The approach to patients with psychogenic nonepileptic seizures in epilepsy surgery centers regarding diagnosis, treatment, and education

Valente, Kette D.; Paola, Luciano De; Palmini, André; Faveret, Eduardo; Araújo-Filho, Gerardo Maria de; Linden, Hélio van der; Bianchin, Marino M.; Walz, Roger; Alessi, Rudá; Velasco, Tonicarlo Rodrigues; Teixeira, Wagner Afonso; LaFrance, W. Curt

doi:10.1016/j.yebeh.2016.12.013

Cited by 11 publications

(12 citation statements)

References 33 publications

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“…The majority of HCPs seemed to prefer etiologically neutral terms, specifically, “nonepileptic seizures,” “nonepileptic attacks,” or “nonepileptic attack disorder.” Rather than saying anything about the putative mechanism causing the seizures, these nonspecific diagnostic labels state what the patient does not have. Other terms such as “psychogenic nonepileptic seizures” were less common . This may be because neurologists, perhaps aware that most patients with PNES perceive their disorder as a predominantly “physical” problem, are hesitant to use a label making an explicit reference to a “psychogenic” origin when talking to patients.…”

Section: Resultsmentioning

confidence: 99%

“…A proportion of HCPs considered that it is acceptable to make the diagnosis of PNES by history and examination alone . Moreover, some HCPs believed that they could reliably distinguish between epilepsy and PNES based on observing seizure events .…”

Section: Resultsmentioning

confidence: 99%

“…Health care practitioners perceived PNES as being closely associated with mental health problems; for one general practitioner, the relationship between PNES and psychiatric disorders was so strong that their absence eliminates the possibility of PNES . In view of this, many treated patients with psychotropic medications . Psychological processes were also viewed as having an important role.…”

Section: Resultsmentioning

confidence: 99%

“…Other terms such as "psychogenic nonepileptic seizures" were less common. 10,18 This may be because neurologists, perhaps aware that most patients with PNES perceive their disorder as a predominantly "physical" problem, 19 are hesitant to use a label making an explicit reference to a "psychogenic" origin when talking to patients. That psychiatrically explicit terms (ie, "dissociative seizures," "conversion seizures") or labels linking PNES to the concept of functional neurological symptom disorder, now embraced by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (ie, "functional seizures"), are rarely used may reflect a lack of certainty (or willful agnosticism) about the pathogenesis of PNES.…”

Section: Concept 1: Uncertaintymentioning

confidence: 99%

“…25 A proportion of HCPs considered that it is acceptable to make the diagnosis of PNES by history and examination alone. [14][15][16]18 Moreover, some HCPs believed that they could reliably distinguish between epilepsy and PNES based on observing seizure events. 13,21,23 Given that this diagnostic approach was more common in low-income than in more affluent countries, 9,14,15 these views may well have been shaped by the lack of access to objective investigations.…”

Section: Concept 1: Uncertaintymentioning

confidence: 99%

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

Rawlings

Reuber

2018

Epilepsia

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%