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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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LaFrance WC, Ho WLN, Bhatla A, Baird G, Altalib HH, Godleski L. Examination of Potential Differences in Reporting of Sensitive Psychosocial Measures via Diagnostic Evaluation Using Computer Video Telehealth. J Neuropsychiatry Clin Neurosci 2021; 32:294-301. [PMID: 32054400 DOI: 10.1176/appi.neuropsych.19080177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors compared baseline characteristics and reporting of psychosocial measures among veterans with seizures who were evaluated in-clinic or remotely via computer video telehealth (CVT). It was hypothesized that the CVT group would report less trauma history, drug use, and comorbid symptoms compared with veterans seen in-clinic. METHODS A cross-sectional design was used to compare 72 veterans diagnosed with psychogenic nonepileptic seizures (PNES) or concurrent mixed epilepsy and PNES who were consecutively evaluated by a single clinician at the Providence Veterans Affairs Medical Center (PVAMC) Neuropsychiatric Clinic. In-clinic evaluations of veterans were performed at the PVAMC Neuropsychiatric Clinic (N=16), and remote evaluations of veterans referred to the VA National TeleMental Health Center were performed via CVT (N=56). All 72 patients were given comprehensive neuropsychiatric evaluations by direct interview, medical examination, and medical record review. Veterans' reporting of trauma and abuse history, drug use, and psychiatric comorbidities was assessed, along with neurologic and psychiatric variables. RESULTS No significant differences were found between veterans evaluated in-clinic or remotely with regard to baseline characteristics and reporting of potentially sensitive information, including trauma and abuse history, substance use, and comorbid symptoms. CONCLUSIONS Veterans with PNES evaluated via telehealth did not appear to withhold sensitive or personal information compared with those evaluated in-clinic, suggesting that CVT may be a comparable alternative for conducting evaluations. Baseline evaluations are used to determine treatment suitability, and telehealth allows clinicians to gain access to important information that may improve or inform care.
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Affiliation(s)
- W Curt LaFrance
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Wing Lam Natalie Ho
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Alana Bhatla
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Grayson Baird
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Hamada Hamid Altalib
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
| | - Linda Godleski
- The Department of Psychiatry, Providence Veterans Affairs Medical Center (PVAMC), and Departments of Neurology and Psychiatry, Brown University, Providence, R.I. (LaFrance, Ho, Bhatla); the Division of Neuropsychiatry (LaFrance) and Division of Biostatistics (Baird), Rhode Island Hospital, Providence, R.I.; the Department of Neurology, Yale University, New Haven, Conn., and Department of Neurology, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Altalib); and the Department of Psychiatry, Yale University, New Haven, Conn., and Department of Psychiatry, West Haven Veterans Affairs Medical Center, West Haven, Conn. (Godleski)
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Baird GL, Harlow LL, Machan JT, LaFrance WC. Cluster reduction in patients in a pilot treatment trial for psychogenic nonepileptic seizures. Epilepsy Behav 2017. [PMID: 28624511 DOI: 10.1016/j.yebeh.2017.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The present study examined seizure clusters as a primary outcome in patients receiving treatment for PNES. Cluster reduction is examined longitudinally using frequency threshold and statistical definitions of seizure cluster for patients. Possible risk factors for clustering will be examined along with clustering as a risk factor for poorer secondary outcomes. METHODS Participants were from a pilot randomized treatment trial for PNES where they received cognitive behavioral therapy-informed psychotherapy (CBT-ip), sertraline, combination therapy, or treatment as usual. Seizure data are from patients' seizure dairies. RESULTS Cluster reduction was observed for those receiving CBT-ip or combination treatment using all definitions of daily clusters and weekly clusters. No risk factors of clustering were observed. Those who were identified as having clusters during the trial had poorer secondary outcomes on several measures at baseline relative to those who were not identified as having clusters. DISCUSSION This is the first study known to the authors to not only examined seizure clusters as a primary outcome for those with PNES, but also the first study to suggest that CBT-ip and combination therapy may be effective in reducing the frequency of clusters.
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Affiliation(s)
- Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, United States; Diagnostic Imaging, The Warren Alpert Medical School of Brown University, United States; University of Rhode Island, Department of Psychology, United States.
| | - Lisa L Harlow
- Lifespan Biostatistics Core, Rhode Island Hospital, United States
| | - Jason T Machan
- Lifespan Biostatistics Core, Rhode Island Hospital, United States; University of Rhode Island, Department of Psychology, United States
| | - W C LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital and Brown University, United States
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