A Comprehensive Profile of Clinical, Psychiatric, and Psychosocial Characteristics of Patients with Psychogenic Nonepileptic Seizures

Ettinger, Alan B.; Devinsky, Orrin; Weisbrot, Deborah M.; Ramakrishna, Ravindra K.; Goyal, Amit

doi:10.1111/j.1528-1157.1999.tb00860.x

Cited by 152 publications

(132 citation statements)

References 26 publications

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“…of patients may stop having spells after being given the diagnosis and explanation of NES, with no other intervention [38][39][40][41], underlining the crucial nature of some patient-doctor conversations in epilepsy practice. CA could be used to improve our understanding of the "machinery" of such conversations and to maximize their therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

Offering patients choices: A pilot study of interactions in the seizure clinic

Toerien

Shaw

Duncan

et al. 2011

Epilepsy & Behavior

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Using Conversation Analysis (CA), we studied conversations between one UK-based epilepsy specialist and thirteen seizure patients in whom there was uncertainty about the diagnosis, and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some form of choice to all patients: in eight cases, a course of action was proposed, to be accepted or rejected, and in the remaining five a "menu" of options was offered. Even when presenting a menu, the specialist sometimes conveyed his own preferences in how he described the options, and in some cases the menu was used for reasons other than offering choice (e.g. to address patient resistance). Close linguistic and interactional analysis of clinical encounters can show why doctors may feel they are offering choices when patients report that the decision was clinician-dominated.

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Section: Discussionmentioning

confidence: 99%

Offering patients choices: A pilot study of interactions in the seizure clinic

Toerien

Shaw

Duncan

et al. 2011

Epilepsy & Behavior

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“…The direct lifetime cost of undiagnosed PNESs may equal that of intractable epilepsy, which for 1995 was estimated to be as high as $231,432 per patient (23). As documented by several studies, the appropriate diagnosis and management of PNESs can lead to resolution of PNESs in 19-52%, to improvement in 75-95% of patients (13,(24)(25)(26), and decrease of health care utilization by 69-97% (22).…”

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confidence: 99%

“…Other studies evaluated the association between PNESs and psychological or sexual trauma or other psychiatric comorbities (30,31), outcome after the diagnosis of PNESs (13,(24)(25)(26), or the incidence of PNESs (20,21). Only two studies evaluated HRQOL in patients with PNESs (14,32).…”

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confidence: 99%

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Quality of Life in Psychogenic Nonepileptic Seizures

Szaflarski¹,

Hughes²,

et al. 2003

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Summary:Purpose: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health-related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs.Methods: We evaluated 105 patients admitted to the Epilepsy Monitoring Unit of University Hospital between January 20, 2001, and January 20, 2002. Only patients with the definite diagnosis of ESs or PNESs were analyzed (n ‫ס‬ 85). Patients completed an epilepsy-specific quality-of-life instrument (QOLIE-89), the Profile of Mood States (POMS), and Adverse Events Profile (AEP). We used t tests and regression analyses to contrast HRQOL in PNESs and ESs and to elucidate the main factors associated with HRQOL in patients with PNESs.Results: In our sample, 45 patients had PNESs, and 40 hadESs. The overall HRQOL and scores on 13 of 19 QOLIE-89 subscales were significantly lower (i.e., worse) in PNES than in ES patients. AEP and scores on five of six POMS subscales also were worse in PNES patients than in ES patients. PNES versus ES diagnosis, POMS depression/dejection, and AEP were significant predictors of HRQOL, jointly explaining 65% variation in HRQOL. The lower HRQOL in PNESs versus ESs was in part explained by depression and AEP.Conclusions: Patients with PNESs have a lower HRQOL and worse mood problems than do patients with ESs. This disadvantage is primarily due to depression and medication side effects, although these factors influence QOL in much the same way in PNES and ES patients. These baseline HRQOL data on patients with PNESs can be used to evaluate the effects of treatment in this patient population.

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“…PNES populations suffer from high rates of depression (28-64%), anxiety disorders (11-47%), somatoform disorders (22-64%), dissociative disorders (22-91%), and posttraumatic stress (49%) (8,9). Furthermore, outcomes among people with PNES are often poor, with persistent depression, suicidal ideation, and suicide attempts common even more than a year after diagnosis disconfirming epilepsy (10).…”

Section: Quality Of Life In Psychogenic Nonepileptic Seizuresmentioning

confidence: 99%