What Are We Communicating When We Present the Diagnosis of PNES?

Dworetzky, Barbara A.

doi:10.5698/1535-7511-15.6.353

Cited by 13 publications

(15 citation statements)

References 12 publications

(14 reference statements)

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“…Qualitative research revealed that HCPs were more likely to consider the diagnosis of PNES once the other possible explanations for the events had been eliminated. Some HCPs seemed to consider the diagnosis as a last resort; only 10% of epilepsy specialists in the USA explained that they “always” discuss the possibility of PNES before EEG examinations …”

Section: Resultsmentioning

confidence: 99%

“…Further evidence for HCPs’ uncertainty about PNES was found in studies that investigated perceptions about treatment. Across specialties and countries, HCPs believed that antiepileptic drugs (AEDs) are not the most appropriate form of treatment; >90% of epilepsy specialists in the USA reported that they tell patients that their events cannot be treated with AEDs . Despite this, South African HCPs reported an “indiscriminate use of antiepileptic drugs” for PNES.…”

Section: Resultsmentioning

confidence: 99%

“…The majority of HCPs explained that patients are likely to reject the diagnosis, fail to understand the condition, or challenge their opinion . As such, HCPs felt the need to persuade patients of their own understanding of the condition and to get them on side by emphasizing that the events are real . Providers appeared to express the need to back up verbal explanations with leaflets and websites, this perhaps demonstrating the perception that the explanation of the disorder often amounts to a process of persuasion …”

Section: Resultsmentioning

confidence: 99%

“…It appeared that some neurologists simply considered any aspect of the treatment of PNES as not being their responsibility. Following the diagnosis, a proportion of HCPs reported not making a referral at all for patients, telling patients to make their own appointment or to find a psychiatrist on their own . In the USA, more than half of level 3‐4 epilepsy monitoring units reported that they do not arrange an inpatient psychiatric consultation for patients newly diagnosed with PNES .…”

Section: Resultsmentioning

confidence: 99%

“…This negative attitude appeared to be reinforced (or created) by other HCPs. Epilepsy specialists in the USA, for example, explained that when they teach residents about PNES, nearly half focus on the cost and misuse of medical services caused by PNES …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

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%