine, A. M. G.V., Koller, S. H., & Santos, M. A. (2013). From authentic happiness to well-being: The flourishing of positive psychology. Psicologia: Reflexão e Crítica, 26(4), 663-670.

- Seligman, M.; & Csikszentmihalyi, M. (2000). Positive Psychology: an introduction. American Psychologist, New York, 55 (1), 5-14.

- Seligman, M. E. P. (2011). Florescer: Uma nova compreensão sobre a natureza da felicidade e do bem-estar (C. P. Lopes, Trad.). Rio de Janeiro: Objetiva.

- Shapiro, S. L., Schwartz, G. E., & Santerre, C. (2005). Meditation and positive psychology. In C. R. Snyder & S. J. Lopez, Handbook of positive psychology (632-645). New York: Oxford USA Trade.

- Silvestre, R. L. S. & Vandenberghe, L. (2013). Os benefícios das emoções positivas. Contextos Clínicos, 6(1), 50-57. DOI: https://dx.doi.org/10.4013/ctc.2013.61.06 - Viteva E. (2013). Impact of stigma on the quality of life of patients with refractory epilepsy.

Seizure. 22(1), 64-9. DOI://dx.doi. org/10.1016/j.seizure.2012.10.010.

- Zanon, C., Bastianello, M. R., Pacico, J. C., & Hutz, C. S. (2013). Desenvolvimento e validação de uma escala de afetos positivos e negativos. Psico-USF, 18 (2), 193-202.

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11 School and Educational Psychology: Orientation about Epilepsy in School Vilma Bastos Machado

Every student who enters a school expects to be welcomed with respect to their characteristics and their life stories.The diversity of conditions highlights the current educational profile and school inclusion is a new paradigm.

It is not enough to simply insert the student into the school or classroom for the difference to be accepted and valued. It is necessary to develop a global transformation of the school, the public policies, the attitudes of teachers, coordinators and all staff involved in the work, in addition to the families themselves and, most importantly, for the student themselves to feel they are members of the school, supported by their colleagues and by the entire staff of the school.

The work in the classroom is not limited to just putting into practice what has been learned in the teacher training course. It goes much further because the teacher will always come across unusual situations and needs to know how to deal with them and to be available to learn constantly.

The teacher is responsible for the preparation and for the reception of students with any condition. Epilepsy is part of this reality and School and Educational Psychology is an area of Psychology that can offer the teacher and students the necessary supports for the challenges presented in school.

The presence of a student with epilepsy at school becomes a challenge to those present at school and to the student themselves since it is necessary to consider the discrimination against it and the prejudice that surrounds it precisely because of the lack of knowledge of professionals, parents and peers, whether young or adult, who live with the person with this disease. According 79

to Muszkat and Rizzutti (2013), epilepsy begins in childhood and about 50% of cases appear in children under five years of age.

According to Spagnol (2017, p. 118), it is considered a chronic and severe neurological disease, reaches all ages, and it is present in any ethnicity and social class. For the clinical diagnosis, it is necessary that epileptic seizures occur repeatedly and in this repetition must occur at least two seizures more than 24 hours apart; for what makes up a seizure are electrical discharges which cause an imbalance in brain functioning where “the brain sends uncoordinated electrical impulses to the body.”

According to the author, people who experience these seizures may remain conscious presenting movements in one of the limbs with altered vision, smell, hearing and taste, but may also present absence seizures without the tremors that many people know.Absence seizures cause a loss of consciousness, the person’s gaze is fixed without reaction, and there is still a third seizure called myoclonic which causes involuntary movements in muscle groups and is short-lived.

The description of these epilepsy conditions is important so that people working in schools can be aware of what is happening around them and do not discriminate against and exclude students causing a panic situation in other children or young people who study with the student who has this disease. Information is the best method for assisting students with epilepsy.

In their daily work teachers are confronted with situations that mobilize the need for updating on the condition of the student under their care. Not all teachers have the possibility of continuing education or are interested in acquiring new knowledge, thus it becomes essential to have professionals who can support the work of the teacher contributing to their adjustment to the new circumstances in school.

In their academic formation, the teacher is instructed to work with the student’s learning. The various learning theories guide the ways of thinking and acting of the future teacher, but what is experienced in the school environment does not only concern the way in which the student learns, but the efficiency in which the teacher’s role is exercised.

The child who attends school brings with them a unique personal story, i.e., a social, emotional, physical and school history. The diversity of situations with which the teacher is confronted often scares them, especially those that are at the beginning of their careers, making them feel without direction in their actions or decisions which then can affect the student’s life. This is where School and Educational Psychology play a fundamental role in school. Coming from this perspective, what contribution can be expected from School and Educational Psychology?

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It is necessary to consider two aspects in the perspective of Psychology focused on the educational area. Inserted into the academic education of the teacher, the first aspect is about the preparation for the profession, the support that is manifested in the clarification about the learning process, in the development of the child, and the attitude of the future teacher. In the aspect of support to the work of the professional already inserted in the school, the scope of the role of the psychologist is effective in the orientation necessary for all professionals who are part of the school, from the doorman to the director of the school, including the parent, the community, and the students.

The teacher is not only responsible for knowing the existing methodologies, but also for understanding the student, at which level of development they are, how their personality traits are, and how they learn (Sisto, 2003). In school not only will there be children with good performance, if all differences are taken in account then both disabilities and learning difficulties will be present.

Education is a process which cannot fail to evolve, cannot be static, and needs new interventions and strategies. It needs to follow the social changes that require an effective reflection and change on the part of the teacher, and this change must be carried out already in the teacher’s training.The role of the teacher in the student’s life marks their existence in a positive or negative way.

According to Martinézand Rey (2017), since the 1980’s, Psychology has a discourse on the function of “social commitment” and new doors have opened to Psychology as a science and profession, and this discourse has become a reference for the consolidation of this scientific area. Thus, through unveiling the function of School and Educational Psychology into the school environment, one can realize how much the student with Epilepsy can be accepted and understood in their condition and respected above all in their learning.

For this it is necessary that the effective work of the team is focused on clarifying what the disease is, which characteristics it has, how to deal with the crises that may arise in the student’s daily life, how to guide students to understand what the disease is or the moment of crisis, as well as using mechanisms of intervention to the learning process when it is impaired.

Final Remarks School and Educational Psychology is an area of Psychology that has an important role in the orientation of the behavior and intervention in diverse school situations. One of them is the orientation to teachers, parents, 81

school staff and students about epilepsy which is a chronic neurological disease misunderstood by many people due to a lack of knowledge of its characteristics.

It is up to the teacher, in addition to the pedagogical work, to welcome all students regardless of any characteristics they may have.

This text was intended to show the role of the psychologist within the school scope and their contribution to the permanence of the student with any condition in the school.Today we talk about school inclusion but discrimination is still present in the face of the unknown and it is up to the school professionals to undo this phenomenon and give place to the understanding and respect for all possible diversities. Finally, may School and Educational Psychology conquer its place of social commitment through its contribution not only in the health area, but in the educational area even when finding it is still met with resistance.

REFERENCES - Martinéz, A. M., & Rey, F. G. (2017). Psicologia, educação e aprendizagem escolar: avançando na contribuição da leitura cultural-histórica (Coleção Construindo o Compromisso Social da Psicologia). São Paulo: Cortez Editora.

- Muszkat, M.,&Rizzutti, S. (2013). Epilepsia na infância. InMiranda, M. C.,Muszkat, M.,& Mello, C. B. (Coords.).Neuropsicologia do desenvolvimento: transtornos do neurodesenvolvimento.

Rio de Janeiro: Rubio.

- Sisto, F. F. (2003). Leituras de Psicologia para a formação do professor. Petrópolis, RJ:Vozes.

- Spagnol, G. (2017).A Epilepsia fora das sombras. In Min, L. L. (Org.). Neuro-o-quê? Neurociência!

A ciência e a arte do cérebro (2ª. ed.). Campinas: ADCiência.

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12 Epilepsy in School: Behaviors, Emotions and Much More than Seizures Involved Thais Pilon Ferro

Saying that learning is part of human nature is somewhat bold, but our organism was selected in such way as to become sensitive to the environment stimulus and from them to send out responses. These produce significant changes in the environment which tend to keep or diminish the emission of these same responses. If this explanation sounds familiar to you then it is because we are talking about Behavior Analysis and its important role in the understanding of learning. Such that there are innate behaviors to the human being which guarantee their survival, there are also learned behaviors from the environment which develop. It is important to consider the impact of several environments where children and teenagers attend and how their role as being important for their development. School environments are places where students spend most of their lives.

There is real concern in these regards for Brazilian schools. Many people familiar with them should understand how much the environments impact the development and tracking of new behaviors on students. The learning depends on several environmental factors which can be summed up as neurobiological, psych emotional and sociocultural.When students are harmed in these areas, it can result in specific learning difficulties and deficits for children and teenagers.

A psychologist in his clinical or schooling settings job must not neglect the influence of these environmental factors when evaluating and keeping up with a child or teenager. From this moment on, we must ask ourselves: if you were keeping up with a student with epilepsy, which would your first concern be? Several times the thoughts and concerns are regarding the control of the 83

epileptic seizures. How are we to deal with them? How do we teach teachers to react in these moments? How can we make the classmates aware? Epilepsy is tagged by social stigmas, especially by the manifestation of convulsive seizures.

The unpredictability of seizures can spawn fear and restlessness in other people which turn this condition into these stigmas. (Ablon, 2002; Diorio et al, 2003).

I challenge you to look at epilepsy beyond the seizures and in the scholarly context! According to Sturniolo and Galletti (1994), children with epilepsy comprise a vulnerable group which presents high risks to develop specific learning disorders thus compromising their academic performance and psychosocial adjustment and enabling the scholar abandonment. In childhood epilepsy, the academic difficulties are related to the medical conditions of the disease, as to the psychosocial conditions. The socioemotional development is frequently impaired in children with epilepsy. Research demonstrates that neuropsychological damage can interfere on the social interactions. However, the negative effect of the stigmas that mark the disease increases the frequency of negative attitudes in relation to the epilepsy, inflicting low self-esteem, marked deficits in social abilities and social communication and higher rates of loneliness and psychological misery in children. (Menlov & Reilly, 2015)

The behavioral interpretation of such skills is important as it assists with the therapeutic procedures for these students. First, we will consider the low self-esteem seen frequently in children and teenagers with epilepsy. It is understood that self-esteem is the feeling which is â&#x20AC;&#x153;the product of contingencies of positive reinforcement of social originâ&#x20AC;? (Guilhardi, 2002), that is, the child is not born with self-esteem, but it can be developed along the personâ&#x20AC;&#x2122;s lifetime.

Based on this explanation, what can a psychologist do to work on the selfesteem of the student with epilepsy? It becomes necessary to intervene in the environment where he lives to create opportunities where the child can express their qualities and how they feel valued by others as they experience the right of making mistakes without losing their social prestige, friendships and affection.

Second, regarding the social skills marked deficits, we might ask: how many times do these students feel encouraged to keep social relations then develop assertive and wanted communication patterns for their corresponding ages?

Many epileptics suffer from the low expectations of parents and teachers about their chances for success, and the possibility of rejection from the educator and classmates (Guerreiro et al, 2000; Maia Filho et al, 2004). Overprotection and feelings of fear, concern and insecurity hinders the social relationships, affections and academics of the child (Souza & Guerreiro, 2000). As a behavior psychologist, it is important to watch the behavioral deficits in social skills of the student with epilepsy then create activities using behavioral procedures 84

such as modeling behavior and behavior assessments among others.

Third, in regard to the high rates of loneliness and psychological misery in children, a behaviorist psychologist will soon ask: could these feelings be products of aversive contingencies because in Behavior Analysis the feelings are products of organism-environment? When this relation is negative, then consequently negative feelings can be produced. Thus, if children with epilepsy present high levels of loneliness and misery, it is necessary to investigate the consequences that are controlling their behaviors, such as, positive punishment, negative punishment, extinction and negative reinforcement then stabilize the therapeutic pathway. How can we develop a tolerance repertoire for the frustrations in these students as the social environment in child’s life cannot be controlled by the professional? Or, how can we work on the ways people attempt to engage in their attempts and social interaction of the students?

Lastly, neurobiological factors must also be involved in how the psychologist views epilepsy in a scholarly context. The learning of these students can be influenced by factors directly related to the illness itself as a neurological disease and to the side effects of the medications, surgeries and the association with other neurological or psychiatric disorders.

The epilepsy as a basis disease increases the risk of learning difficulties among 41 to 62% in children and it can present academic difficulties in mathematics and reading and interfere in the development pathways of brain networks underlying to cognition, whether global or specific (Fastenau et al 2008, Jackson et al., 2013; Puka et al, 2015). The medication effects can harm the cognition and the behavior of the students, such as attention, psychomotor speed and verbal fluency. (Gulati, 2014)

The epilepsy in the scholarly context is not limited to the characterization of the seizures, but also comprises the precocious identifying and management of comorbidities and psychiatric disorders. Children with epilepsy are five times more inclinable to develop behavior and neurological disorders and 2.5 times more inclinable to suffer from psychiatric disorder, by the fact of several genetic and physiological mechanisms common in both cases. For instance: one every twenty children with epilepsy develops the Autism Spectrum Disorder and one every five children with autism develops epilepsy (Woa et al, 2017; Saemundsen, 2007). Another example is the Attention Deficit Hyperactivity Disorder which has a prevalence of 30-40% in epilepsy cases.

There’s nothing more natural to the human being than learning. We understand, also, about the importance of the environment in the development and maintenance of children’s and teenager’s behaviors. In conclusion, how many ways of learning are there? To reflect on the answer, remember how many kinds of students there are! Each student has a life background different 85

from the other, so there will be different contingencies histories involved with their schooling and their other internal and external environments.

REFERENCES - Ablon, J. (2002). The nature of stigma and medical conditions. Epilepsy Behaviour, 3(62), 2-9.

- Berg, A.Y., Langfitt, J. T., Testa, F. M., Levy, S. R. & Westerveld, M. (2008). Global cognitive function in children with epilepsy: a community based study. Epilepsia, 49, 608-614.

- Dilorio, C., Osborne, S. P., Letz, R., Henry,T., Schomer, D. L. & Yeager, K. (2003).The association of stigma with self-management and perceptions of health care among adults with epilepsy.

Epilepsy Behaviour, 4(3), 259-267.

- Fastenau, P. S., Shen, J., Dunn, D. W. & Austin, J. K. (2008). Academic underachievement among children with epilepsy proportion exceeding psychometric criteria for learning disability and associated risk factors. J. Learning Disabilities, 41, 105-207.

- Guerreiro, C. A. (2000). Epilesy. Epilepsia, São Paulo: Lemos.

- Guilhardi, H. J. (2002). Self-esteem, self-confidence and responsibility – Human Behaviour Everything (or almost everything) you must know to live better - (Auto estima, autoconfiança e responsabilidade – Comportamento Humano – Tudo (ou quase tudo) que você precisa saber para viver melhor): Brandão, M. Z. da S.; Conte, F. C. de S. & Mezzaroba, S. M. B. (orgs.)

Santo André, SP; ESETec Editores Associados; Retrieved from https://itcrcampinas.com.br/ pdf/helio - Gulati, S.,Yoganathan, S. & Chakrabarty, B. (2014). Epilepsy, Cognition and Behavior. Indian J. Pediatr., 81(10), 1056-1062.

- Jackson, D. C., Dabbs, K. Walker, N. M., Jones, J. E., Hsu, D. A., Stafstrom, C. E., Seidenberg, M., Hermann, B. P. (2013). The neuropsychological and academic substrate of new/recentonset epilepsies. J. Pediatr., 162, 1047-1053.

- Maia Filho, H. S., Gomes, M. M. & Fontenelle, L. M. C. (2004). Epilepsy in childhood and quality of life. J. Epilepsy Clin. Peurophysiol, Porto Alegre, 10(2), 87-92.

- Menlove, L. & Reilly, C. (2015). Memory in children with epilepsy: A systematic review. Seizure, (25), 126-135.

- Motamedi, G. & Meador, K. (2003). Epilepsy and cognition. Epilepsy Behaviour, 4, 25-28.

- Puka, K., Khattab, M., Kerr, E. N. & Smith, M. L. (2015). Academic achievment one year after resective epilepsy surgery in children. Epilepsy Behaviour. 47, 1-5.

- Saemundsen, E., Ludvigsson, P. & Hilmarsdottir, I.V. (2007). Autism spectrum disorders in children with seizures in the first year of life: a population-based study, 48, 1724-30.

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- Souza, E. A. P. & Guerreiro, M. M. (2000). Quality of life and epilepsy. In Guerreiro, C. A. M., Guerreiro, M. M., Cendes, F. & Lopes-Cendes, I. Epilepsia, SĂŁo Paulo: Lemos, 223-229.

- Sturniolo, M. G., Galletti, F. (1994). Idiopatic Epilepsy and school achievement. Arch Dis Child, (70), 424-428.

- Woa, S. W., Ongb, L. C., Lowx, W.Y. & Laia, P. S. M. (2017). The impact of epilepsy on academic achievement in children with normal intelligence and without major comorbidities: A systematic review. Epilepsy Research, 136, 35-45.

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13 Dimensions of Sexuality in Epilepsy Sueli Adestro

Amidst several written books and articles which have been produced, the theme of sexuality is evolving to bring up the biopsychosocial, moral, anthropological and cultural aspects of this chronic condition. Nonetheless, the several dimensions of sexuality involve the human existence at the interface of affective-sexual desire. There’s a bunch of rich literature to be researched in the Psychology area, seeing that the recognition of the sexed body within behavioral patterns can result in fragile egos, insecurities, suffering, shame, misery, and denial of the body. The body can be the object of pleasure seeking, to be seen and to attract the other’s attention. In a Lacainian concept, “the I is built form the other’s look” (LACAN, 1985). In this sense, after an epileptic seizure, the look toward the other can be one of estrangement. It would be better to be looked and not to be seen – for the epileptic’s coping with selfdeception and/or rejection feelings.

These short considerations present the epilepsy and sexuality as phenomenal occurring in one and all people, social classes, level of education, sexual-affective orientation, and it manifests in any person. Anyone who has a brain might have epilepsy. In this chapter of alleged literature review about sexuality and epilepsy, we will reflect about the possible outcomes for the person who has epileptic seizures to be impacted by the difficulties of creating sexual-affective relationships which will enclose reproductive and mental health.

Sex and Sexuality

The flair about expressions, which seem apparently obvious as sexuality 88

and sex, refers to the comprehension of the procreation transformations and sexual behavior culture to narrow down their impacts in the significance of human sexuality. It is understandable that self-deceptions occur regarding sexuality, sometimes marveling the notion between what’s morally recommended and personally possible. This can culminate into the oscillating questions regarding the consciousness of our acts and repressed feelings and behaviors.

Freud (1905), in his “Three Essays on the Theory of Sexuality,” proposes the definition that the sexual period starts in childhood in a complex and elongated manner winding into adulthood where the functions of reproduction and obtainment of pleasure can be associated, as in men and women. Such information would be odd to the predominant thinking of that time, seeing the mores of his time deemed that sex would be exclusively for reproduction. It is known that the assumption of Freud’s composition describes the psychoanalytic method.

The French philosopher, Foucault (1994), wrote a composition in three volumes, from 1976 to 1984, named “The History of Sexuality.” For each book, the author demonstrated that sex and sexual practices are ruled by the sexual devices established between knowledge and power, producing an acceptable behavior for the society.

In Guimarães’ definition (1995), the term sex must be normal, hereditary, biological, in physical difference, anatomical and biological between man and woman, as well as the attraction a person feels for another as for pleasure and reproduction alike. The term sexuality refers to the extended concept of sex, focusing the large phenomenon that involves reflection and discussion about genitals, the senses, the sex intentionality in all the levels and variations of identity and gender role.

Psychology justifies the difference one makes between identity and gender roles, conceptualizing that the identity deals with the conscience that each one has of themselves while belonging to a gender category (male and female). And, gender role refers to the social behaviors that reveal if the person is man or woman and how they act in the social space.

In this perspective the World Health Association (OPAS-WHA, 2001) proposed a concept of sexuality as an energy that motivates us to find love, contact, tenderness and intimacy; and integrates in how we feel, move, touch and are touched. It is being sensual and being sexual at the same time. So, the sexuality influences thoughts, feelings, actions and interactions and also influences our physical and mental health.

As it pertains to the human sexuality analysis, the intention of uncovering the multiple and deep feelings that enclose the sexuality dimension are to be lead in a critical and scientific manner. But, equally close and present 89

in the life world, become one of the most complex and demanding tasks of the affective education and ethical education of our time. (NUNES, 2011)

It is surprising though, to observe several and varied interpretations in literature, which go from the determinism of sex and sexuality terms, their significance and meanings, to the sexual spectrum and their dimensions. In the meantime, it’s up to the university to invest in production and socialization of knowledge about sexuality and training of multidisciplinary professionals who can break off the prejudices, stigmas and materialized taboos in social practices which stop us from expressing affectivity, the erotic desire, that is, the sexuality in a health manner. (BRUNS & ADESTRO, 2017) The Body as a Pleasure Space versus Its Prejudice and Stigma

In the ethical hedonism philosophy (from hedoné; in Greek meaning pleasure), rises two meanings of the term pleasure which sometimes get confused: a) as a feeling or pleasant affective state that follows various affective and emotional experiences (as the meeting with a person we like; the contemplation of a song) for which the opposite is “displeasure” (as the meeting with a person who is scorned); b) as a pleasant sensation produced by the activation of body stimulus connected to the brain (orgasm, tickle, body massage) for which the opposite is the physical or emotional pain (absence of orgasm in a sexual relation, sexual violence, physical aggression).

When hedonists in the antiquity (IV B.C. century) stated that pleasure is good and bad, its opposite, and that the human actions are measured by pleasure, it has to be analyzed that there are sensitive pleasures, erotic, immediate, fleeting, as the ones provided by food, by sex, among others. There are more lasting and superior pleasures as the intellectual, ethical, aesthetic.

Thus, we must remember that people prefer the pleasure to displeasure or pain. They prefer to be happy against the possibility of unhappiness. They prefer being respected on their rights and accepted by society before they become part of a social exclusion statistic. We must emphasize that in (FERNANDES’ et. al., 2011) words, the social acceptance of the person with epilepsy is the starting point for difficulties in overcoming personal relationships which take us to the psychological associated difficulties so that people with epilepsy and their families stop being victims of prejudice and stigma.

In this context, mental health professionals, as phycologists with and an opening to inquire, investigate the low self-esteem complaints and the vulnerability of the person with epilepsy.These contributions guide with refuge, preventing the emotional pain, the social distance, affectionate-loving and sexual, 90

in addition to the inadequacy and deprived feelings. “The stigmatized attributes his deprivations as a compensatory character, thanks to a belief that for the suffering he learns to accept them.” (GOFFMAN, 1998) Health in Epilepsy Aspects

There’s no way to measure in dimensions the neuroscience evolution from this last decade because the therapeutic variables were extended and refined. However, it has remained the consensus of researchers and neurological doctors for the drug treatment of epilepsy to allow conditions for ensuring the best life quality possible to the patient searching for an adequate control of epileptic seizures with a minimum of associated side effects. Epilepsy is seen as a treatable chronic neurological disease, but when it is neglected it brings into its history so many distressing narratives.

Several patients who suffer from seizures bring with themselves the experience of rejection, so they try to hide that they live with the epilepsy diagnosis. They report many equivocations and lack of knowledge about the difficulties which they face every day. They don’t share group experiences of psychological support because of their feelings of social inadequacy. They don’t know exactly how the epileptic seizures can affect their general, sexual, reproductive and mental medical conditions. Several suffer professional or qualification losses because they can’t keep their independence and autonomy.

And, there’s still another parcel of patients who present cognitive and scholar deficits with chances of also having psychological or psychiatric comorbidities (with epilepsy and autism prevalence; epilepsy and attention deficit hyperactive disorder; epilepsy and psychosis). Once again, the epilepsy is a disease which affects the biopsychosocial welfare and the patient’s life as a whole.

Punctually, the female sexuality is more complex when treated in epilepsy. The female body produces the sexual hormone, estrogen and with medical uses for treatment (AED - anti-epileptic drug), it tends to put on weight, sleep deprivation, sexual desire alterations and other symptoms. There is evidence in studies about the relation between epilepsy and pregnancy since modifications used for epileptic seizures can lead to fetal malformations. The pregnancy seems to affect the frequency of seizures through physiological effects such as hyperventilation, weight gain and hormonal, psychological changes, such as the fear in fetal malformations and pharma kinetic changes with the use of AED’s. (SCHMIDT, 1982; PHILBERT & DAM, 1982)

In cases of pregnancy it is required “to comply strictly with neonatal accompaniment” being “the ideal that the patient has a programed pregnancy.”

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(NOROMHA et. al, 2003:51-52) Therefore, the fertile woman with epilepsy should talk with a neurologist in order to adopt an oral contraceptive method concomitantly with another contraceptive. The oral method can cause drug interactions with the AED’s and taken can result in contraceptive ineffectiveness.

In order for the woman to prepare for a safe gestation, it is not recommended for the AED’s interruption. The public (SUS) attendance (2017) provides fertile women with these methods: monthly injection, trimonthly injection, mini pill, combined pill, diaphragm, contraceptive pill, emergency contraceptive pill (ECPs), and intrauterine device (IUD).

Therefore, people who have epilepsy need to experience the sexuality and the sexual desire naturally and perform appropriate monitoring, like any other person with an active sex life, in order to prevent sexual transmitted diseases (STD’s), HIV/AIDS, HPV (human papillomavirus), Zika virus, syphilis, hepatitis, and all the other infectious diseases. It is very important to incorporate specialized medical monitoring and a multidisciplinary team support system so that the sexual life of women and men who live with seizures (or don’t) can be a naturally affective-sexual experience, without sublimating the vital needs of a sexual and reproductive body.

Psychology and Epilepsy: the Dialog Has Just Started

This brief literature revision about sexuality and epilepsy refers to the psychologist’s training and formation at the University. It’s the psychologist’s responsibility to perform psychotherapeutic monitoring to treat sexual problems and comprehend the medical, affective-emotional and social impact that determines the quality of life for the person with epilepsy.

The impact of rejection to the person with epilepsy and the interpersonal-social which he or she lives helps to disseminate prejudice and the stigma, making the individual feels diminished in his or her self-esteem, depreciated in his or her self-image and cognitive-mental skills. These factors indicate the personal and social inadequacy conditions serving as a trigger for a possible “personality, psychological and disorder conditions” (CANTILINO, A., & CARVALHO, 2001). In this case, it is more than justified to comprehend that the patient needs to be treated with AED medicines, but also must have individual psychological monitoring or takes part in support groups. By means of psychological care, it is possible to investigate and expound the verbalization of feelings, incomprehension and disinformation about what occurs in the brain of a person with epilepsy.

The practice of counseling about sexuality elaborates upon the 92

perceptions of body censorship, virginity, programed pregnancy, fertility, orgasm, frigidity, ejaculation, marriage, contraception, social and sexual rejection.

This allows learning about affective and sexual relations. Talking openly and proactively about sexuality and sex breaks the taboo that exists around the body as “a self-dissolution place” (FOCAULT, 1982, p. 22) and brings with it “in your life and your death, in its drive and weakness, the inscription of all the happenings and conflicts, mistakes and desires.” Speaking openly eases the barriers which can hinder the formation of trust needed in such significant exchanges.

In cases of chronic diseases such as epilepsy, the monitoring of epileptics within a dynamic group extends the openness of interpersonal relations and eases the experiences since this is an integrative practice between patients and psychologists. The support group enables each participant to know him or her better, recognizing themselves in the difficulties of other people. Each participant has the opportunity of benefitting from the group and seeing its significance to discuss privately shared fears, and, many times, even groundless fears which have resulted in self-deception. Lastly, this enables patients to overcome the stigmatic condition of “being a person with epilepsy” and “living without seizures.”

REFERENCES - BALLONE G. J. Epilepsia, Agressividade e Personalidade, In. PsiqWeb. Disponível em <www. psiqweb.med.br>, revisto em 2005.

- BRUNS, M.A.T., ALMEIDA, S. Sexualidade preconceito, tabus, mitos e curiosidades. Campinas: Editora Átomo, 2004.

- BRUNS, M. A.T., & ADESTRO, S. Epilepsia na interface com a sexualidade. In: XVI Congresso Brasileiro de Sexualidade Humana, SBRASH: Campinas, 2017. Disponível em: http://www.cbsh.com.br/cd/autores.html, acesso em: 30 de ago, 2018.

- CANTILINO, A., & CARVALHO, J.A. Psicoses relacionadas à epilepsia: um estudo teórico.

Revista Neurobiologia 64 (3-4): p. 109-16, 2001.

- CONITEC (2017). Protocolo Clínico e Diretrizes Terapêuticas da Epilepsia. Disponível em: http://neurologiahu.ufsc.br/files/2016/10/Relatorio_PCDT_Epilepsia_CP_65_2017.pdf.

- FERNANDES, P. T., & Li, L. M. (2006). Percepção de estigma na epilepsia. Journal of Epilepsy and Clinical Neurophysiology, 12(4), 207-218. Disponível em: https://dx.doi.org/10.1590/ S1676-26492006000700005.

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- FOUCAULT, M. (1982). Le sujet et le pouvoir. In. Dits et écrits, v. IV (1980-1988). Paris: Gallimard,1994.

- FREUD, S. (1905). Trois essais sur la théorie de la sexualité. Paris: Gallimard, 1987.

- _________. O futuro de uma ilusão. Rio de Janeiro: Editora Imago, 1997. Disponível em: http://geffoucault.blogspot.com/p/livros-para-download.html, acesso em: 31 de jul. 2018.

- GOFFMAN, E. Estigma: notas sobre a manipulação da identidade deteriorada. Rio de Janeiro: Zahar, 1988.

- GUIMARÃES, I.R.F. Educação sexual na escola: mitos e realidades: Campinas, SP. Ed. Mercado de Letras, 1995.

- LACAN, J. (1951) Algumas reflexões sobre o eu. In. Psicanálise: Algumas reflexões sobre o espelho, por Jacques Lacan. nº2. São Paulo: Clínica Freudiana, 1985.

- _________ (1966).Variantes do tratamento-padrão. In: Escritos. Rio de Janeiro: Jorge Zahar Ed., 1998. p. 325-364.

- MAERCHETTI, R. L. Aspectos Psiquiátricos da Epilepsia. In: Fundamentos Neurobiológicos das Epilepsias. Eds: Da Costa JC, Palmini A, Yacubian EMT, Cavalheiro EA: São Paulo, Lemos Editorial, pp 1297-1319, v.2, 1998.

- MAURANGES, P. apud SCHMIDT, D.The Effect of Pregnancy on the Natural History of Epilepsy: A Review of Literature. In: JANZ, D.; BOSSI, L.; DAM, M.; HELGE, H.; RICHENS,A.; SCHMIDT, D. (eds). Epilepsy, Pregnancy, and the Child, New York, Raven Press, Ltd., 1982; p.3-14.

- MEZAN, Renato. “Uma arqueologia inacabada: Foucault e a psicanálise”. In: RIBEIRO, Renato (org.). Recordar Foucault. São Paulo: Brasiliense, 1985.

- NORONHA, A.L.A. et al. Epilepsia sob nova perspectiva: condição tratável: Campinas, p. 51-52, 2003.

- NUNES, C. A. Desvendando a Sexualidade: Campinas, SP, Editora Papirus, 2010.

- OPAS-OMS. Relatório sobre a saúde no mundo 2001: saúde mental: nova concepção, nova esperança. Genebra: OPAS/OMS, 2001. Disponível em: https://www.nescon.medicina.ufmg.br/biblioteca/imagem/0205.pdf, acesso em: 28 de jul, 2018.

- SUS (2017). Ministério da Saúde. Disponível em: http://www.brasil.gov.br/noticias/saude/2012/03/sus-oferece-oito-opcoes-de-metodoscontraceptivos, acesso em: 11 de ago. 2018.

- VASCONCELOS, N. Os dogmatismos sexuais. Rio de Janeiro: Ed. Paz e Terra, 1971.

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14 Epilepsy and Employability: Barriers to Overcome MaĂ­ra Frizzi da Cunha Bergo

The relationship between epilepsy and work has been in discussion in Brazil for more than eighteen years. Authors such as Borges et al. (2000) who conducted investigations in the area consider the biopsychosocial factors of individuals diagnosed with epilepsy as an important part of this relationship.

These factors represent possible difficulties in the insertion or maintenance of such individuals in the labor market. With consideration to the intra- and interpsychological functioning of patients in their dialectic relationship with the environment, added to psychosocial factors and factors intrinsic to the disease, it is necessary to reflect on the role of work in the constitution of the subjectivity of the human being and their quality of life. In this chapter, this reflection will focus on barriers faced by patients with epilepsy in the labor market.

The Diagnosis and Its Consequences

To start our thoughts on the topic, first it is important to understand the impact that the diagnosis has on the everyday life of a person with epilepsy.

Studies show that when one reveals a diagnosis of epilepsy either to a patient or to an acquaintance, the levels of anxiety arising from informing the disease are higher when compared to other diagnoses, even when there are no generalized tonic-clonic seizures.The existence of the diagnosis also has a direct relationship with the performance of workers with epilepsy, considering the prejudice that 95

accompanies the condition and the restrictions imposed on performing work where there is risk involved. In addition, there is little knowledge disseminated about the diagnosis of epilepsy and its real consequences, since it comprises many different conditions - it is necessary to evaluate each case individually.

(Harden, Kossoy e Nokolov, 2004).

Regardless of the peculiarities of the diagnosis, it is possible to affirm, based on research conducted on the subject, that patients with epilepsy experience psychosocial problems in similar areas, such as difficulties in their interpersonal relationships. Reflecting on what is understood by constitution of the subject, Vygotsky, in his theories, describes Man as “an aggregation of its social relationships”, which are the subject’s foundations. Therefore, when we analyze an individual in their development, it is not possible not to consider the work environment, either as an absent or acting factor, as one of the main pillars in Man’s development process.

It is estimated that 50% of adults diagnosed with epilepsy in Brazil face unemployment or underemployment, work being the most affected area in these individuals’ lives (Salgado & Souza, 2002). On this note, and according to literature, the stigma that comes with a diagnosis of epilepsy appears to have a major impact on the lives of these individuals when looking for or keeping a job.

In addition, people with epilepsy tend to experience stigma in the workplace, which can lead to social isolation. According to Goffman (1988), stigma is a general feature of society and can be attached to a determining characteristic of an individual, such as a different trait one is ashamed to have. The diagnosis of epilepsy is therefore portrayed as a characteristic about which the patient feels ashamed and it becomes a barrier in the work environment.

With regard to social and work relations as active factors in the individual’s dialectic relationship with their environment, the historical-critical psychology of Vygotsky also points out the impossibilities of constituting the subject immersed in the social practices of a particular context. Therefore, an individual with epilepsy that carries stigma in the workplace can be affected in their social relations and hindered from constituting a participant subject in this context, which consequently, affects their quality of life directly.

Work and Quality of Life

While considering unemployment among people with epilepsy, it is necessary to point out the direct relationship between work and quality of life. Studies show that based on biopsychosocial analyses of diagnosed individuals, it is possible to detect deterioration in their quality of life with 96

regard to some factors, the most important of which is work (Pinto, 2014). It is important to ponder this information, since when talking about the quality of life of these individuals, their relationship with work touches on issues already mentioned before, such as stigma, social isolation and others. However, despite the impossibility of pointing out precisely all the factors that influence this relationship, there are those that appear in much of the literature on the topic, influencing on seeking and keeping employment by individuals with epilepsy and, consequently, affecting their quality of life.

Another factor that is also widely cited as a major influence on the working life of persons with epilepsy and their quality of life is control of seizures. Making use of correct medication and keeping seizures under control are crucial not only to keep employment, but especially for a better quality of life. Data indicate that approximately 30% of patients diagnosed with epilepsy are refractory to drug treatment and therefore do not have their seizures under control. As a result of these indicators, there is the unpredictability of seizures and the behavior of the person with epilepsy during and after them, which can lead to feelings of guilt, shame and dependence, corroborating with the social isolation mentioned previously (Hopker et al., 2017).

Still on the subject of seizures, in some cases in which there is no control over them, the individual may be unable to work or need constant supervision. There are other aspects affecting the performance and/or permanence of such persons in the workplace, as well as comorbidities and side effects of medications. (Varela, 2016). Thus, considering the factors mentioned, the impact of work on the quality of life of a human being and based on the biopsychosocial analysis of patients with epilepsy, it is possible to detect that these people tend to have less quality of life than those not diagnosed with epilepsy when it comes to social interaction.

Social and Economic Impacts

From an epidemiological survey of the disease, according to Kanashiro (2006), 1% of the world population has been diagnosed with epilepsy, of which approximately 3 million are Brazilians. Further to the reduction in the quality of life of these individuals and to barriers faced in the labor market as a consequence of aspects already mentioned in this chapter, when persons with epilepsy are not employed they also fail to generate social contributions for their family and the government. Therefore, it is imperative to deal with epilepsy as a public health problem.

Considering human beings as historical subjects, it is important to 97

think about the impact and scope of social issues such as prejudice and stigma.

As a result of aspects already discussed earlier in this chapter, it is possible to identify that the impacts of an epilepsy diagnosis go far beyond epileptic seizures - physiological issues of the disease stand out.The diagnostic has direct influence on the status of the patient and as a result, considerable social impact.

When looking at unemployment data among people with epilepsy, research also suggests there is considerable economic impact behind these indices, since they refer to a large portion of the population that stops producing and contributing formally to the work market.

Therefore, it is important to emphasize that there are still no public policy instruments in place in Brazil that guarantee the rights of persons with epilepsy with regard to work and that protect them from discriminatory attitudes. Some discussions underway regarding the assurance of these rights raise the possibility of an adaptation of Law1314615 (Brazilian Inclusion Law) with the primary thought that although epilepsy is not considered a disability, individuals diagnosed with the condition face similar difficulties when seeking or keeping a job.

Conclusion

Literature on the relationship between epilepsy and work points to determining factors that make it difficult for individuals with epilepsy to enter the labor market, as well as the stigma and prejudice of the diagnosis and the lack of instruments that guarantee the rights of persons with epilepsy in this context. In addition to these issues, with regard to the psychosocial conditions of these individuals and also considering the biological factors inherent to the disease, we conclude that persons with epilepsy tend to have lower quality of life and a stronger propensity for social isolation, and may even develop a stronger propensity for mental disorders.

However, there is still much to learn about the subject, since it is not possible to determine accurately all factors influencing the employability process of persons with epilepsy. It is a considerable challenge to specify precisely the interactions between psychosocial variables and the job market, because the difficulties of these individuals in entering and staying in the labor market cannot be reduced to a single factor. It is also important to consider the peculiarities of the diagnosis in each case.

Thus, it is necessary to include the view of professionals in this relationship, whether they are health care workers or labor professionals, to engage in the construction of instruments to break the barriers already 98

identified. For psychologists in this context, it is essential to consider individuals as historic subjects and the biopsychosocial factors present in this relationship.

In this way, and from an historical-critical point of view of psychology to the reality of persons with epilepsy in the labor market, it will be possible to facilitate and ensure a favorable environment for these individuals, better quality of life and assurance of the constitutional right to work.

REFERENCES - Borges M. A. et al. (2000) As síndromes e crises epilépticas e suas relações com trabalho: estudo prospectivo ambulatorial de 412 pacientes. Arq. neuropsiquiatr. 58(3A):691-7.

- Goffman, E. (1988) Estigma: notas sobre a manipulação da identidade deteriorada. 4. ed. Rio de Janeiro: LTC. - Harden, C. L.; Kossoy, A.; Nikolov, B. (2004) Reaction to Epilepsy in the Workplace. Epilepsia, 45(9):1134–1140.

- Hopker, C. L. et al. (2017) The individual with epilepsy: perceptions about the disease and implications on quality of life. 29(1).

- Kanashiro, A. L. A. N. (2006) Epilepsia: prevalência, características epidemiológicas e lacuna de tratamento farmacológico. Thesis [Doctor’s in Medical Sciences] – University of Campinas, Brazil.

- Molon, S. I. (2011) Notas sobre constituição do sujeito, subjetividade e linguagem. Psicologia em Estudo, v.16, n.4, p.613-622.

- Pinto, L. A. (2014) Visão do paciente, do familiar e do empregador sobre o trabalho da pessoa com epilepsia de difícil controle. Dissertation [Master’s in Internal Medicine] – Federal University of Paraná, Brazil.

- Salgado, P. C. B. & Souza, E. A. P. Impacto da epilepsia no trabalho - avaliação da qualidade de vida.

Arq. Neuropsiquiatr. v.60, n.2B, p.442-445. 2002.

- Smeets, M. J. (2007) Epilepsy and employment: Literature review. Epilepsy & Behavior 10 354– 362.

- Varela, J. S. (2016) Qualidade de vida e controle de crises epilépticas conforme definição da International League Against Epilepsy. Dissertation [Master’s in Medical Sciences] - Federal University of Rio Grande do Sul, Brazil.

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SECTION II

CASE STUDIES ON EPILEPSY

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15 Epilepsy and Autism: A Comorbidity Case Veviane Spergue

In this study we will present A. F., a 19 year-old male, second in a family of three children of a nonconsanguineous couple, who had no complication during the gestation and perinatal period, and with appropriate neuropsychomotor development.

At seven months of age, A. presented a convulsive crisis in the presence of hyperthermia (99.5 ÂşF), characterized by clonus in the upper left limb, associated with latero-lateralization movements of mouth and eyes with an approximate duration of one minute. He was taken to the nearest hospital, medicated with one injection of Diazepam and liberated, and his parents were instructed to seek out a neuropediatrician. The second crisis occurred at ten months of age, with the same characteristics of the first one. In the moment of the crisis, A. was crawling; he was taken to the hospital again and was given another injection of Diazepam. Electroencephalogram and laboratory tests results were normal. Even so the neuropediatrician decided to prescribe Fenobarbital, since it was the second time a crisis had happened. A. did not respond to drug therapy and in this moment started to present weekly crises and afebrile crises; determination of serum was realized periodically to adjust the medication, without success. The treatment was associated with Divalproex sodiumÂŽ but A. presented changes in his sleep pattern. Before the first convulsive crisis, he was a quiet child and interacted with everyone. Changes in behavior were observed after the onset of crises, such as impulsivity in the moment of playing, agitation, recklessness, inattention, dispersion, and no awareness of danger.

Due to the lack of response to the drug therapy, when A. was two years-old he was referred to a tertiary center of epilepsy. At the age of three, A. was diagnosed with Febrile Seizure Plus. In this process he presented periods of 102

improvement and worsening, even having a period of two years without crises.

Despite the number of crises, his tests did not show any abnormalities.

A. started preschool when he was 4 years-old, he liked to go to school and had always been affective, loving, and kind, however, in other moments he would be irritated, sleepy, sometimes impulsive, and it would result in educational and social difficulties. The professionals who assisted him did not know how to deal with the child. The parents faced many barriers in addition to the crises, such as socialization and social interaction. The suspicion of autism was raised only when A. started going to school, because of the cases of impulsiveness, aggressiveness and sometimes social isolation.

As it was described in the case report, the patient presented epilepsy associated with autism.The autism presented itself in the evolution of refractory epilepsy that in addition to the scheme of antiepileptic polypharmacy, needed psychotropic medication for the impulsiveness. Besides that, the parents struggled and still struggle with the placement and adaptation of their son in a society that unfortunately still does not have the necessary knowledge and tools to deal with this type of child.

Epilepsy and Autism

According to the International League against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE), epilepsy is a brain disorder characterized by a constant predisposition to generate epileptic crises with neurobiological, cognitive, psychosocial, and social consequences. The epileptic crisis is defined as the transitory occurrence of signs and/or symptoms, with clinical manifestations and abnormal synchronization due to abnormal neural activity (Fiore & Souza, 2018).

Epilepsy is one of the most observed comorbities in autism. Autism has several definitions.When we define it by period, the classic and straightforward definition explains that autism is a complex development disorder that involves delays and impairment in the areas of social interaction and language, including a wide range of emotional, cognitive, motor, and sensorial symptoms (Assumpção & Kuczynski, 2018).

The first references to autism date back to the beginning of the twentieth century, with Pouller in 1906 who investigated cases of dementia and schizophrenia with autistic characteristics and Eugene Bleuler who in 1911 used the term “autism” more appropriately, designating loss of touch with reality (Camargos, 2005; Assumpção et al., 2014).

According to the authors, Kanner defined Autism in 1943 as a 103

syndrome characterized by difficulty in communication, behavior with repetitive gestures, tendency to isolation, and manipulation of small objects. In the following year, Hans Asperger, an Austrian pediatrician interested in special education published his doctoral thesis presenting in his study four children with characteristics similar to those described by Kanner, also using the same term, “Autism” (Assumpção et al., 2014; Klin, 2006). Since then, much has been written about Autism, and even its definition has gone through modifications as research in the findings of etiologic factors and better explanation of the clinical presentation advanced.

Between the years of 1950 and 1960, very controversial hypotheses about the nature and etiology of Autism were discussed. One of them argued that Autism was caused by parents who were not much affectionate toward their children, and in the decade of 1960, studies resulted in evidence that it is a brain disorder present from birth. In 1978, Rutter proposed the definition of Autism with four criteria that influenced its inclusion as a class of Pervasive Development Disorders (PDD) in the DSM-III, in 1980 (Klin, 2006).

Nowadays the discussion about the subject “Autism” invites us to pursue a long and complex field of investigation marked by contradictions and controversies. The fourth version of the Manual Diagnostics and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association (APA), distinguishes the Autistic Disorder (Autism), Asperger’s Disorder (AD), Rhett’s Disorder, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), and Childhood Disintegrative Disorder (TDI) (American Psychiatric Association [APA], 2002).

In 2007, Assumpção et al. and Klin described that individuals with AD differ from those with Autism because they do not present intellectual difficulty, significant delays in language and communication, and because they show specific abilities (Assumpção et al., 2014; Klin, 2006). The criteria of the onset of the disorder also differ, since there is no delay in the development of cognitive abilities and self-care. Many individuals with AD express themselves verbally creatively, using sophisticated vocabulary and correct grammatical structures, however, difficulties in using language in a contextualized way in everyday situations can be noticed (Klin, 2006; Lendhardt et al., 2013).

Studies conducted in 2007 showed that children afflicted with AD present different motor characteristics from development standards considered appropriate since birth (Ozonoff et al., 2008; Jasmin et al., 2009).

The DSM-V was released in May 2013 presenting some alterations that were explained in the APA publication entitled “Highlights of Changes from DSMIV-TR to DSM-V” (APA, 2013).The update in relation to the previous version is the definition of the term Autism Spectrum Disorders (ASD) encompassing the 104

disorders previously separated in the DSM-IV, considering that they are part of the same condition with varying levels of severity of symptoms.Therefore, ASD encompasses Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.

They are characterized by: 1) significant deficit; 2) restricted and repetitive behavior with excessive adoption of routines and ritualized patterns of behavior, and showing interest in specific often intense activities.Thus AD is contained in ASD, considering that the term “Asperger Syndrome” was discontinued in this version of DSM-V (Duffy, Shankardass, McAnulty, & Als, 2013).

Nowadays autism is clinically identified and defined by a comprehensive set of symptoms that are well represented by one single category of diagnosis, adjustable according to the individual clinical presentation. This allows us to include clinical specifics such as epilepsy and other comorbidities (Fiore & Souza, 2018).

The Relationship between ASD and Epilepsy

Studies indicate that epilepsy and ASD are conditions that usually occur during childhood, and may occur at the same time because the child inherited both conditions or because they developed it after the epilepsy in consequence of a cerebral pathology, e.g. congenital rubella (Pereira, Pegoraro, & Cendes, 2012).

According to Pereira et al. (2012), there are cases where autism could occur in consequence of an epileptic process. It could be caused by the interferences in the functioning of the limbic system, which contains the specific neural networks related to social behavior and communication.

Epilepsy and Comorbidities

Psychiatric disorders can precede, concur or follow the diagnosis of epilepsy. Specialists have described this connection for years and psychiatric comorbidities such as neurosis, psychosis, and personality, humor and behavior disorders have great clinical impact in the patients (Pereira et al., 2012).

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Psychological Therapy in the Cognitive-behavioral Approach

The diagnosis of autism and/or epilepsy in a child is a sad announcement for the family and it is of great importance to seek for psychological orientation to support acts of medical care that prescribe medication, prevention or minimization of the effects of the pathology that has proven to alter behaviors and brain plasticity (Bunge, Scandar, Musich, & Carrea, 2015).

The clinical practice of cognitive-behavioral therapy (CBT) is based on a set of successful theories that tend to be planned in a structured manner so that it can orientate the actions of the therapist in order to meet the needs of the person who seeks them. This structure should be adapted to the client considering their age, activity level, problematic comorbidities, abilities, context, and the conceptualization of their case.The structure of the session works as a logical sequence to be followed so that the improvement of the person can be obtained (Bunge et al., 2015).

In the CBT sessions, situations are created to seek the development of functional behaviors and thus conversations, interactive games and activities are developed with the function of reducing the behaviors that are inadequate for a social life (Bunge et al., 2015). Conversations where sometimes only the therapist speaks and the patient ignores the attempt of interaction seek to identify the operative ways to resume a dialog in the attempt to extract important information so that the therapist can help the patient later with their social skills. When repeated disconnected sentences and contexts can be noticed an intervention is needed to break these repetitive conversations suddenly changing the subject.

Therapies are as important to the patient as they are to the family in helping with the construction of goals to be met (Oliveira et al., 2015).

McLaughlin et al. (2011) used CBT to control epileptic crises by proposing the use of a diary to register epileptic crises and associating them with situational or environmental factors and aspects of affection and cognition.

Therapy sessions also introduce therapeutic games and ludic activities in the attempt to spark the interest of the patient in contributing to their own stimulation with behavior change techniques. Thompson et al. (2010) indicated his use of the main techniques of psychoeducation for the neurological condition, problem solving and thought monitoring in therapy (Thompson et al., 2010) so that there could be new neural connections for the brain to reorganize new memorizations and learning (Bunge et al., 2015).

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REFERENCES - American Psychiatric Association. (2002). DSM-IV-TR: manual diagnóstico e estatístico de transtornos mentais (4ª. ed.). Porto Alegre: Artmed.

- American Psychiatric Association. (2013). Highlights of Changes from DSM-IV-TR to DSM-5.

- Assumpção, F. B., Jr., & Kuczynski, E. (2018). Transtorno do espectro autista/autismo: conceito e diagnóstico. In Assumpção, F. B., Jr., Kuczynski E. Tratado de psiquiatria da infância e da adolescência (3ª. ed.) (p.299). São Paulo: Atheneu.

- Assumpção, F. B., Jr., Russo, A. F., Padovani, R. C., Pozzi, M. C., Kuczynski, E., Bernal, M. P., Mendoza, M., & Rossetti, M. O. (2014). Psiquiatria da infância e da adolescência: casos clínicos. Porto Alegre: Artmed.

- Bunge, E., Scandar, M., Musich, F., & Carrea, G. (2015). Sessões de psicoterapia com crianças e adolescentes: erros e acertos. Novo Hamburgo: Sinopsys.

- Camargos, W. Jr., (Coord.). (2005). Transtornos Invasivos do Desenvolvimento: 3º milênio.

Brasília: Presidência da República, Secretaria Especial Direitos Humanos, Coord. Nacional para Integração da Pessoa Portadora de Deficiência.

- Duffy, F. H., Shankardass, A., McAnulty, G.B., & Als, H. (2013). The relationship of Asperger’s syndrome to autism: a preliminary EEG coherence study. BMC Medicine, 11(1), 175. Retrieved from: https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-11-175. doi: 10.1186/1741-7015-11-175 - Fiore, L. A., & Souza, M. S. T. (2018). Epilepsia. In Assumpção, F. B., Jr., & Kuczynski, E. Tratado de psiquiatria da infância e da adolescência (3ª. ed.) (p.577). São Paulo: Atheneu.

- Jasmin, E., Couture, M., McKinley, P., Reid, G., Fombonne, E., & Gisel, E. (2009). Sensori-motor and daily living skills of preschool children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(2), 231-241.

- Klin A. (2006). Autism and Asperger syndrome: an overview. Revista Brasileira de Psiquiatria, 28 (Suppl. 1), s3-s11. Retrieved from http://www.scielo.br/pdf/rbp/v28s1/en_a02v28s1.pdf. doi: 10.1590/S1516-44462006000500002 - Lehnhardt, F. G., Gawronski, A., Pfeiffer, K., Kockler, H., Schilbach, L., & Vogeley, K. (2013). The Investigation and Differential Diagnosis of Asperger Syndrome in Adults. Deutsches Ärzteblatt International, 110(45), 755-763. Retrieved from https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3849991/. doi: 10.3238/arztebl.2013.0755 - Oliveira, C. R. de, Lima Argimon, I. I. de, Irigaray, T. Q., Moraes, A. A., & Piccoloto, N. M. (2015).

Terapia cognitivo-comportamental em pacientes neurológicos: uma revisão sistemática.

Revista Brasileira de Terapia Comportamental e Cognitiva, 17(1), 54-67. Retrieved from http://www.usp.br/rbtcc/index.php/RBTCC/article/view/736. doi: 10.31505/rbtcc.v17i1.736

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- Ozonoff, S.,Young, G. S., Goldring, S., Greiss-Hess, L., Herrera, A. M., Steele, J., Macari, S., Hepburn, S., & Rogers S. (2008). Gross motor development, movement abnormalities, and early identification of autism. Journal of Autism and Developmental Disorders, 38(4), 644656.

- Pereira, A., Pegoraro, L. F. L., & Cendes, F. (2012). Autismo e epilepsia: modelos e mecanismos.

Journal of Epilepsy and Clinical Neurophysiology, 18(3), 92-96. Retrieved from http://www. scielo.br/pdf/jecn/v18n3/v18n3a05.pdf. doi: 10.1590/S1676-26492012000300005 - Thompson, N. J., Walker, E. R., Obolensky, N., Winning, A., Barmon, C., Dilorio, C., & Compton, M. T. (2010). Distance delivery of mindfulness-based cognitive therapy for depression: project UPLIFT. Epilepsy & Behavior, 19(3), 247-254.

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16 Absence Seizures: Intervention in Elementary School Students Ádrinne Uchôa Introduction

Over recent years, epilepsy has been a condition which has been gaining higher visibility, besides the stigmas it still suffers from due to lack of proper information. Epilepsy is a serious neurological condition of higher prevalence in the world. It attacks 1% of the population, that is, 60 million people around the world. Each year that sums up about three million new medical cases (Sander and Shorvon, 1996), of which at least 50% of the cases start in childhood or adolescence. According to the neurologist, Li Li Min, from the medical school of UNICAMP, epilepsy is the neurological category holding the highest incidence in the world. This information is extremely important for parents, responsible persons and educational institutions. They need to have a professional and welcoming look at these children who arrive in their classrooms and are committed to learning.

According to Zanini (2011), epilepsy is a chronical disorder. It is marked by constant recurrent crises due to an excessive discharge of neurons in certain areas of the common encephalon. It begins in the child’s early years and is reflected in the cognitive area, languages and during the school term of the child who presents with epileptic seizures. It is known that any chronic disease which begins in childhood will bring damages in physical, psychic and cognitive development and increases in with psychosocial comorbidity (Souza, 2011).

According to Zanni and Matsukura (2010), epilepsy while being a 109

chronic disease, affects the child more than other diseases, such as asthma or diabetes. To Costa, Maia and Gomes (2009), it presents behavioral and learning changes in children and adolescents. For each crisis and depending on the duration, it causes more sequels in areas that are important for the cognitive development. This occurs because epilepsy attacks directly the nervous system and consequently it can bring damages to perception, movement, consciousness and other cortical functions. This compromises the life quality, either for those who suffersfrom this disease or for those family members who live with relatives who suffer from this disease (Machado, Fran & Tomaz, 2008).

Epilepsy has many forms which depend on physical, psychological and cognitive symptoms which cause an even bigger impact in the social and academic lives of the afflicted subjects. It is highly important and relevant that professionals in psychology are more qualified to intervene in situations like these, particularly in multidisciplinary monitoring. It is with this intention that we aim to highlight through a case study, the interventive tasks which need to be carried out for epileptic students beginning at the age of five.

According to Rizzuti, Muskat and Vilanova (2000), the most well known absence seizures, the classical absence, is distinguished by disconnection crises.

In its peculiar configuration, there is the abrupt loss of the start and ending of consciousness, vague and short-term (lasting 5 to 25 seconds). It can occur several times a day, it is benign and it is not related with psychomotor delay or with cerebral structural injury.

The same authors cite the classification of International Epileptic Seizures (1981) which characterizes six clinical types of absence crisis, being: 1) simple absence with conscious alteration (10% of cases); 2) absence with clonic components, usually with eyelids (50% of the cases) lips and chin; 3) absence with an astonishing component by the decreasing of muscle tone, with fallen head and arms (20% of cases); 4) absence with tonic components by increasing of extensor musculature with retro drive of the torso; 5) absence with automatism, during which the patient can continue with what he was doing, such as eating, walking, or even starting new movements such as swallowing, licking lips and touching clothes; 6) absence with autonomic component by pupillary dilatation, tachycardia, flushing and pallor.This last one was the type of symptom that the child in the study presented.

The case came through a mother’s request to do the pedagogical monitoring because the child besides presenting low school performance also couldn’t follow the class, his handwriting wasn’t consistent for a 5th grade student and was difficult to comprehend. I could have concluded that there was also dysgraphia, but that wasn’t the case here. It is necessary to comprehend the whole background and context forthis child in this case.

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Here we had the request of a mother who didnâ&#x20AC;&#x2122;t know much how to help her own child, but she took great effort to help monitor and resolve school doubts. For example, through helping him everyday in his learning process, while on the other side, the school understood this to be an attention deficit matter and didnâ&#x20AC;&#x2122;t present itself as being totally prepared to deal with the demands related to his actual epilepsy.

Justification

Several educational institutions have been trained to deal with the learning difficulties, specifically in relation to ADD and ADHD. However, epilepsy conditions take a low approach as a matter to deal with in the classrooms.What to do? How to come up and deal with all this in its full context? The patient frequented a private school which provided several activities and there was a trained team by professionals, such as educators and educational psychologist.

The cases were evaluated and the ones which demanded follow-up care of other professionals were referred the parents to seek a due service.

This case study used the approach of how the psychology professional is important in these assistances and follow-ups not just leaving it up to the parents to seek services. Besides intervening directly with the child, he can mediate inside the school spheres and together with the parents determine the next steps which are more appropriate to the childâ&#x20AC;&#x2122;s needs.

It is important to point out that in addition to the absence epilepsy there can be benign cases offering a good prognosis, but the absence of crises can be mistaken with distraction episodes therefore hypothesized with other diseases (Rizzuti, Muskat & Vilanova, 2000).

There are situations where there is comorbidity. Studies reveal high rates of epilepsy episodes with neuropsychiatric disorders such as oppositional defiant disorder (ODD), conduct disorder (CD), depression, and Attention Deficit Disorder with Hiperactivity (ADHD) (Anto-niuk, 2004).

Therefore, it is highly important that the Institutions and the professionals understand that the child diagnosed with epilepsy since their initial years should be monitored by a psychologist and for schools to be open to enlightening dialogues about this disease which attacks millions of young children. It is only under the psychological and clinical examinations that we can intervene in the emotional, cognitive and social aspects, together with a multidisciplinary team, to trace which interventive strategies are the best to be developed and to provide a good quality of life for the children and families attacked by epilepsy.

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Methodology

The study aims to investigate psychological and educational aspects of epilepsy, highlighting their impacts over learning and how the psychological and educational interventions were done. It is about a qualitative research of descriptive feature that includes a bibliographical revision and a case study focused on the subject (student) with epilepsy.A structured research was applied to the mother to collect important datas about the studentâ&#x20AC;&#x2122;s background and birth conditions, whose name is Pedro (fictional name).

Pedro is 10 years old and studies at the 5th grade of Junior High in the mornings. He has an older brother, aged 12. His parents are divorced and he is medicated with Depacot. Pedro is a peaceful and quiet child, but with few friends.

Even though he is 10, his mother treats him as much younger as a consequence of his epileptical crises. She has developed a fierce overprotectiveness on him.

After the interview with the mother, an activity was applied for Pedro containing Portuguese and Mathematical questions. The goal was to evaluate his handwriting, spelling mistakes, his reading and the logical-mathematical rationality. Pedro showed slowness in writing, his handwriting was very much compromised and he wrote outside of the lines in his notebook. According to Gomes et al. (2013) the difficulties in the learning process result in considerable damage losses, such as motor disorders, disinterests and behavioral problems.

I went to Pedroâ&#x20AC;&#x2122;s school to understand how his relation with friends and studies were. Gomes et al (2013) states that the high incidence of epilepsy in school age, it is fundamental to observe children attending to their basic needs of physical, emotional and social nature. According to Pinheiro et al (2005), in order to understand the impact of epilepsy in the childâ&#x20AC;&#x2122;s life, you must approach not only the biological aspects that are caused, diagnosis, medical teatment, among others, but also the psycosocial aspects, such as school and family relationships, creeds and behaviors related directly to the disorder.

The attendances were carried out through 2 weekly meetings with the duration of 60 minutes each. Resources and activities were delivered to collaborate in writing, exercises of handwriting, executive functions training, cognitive and conative, and to help in the routine planning of studies and organization. Art therapy was another tool to help work with his emotions.

Art therapy is a psychological field of work that uses artistic resources with therapeutical purpose (Carvalho, 1995).

We intervened at the school in relation to the quantity of questions in tests because the slowness was also influenced by his medication. This caused low self-esteem for him since he always delivered the tests incompletely because of the exceeded time.

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As the weeks passed by, we realised a significant change in Pedroâ&#x20AC;&#x2122;s behavior. He presented more certainty while taking the test, followed a routine in a disciplined and organized way, and started receiving positive results in his school environment. Pedro started presenting maturity and understood that he is able to learn even though there is engagement needed in his executive functions. The cognitive, conative and executive training contributed to the excellent results for him.

Accordingly to Fonseca (2014), the cognitive, conative and executive training are one of the keys for school success in life. The earlier it is practiced, the easier it tends to rise in the subsequent learning. So, an intervention taking into consideration the biopsicosocial context will have higher chances of evolution. Gomes et al (2012), mentions that nowadays there are many signs that the learning difficulties related to the cognitive problems associated to epilepsy of absence can be characterized by intrinsic problems to the condition than to the disorder by itself.

Final Considerations

Accomplishing the follow-up in a multidisciplinary way for children that show the epilepsy diagnosis is of great gain in biopsychosocial development.

When we take into consideration needed aspects together with other professionals, a psychological intervention will contribute to better results.

Promoteing a good quality of life for each individual is one of the biggest goals to be reached.

For Gomes et al (2013), children with typical conditions of epilepsy absence in childhood can be treated as attention deficit carriers and wind up being referred to neurological assistance with the claim of having a â&#x20AC;&#x153;low performance at school.â&#x20AC;? This misconception leads to a late diagnosis and intervention which contributes to higher damages and sequels to those children.

Pedro relied strictly on the expert professionals of neurology and had been taking medications since age five. Even so, he still had problems of low performance, but with the intervention at the right time this could only provide him with a better academic life style.

We can analyze and compare the difference between Pedro initial condition to those at the end of his treatment as his being a child with stronger egoic resources, better organization and increased self-esteem. Because his test grades got better, so did his handwriting become easier understood and more organized for reading. However, to be allowed to delight in a good school performance, it is necessary that even the parents or the teachers and the 113

involved professionals in the diagnosis, join forces to provide to the child an emphathetic, friendly environment and a proper treatment, so he can develop properly.

REFERENCES - Carvalho, M. M. M. J. (1995). What is art therapy?. In M. M. M. J. Carvalho (Org.), Does the art cure? Artistic resources in psychotherapy, (pp. 22-26). Campinas: Editorial Psy II. - Chaix,Y., Laguitton,V; Lawvers-Cancès, C; Démonet J.F & et al.; (2006). Reading habilities and cognitive functions of children with epilepsy: Influence o epileptic syndrome.. Brain Dev. 28:122-30 - Costa, C. R. C. M., Maia, H.S., & Gomes, M. M. (2009). Clinical and neurological evaluation of attention and comorbidity with ADHD in the epilepsy of the childhood: a sistematic revision., J.Epilepsy Clin.Neurophysiol. pp.15(2):77-82.

- Fonseca,V. (2014) Cognitive, conative and executive functions role in learning: a neurophycopedagogical approach. São Paulo: Revista Psicopedagogia; (vol. 31), nº 96.

- Gomes, R. F.; Freitas, A. M; Pereira, A. G; Ferreira, E. E. S. Portuguez, M. W. (2013) Epilepsy of ab sence in the childhood and it’s impact over learning. Revista Neurosciências; 21(4) (p. 628632).

- Machado, L. D.V; Frank, J.E; Tomaz, C. (2008) Memory alterations in epilepsy of lobo temporal.

Brasília: Brasília Med., 45(1): (p.58-66).

- Pinheiro, M; Alves, M; Preto, G. R; Almeida, L. C. (2005) About epilepsy and the epileptical student learning. Natal: Revista Educação em Questão, (v. 24), n 10, (p. 191-210).

- Rizzuti, S; Muszkat, M;Vilanova, L. C. P. (2000) Epilepsy in childhood. Revista Neurociências, 8(3): (p. 108-116).

- Sander, J.W. Shorwon SD. (1996) Epidemiology of the epilepsies. J. Neutrol Neurosurg Psychiatry; 61: (p. 433-443).

- Zanini, R. S. (2011) Language and cognition of the child with epilepsy in the educational context.

Atos Pesq., 6 (1): (p. 245-251).

- Zanini, K. P; Maia, H. S, Matsukura,T. S. (2010) The impact of the epilepsy in the schooling process of children and teenagers. Revista Brasil Educação; 16(2): (p.215-230).

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