Health care practitioners’ perceptions of psychogenic nonepileptic seizures: A systematic review of qualitative and quantitative studies

Abstract

A recent systematic synthesis of qualitative research demonstrated that patients with psychogenic nonepileptic seizures (PNES) often experience unsatisfactory encounters with health care practitioners (HCPs). It is important to understand such interactions from the perspective of those responsible for delivering care. This systematic review aimed to examine the attitudes and perceptions of HCPs toward PNES. A systematic search of 3 databases (Web of Science, PubMed, and CINAHL) was conducted in November 2017. Studies from around the world published after 1997 using qualitative or quantitative methodologies were reviewed. An interpretative stance was taken to analyze the data utilizing a grounded theory approach. The quality of studies included was assessed using the Mixed Methods Appraisal Tool. Overall, 30 separate studies capturing the views of at least 3900 professionals were included. Five concepts emerged from the analysis: (1) HCPs' responses demonstrated uncertainty about many aspects of PNES, including diagnosis and treatment; (2) HCPs understood PNES in dualistic terms, perceiving the condition as largely associated with psychological factors; (3) Patients with PNES were considered challenging and frustrating; (4) HCPs held mixed or contested views about who is responsible for treating patients with PNES; and (5) PNES was viewed as less severe or disabling than epilepsy and associated with a greater degree of volition. Although some HCPs have an excellent understanding of PNES, the views of many give rise to concern. The number of qualitative studies that directly ask HCPs about their perceptions of PNES is limited. Moreover, some professional groups (ie, mental health specialists) are underrepresented in current research. This study reveals a demand for additional training. However, effort is needed also to change the attitudes of some practitioners toward PNES.

Functional seizures: An evaluation of the attitudes of general practitioners local to a tertiary neuroscience service in London

“…In both studies GPs felt it was primarily the role of GPs and neurologists, or neurologists and psychiatrists to manage patients. 14 Our results should be considered, bearing in mind the following limitations. 35,36 From a practical standpoint, neurology services, although limited, are more readily available than neuropsychiatric and psychotherapeutic services, 19 whereas general psychiatrists have little interest or expertise in the management of these patients, 37,38 and access to appropriate psychological treatments can be limited.…”

“…A review of healthcare practitioners' attitudes toward patients with functional seizures 14 has reported previously that most healthcare practitioners use etiologically neutral terminology, rather than any terms that reference mechanisms potentially underlying functional seizures. At least 75% of GPs readily use the term "pseudoseizures," and over 50% of GPs did not agree with, or were unsure about, the involuntary nature of functional seizures.…”

“…This is in keeping with 2 other studies that have assessed GP opinions regarding the management of patients with functional seizures. 14 We suspect that this is in part related to resource limitations, and the inherent challenges in managing patients with functional seizures. 12,13 Neurologists, rather than GPs or psychiatrists, may indeed be well placed to take on this role of "treatment maintenance" for both practical and medical reasons.…”

“…7 Although there are studies reporting GP attitudes to common, chronic neurologic disorders such as multiple sclerosis, 8 and psychiatric disorders, such as anxiety and depression, 9 only 4 studies have assessed GP attitudes toward patients with functional seizures. 14 St George's University Hospitals NHS Foundation Trust (SGUH), which houses the Atkinson Morley Regional Neuroscience Centre (AMRNC), is one of the largest university hospitals in the United Kingdom, serving a population of 1.3 million across southwest London and the surrounding regions. Indeed, most studies of the attitudes of healthcare practitioners toward patients with functional seizures have concentrated on specialized professionals, particularly neurologists.…”

“…Indeed, most studies of the attitudes of healthcare practitioners toward patients with functional seizures have concentrated on specialized professionals, particularly neurologists. 14 St George's University Hospitals NHS Foundation Trust (SGUH), which houses the Atkinson Morley Regional Neuroscience Centre (AMRNC), is one of the largest university hospitals in the United Kingdom, serving a population of 1.3 million across southwest London and the surrounding regions. The presence of a tertiary epilepsy service, a neuropsychiatry department in collaboration with the South-West London and St George's Mental Health Trust, and a clinical psychologist with an interest in functional neurologic disorders, provides a comprehensive tertiary service to patients with functional seizures.…”