This chapter discusses the case of an 18-year-old woman, who had dystonia. She was sent to a psychiatric facility. She received low doses of haloperidol and a tricyclic antidepressant and after 2 weeks developed drooling, twisting of the neck to the right, and trouble walking. At that point, the psychiatrist consulted the movement disorders neurologist. She had drooling and cervical dystonia with laterocollis to the right with a mild rotational component. She presented an interesting diagnostic and treatment challenge. At the outset, the differential diagnosis consisted of primary psychiatric disorder and a possibility of drug-induced movement disorder versus a spontaneous movement disorder with psychiatric manifestations as seen in Wilson’s disease (WD). Her tests confirmed the diagnosis of WD, and she was treated with Penicillamine with the knowledge that it can cause further drop in platelets. Over the next several months, her eye movement became normal and the cervical dystonia disappeared.

College counseling has entered an era that promises to be radically different than any time in its previous 100-year history. College students in this 21st century are more technologically advanced than previous generations and more likely to take virtual classes than previous generations of college students. Traditional services provided by the college counseling center are: individual and group counseling, psychoeducational groups, evaluation and assessment, career counseling, consultation to faculty and staff, medication management and resident advisor (RA) training. Nontraditional services are defined as virtual counseling, advising, and related services offered via distance technology. College counseling centers have long offered types of self-instructional services. They will need to address social media in ways that are both ethically sound and also able to effectively engage college students in seeking counseling services. The counselor can administer the Dimensions of a Healthy Lifestyle Scale (DHLS) to the client and then discuss the findings.

This chapter discusses the case of a 38-year-old woman with diffuse, occasionally throbbing, headaches associated with nausea, which was worse while waking, together with intense pain accompanied by episodes of vomiting, diplopia, drowsiness, and torpor. Since symptoms’ onset, she reported being slower and having bilateral hand tremor. Analysis of cerebrospinal fluid (CSF) demonstrated a mild inflammatory reaction and neurocysticercosis (NCC) as detected by positive reactions to cysticercus antigens. She was assessed in the neurology service and diagnosed with intracranial hypertension after a brain MRI that showed the presence of supratentorial hydrocephalus with evidence of intraventricular cysts, as well as edema in the midbrain periaqueductal region. Methylprednisolone pulse therapy was then started, together with half a tablet of levodopa/carbidopa, with progressive improvement in the symptoms of parkinsonism. Eight months later, she was progressively taken off entacapone and then levodopa. She remained asymptomatic and returned to normal activities of daily life.

This chapter discusses the case of a 28-year-old man, who had progressive gait ataxia since the age of 16 years. Within a year, he developed dysarthria, followed by difficulties with fine finger movements. On examination, he had bilateral pes cavus and moderate scoliosis. He had gait and truncal ataxia with intention tremor, head tremor, dysmetria, dysdiadochokinesia, areflexia at lower limbs, bilateral Babinski sign, absent position and vibration senses in the feet, and positive Romberg’s sign. Neuropsychological examination revealed signs of minimal executive dysfunction. Supplementation with vitamin E in patients with ataxia with vitamin E deficiency (AVED) may improve neurologic symptoms and favorably influence prognosis. Therefore, screening for vitamin E deficiency is important in patients with ataxia of unknown etiology. Genetic analysis and early recognition of AVED may allow early introduction of effective treatment and appropriate genetic counseling.

Interictal epileptiform discharges (IEDs) represent a distinct group of waveforms that are characteristically seen in people with epilepsy. Scalp detection of IEDs is based upon dipole localization and the surrounding field. The interictal electroencephalogram (EEG) plays a pivotal role in providing ancillary support for a clinical diagnosis of epilepsy. Abnormal focal IEDs on EEG represent a heightened predisposition for the expression of focal seizures. Epileptiform discharges appear in different morphologies. Both spikes and sharp waves are referred to as IEDs and are defined by their duration. Mid-temporal IEDs occur in patients with temporal lobe epilepsy. Benign childhood epilepsy with centrotemporal spikes is a common childhood genetic localization related epilepsy syndrome. Frontal spikes are often found in patients with frontal lobe epilepsy, although they may be absent in up to one-third of patients. Central IEDs can occur with symptomatic focal epilepsies at any age.

Interictal electroencephalogram (EEG) provides useful information about the presence of nonepileptiform neurophysiological dysfunction. When abnormalities are encountered, they are not specific for an underlying etiology, and as such represent abnormalities without further differentiation of the pathological process. This chapter discusses and focuses on generalized and focal nonepileptiform abnormalities. Diffuse slowing on the EEG may have various morphologies, and occur intermittently or continuously, to reflect abnormal cerebral function. Low-voltage EEG is typically associated with diffuse slowing of the background rhythm. Focal abnormalities on the EEG provide electrographic evidence of a localized abnormal cerebral function. Intermittent irregular slowing has a low correlation with an underlying lesion compared to focal slowing that is continuous. EEG can reveal many types of nonepileptiform abnormalities corresponding to varied cerebral dysfunctions occurring at any age. Reactivity of nonepileptiform abnormalities is an important feature that helps assess the cause and prognosis of the clinical condition.

This chapter considers specific abnormal grief reactions that would require grief therapy. It is important to understand why people fail to grieve. The chapter examines the types of abnormal or complicated grief and sees how the clinician can diagnose and determine these cases. Complicated mourning manifests in several forms and has been given different labels. It is sometimes called pathological grief, unresolved grief, complicated grief, chronic grief, prolonged grief, delayed grief, or exaggerated grief. The chapter lists two principal reasons for the continuing dialogue and debate about complicated mourning: financial support for research and reimbursement from third-party payers for treatment. It describes four clinical manifestations of complicated mourning. There are a number of clues to an unresolved grief reaction. The chapter describes 12 clues for identifying complicated mourning.

This chapter discusses case of a 19-year-old fine arts college student who was a very good athlete. A psychiatrist diagnosed her psychogenic gait and prescribed Clonazepam and later Seritonine reuptake inhibitors (IRSS), but no improvements were noted. She presented with dysthymia according to the DSM-III, and the movement disorder persisted unmodified. She underwent intravenous placebo therapy, but it never worked. An electromyography (EMG) was performed that did not reveal any cocontraction. The patient’s mother and sister came to the clinic and evident clinical ataxia was confirmed in both individuals with severe dysarthria and difficulties in walking without aid. She developed an increase in basal sustentation and alterations in her postural reflexes, therefore developing difficulties with walking as the disease progressed. She has almost completely recovered from the movement interpreted as “task-specific dystonia” because it has been predominantly replaced by pancerebellar ataxia with few extracerebellar signs.

The Wedging or Strengthening Technique has been modified in Germany and is called the Absorption Technique to create resources to deal with what the client is concerned about in the future, or having stress about working with eye movement desensitization and reprocessing (EMDR) in the future, a present trigger or even an intrusive memory. Having clients imagine a strength or skill that would help them during the problem often helps them to reduce their anxiety. Focusing on a specific strength or coping skill may create a wedge of safety or control that will assist clients with the difficult situation in the future. During the Future Phase of the Inverted Protocol for Unstable complex post-traumatic stress disorder (C-PTSD) use the Absorption or Wedging Technique to develop as many different resources for the different issues about which the client might be concerned.