Psychological treatment of patients with psychogenic non-epileptic seizures: An outcome study

BackgroundA clear distinction has been made between efficacy and effectiveness in relation to the methods of evaluation of new psychological treatments in psychiatry. Efficacy trials target patients with relatively pure conditions, who may not be representative of the patients who are usually referred for psychological treatment in a clinical setting. Few studies have explored the benefits of psychotherapy in patients with complex disorders and enduring symptoms.AimsTo explore the rationale for the distinction between efficacy and effectiveness, particularly in relation to outcome studies of patients with complex and enduring disorders.MethodA narrative review with examples drawn from the literature, and an illustration of a recent naturalistic outcome study which combines features of both efficacy and effectiveness.ResultsStudies of patients with complex and mixed disorders can be designed so that they retain internal validity, but also have external validity and are relevant to clinical practice.ConclusionStudies which evaluate psychological interventions should be carried out in populations of patients clinically representative of those who are likely to receive the intervention, should it be shown to be of benefit.

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Psychological treatments for functional non-epileptic attacks: a systematic review

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2009.00376.x ◽

2009 ◽

Vol 21 (4) ◽

pp. 158-168 ◽

Cited By ~ 17

Author(s):

Danielle Gaynor ◽

Hannah Cock ◽

Niruj Agrawal

Keyword(s):

Systematic Review ◽

Psychological Treatment ◽

Controlled Trial ◽

Epileptic Seizures ◽

Future Research ◽

Psychological Treatments ◽

Psychogenic Seizures ◽

Epileptic Attack ◽

Behavioural Therapies ◽

Randomised Controlled

Objective:There is a lack of clarity about the most useful intervention for functional non-epileptic attacks (FNEA). Outcomes for this condition remain often poor, with considerable personal, social and economic impact. In order to guide clinical practice and future research in this area, we have performed a systematic review of the published literature on the psychological treatment of FNEA.Methods:A comprehensive literature search was carried out using key words: non-epileptic seizures; psychogenic seizures; psychogenic non-epileptic seizures; pseudoseizures; funny turns; non-epileptic attack; hysterical seizures; and pseudoepileptic. Studies specifically looking at psychological treatment of FNEA were identified. Studies of patients also having comorbid organic seizure disorders were excluded.Results:17 studies that met the inclusion criteria were identified. A broad variety of psychological interventions for FNEA has been investigated. Only one randomised controlled trial has been completed to date. Existing evidence appears to suggest that various psychological treatments, including presenting the diagnosis, psychoeducation, behavioural therapies and mixed modality treatments, may be effective.Conclusion:While a range of psychological treatments may be beneficial for this patient group, we do not have clear evidence to suggest which treatment is most efficacious. Specific elements of presenting the diagnosis and psychoeducation may be required in addition to traditional cognitive behavioural therapeutic approaches. Large, methodologically robust studies are urgently required to establish the most effective form of treatment.

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Eye movement desensitization and reprocessing in the psychological treatment of trauma-based psychogenic non-epileptic seizures

Clinical Psychology & Psychotherapy ◽

10.1002/cpp.525 ◽

2007 ◽

Vol 14 (2) ◽

pp. 135-144 ◽

Cited By ~ 11

Author(s):

Susan D. M. Kelley ◽

Selim Benbadis

Keyword(s):

Eye Movement ◽

Psychological Treatment ◽

Epileptic Seizures

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Psychogenic non-epileptic seizures: aetiology, diagnosis and management

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.113.011171 ◽

2014 ◽

Vol 20 (1) ◽

pp. 13-22 ◽

Cited By ~ 5

Author(s):

Maria Oto ◽

Markus Reuber

Keyword(s):

Psychological Treatment ◽

Epileptic Seizures ◽

Initial Step ◽

Diagnosis And Management ◽

Model Combining ◽

Underlying Causes ◽

Iatrogenic Harm ◽

Patient’S History

SummaryPsychogenic non-epileptic seizures (PNES) have a significant impact on most patients in terms of distress, disability, loss of income and iatrogenic harm. Three-quarters of patients with PNES are initially misdiagnosed and treated for epilepsy. Misdiagnosis exposes patients to multiple iatrogenic harms and prevents them from accessing psychological treatment. In most cases, the patient's history (and witness accounts) should alert clinicians to the likely diagnosis of PNES. Since this diagnosis may be resisted by patients and may involve ‘un-diagnosing’ epilepsy, video-electroencephalogram recording of typical seizures is often helpful. The underlying causes of PNES are diverse: a model combining predisposing, precipitating and perpetuating factors is a useful way of conceptualising their aetiology. The initial step of treatment should be to limit iatrogenic harm. There is some evidence for the effectiveness of psychotherapy.

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Pulmonary Edema and Simultaneous Cardiac Dysfunction After Epileptic Seizures

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100017911 ◽

2013 ◽

Vol 40 (06) ◽

pp. 896-897

Author(s):

V. Pelliccia ◽

C. Pizzanelli ◽

S. Pini ◽

P. Malacarne ◽

U. Bonuccelli

Keyword(s):

Pulmonary Edema ◽

Cardiac Dysfunction ◽

Epileptic Seizures

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Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2013.janfeb01 ◽

2013 ◽

Vol 18 (1) ◽

pp. 1-18 ◽

Cited By ~ 1

Author(s):

Robert J. Barth

Keyword(s):

Health Outcomes ◽

Pain Perception ◽

Driving Forces ◽

Psychological Treatment ◽

Dominant Role ◽

Meta Analysis ◽

General Medicine ◽

Pain Syndrome ◽

Problematic Relationship

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

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