A Case Report of Schizoaffective Disorder with Pseudoseizures in a 42-year-old Male

Abstract

Psychogenic nonepileptic seizures (PNES), historically referred to as pseudoseizures or hysterical seizures, are sudden disturbances of motor, sensory, autonomic, cognitive, or emotional functions that can mimic epileptic seizures. PNES have a psychologic etiology related to dissociative disorders or conversion disorders, as opposed to the abnormally excessive neuronal activity found in epileptic seizures. Psychosocial conflicts are essentially converted into physical symptoms, resulting in seizure-like symptoms. This case report presents a 42-year-old male with a past history of child abuse, drug abuse, schizoaffective disorder, prior psychiatric hospitalizations, and diabetes mellitus type 2 who was admitted to the behavioral health unit with recurrent seizure-like episodes. These episodes were witnessed in the ED, however, appropriate workup failed to confirm abnormal neural activity or evidence of any brain injury. The patient was admitted to the psychiatric service where he was monitored for additional epileptic activity using long-term video-electroencephalogram (EEG) monitoring (LT-VEEG). While subsequent clinical events that resembled epileptic seizures were observed, the LT-VEEG failed to identify any epileptic activity. A diagnosis of PNES was established and a decision was made for the patient to remain on his current antiepileptic, psychiatric, and diabetes medications during his hospitalization. He showed gradual improvement during his stay and confirmed an understanding of his diagnosis. He was released three days later with instructions for follow-up and continued treatment with his outpatient psychiatrist. Early therapeutic counseling in patients who have a differential diagnosis of PNES should be considered to help identify and address the underlying causes of the seizure activity in an effort to curtail these seizure-like events.

Psychogenic Nonepileptic Seizures (PNES) in the Setting of Trauma and Schizophrenia

“…In 2007, Duncan et al [ 15 ] and Devine and Duncan [ 16 ] described the onset of auditory hallucinations and abnormal motor movements leading to the development of PNES in a 23 year-old male. Another report describes a 42-year-old male with teenage-onset schizoaffective disorder and childhood abuse who presented to the emergency department with seizure-like episodes that were found to be PNES [ 17 ]. Most recently, a report by Banks and Plattes [ 18 ] in 2023 highlighted PNES in a 29-year-old male who developed schizophrenia at 23 years old.…”

A Case Report of Psychogenic Non-epileptic Seizures in a 29-Year-Old Male With Schizophrenia

“…Several studies have described the challenge of distinguishing PNES from an epileptic seizure [9][10][11]. There has also been a case report highlighting the challenge of diagnosing PNES with comorbid schizoaffective disorder [12]. However, no known studies to date have described PNES in a patient with schizophrenia and a history of type I diabetes mellitus with a previous suicide attempt by insulin overdose.…”