Anxiety and mood disorders in psychogenic nonepileptic seizures

Abstract

The diagnosis of psychogenic nonepileptic seizures (PNES), particularly in patients with epilepsy, poses a special challenge to the physician in care of these patients. Psychiatric disorders (PD) are more common among patients with epilepsy than in the general population, and this appears to be even more important in patients with PNES. Depression and other mood disorders, as well as anxiety disorders -particularly panic attacks -may make the management of these patients even more difficult in the clinical practice. Concomitant psychiatric conditions have been associated with a poor outcome in patients with PNES]. Psychiatric and psychological intervention has been shown to be associated with improved outcome in PNES in outcome studies, although data is conflicting in this matter. The intricacies and practical implications of such issues are discussed.Key words: epilepsy, psychogenic nonepileptic seizures, psychiatric disorders, anxiety. RESUMO Ansiedade e desordens de humor em crises não-epilépticas psicogênicasDiagnóstico de crises não-epilépticas psicogênicas (CNEP), particularmente em pacientes com epilepsia, é de modo geral desafiador para os profissionais associados ao cuidado com estes pacientes. As desordens psiquiátricas são mais freqüentes em pacientes com epilepsia quando comparadas à população em geral, sendo ainda mais significativas em pacientes portadores de CNEP. Depressão e desordens de humor, bem como transtorno de ansiedade -particularmente os ataques de pânico -podem imputar dificuldades significativas ao manejo destes pacientes. Comorbidades psiquiátricas têm sido associadas a prognóstico mais reservado em pacientes portadores de CNEP. Intervenções psiquiátricas e psicológicas potencialmente podem melhorar o prognóstico, mas os estudos disponíveis são conflitantes. Detalhes e implicações práticas relacionadas a este cenário são apresentadas e discutidas.Unitermos: epilepsia, crises não-epilépticas psicogênicas, desordens psiquiátricas, ansiedade.

Comorbid depression and associated factors in PNES versus epilepsy: Systematic review and meta-analysis

“…As such, the demographic differences in the samples could account for the difference in levels of depression between PWE and pwPNES observed in this review. However, it is important to note that up to 80% of pwPNES are female [2] and therefore the observed differences may reflect a reliable difference between populations of pwPNES and PWE.…”

“…Mood disorders (including major depression) are the most common with a prevalence of 24.4%/14.1% (lifetime/past year) in PWE, as compared to 13.2%/5.2% in the general population [1]. Similarly, co-morbid psychiatric disorders are more common in pwPNES than in the general population and again, depression is the most common psychiatric disorder with an average prevalence of 31% and lifetime rates ranging from 36 to 80% [2].…”

Comparing standard medical care for nonepileptic seizures in Chile and the United States

“…Stressing the treatment gap for PNES, literature in LA, largely from Argentina and Brazil, reveals that vEEG usage is highly suggested as a diagnostic tool (where available) to correctly diagnose the patients [10,[13][14][15]25,26,[28][29][30][31][32][33][34]. Studies in LA have identified higher frequencies of psychiatric comorbid diagnoses, such as anxiety and dissociation, than studies in the US [11,15,25,27,35,36]. Moreover, reports in LA of trauma and abuse, such as physical or sexual abuse, reveal lower frequencies [13,25,35] than those reported in the US [14,37].…”

Clinical Classifications of Children With Psychogenic Non-epileptic Seizure

“…Abnormal behaviors including crying, shouting, laughing as well as other uncontrollable behaviors observed in our study. In reported semiological classifications for PNES, such kind of symptoms were considered as emotional or psychological disorders ( 32 , 33 ), meanwhile, they were re-defined in our study with respect to behaviors rather than triggers. Importantly, as abnormal behaviors were also seen in immune encephalitis patients ( 34 ), the involvement of immune encephalitis should be examined for better diagnosis.…”