Effective evidence-based psychotherapeutic regimens for psychogenic nonepileptic seizures (PNES) are available, but several obstacles still contribute to poor adherence to treatment. This chapter reviews the three stages at which patient dropout tends to occur in clinical practice and in studies. Patient-related, provider-related, and systemic causes of nonadherence are reviewed. Patient-related factors include a failure to accept or understand the diagnosis, psychiatric comorbidities, and ambivalence about change. Provider-related and systemic factors include a shortage of behavioral health specialists, gaps in care between neurologists and mental health providers, a lack of familiarity with the disorder, and stigmatization of patients. The chapter concludes with a review of potential interventions to address obstacles to treatment, including an integrated treatment team with joint presentation of the diagnosis, rapid and streamlined transition into psychotherapy, motivational interviewing, and engagement of patients’ family members and support systems.
Cognitive differences between patients who have psychogenic nonepileptic seizures (PNESs) and posttraumatic stress disorder (PTSD) and patients who have PNESs without PTSD