Predicting first attendance at psychiatry appointments in patients with dissociative seizures

Abstract

Patients with dissociative (non-epileptic) seizures typically receive their diagnosis from neurologists, but are often referred to psychiatrists, whom they may be reluctant to go and see. We aimed to assess which factors were associated with first attendance at psychiatric services. Methods: A cohort study of 698 participants involved in the pre-randomisation phase of the CODES trial, a randomised controlled trial assessing the benefit of cognitive behavioural therapy for dissociative seizures when added to standardised medical (including psychiatric) care. Patients diagnosed by neurologists from 27 UK centres provided demographic information and a measure of diagnostic confidence. Neurologists described predominant seizure type and comorbidity with epilepsy. We analysed hypothesised (young age, male, residing in areas of higher deprivation, low belief in diagnosis) and exploratory factors for their association with first attendance with the psychiatrist about 3 months later. Results: 568/698 (81.4 %) participants attended a psychiatry appointment. None of the following were associated with attendance: Location, age, gender, deprivation score, relationship status, ethnicity, level of education, employment status, receipt of disability benefits, duration, previous diagnosis of epilepsy or mental health problems and degree of confidence in the diagnosis. The only variable differing between groups was having a carer (21.5 % not attending vs 38.6 % attending). Conclusion: First attendance at a psychiatry appointment after a neurologist had given a diagnosis of dissociative seizures was not associated with any hypothesised predictors, including patient confidence in the diagnosis. Neurologists should put aside any expectations about these variables when referring to and anticipating attendance with a psychiatrist.

Screening for Psychiatric Comorbidities and Psychotherapeutic Assessment in Inpatient Epilepsy Care: Preliminary Results of an Implementation Study

“…Considering patients’ preferences, treatment recommendations were discussed with the majority of patients who were not already receiving any treatment and follow-up yielded high adherence rates in epilepsy and PNES patients (94 and 100%). In comparison to other studies the initial adherence to therapeutic recommendations in this study is high, particularly in PNES patients ( Goldstein et al, 2020 ; Stone et al, 2020 ). Previous studies have demonstrated the clinical relevance of strengthening patient motivation when discussing therapeutic recommendations with PNES patients ( Tolchin et al, 2019 ).…”

Psychological and demographic characteristics of 368 patients with dissociative seizures: data from the CODES cohort

“…Although we did not collect detailed data about psychiatric comorbidity on the 698 people initially entering the study, basic demographics of the cohort ( N = 368) reported here were similar to the larger group of 698 patients initially recruited into the CODES study (Goldstein et al, 2019). Furthermore, the generalisability of the sample reported here is supported by the observation that there were no significant differences in clinical and demographic variables between 568 of this initial group who attended a psychiatric assessment (and whose further eligibility was therefore considered for the RCT), compared to 130 who did not (Stone et al, 2020). In addition, we have recently shown (Goldstein et al, in press) that the 368 people reported here did not differ on key characteristics from the 58 people eligible for the RCT but who ultimately did not participate (see Fig.…”

“…Characteristics of the 698 for whom baseline assessments were collected for Phase 1 have been reported by Goldstein et al (2019). In addition, variables predicting which of the 698 participants did not attend psychiatry appointments have been reported by Stone et al (2020). …”

“…The pre-randomisation measure of DS frequency was DS occurrence over the 4 weeks prior to psychiatric assessment (Robinson et al, 2017) with subjective severity of DS, and how Goldstein et al (2019). In addition, variables predicting which of the 698 participants did not attend psychiatry appointments have been reported by Stone et al (2020).…”

Adherence to mental health care and caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures: Longitudinal follow-up study

“…These classic obstacles are also found at an international level, with even greater difficulties in the poorer countries [20]. A recent cohort study [21] showed that a first attendance at a psychiatry appointment after a diagnosis of PNES delivered by was not associated with any predictors, including patient confidence in the diagnosis.…”