1
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Coey P, Nic Craith I, McQuaid L, D'Alton P, O'Connor C. Does explaining psychogenic nonepileptic seizures using either a biomedical or biopsychosocial framework affect young people's illness representations? An experimental vignette study. Epilepsy Behav 2023; 142:109186. [PMID: 37028150 DOI: 10.1016/j.yebeh.2023.109186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
Lay representations of psychogenic nonepileptic seizures (PNES) are important both for understanding public stigma and anticipating patient responses to PNES diagnosis. The current study presents the first evidence of the general public's representations of PNES and the malleability of these understandings to different ways of explaining PNES. An online experimental study exposed participants (n = 193, aged 18-25 years) to a vignette describing a case of PNES in biomedical terms, PNES in biopsychosocial terms, or epilepsy. Subsequent questionnaires assessed participants' illness representations, causal attributions, and stigmatising attitudes regarding the case about which they read. Results suggest that compared with biomedical framings, biopsychosocial explanations increased perceptions of PNES as threatening. While epilepsy was attributed to significantly more biological and less social causes than either of the PNES vignettes, causal attributions did not differ between biomedically- vs. biopsychosocially-framed PNES. Neither were there any differences between the three conditions in stigmatising attitudes towards people who experience seizures. These findings are useful for clinicians delivering a PNES diagnosis and patients disclosing a PNES diagnosis, in helping anticipate responses to these communications. Further research is required to confirm the clinical and societal significance of the study's first insights into the dynamics of lay responses to PNES.
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Affiliation(s)
- Phillip Coey
- Paediatric Psychology Department, Children's Health Ireland at Crumlin, Dublin 12, Ireland; School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | | | - Léa McQuaid
- School of Psychology, University College Dublin, Dublin 4, Ireland
| | - Paul D'Alton
- School of Psychology, University College Dublin, Dublin 4, Ireland; Psychology Department, St. Vincent's University Hospital, Dublin 4, Ireland
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2
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María Marta AP, Mercedes S, Alejandra Inés L, Cristina T, Camila W, Luciana DA, Guido Pablo K. Cultural issues: Perspectives and experiences of patients with dissociative seizures in Argentina. Seizure 2023; 106:101-109. [PMID: 36812680 DOI: 10.1016/j.seizure.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE To explore patients' subjective experience when receiving a diagnosis of Dissociative Seizures (DS) in Buenos Aires, Argentina, and their explanatory models about DS. METHOD A qualitative approach using semi-structured interviews was used to gain an in-depth and contextual understanding of the perspectives of 19 patients with DS. Data collection and analysis were followed by an inductive and interpretive approach informed by the principles of thematic analysis. RESULTS Four main themes emerged: 1) Reactions to the Diagnosis; 2) Ways of Naming the Disease; 3) Own Explanatory Models; 4) External Explanatory Models. CONCLUSIONS This information might help achieve an adequate knowledge of the local characteristics of patients with DS. Most patients could not express any emotions or considerations about being diagnosed with DS, and they related their seizures to a personal or social-emotional conflict and environmental stress; however, family members related patients' seizures to a biological cause. It is important to analyze cultural differences in patients with DS in order to develop appropriate interventions for this specific population.
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Affiliation(s)
- Areco Pico María Marta
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina.
| | - Sarudiansky Mercedes
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Lanzillotti Alejandra Inés
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Tenreyro Cristina
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - Wolfzun Camila
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
| | - D' Alessio Luciana
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina; Buenos Aires University, Ramos Mejía Hospital, Epilepsy Center, Gral. Urquiza 609, C1221ADC, Buenos Aires, Argentina; Buenos Aires University, Medicine School, Cell Biology and Neuroscience Institute (IBCN)- National Council for Scientific and Technical Research (CONICET), Paraguay 2155, C1121 ABG, Buenos Aires, Argentina
| | - Korman Guido Pablo
- Buenos Aires University, Psychology School, Psychology School Research Institute National Council for Scientific and Technical Research (CONICET), Lavalle 2353 C1052AAA, Buenos Aires, Argentina
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3
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Finkelstein SA, Adams C, Tuttle M, Saxena A, Perez DL. Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide. Semin Neurol 2022; 42:204-224. [PMID: 35189644 DOI: 10.1055/s-0042-1742773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.
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Affiliation(s)
- Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Adams
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Inpatient Psychiatry, Department of Psychiatry, Mass General Brigham Salem Hospital, Salem, Massachusetts
| | - Margaret Tuttle
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Primary Care Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aneeta Saxena
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Epilepsy Division, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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4
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Ertan D, Aybek S, LaFrance WC, Kanemoto K, Tarrada A, Maillard L, El-Hage W, Hingray C. Functional (psychogenic non-epileptic/dissociative) seizures: why and how? J Neurol Neurosurg Psychiatry 2022; 93:144-157. [PMID: 34824146 DOI: 10.1136/jnnp-2021-326708] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric intricacies of this disorder. Psychological and neurobiological processes of FS are incompletely understood. Nevertheless, important advances have been made on underlying neuropsychopathophysiological mechanisms of FS. These advances provide valuable information about the underlying mechanisms of mind-body interactions. From this perspective, this narrative review summarises recent studies about aetiopathogenesis of FS at two levels: possible risk factors (why) and different aetiopathogenic models of FS (how). We divided possible risk factors for FS into three categories, namely neurobiological, psychological and cognitive risk factors. We also presented different models of FS based on psychological and neuroanatomical understanding, multilevel models and integrative understanding of FS. This work should help professionals to better understand current views on the multifactorial mechanisms involved in the development of FS. Shedding light on the different FS profiles in terms of aetiopathogenesis will help guide how best to direct therapy, based on these different underlying mechanisms.
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Affiliation(s)
- Deniz Ertan
- CRAN,UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, France.,Unité de recherche clinique, Établissement Médical de La Teppe, Tain-l'Hermitage, France
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland.,Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - W Curt LaFrance
- Psychiatry and Neurology, Brown Medical School Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kousuke Kanemoto
- Neuropsychiatric Department, Aichi Medical University, Nagakute, Aichi, Japan
| | - Alexis Tarrada
- Neurology Department, CHRU de Nancy, Nancy, Lorraine, France.,University Psychiatry Department, Centre Psychothérapique de Nancy, Laxou, Lorraine, France
| | - Louis Maillard
- CRAN,UMR7039, Centre de Recherche en Automatique de Nancy, Vandoeuvre les Nancy, Grand Est, France.,Neurology Department, CHRU de Nancy, Nancy, Lorraine, France
| | - Wissam El-Hage
- Department of Psychiatry, CHRU Tours, Tours, Centre, France
| | - Coraline Hingray
- Neurology Department, CHRU de Nancy, Nancy, Lorraine, France .,University Psychiatry Department, Centre Psychothérapique de Nancy, Laxou, Lorraine, France
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5
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Kotwas I, Arthuis M, Cermolacce M, Bartolomei F, McGonigal A. Psychogenic non-epileptic seizures: Chronology of multidisciplinary team approach to diagnosis and management. Rev Neurol (Paris) 2021; 178:692-702. [PMID: 34980511 DOI: 10.1016/j.neurol.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
While the diagnosis and management of psychogenic non-epileptic seizures (PNES) remain challenging, certain evidence-based guidelines exist, which can help to optimize patient care. A multidisciplinary team approach appears to have many benefits. Current recommendations exist for some aspects of diagnosis and management of PNES, including levels of diagnostic certainty as proposed by the International League Against Epilepsy's expert Task Force on PNES. Other aspects of clinical still care lack clear consensus, including use of suggestion techniques for recording PNES and optimal terminology, since the term "functional seizures" has recently been proposed as a possible term to replace "PNES". The present article aims to (1) review current recommendations and (2) discuss our own team's experience in managing patients with PNES. This is organized chronologically in terms of the roles of the neurologist, psychiatrist and psychologist, and discusses diagnostic issues, psychiatric assessment and treatment, and psychotherapeutic approaches.
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Affiliation(s)
- I Kotwas
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - M Arthuis
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | - M Cermolacce
- University Department of Psychiatry, AP-HM, Sainte-Marguerite Hospital, Marseille, France
| | - F Bartolomei
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix-Marseille Université, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France
| | - A McGonigal
- AP-HM, Timone Hospital, Clinical Neurophysiology, Marseille, France; Aix-Marseille Université, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France.
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6
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Reuber M, Roberts NA, Levita L, Gray C, Myers L. Shame in patients with psychogenic nonepileptic seizure: A narrative review. Seizure 2021; 94:165-175. [PMID: 34844847 DOI: 10.1016/j.seizure.2021.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/02/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022] Open
Abstract
Psychogenic Nonepileptic Seizures (PNES) have been linked to dysregulated emotions and arousal. However, the question which emotions may be most relevant has received much less attention. In this multidisciplinary narrative review, we argue that the self-conscious emotion of shame is likely to be of particular importance for PNES. We summarize current concepts of the development of shame processing and its relationship with other emotional states. We demonstrate the potential of acute shame to cause a sudden disruption of normal cognitive function and trigger powerful behavioral, cognitive, physiological and secondary emotional responses which closely resemble key components of PNES. These responses may lead to the development of shame avoidance strategies which can become disabling in themselves. We discuss how excessive shame proneness and shame dysregulation are linked to several psychopathologies often associated with PNES (including depression and PTSD) and how they may predispose to, precipitate and perpetuate PNES disorders, not least by interacting with stigma. We consider current knowledge of the neurobiological underpinnings of shame and PNES. We explore how shame could be the link between PNES and a heterogeneous range of possible etiological factors, and how it may link historical aversive experiences with individual PNES events occurring much later and without apparent external trigger. We argue that, in view of the potential direct links between shame and PNES, the well-documented associations of shame with common comorbidities of this seizure disorder and the well-characterized relationship between chronic shame and stigma, there is a compelling case to pay greater attention to shame in relation to PNES. Its role in the treatment of patients with PNES is discussed in a separate, linked review incorporating case vignettes to highlight the complex interactions of different but interlinked shame-related issues in individual patients.
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Affiliation(s)
- M Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom.
| | - Nicole A Roberts
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA
| | - Liat Levita
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cordelia Gray
- Specialist Psychotherapist, Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, University of Sheffield, Sheffield, UK
| | - Lorna Myers
- Director, Northeast Regional Epilepsy Group, New York, United States
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7
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Is sexual trauma a risk factor for functional (psychogenic) seizures? Neurosci Biobehav Rev 2021; 128:58-63. [PMID: 34119526 DOI: 10.1016/j.neubiorev.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022]
Abstract
The relationship between functional seizures (FS) and sexual trauma has received attention in many previous studies. However, the mechanisms underlying this relationship have not been elucidated yet. The purpose of this narrative review is to explore and speculate on the underpinning neurobiological mechanisms for the association and link between sexual trauma and functional seizures. While existence of a causal relationship between a history of sexual trauma and functional seizures is plausible, it should be viewed and treated as a hypothesis. In explaining this hypothesis, we can speculate that interactions between genetic factors and a history of sexual trauma may contribute to the risk of experiencing functional seizures. Childhood sexual trauma may lead to structural and functional connectivity changes in the brain and dysregulation of the biological stress systems, particularly in women. These neurobiological changes speculatively may predispose patients to functional seizures later in life. Importantly, a history of sexual trauma has many other implications beyond the predisposition towards FS.
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8
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Yeom JS, Bernard H, Koh S. Myths and truths about pediatric psychogenic nonepileptic seizures. Clin Exp Pediatr 2021; 64:251-259. [PMID: 33091974 PMCID: PMC8181023 DOI: 10.3345/cep.2020.00892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body's expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mindbody dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNES may help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous system dysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.
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Affiliation(s)
- Jung Sook Yeom
- Department of Pediatrics, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.,Gyeongsang Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Heather Bernard
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sookyong Koh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA
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9
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What do patients prefer their functional seizures to be called, and what are their experiences of diagnosis? - A mixed methods investigation. Epilepsy Behav 2021; 117:107817. [PMID: 33621810 DOI: 10.1016/j.yebeh.2021.107817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/21/2022]
Abstract
This study explored the preferred terms for functional seizures, and the experience of being diagnosed, from the patient's perspective. 39 patients in a neuropsychiatry service diagnosed with functional seizures completed an online survey to investigate preferences for, and offensiveness of, 11 common diagnostic terms used to describe functional seizures. Of these 39 patients, 13 consented to take part in a semistructured interview exploring the experience of receiving a diagnosis. Nonepileptic attack disorder (NEAD), functional seizures, functional nonepileptic attacks (FNEA), and dissociative seizures were ranked the highest preferred terms and did not significantly differ from one another. NEAD was the least offensive term, with functional seizures and FNEA following closely. Significant overlap in confidence intervals was found between the offensiveness of all terms. Terms that indicated a psychological origin were the least preferred and viewed as most offensive. Thematic analysis identified three main themes on the experience of being diagnosed: 'being heard and having a shared understanding', 'feeling alone', and 'sense of hope'. Patients favored diagnostic terms that facilitated and alleviated these themes on a personal basis; however, preferences differed across individuals. Our findings suggest that a range of terms have a similar level of preference and offense rating, with NEAD, functional seizures, and FNEA being the most favorable. Qualitative analysis indicates that a term and its accompanying explanation should facilitate shared acceptance and understanding, and several terms provide this. In combination with our previous study on healthy participants, we propose that one of the two terms researched are adopted by patients, health professionals, and the public: Functional nonepileptic attacks or Functional seizures.
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10
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Sojka P, Paredes-Echeverri S, Perez DL. Are Functional (Psychogenic Nonepileptic) Seizures the Sole Expression of Psychological Processes? Curr Top Behav Neurosci 2021; 55:329-351. [PMID: 33768494 DOI: 10.1007/7854_2021_225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neurological disorder subtypes were of immense interest to early founders of modern-day neurology and psychiatry. Unfortunately, the divide that occurred between the both specialties throughout the mid-twentieth century placed FND-seiz at the borderland between the two disciplines. In the process, a false Cartesian dualism emerged that labeled psychiatric conditions as impairments of the mind and neurological conditions as disturbances in structural neuroanatomy. Excitingly, modern-day neuropsychiatric perspectives now consider neurologic and psychiatric conditions as disorders of both brain and mind. In this article, we aim to integrate neurologic and psychiatric perspectives in the conceptual framing of FND-seiz. In doing so, we explore emerging relationships between symptoms, neuropsychological constructs, brain networks, and neuroendocrine/autonomic biomarkers of disease. Evidence suggests that the neuropsychological constructs of emotion processing, attention, interoception, and self-agency are important in the pathophysiology of FND-seiz. Furthermore, FND-seiz is a multi-network brain disorder, with evidence supporting roles for disturbances within and across the salience, limbic, attentional, multimodal integration, and sensorimotor networks. Risk factors, including the magnitude of previously experienced adverse life events, relate to individual differences in network architecture and neuroendocrine profiles. The time has come to use an integrated neuropsychiatric approach that embraces the closely intertwined relationship between physical health and mental health to conceptualize FND-seiz and related functional neurological disorder subtypes.
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Affiliation(s)
- Petr Sojka
- Department of Psychiatry, University Hospital Brno, Brno, Czech Republic.
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Divisions, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology and Neuropsychiatry Divisions, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Catastrophising and repetitive negative thinking tendencies in patients with psychogenic non-epileptic seizures or epilepsy. Seizure 2020; 83:57-62. [PMID: 33096457 DOI: 10.1016/j.seizure.2020.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/01/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Previous research suggests that catastrophisation and perseverative, or repetitive negative thinking (RNT) could play an important role in the aetiology of Psychogenic Nonepileptic Seizures (PNES). This study was designed to explore whether these cognitive tendencies are more prevalent in patients with PNES than those with epilepsy and to examine the relationship between these cognitions, depression, anxiety, seizure frequency and diagnosis. METHODS 26 patients with PNES (PWPNES) and 29 with epilepsy (PWE) self-reported RNT (Perseverative Thinking Questionnaire), catastrophisation tendencies (modified Safety Behaviors and Catastrophizing Scale), symptoms of anxiety (Generalised Anxiety Disorder Assessment 7) and depression (Primary Health Questionnaire 9) as well as seizure frequency. RESULTS RNT and catastrophic thinking were highly correlated with each other and more prevalent in PWPNES than PWE. Positive correlations were also found between all other self-report measures and seizure frequency. The PNES diagnosis predicted RNT (perseverative thinking) independently of catastrophic thinking, anxiety, depression and seizure frequency. CONCLUSION PWPNES exhibit greater negative perseverative and catastrophising cognitive tendencies than PWE. PNES as a diagnosis independently predicted RNT. Hence, RNT and catastrophisation should be considered as possible specific targets for psychological interventions in patients with PNES.
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12
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Wolf P, Lin K, Mameniškiené R, Walz R. Does Epilepsy Have an Impact on Locus of Control? Front Psychol 2020; 11:2251. [PMID: 33013587 PMCID: PMC7509065 DOI: 10.3389/fpsyg.2020.02251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/11/2020] [Indexed: 11/13/2022] Open
Abstract
Many chronic diseases impair patients' quality of life and may also affect their control perceptions. This could particularly happen for patients with epilepsy whose seizures often imply loss of control as a deeply disturbing experience. In 1980, a study on learned helplessness in epilepsy found a highly significant reduction of internal general locus of control (GLOC) and an increase of chance and powerful others health-related LOC (HLOC). In consequence, LOC became a frequent target of investigations relating to depression and anxiety, quality of life, coping, compliance, and other psychosocial aspects of epilepsy. Both GLOC and HLOC were investigated, and special groups like children, elderly, mentally handicapped persons, and those with psychogenic non-epileptic seizures were addressed. Most studies attempted to relate in-group differences of LOC to other parameters. Seizure-free patients were found to have a more internal HLOC, and patients with severe epilepsies have a more external HLOC. Patients with a high external HLOC seem to have more difficulties with coping and to be more anxious. Whereas external GLOC was correlated with learned helplessness, internal GLOC was associated with high self-efficacy and better life quality. An association of external LOC with depression seemed not to be a stable co-relation as clinical improvement following epilepsy surgery dissociated the two. A hypothesis was confirmed that the ability of some patients to counteract seizures at their onset, thus preserving control, was correlated with a higher internal HLOC. Some other theoretically well-founded hypotheses were not supported. Absolute figures as reported in several papers are of limited use because the only normative data for comparison come from a local sample of 1976 from Tennessee, whereas LOC scores may differ largely dependent on cultural and societal conditions. Very few controlled studies exist, and the early finding of a generally externalized LOC in epilepsy was confirmed only in one study performed in a South Indian community known for strong stigma against epilepsy. A recent transcultural investigation conducted in Brazil and Lithuania found no differences from healthy controls and between countries. It seems worthwhile to further investigate relations of LOC with epilepsy stigma.
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Affiliation(s)
- Peter Wolf
- Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Katia Lin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Rüta Mameniškiené
- Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania
| | - Roger Walz
- Center for Applied Neuroscience, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Center for Epilepsy Surgery of Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Department of Internal Medicine, Neurology Service, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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13
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Adherence to mental health care and caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures: Longitudinal follow-up study. Seizure 2020; 80:227-233. [PMID: 32659654 DOI: 10.1016/j.seizure.2020.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/21/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study aimed to describe the quality of adherence to mental health care follow-up and the mental health caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures (PNES). METHODS We conducted an ancillary study of a multicenter prospective study. Patients (n = 108) received a standardized diagnostic explanation of PNES following video-EEG. They were referred to their community mental health centers or to a private psychiatrist/psychologist, who received written information about PNES and the study. Data collected about adherence to care (follow-up started or not, consensual and those who withdrew non-consensually, ongoing follow-up) were cross-tabulated from patients and care structures by telephone at 6, 12, 18 and 24 months after diagnosis. At M24, we collected reasons for stopping follow-up by phone using a predefined 9-item questionnaire. We also assessed the perception of the caregiver-patient relationship among patients who started follow-up and their mental health caregivers with a simple questionnaire based on five dimensions: feeling comfortable, continuity of care, content of therapy sessions, effectiveness of therapy sessions, and the patient's overall assessment of the follow-up. RESULTS From M6 to M24, ongoing follow-up decreased from 64.8 to 25.8%, while the "not following initial recommandations" group of patients (those who never started follow-up and those who withdrew non-consensually) increased from 35.2 to 64.9%. We found two main reasons for stopping follow-up: lack of interest and feeling better. Adherent patients had an overall more positive view of their therapy than caregivers. CONCLUSION Only a third of PNES patients adhered to a mental health care program and felt comfortable in the caregiver-patient relationship. Solutions need to be found to help patients understand the interest of follow-up therapy and help mental health caregivers improve their feeling of competence.
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Giussani G, Erba G, Bianchi E, Beghi E. Self-Report questionnaires for the diagnosis of psychogenic non-epileptic seizures in clinical practice. A comprehensive review of the available instruments. Seizure 2020; 79:30-43. [DOI: 10.1016/j.seizure.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
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Lidstone SC, MacGillivray L, Lang AE. Integrated Therapy for Functional Movement Disorders: Time for a Change. Mov Disord Clin Pract 2020; 7:169-174. [PMID: 32071934 PMCID: PMC7011811 DOI: 10.1002/mdc3.12888] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/22/2019] [Accepted: 12/07/2019] [Indexed: 11/11/2022] Open
Abstract
View Supplementary Video 1View Supplementary Video 2
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Affiliation(s)
- Sarah C. Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of TorontoTorontoOntarioCanada
| | - Lindsey MacGillivray
- Division of PsychiatryUniversity Health Network and the University of TorontoTorontoOntarioCanada
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of TorontoTorontoOntarioCanada
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Johnsen C, Ding HT. First do no harm: Preventing harm and optimizing care in psychogenic nonepileptic seizures. Epilepsy Behav 2020; 102:106642. [PMID: 31759315 DOI: 10.1016/j.yebeh.2019.106642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/06/2019] [Accepted: 10/06/2019] [Indexed: 10/25/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are challenging clinical occurrences consisting of any combination of altered movement, sensation, or awareness that resemble epileptic seizures (ES) but do not coincide with electrographic ictal discharges and are presumed to be neuropsychiatric-neurobehavioral in origin. Securing the PNES diagnosis is a crucial first step and is best confirmed by recording events on video-electroencephalogram (v-EEG) and finding an absence of ictal EEG changes and the presence of normal awake EEG rhythms before, during, and after the event. However, obstacles to timely diagnosis and referral to psychiatric treatment frequently occur, placing these patients at risk for harm from unnecessary medications and procedure as well as placing high burden on medical systems. Although providers across all disciplines share the responsibility by maintaining high suspicion of PNES in relevant clinical settings and engaging swiftly and empathically in securing and sharing the diagnosis with patients and families, psychiatric and neurologic providers are uniquely positioned to help lead patients towards safe and effective long-term care through a cohesive approach that is rooted in therapeutic alliance, interdisciplinary collaboration, and realistic treatment goals.
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Affiliation(s)
- Clark Johnsen
- Weill Cornell Medicine, Department of Psychiatry, 1300 York Avenue, New York, NY 10065, United States; New York-Presbyterian Hospital Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605, United States.
| | - Helen T Ding
- Weill Cornell Medicine, Department of Psychiatry, 1300 York Avenue, New York, NY 10065, United States; New York-Presbyterian Hospital Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605, United States
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O'Connell N, Jones A, Chalder T, David AS. Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study. Neuropsychiatr Dis Treat 2020; 16:1795-1805. [PMID: 32801714 PMCID: PMC7399446 DOI: 10.2147/ndt.s251328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/07/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION A proportion of patients admitted to acute-stroke settings have not had a stroke, but have conditions mimicking a stroke. Approximately 25% of suspected stroke cases are "stroke mimics" and 2% are patients with functional symptoms - "functional stroke mimics". This study aimed to explore experiences and illness perceptions of patients with functional symptoms admitted to hyperacute stroke wards. METHODS This study used mixed methods. Patients with functional stroke symptoms participated in semistructured qualitative interviews immediately after admission to one of two acute-stroke units in London and again 2 months after hospital discharge. Qualitative data were assessed using thematic analysis. The Brief Illness Perception Questionnaire (Brief-IPQ) measured illness perceptions at admission and at 2-month follow-up. RESULTS A total of 36 participants completed baseline interviews and 25 completed follow-up. Six themes emerged: physical symptom experience, emotional and coping responses, symptom causes, hospital experiences, views on the future, and uncertainty after hospital discharge. Mean Brief-IPQ score at admission was 49.3 (SD: 9.9), indicating a moderate-high level of perceived illness threat. Participants presented with a range of functional symptoms. At baseline, participants were highly concerned about their symptoms, but this had decreased at 2-month follow-up. Two months later, many were confused as to the cause of their admission. CONCLUSION This is the first study to examine functional stroke patients' experiences of acute-stroke admission. At admission, patients expressed confusion regarding their diagnosis, experienced high levels of emotional distress, and were concerned they were perceived as time wasting by stroke clinicians. While most participants experienced symptom recovery, there was a significant subgroup for whom symptoms persisted or worsened. A lack of care guidelines on the management of functional stroke patients may perpetuate functional symptoms.
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Affiliation(s)
- Nicola O'Connell
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Abbeygail Jones
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- UCL Institute of Mental Health, University College London, London, UK
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Campbell J, Walker E, No L, Sundram F. Nonepileptic seizures in individuals attending neurological services in New Zealand. Epilepsy Behav 2019; 101:106568. [PMID: 31675600 DOI: 10.1016/j.yebeh.2019.106568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/08/2019] [Accepted: 09/13/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study examined the demographic, social, and clinical (neurological and psychiatric) characteristics of people with psychogenic nonepileptic seizures (PNES) presenting to tertiary neurological services at Auckland District Health Board, New Zealand. METHODS Electronic notes and video-electroencephalography (video-EEG) data gathered from the telemetry unit based on synchronized acquisition (motor activity and brain electrophysiology) over a five-year period (2011 to 2015 inclusive) were retrospectively examined. Two groups were compared: people with PNES only or people with combined PNES and epileptic seizures (ES) (the group with PNES) and a control group with ES only, matched 1:1 by age and gender. RESULTS Sixty-six people in the group with PNES were matched with an equivalent number of ES controls. As a cohort, there was high psychiatric and medical comorbidity in both groups, but overall, those with PNES experienced higher rates than their ES counterparts. An older age of onset, female gender, and history of abuse were more frequently seen in those with PNES. Compared with controls, people with PNES more commonly had daily seizures (rather than monthly) but presented less frequently to neurology services. A high proportion of people with PNES experienced historical traumas, ongoing stressors, and disability. Almost half of the people with PNES were on antiepileptic drugs (AEDs) and received limited psychiatric or psychological input. In contrast, people with ES were more likely to be on psychotropic medication. CONCLUSION Both PNES and ES are associated with high levels of psychiatric and medical comorbidity. Additionally, PNES were found to be associated with iatrogenic harm and disability. Though people with PNES and ES often have a range of associated needs, there is, however, limited access to appropriate services. The needs of these populations should be better met through enhanced integration across psychiatry, neurology, and multidisciplinary services.
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Affiliation(s)
- Jill Campbell
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
| | - Elizabeth Walker
- Department of Neurology, Auckland City Hospital, 2 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Liz No
- Middlemore Hospital, Hospital Road, Otahuhu, Auckland 1640, New Zealand.
| | - Frederick Sundram
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
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Personality traits, illness behaviors, and psychiatric comorbidity in individuals with psychogenic nonepileptic seizures (PNES), epilepsy, and other nonepileptic seizures (oNES): Differentiating between the conditions. Epilepsy Behav 2019; 98:210-219. [PMID: 31382179 DOI: 10.1016/j.yebeh.2019.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 05/26/2019] [Accepted: 05/28/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The study aimed to investigate if South African individuals with psychogenic nonepileptic seizures (PNES) differ from individuals with epileptic seizures (ES) and other nonepileptic seizures (oNES) in terms of demographic and seizure characteristics, personality traits, illness behaviors, and depression, anxiety, and posttraumatic stress disorder (PTSD) comorbidity in statistically significant ways; and if so, to test if these differences can be utilized in raising suspicion of PNES as the differential diagnosis to epilepsy and oNES in practice. METHODS Data were analyzed from 29 adults with seizure complaints recruited using convenience sampling from a private and a government hospital with video-electroencephalography (vEEG) technology. A quantitative double-blind convenient sampling comparative design was used. A demographic and seizure questionnaire, the NEO Five Factor Inventory-3 (NEO-FFI-3), an abbreviated version of Illness Behavior Questionnaire (IBQ), and the Beck Anxiety Inventory - Primary Care (BAI-PC) were administered. Cronbach's alphas, analysis of variance (ANOVA), cross-tabulation, Fisher exact test, and receiver operating characteristic (ROC) analyses were performed on the dataset. RESULTS The total sample consisted of 29 participants, of which 5 had PNES (17%), 21 ES (73%), and 3 oNES (10%). The final sample was comprised of 24 participants from the private hospital and 5 from the government hospital. The group with PNES was found to be significantly more male, to experience significantly more monthly seizures, and chronic pain when comparing the PNES with the ES group, and the PNES with the combined ES and oNES group in both private only sample, as well as the private and government hospital combined sample. Patients with PNES also had a higher level of education compared with the group with ES in the combined private and government hospital sample, something that was not evident in the private hospital only sample. No significant differences between groups were found in either sample in terms of age, population group, language, age at first seizure, and the NEO-FFI-3 subscales. All three groups scored above the cutoff point of 5 exhibiting depression, anxiety, and PTSD symptoms on the BAI-PC in both samples. However, the group with PNES tended to score significantly higher than the group with ES and the combined ES and oNES group in the private hospital sample. A cutoff point of 12 on the BAI-PC was found to predict PNES in this seizure population with 80% sensitivity and 89% specificity. However, once the analysis was repeated on the combined private and government hospital sample, significance in BAI-PC scores between groups was lost. All scales showed good reliability in our study, with the exception of the "Openness to Experience" subscale of the NEO-FFI-3 once reliability analysis was carried out on the combined private and government hospital group. CONCLUSIONS This study provides an important stepping stone in the understanding of demographic and seizure factors, personality domains, abnormal illness behaviors, and psychiatric comorbidity in the South African population with PNES. The study also reported on a cutoff score of 12 on the BAI-PC predicting PNES with 80% sensitivity and 89% specificity in a private hospital sample.
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Salinsky M, Rutecki P, Parko K, Goy E, Storzbach D, Markwardt S, Binder L, Joos S. Health-related quality of life in Veterans with epileptic and psychogenic nonepileptic seizures. Epilepsy Behav 2019; 94:72-77. [PMID: 30893618 DOI: 10.1016/j.yebeh.2019.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 11/18/2022]
Abstract
RATIONALE Health-related quality of life (HRQoL) is compromised in civilians with epileptic seizures (ES) or psychogenic nonepileptic seizures (PNES). U.S. Veterans are a distinct patient group with regard to gender, age, and background. We studied HRQoL in Veterans and asked the following: (1) Is there a difference in HRQoL in Veterans with ES vs. PNES?; (2) What factors influence HRQoL in each group?; (3) What factors influenced the difference between seizure groups? METHODS We studied consecutive Veterans entering the epilepsy monitoring units (EMUs) of three VA Epilepsy Centers of Excellence. Patients underwent continuous video-EEG monitoring. Seizure diagnoses followed established criteria. Health-related quality of life was measured with the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). Evaluations included the Structured Clinical Interview for Diagnostic and Statistical Manual-IV (DSM IV), the posttraumatic stress disorder (PTSD) Checklist (PCL), the Beck Depression Inventory II (BDI-II), and the Minnesota Multiphasic Personality Inventory-2 Restructured form (MMPI-2RF). Between-group differences were tested with Wilcoxon tests. Nested regression analysis was used to evaluate the influence of demographic, social, military, seizure-related, and psychological factors on QOLIE-31 scores. RESULTS The median QOLIE-31 total score was 14 points lower in Veterans with PNES vs. ES (p < 0.001; Cohen's d = 0.73). Within each seizure group, psychological factors accounted for ≥50% of the variance in QOLIE scores while combined demographic, social, and seizure-related factors accounted for 18% (group with ES) and 7% (PNES). Psychological measures, particularly PCL and the BDI-II scores, accounted for all of the difference in QOLIE-31 total scores between Veterans with ES and those with PNES. CONCLUSIONS Health-related quality of life as measured by the QOLIE-31 is worse in Veterans with PNES as compared with those with ES. Psychological factors account for the most of the variance in QOLIE-31 scores regardless of seizure type and also account for the difference between groups with PNES and ES. Demographic, military, social, and seizure-related factors have minimal influence on HRQoL. These results in U.S. Veterans are similar to those found in civilians despite differences in patient age, gender, and background.
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Affiliation(s)
- Martin Salinsky
- VA Portland Health Care System, Portland, OR, United States of America; Oregon Health & Science University, Portland, OR, United States of America.
| | - Paul Rutecki
- William S. Middleton Memorial Veterans Affairs Medical Center, Madison, WI, United States of America
| | - Karen Parko
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States of America
| | - Elizabeth Goy
- VA Portland Health Care System, Portland, OR, United States of America
| | - Daniel Storzbach
- VA Portland Health Care System, Portland, OR, United States of America
| | - Sheila Markwardt
- Oregon Health & Science University, Portland, OR, United States of America
| | - Laurence Binder
- Oregon Health & Science University, Portland, OR, United States of America
| | - Sandra Joos
- VA Portland Health Care System, Portland, OR, United States of America
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Yogarajah M, Child R, Agrawal N, Cope S, Edwards M, Mula M. Functional seizures: An evaluation of the attitudes of general practitioners local to a tertiary neuroscience service in London. Epilepsia Open 2019; 4:54-62. [PMID: 30868115 PMCID: PMC6398091 DOI: 10.1002/epi4.12283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/17/2018] [Accepted: 10/17/2018] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Functional seizures are a common functional neurologic disorder. Given their chronic nature, and the biopsychosocial factors involved in their etiology, general practitioners (GPs) play a crucial role in the care of these patients. However, little is known about the attitudes of GPs toward, and knowledge of, functional seizures. METHODS The Atkinson Morley Regional Neuroscience Centre in London provides a comprehensive service to patients with functional seizures. As part of a service evaluation we conducted an online survey among local GPs over a 1-month period assessing their attitudes toward, and knowledge of, functional seizures. RESULTS One hundred twenty of 974 surveyed GPs replied to the survey (12.3%). Approximately 75% of GPs readily use the term "pseudoseizures," and over 50% were not sure or did not think that functional seizures were involuntary. Nearly 30% believed, or were unsure as to whether, functional seizures occur only when patients are stressed. Despite approximately 50% of GPs expressing interest in getting involved in the management of these patients, a similar proportion do not feel confident in dealing with queries from patients with functional seizures. Although most GPs felt that neurology and psychiatry should be the primary caregivers in the diagnosis and management, respectively, of functional seizures, 50% were also of the opinion that neurology should be involved in the management of these patients. SIGNIFICANCE This survey highlights the attitudes of, and descriptive terms used by, GPs toward patients with functional seizures. Our findings suggest a need for better and clearer provision of information to GPs about this condition.
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Affiliation(s)
- Mahinda Yogarajah
- Atkinson Morley Regional Neuroscience CentreSt George's University Hospitals NHS Foundation TrustLondonUK
- Institute of Molecular and Clinical SciencesSt George's University of LondonLondonUK
| | - Ruth Child
- Medical SchoolSt George's University of LondonLondonUK
| | - Niruj Agrawal
- Atkinson Morley Regional Neuroscience CentreSt George's University Hospitals NHS Foundation TrustLondonUK
- Department of NeuropsychiatrySouth West London & St George's Mental Health TrustLondonUK
| | - Sarah Cope
- Department of NeuropsychiatrySouth West London & St George's Mental Health TrustLondonUK
| | - Mark Edwards
- Atkinson Morley Regional Neuroscience CentreSt George's University Hospitals NHS Foundation TrustLondonUK
- Institute of Molecular and Clinical SciencesSt George's University of LondonLondonUK
| | - Marco Mula
- Atkinson Morley Regional Neuroscience CentreSt George's University Hospitals NHS Foundation TrustLondonUK
- Institute of Medical and Biomedical EducationSt George's University of LondonLondonUK
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Baizabal-Carvallo JF, Hallett M, Jankovic J. Pathogenesis and pathophysiology of functional (psychogenic) movement disorders. Neurobiol Dis 2019; 127:32-44. [PMID: 30798005 DOI: 10.1016/j.nbd.2019.02.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/31/2019] [Accepted: 02/20/2019] [Indexed: 11/17/2022] Open
Abstract
Functional movement disorders (FMDs), known over time as "hysteria", "dissociative", "conversion", "somatoform", "non-organic" and "psychogenic" disorders, are characterized by having a voluntary quality, being modifiable by attention and distraction but perceived by the patient as involuntary. Although a high prevalence of depression and anxiety is observed in these patients, a definitive role of psychiatric disorders in FMDs has not been proven, and many patients do not endorse such manifestations. Stressful events, social influences and minor trauma may precede the onset of FMDs, but their pathogenic mechanisms are unclear. Patients with FMDs have several abnormalities in their neurobiology including strengthened connectivity between the limbic and motor networks. Additionally, there is altered top-down regulation of motor activities and increased activation of areas implicated in self-awareness, self-monitoring, and active motor inhibition such as the cingulate and insular cortex. Decreased activation of the supplementary motor area (SMA) and pre-SMA, implicated in motor control and preparation, is another finding. The sense of agency defined as the feeling of controlling external events through one's own action also seems to be impaired in individuals with FMDs. Correlating with this is a loss of intentional binding, a subjective time compression between intentional action and its sensory consequences. Organic and functional dystonia may be difficult to differentiate since they share diverse neurophysiological features including decreased cortical inhibition, and similar local field potentials in the globus pallidus and thalamus; although increased cortical plasticity is observed only in patients with organic dystonia. Advances in the pathogenesis and pathophysiology of FMDs may be helpful to understand the nature of these disorders and plan further treatment strategies.
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Affiliation(s)
- José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA; University of Guanajuato, Mexico.
| | - Mark Hallett
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Diagnostic utility of the Minnesota Multiphasic Personality Inventory-2 Restructured Form in the epilepsy monitoring unit: Considering sex differences. Epilepsy Behav 2018; 88:117-122. [PMID: 30261450 DOI: 10.1016/j.yebeh.2018.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 11/23/2022]
Abstract
Psychological assessment measures are frequently used to evaluate patients in epilepsy monitoring units. One goal of that assessment is to contribute information that may help with differential diagnosis between epilepsy and psychogenic nonepileptic seizures (PNES). The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is one such measure. Del Bene et al. (2017) recently published an analysis that was the first to compare MMPI-2-RF scale elevations between diagnostic groups stratified by sex. The purpose of the present study was to replicate that analysis in a larger sample. Similar to previous work, we found that both men and women with PNES were more likely than men and women with epilepsy to report high levels of somatic complaints (2 to 5 times greater odds of somatic symptom reporting) and a variety of types of complaints. Mood disturbance scales were not significantly elevated in our PNES sample. Results contribute to the small body of research on sex differences in patients with PNES and suggest that somatization is a key characterization across sexes.
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Moritz JLW, Mameniškienė R, Rimšienė J, Budriūnienė A, de Almeida Calado G, Rigon IB, Cantú PLM, Meneguzzi C, Walz R, Lin K, Wolf P. Control perceptions in epilepsy: A transcultural case-control study with focus on auras. Epilepsy Behav 2018; 88:130-138. [PMID: 30269031 DOI: 10.1016/j.yebeh.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/08/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE General Locus of Control (GLoC) is used to measure the extent to which people perceive life events as results of their own actions or external factors. This study analyzes the relationship between GLoC and people with epilepsy's (PWE) clinical characteristics, levels of anxiety, depression, religiosity/spirituality, and quality of life, with particular attention to possible influences of auras. METHODS A case-control study was carried out with 186 consecutive patients with a definite diagnosis of epilepsy in Brazil and Lithuania. Besides clinical and demographic data, all patients answered to internationally validated scales: Rotter's GLoC, Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy (QOLIE-31), and Index of Core Spiritual Experiences-Revised (INSPIRIT-R). RESULTS Patient's mean age was 36.15 ± 13.75 years, 61.3% were female, mean age at onset of epilepsy was 17.27 ± 13.59 years, and monthly seizure frequency was 8.22 ± 20.00. People with epilepsy were more depressed than controls, (p = 0.03). Within the group with epilepsy, patients reporting auras and reacting to them had higher levels of depression (p = 0.002) and anxiety (p = 0.004) and lower QOLIE-31 (p = 0.01) score but did not differ in GLoC (p = 0.73) or INSPIRIT-R (p = 0.71). Patients with perceived ability to prevent seizures in response to auras had no increased levels of depression and anxiety. CONCLUSIONS General Locus of Control externalization in PWE was not confirmed. To perceive and be able to react to auras is associated with increased anxiety and depressive symptoms in PWE but not if it results in preventing seizures. No transcultural differences in these parameters were found.
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Affiliation(s)
- Jorge Luís Wollstein Moritz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Rūta Mameniškienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Justė Rimšienė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - Atėnė Budriūnienė
- Department of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | | | - Isadora Barazzetti Rigon
- Curso de Graduação em Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | | | - Caroline Meneguzzi
- Curso de Graduação em Medicina, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Roger Walz
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Kátia Lin
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Peter Wolf
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Serviço de Neurologia, Departamento de Clínica Médica, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark.
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Adams C, Anderson J, Madva EN, LaFrance WC, Perez DL. You've made the diagnosis of functional neurological disorder: now what? Pract Neurol 2018; 18:323-330. [PMID: 29764988 DOI: 10.1136/practneurol-2017-001835] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/04/2022]
Abstract
Patients with functional neurological disorders (FND)/conversion disorder commonly present to outpatient clinics. FND is now a 'rule in' diagnosis based on neurological examination findings and semiological features. While neurologists may be more comfortable diagnosing patients with FND, there is only limited guidance as to how to conduct follow-up outpatient visits. Using clinical vignettes, we provide practical suggestions that may help guide clinical encounters including how to: (1) explore illness beliefs openly; (2) enquire longitudinally about predisposing vulnerabilities, acute precipitants and perpetuating factors that may be further elucidated over time; (3) facilitate psychotherapy engagement by actively listening for potentially unhelpful or maladaptive patterns of thoughts, behaviours, fears or psychosocial stressors that can be reflected back to the patient and (4) enquire about the fidelity of individual treatments and educate other providers who may be less familiar with FND. These suggestions, while important to individualise, provide a blueprint for follow-up FND clinical care.
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Affiliation(s)
- Caitlin Adams
- Functional Neurology Research Group, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Anderson
- Department of Neurology, Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.,Department of Psychiatry, Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Elizabeth N Madva
- Functional Neurology Research Group, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Curt LaFrance
- Department of Neurology, Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA.,Department of Psychiatry, Alpert Medical School, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - David L Perez
- Functional Neurology Research Group, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Zeng R, Myers L, Lancman M. Post-traumatic stress and relationships to coping and alexithymia in patients with psychogenic non-epileptic seizures. Seizure 2018; 57:70-75. [DOI: 10.1016/j.seizure.2018.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/24/2018] [Accepted: 03/10/2018] [Indexed: 12/01/2022] Open
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Tsui P, Deptula A, Yuan DY. Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment. Curr Pain Headache Rep 2018; 21:29. [PMID: 28434123 DOI: 10.1007/s11916-017-0627-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms. RECENT FINDINGS Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study. There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.
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Affiliation(s)
- Patricia Tsui
- Department of Anesthesiology, Chronic Pain Division Stony Brook Medicine, 3 Edmund Pellegrino Rd, Stony Brook, NY, 11794, USA.
| | - Andrew Deptula
- Department of Psychiatry, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Derek Y Yuan
- Department of Neurology, Health Sciences Center T-12, 020, Stony Brook Medical Center, Stony Brook, NY, 11794, USA
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Rawlings GH, Brown I, Stone B, Reuber M. Written accounts of living with psychogenic nonepileptic seizures: A thematic analysis. Seizure 2017. [PMID: 28633044 DOI: 10.1016/j.seizure.2017.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Qualitative studies examining lived experiences of psychogenic nonepileptic seizures (PNES) have predominantly relied on datasets collected using clinical or research interviews. This study pursued a different approach by investigating individuals' written accounts of their condition. METHODS Participants (n=19) were recruited from membership-led organisations for individuals living with seizures and from a United Kingdom hospital. Participants were instructed to produce four pieces of writing: 1) about their thoughts and feelings about their condition; 2) a letter to their condition; 3) a letter to their younger self; and 4) about a personal value. All writings were analysed using thematic analysis. RESULTS Six main-themes emerged from the data. Theme 1: 'living with PNES' demonstrated that all participants presented the condition as having a debilitating effect. Theme 2: 'Emotions' revealed that individuals were struggling with anxiety, low mood and self-worth. Theme 3: 'Seizure symptoms' showed variability was a prominent feature in the description of ictal events. Theme 4: 'Treatment and outcomes' demonstrated that individual's perception of diagnosis and therapy differed greatly. Theme 5: 'Causation and development' revealed that the majority of participants spontaneously reported experiencing a traumatic event in the past. Theme 6: 'Lack of understanding' by themselves, the public and healthcare professionals appeared to pose considerable challenges to participants. CONCLUSIONS Qualitative research has an important role to play for improving our understanding of PNES. The findings contribute to the literature by highlighting the nature of stigma that people with PNES experience, and also their proneness to demonstrate problems with self-worth.
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Affiliation(s)
| | - Ian Brown
- Department of Psychology, University of Sheffield, UK.
| | | | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, UK.
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Predicting wellbeing among people with epilepsy using illness cognitions. Epilepsy Behav 2017; 71:1-6. [PMID: 28437681 DOI: 10.1016/j.yebeh.2017.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study sought to examine the synergistic contribution of illness-related perceptions (stigma, severity, and threat) and illness behavior to wellbeing among people with epilepsy. Poorer wellbeing was expected among those who perceived greater stigma, illness severity, and threat and had more extreme illness behavior. METHODS Individuals with a diagnosis of epilepsy (N=210), recruited through local and online support groups, completed a questionnaire comprising demographic and epilepsy-specific information, and validated measures of illness perceptions and behavior, epilepsy-related quality of life, and general psychological health. RESULTS Bivariate associations among illness cognition, illness behavior, and wellbeing were all as expected. Structural equation modeling highlighted the strong, direct effect of illness threat on quality of life, with other contributions from perceived stigma and an abnormal illness behavior syndrome (i.e., maladaptive illness responses). Significant variance was accounted for in both quality of life (64%) and psychological health (34%). CONCLUSION Preliminary evidence of the contributions of illness threat and maladaptive illness responses to wellbeing highlights the need for longitudinal research to examine the dynamic nature of such findings. Clinicians are encouraged to consider the potential value of screening for both illness threat and abnormal illness behavior to facilitate interventions.
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Rawlings GH, Brown I, Reuber M. Predictors of health-related quality of life in patients with epilepsy and psychogenic nonepileptic seizures. Epilepsy Behav 2017; 68:153-158. [PMID: 28189920 DOI: 10.1016/j.yebeh.2016.10.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
Epilepsy and psychogenic nonepileptic seizures (PNES) are associated with reduced health-related quality of life (HRQoL). The present study investigated the profile, relationship, and predictive power of illness perceptions, psychological distress (depression and anxiety), seizure activity, and demographic factors on HRQoL in these patient groups. Patients with epilepsy (n=62) and PNES (n=45) were recruited from a United Kingdom hospital and from membership-led organizations for individuals living with seizures. Patients completed a series of self-report questionnaires assessing: anxiety (GAD-7), depression (NDDI-E), illness perceptions (B-IPQ), HRQoL (NEWQOL-6D), and seizure frequency and severity (LSSS-3). Correlational and hierarchical multiple regression analyses were conducted. Patients with epilepsy reported higher HRQoL and scored lower on measures of depression and anxiety. Patients with PNES perceived their condition as more threatening overall. In both conditions, HRQoL was negatively correlated with more severe illness perceptions and psychological distress. In epilepsy and PNES, psychological distress (epilepsy: 27%; PNES: 24.8%) and illness perceptions (epilepsy: 23.1%; PNES: 23.3%) accounted for the largest amount of variance in HRQoL. Clinical factors were found not to be significant predictors, while demographic factors predicted HRQoL in epilepsy (12.6%), but not in PNES. Our findings support the notion that psychological factors are a stronger predictor of HRQoL in epilepsy and PNES than condition-related and demographic variables. Prior research suggests that anxiety and depression are key predictors of HRQoL; this study demonstrates that the relationship between illness perceptions and HRQoL is similarly close. These findings highlight the importance of addressing patients' beliefs about their condition.
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Affiliation(s)
| | - Ian Brown
- Department of Psychology, University of Sheffield, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, UK.
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Reuber M, Brown RJ. Understanding psychogenic nonepileptic seizures—Phenomenology, semiology and the Integrative Cognitive Model. Seizure 2017; 44:199-205. [DOI: 10.1016/j.seizure.2016.10.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022] Open
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Asadi-Pooya AA, Rabiei AH, Tinker J, Tracy J. Review of systems questionnaire helps differentiate psychogenic nonepileptic seizures from epilepsy. J Clin Neurosci 2016; 34:105-107. [DOI: 10.1016/j.jocn.2016.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/15/2016] [Indexed: 11/29/2022]
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What patients say about living with psychogenic nonepileptic seizures: A systematic synthesis of qualitative studies. Seizure 2016; 41:100-11. [DOI: 10.1016/j.seizure.2016.07.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022] Open
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Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). Clin Psychol Rev 2016; 47:55-70. [DOI: 10.1016/j.cpr.2016.06.003] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/16/2016] [Accepted: 06/16/2016] [Indexed: 01/10/2023]
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Hingray C, Biberon J, El-Hage W, de Toffol B. Psychogenic non-epileptic seizures (PNES). Rev Neurol (Paris) 2016; 172:263-9. [DOI: 10.1016/j.neurol.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/23/2015] [Indexed: 10/21/2022]
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Brown RJ, Reuber M. Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review. Clin Psychol Rev 2016; 45:157-82. [PMID: 27084446 DOI: 10.1016/j.cpr.2016.01.003] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/22/2015] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Abstract
Psychogenic non-epileptic seizures (PNES) are common in neurological settings and often associated with considerable distress and disability. The psychological mechanisms underlying PNES are poorly understood and there is a lack of well-established, evidence-based treatments. This paper advances our understanding of PNES by providing a comprehensive systematic review of the evidence pertaining to the main theoretical models of this phenomenon. Methodological quality appraisal and effect size calculation were conducted on one hundred forty empirical studies on the following aspects of PNES: life adversity, dissociation, anxiety, suggestibility, attentional dysfunction, family/relationship problems, insecure attachment, defence mechanisms, somatization/conversion, coping, emotion regulation, alexithymia, emotional processing, symptom modelling, learning and expectancy. Although most of the studies were only of low to moderate quality, some findings are sufficiently consistent to warrant tentative conclusions: (i) physical symptom reporting is elevated in patients with PNES; (ii) trait dissociation and exposure to traumatic events are common but not inevitable correlates of PNES; (iii) there is a mismatch between subjective reports of anxiety and physical arousal during PNES; and (iv) inconsistent findings in this area are likely to be attributable to the heterogeneity of patients with PNES. Empirical, theoretical and clinical implications are discussed.
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Affiliation(s)
- Richard J Brown
- 2nd Floor Zochonis Building, Brunswick Street, School of Psychological Sciences, University of Manchester, Manchester M13 9PL, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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Sadan O, Neufeld MY, Parmet Y, Rozenberg A, Kipervasser S. Psychogenic seizures: long-term outcome in patients with and without epilepsy. Acta Neurol Scand 2016; 133:145-151. [PMID: 26177156 DOI: 10.1111/ane.12458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Psychogenic non-epileptic seizures (PNES) may resemble epileptic events. Epileptic and non-epileptic seizures are not mutually exclusive phenomena and may coexist in the same patient. The aim of this study was to evaluate the long-term outcome of psychogenic events in patients with PNES alone and those with both PNES and epilepsy (PNES + EPI) as diagnosed by video-EEG (vEEG) monitoring. MATERIALS AND METHODS All adult admissions to the Tel-Aviv Medical Center's vEEG unit between 2004 and 2009 were screened for the presence of PNES. We retrospectively retrieved data from their medical files and supplemented the follow-up by a telephonic questionnaire. RESULTS Eligible patients (n = 51) were divided into those with PNES + EPI (n = 24) and those with PNES alone (n = 27). The follow-up period was 4.8 ± 0.3 and 4.3 ± 0.3 years, respectively. Both groups had similar female predominance and similar age at admission to the vEEG unit. Time from PNES onset to hospitalization was longer in PNES patients compared to those with PNES + EPI. The majority of subjects in each group reported a history of at least one major stressful life event. Opisthotonus was significantly more frequently observed in PNES patients, and they had more events during vEEG hospitalization. Psychogenic events ceased during the follow-up period in 22% of the PNES patients and in 58% of the PNES + EPI patients (P > 0.001). CONCLUSION Our results indicate that following vEEG-based diagnosis of PNES, the long-term outcome of PNES cessation may be more favorable for patients with concomitant epilepsy than for patients without epilepsy.
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Affiliation(s)
- O. Sadan
- EEG and Epilepsy Unit; Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
| | - M. Y. Neufeld
- EEG and Epilepsy Unit; Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
| | - Y. Parmet
- Department of Industrial Engineering and Management; Ben-Gurion University of the Negev; Beersheva Israel
| | - A. Rozenberg
- EEG and Epilepsy Unit; Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
| | - S. Kipervasser
- EEG and Epilepsy Unit; Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel-Aviv Israel
- Sackler School of Medicine; Tel-Aviv University; Tel-Aviv Israel
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Abstract
The epidemiology of functional neurologic disorders (FND) is complex and has been hampered over the years by a lack of clear definition, with previous definitions struggling with an uneasy mix of both physical and psychologic components. The recent changes in DSM-5 to a definition based on positive identification of physical symptoms which are incongruent and inconsistent with neurologic disease and the lack of need for any associated psychopathology represent a significant step forward in clarifying the disorder. On this basis, FND account for approximately 6% of neurology outpatient contacts and putative community incidence rates of 4-12 per 100 000 per annum. Comorbid neurologic disease occurs in around 10% of cases. The diagnosis is reliable, with revision rates less than 5%. Of note, this revision rate was consistent prior to the widespread utilization of computed tomography and magnetic resonance imaging. FND symptoms are disabling and associated with significant distress. They are more common in women and have a peak incidence between the ages of 35 and 50; however the presentation is common in men and throughout the lifespan. The issues surrounding case definition, ascertainment, misdiagnosis, and risk factors are discussed in detail.
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Affiliation(s)
- A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - A Lehn
- Department of Neurology, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Australia
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Carson A, Ludwig L, Welch K. Psychologic theories in functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:105-120. [PMID: 27719831 DOI: 10.1016/b978-0-12-801772-2.00010-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this chapter we review key psychologic theories that have been mooted as possible explanations for the etiology of functional neurologic symptoms, conversion disorder, and hysteria. We cover Freudian psychoanalysis and later object relations and attachment theories, social theories, illness behavior, classic and operant conditioning, social learning theory, self-regulation theory, cognitive-behavioral theories, and mindfulness. Dissociation and modern cognitive neuroscience theories are covered in other chapters in this series and, although of central importance, are omitted from this chapter. Our aim is an overview with the emphasis on breadth of coverage rather than depth.
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Affiliation(s)
- A Carson
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
| | - L Ludwig
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - K Welch
- Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Correlates of health-related quality of life in adults with psychogenic nonepileptic seizures: A systematic review. Epilepsia 2015; 57:171-81. [DOI: 10.1111/epi.13268] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 12/01/2022]
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Ludwig L, Whitehead K, Sharpe M, Reuber M, Stone J. Differences in illness perceptions between patients with non-epileptic seizures and functional limb weakness. J Psychosom Res 2015; 79:246-9. [PMID: 26047955 DOI: 10.1016/j.jpsychores.2015.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Illness perceptions play an important role in the onset and maintenance of symptoms in functional neurological symptom disorder (conversion disorder). There has, however, been little work examining differences between subtypes of this disorder. We therefore aimed to compare illness perceptions of patients with non-epileptic seizures (NES) and those with functional weakness (FW) with matching neurological disease controls to examine their specificity. METHODS The Illness Perception Questionnaire Revised (IPQ-R) was completed by patients with functional limb weakness, non-epileptic seizures and patients with neurological disease causing limb weakness and epilepsy in two separate case control studies. RESULTS Patients with FW (n=107), NES (=40), Epilepsy (n=34) and neurological disease causing limb weakness (NDLW) (n=46) were included in the analysis. Both FW and NES patients reported a low level of personal control, understanding of their symptoms and a tendency to reject a psychological causation of their symptoms. However NES patients rejected psychological causes less strongly than FW patients (P<.01). Patients with NES were also more likely to consider their treatment to be more effective (P<.01). None of these differences appeared in a similar comparison between patients with epilepsy and patients with NDLW. CONCLUSION Although patients with NES tended, as a group, to reject psychological factors as relevant to their symptoms, they did so less strongly than patients with functional limb weakness in these cohorts. This has implications for both the way in which these symptoms are grouped together but also the way in which treatment is approached.
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Affiliation(s)
- Lea Ludwig
- Dept of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
| | - Kimberley Whitehead
- Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Michael Sharpe
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield Royal Hallamshire Hospital, Sheffield, UK.
| | - Jon Stone
- Dept of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
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Health resource utilization among US veterans with psychogenic nonepileptic seizures: A comparison before and after video-EEG monitoring. Epilepsy Res 2015; 114:114-21. [DOI: 10.1016/j.eplepsyres.2015.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 05/05/2015] [Indexed: 11/19/2022]
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LaFrance WC, Ranieri R, Bamps Y, Stoll S, Sahoo SS, Welter E, Sams J, Tatsuoka C, Sajatovic M. Comparison of common data elements from the Managing Epilepsy Well (MEW) Network integrated database and a well-characterized sample with nonepileptic seizures. Epilepsy Behav 2015; 45:136-41. [PMID: 25825372 DOI: 10.1016/j.yebeh.2015.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Epilepsy and psychogenic nonepileptic seizures (PNES) are both chronic illnesses characterized by similar and overlapping clinical features. A limited number of studies comparing people with epilepsy (PWE) and patients with PNES that address determinants of health outcomes exist. We conducted an analysis using a well-characterized sample of people with PNES and the Managing Epilepsy Well (MEW) Network integrated data, comparing descriptive data on samples with epilepsy and with documented PNES. Based on the pooled data, we hypothesized that people with PNES would have worse QOL and higher depression severity than PWE. MATERIAL AND METHODS We used data from the MEW Network integrated database involving select epilepsy self-management studies comprising 182 PWE and 305 individuals with documented PNES from the Rhode Island Hospital Neuropsychiatry and Behavioral Neurology Clinic. We conducted a matched, case-control study assessing descriptive comparisons on 16 common data elements that included gender, age, ethnicity, race, education, employment, income, household composition, relationship status, age at seizure onset, frequency of seizures, seizure type, health status, healthy days, quality of life, and depression. Standardized rating scales for depression and quality of life were used. RESULTS Median seizure frequency in the last 30days for PWE was 1, compared to 15 for patients with PNES (p<0.05). People with epilepsy had a QOLIE-10 mean score of 3.00 (SD: 0.91) compared to 3.54 (0.88) (p<0.01) for patients with PNES. Depression severity was moderate to severe in 7.7% of PWE compared to 34.1% (p<0.05) of patients with PNES. DISCUSSION People with epilepsy in selected MEW Network programs are fairly well educated, mostly women, with few minorities and low monthly seizure rates. Those with PNES, however, have higher levels of not working/on disability and had more frequent seizures, higher depression severity, and worse QOL. These differences were present despite demographics that are largely similar in both groups, illustrating that other determinants of illness may influence PNES.
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Affiliation(s)
| | - Rebecca Ranieri
- San Paolo Hospital, Dipartimento di Scienze Della Salute Mentale, Psychiatry Branch Universita' degli Studi di Milano, Italy
| | - Yvan Bamps
- Rollins School of Public Health, Emory University, USA
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O'Brien FM, Fortune GM, Dicker P, O'Hanlon E, Cassidy E, Delanty N, Garavan H, Murphy KC. Psychiatric and neuropsychological profiles of people with psychogenic nonepileptic seizures. Epilepsy Behav 2015; 43:39-45. [PMID: 25553390 DOI: 10.1016/j.yebeh.2014.11.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study examined the psychiatric and neuropsychological profiles of people with psychogenic nonepileptic seizures (PNES). METHODS Twenty-people who had been diagnosed with psychogenic nonepileptic seizures (PNES), but not epilepsy, were recruited into this study. A healthy control group was also recruited and was matched for age and gender. All participants underwent structured psychiatric assessment and psychometric assessment. Neuropsychological assessment was carried out using the Cambridge Neuropsychological Test Battery (CANTAB) after participants passed the Medical Symptom Validity Test (MSVT) of effort. RESULTS One patient failed the MSVT and was excluded from the analysis. Therefore, data from 19 people with PNES and their matched healthy controls were analyzed. Compared with controls, people with PNES had significantly higher levels of depressive symptoms, anxiety symptoms, dissociative experiences, and alexithymic traits. In addition, people with PNES had impairments in spatial working memory and attention when compared with healthy controls. CONCLUSION To our knowledge, this is the first study to report that, compared with controls, people with PNES have abnormal cognitive functioning after controlling for effects of effort and FSIQ. People with PNES also have high levels of anxiety, depressive, and dissociative symptoms. In addition, they appear to particularly focus on health problems and show evidence of chronic emotional dysregulation. Further studies are required to replicate our results and to help clarify the pathogenic mechanisms underlying PNES.
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Affiliation(s)
- Finian M O'Brien
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Psychiatry, Cavan Monaghan Mental Health Service, Cavan General Hospital, Cavan, Ireland.
| | - Gillian M Fortune
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland; Department of Psychology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Patrick Dicker
- Department of Epidemiology & Public Health Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Erik O'Hanlon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Eugene Cassidy
- Cork University Hospital, Cork, Ireland; Department of Psychiatry, College of Medicine and Health, University College Cork, Ireland
| | - Norman Delanty
- Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - Hugh Garavan
- Trinity College Dublin, Dublin 2, Ireland; University of Vermont, VT, USA
| | - Kieran C Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland; Department of Psychiatry, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland
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Whitehead K, Stone J, Norman P, Sharpe M, Reuber M. Differences in relatives' and patients' illness perceptions in functional neurological symptom disorders compared with neurological diseases. Epilepsy Behav 2015; 42:159-64. [PMID: 25516111 DOI: 10.1016/j.yebeh.2014.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/25/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The illness perceptions of the relatives of patients with functional neurological symptom disorders (FNSDs) and their relation to the illness perceptions of the patients have been little studied. We aimed to compare illness perceptions of relatives of patients with FNSDs with those held by patients themselves. We used control pairs with neurological diseases (NDs) to examine the specificity of the findings to FNSDs. MATERIAL AND METHODS Patients with FNSDs (functional limb weakness and psychogenic nonepileptic seizures) and patients with NDs causing limb weakness and epilepsy, as well as their relatives, completed adapted versions of the Illness Perception Questionnaire - Revised (IPQ-R). RESULTS We included 112 pairs of patients with FNSDs and their relatives and 60 pairs of patients with NDs and their relatives. Relatives of patients with FNSDs were more likely to endorse psychological explanations and, in particular, stress as causal factors than patients with FNSDs (p<.001). Relatives of patients with FNSDs were also more pessimistic about the expected duration of the disorder and perceived a greater emotional impact compared with patients themselves (p<.001). However, the latter two differences between patients and relatives were also found in pairs of patients with NDs and their relatives. CONCLUSION The main difference in illness perceptions between relatives and patients that appeared specific to FNSDs was a tendency for relatives to see psychological factors as more relevant compared with patients. Some other differences were observed between pairs of patients with FNSDs and their relatives, but the same differences were also seen in pairs of patients with NDs and their relatives. These other differences were, therefore, not specific to FNSDs. Discussion about possibly relevant psychological factors with patients suffering from FNSDs may be helped by including relatives.
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Affiliation(s)
- Kimberley Whitehead
- Department of Clinical Neurophysiology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
| | - Jon Stone
- Dept Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XU, UK.
| | - Paul Norman
- Department of Psychology, University of Sheffield, Sheffield S10 2TP, UK.
| | - Michael Sharpe
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
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Karterud HN, Risør MB, Haavet OR. The impact of conveying the diagnosis when using a biopsychosocial approach: A qualitative study among adolescents and young adults with NES (non-epileptic seizures). Seizure 2015; 24:107-13. [PMID: 25458100 DOI: 10.1016/j.seizure.2014.09.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022] Open
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Urbanek M, Harvey M, McGowan J, Agrawal N. Regulation of emotions in psychogenic nonepileptic seizures. Epilepsy Behav 2014; 37:110-5. [PMID: 25010325 DOI: 10.1016/j.yebeh.2014.06.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/25/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite the long history of psychogenic nonepileptic seizures (PNES), relatively little is known about the mechanisms that cause and maintain this condition. Emerging research evidence suggests that patients with PNES might have difficulties in regulating their emotions. However, much remains to be learned about the nature of these difficulties and the emotional responses of individuals with PNES. This study aimed to gain a detailed understanding of emotion regulation processes in patients with PNES by examining differences between patients with PNES and a healthy control group with regard to intensity of emotional reactions, understanding of one's emotional experience, beliefs about emotions, and managing emotions by controlling emotional expression. METHOD A cross-sectional design was used to compare the group with PNES (n=56) and the healthy control group (n=88) on a range of self-report measures. RESULTS Participants with a diagnosis of PNES reported significantly poorer understanding of their emotions, more negative beliefs about emotions, and a greater tendency to control emotional expression compared to the control group. While intensity of emotions did not discriminate between the groups, poor understanding and negative beliefs about emotions were found to be significant predictors of PNES, even after controlling for age, education level, and emotional distress. Furthermore, the presence of some emotion regulation difficulties was associated with self-reported seizure severity. CONCLUSIONS The results of this study are largely consistent with previous literature and provide evidence for difficulties in emotion regulation in patients with PNES. However, this research goes further in bringing together different aspects of emotion regulation, including beliefs about emotions, which have not been examined before. As far as it is known, this is the first study to suggest that levels of alexithymia in a population with PNES are positively associated with self-reported seizure severity. The findings suggest a need for tailored psychological therapies addressing specific emotion regulation difficulties in individuals with PNES.
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Affiliation(s)
- Monika Urbanek
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Runcie Court, David Salomons Estate, Broomhill Road, Tunbridge Wells TN3 0TF, UK.
| | - Martin Harvey
- West Kent Neuro-Rehabilitation Unit, West Kent Neuropsychiatry Service, Darent House, Sevenoaks Hospital, Hospital Road, Sevenoaks TN13 3PG, UK
| | - John McGowan
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Runcie Court, David Salomons Estate, Broomhill Road, Tunbridge Wells TN3 0TF, UK
| | - Niruj Agrawal
- Neuropsychiatry Unit, Clare House, St George's Hospital, Blackshaw Road, London SW17 0QT, UK
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Abstract
AbstractObjectives: To examine the prevalence, psychiatric co-morbidity and management of psychogenic non-epileptic seizures (PNES) in patients admitted to a tertiary referral Epilepsy Monitoring Unit (EMU).Methods: Medical records of patients admitted to the EMU between 2003 and 2005 were examined and data from neurological, neuropsychiatric and neuropsychological assessments were analysed.Results: Over a three year period 224 patients were referred to the EMU and 44 (20%) were diagnosed with psychogenic non-epileptic seizures (PNES). A total of 13 people (6%) were diagnosed with both PNES and epilepsy. Of those diagnosed with PNES 34 (75%) were referred to psychology services for cognitive behavioural therapy (CBT) and 26 (58%) were followed-up by psychiatry services.Conclusions: The prevalence rates for PNES and co-existing PNES and epilepsy are consistent with previous reports. Rates of psychiatric co-morbidity were less than would be expected in this clinical population. Clear evidence-based guidelines to manage people with PNES are required.
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Dimaro LV, Dawson DL, Roberts NA, Brown I, Moghaddam NG, Reuber M. Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety. Epilepsy Behav 2014; 33:77-86. [PMID: 24632427 DOI: 10.1016/j.yebeh.2014.02.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 01/22/2023]
Abstract
This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p<.001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r=.63, p<.01) and frequency of seizures (r=.67, p<.01); implicit anxiety correlated with frequency of seizures only (r=.56, p<.01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder.
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Affiliation(s)
- Lian V Dimaro
- Nottinghamshire Healthcare NHS Trust, Rampton Hospital, Retford, Nottinghamshire DN22 0PD, UK.
| | - David L Dawson
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - Nicole A Roberts
- School of Social and Behavioural Sciences, Arizona State University, 4701 W, Thunderbird Road, MC 3051, Glendale, AZ 85306, USA.
| | - Ian Brown
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
| | - Nima G Moghaddam
- Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK.
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
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