Diagnostic Challenges for the Mental Health Team and Psychiatrist

2017 ◽  
Author(s):  
Lorna Myers ◽  
John J. Barry
Keyword(s):  
Therapeutic Alliance ◽  
Patient Characteristics ◽  
Inpatient Setting ◽  
Developmentally Delayed ◽  
Psychiatric Interview ◽  
Mental Health Team ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
High Event

Establishing a positive therapeutic alliance during the initial psychiatric interview allows the clinician to collect the necessary diagnostic information and can have a significant impact on a patient’s decision to follow up with treatment recommendations once the diagnosis of psychogenic nonepileptic seizures (PNES) is determined. When evaluating a patient with suspected PNES in an out- or inpatient setting, there are a variety of clinician behaviors that can support or obstruct the establishment of a positive therapeutic alliance. Similarly, a number of typical patient characteristics in PNES can affect the psychiatric assessment. In this chapter, these characteristics and behaviors are discussed, a clinician checklist is provided, and dialogue boxes illustrate a few common patient–clinician interactions, hypothetical challenges, and clinician responses. Distinctive challenges, including interaction with specific PNES subtypes (i.e., developmentally delayed, malingering, or hostile patients) and patients who are effectively incapacitated by high event frequency and systemic barriers, are presented.

Outcome in psychogenic nonepileptic seizures: 1 to 10-year follow-up in 164 patients

2003 ◽  
Vol 53 (3) ◽  
pp. 305-311 ◽  
Author(s):  
Markus Reuber ◽  
Ralf Pukrop ◽  
J�rgen Bauer ◽  
Christoph Helmstaedter ◽  
Natalie Tessendorf ◽  
...  
Keyword(s):  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures

Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans (Preprint)

2021 ◽  
Author(s):  
Marylene Cloitre ◽  
Miryam Wassef ◽  
Julianna B. Hogan ◽  
Terri L. Fletcher ◽  
Christie Jackson ◽  
...  
Keyword(s):  
Therapeutic Alliance ◽  
Clinical Care ◽  
Patient Characteristics ◽  
Experimental Comparison ◽  
Completion Rates ◽  
Treatment Conditions ◽  
Quasi Experimental ◽  
Symptom Outcome ◽  
Therapist Support

BACKGROUND Blended models which incorporate elements of both internet and face-to-face therapies have been shown to be effective. Therapist and patients have expressed concerns that less rather more therapy sessions relative to self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates and poorer outcomes. OBJECTIVE A multi-site quasi-experimental comparison study with a noninferiority design conducted in routine clinical care was used to assess webSTAIR, a 10-module blended therapy for trauma-exposed individuals delivered with 10 weekly therapist sessions (Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be “as good as” Coach10 regarding a range of outcomes. METHODS : A total of 202 Veterans were enrolled in the study (Coach5 n = 101, Coach10 n = 101). PTSD symptoms, depression, emotion regulation, interpersonal problems and social functioning measures were collected at pretreatment, mid, posttreatment and 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons of continuous and categorical measures regarding participant and therapist activities were conducted. RESULTS : Participants reported moderate to severe levels of baseline PTSD and/or depression. Significant reductions were obtained on all symptom measures at post and 3-month follow-up. Coach5 was not inferior to Coach10 on any outcome. Therapeutic alliance was high and equivalent across the two treatment conditions and completion rates and web usage were similar. Coach5 therapists’ total session time was substantially less than Coach10. Both programs were associated with a low and equal number of therapist activities related to scheduling and crisis/motivational sessions. CONCLUSIONS A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions among individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes in high versus low dose of therapist support will help create flexible technology-based intervention programming.

The Role of the Neurologist after Diagnosis

2017 ◽  
Author(s):  
Adriana Bermeo-Ovalle ◽  
Andres M. Kanner
Keyword(s):  
Healthcare Providers ◽  
Epileptic Seizures ◽  
Pharmacological Therapy ◽  
Diagnostic Evaluation ◽  
Initial Contact ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
Functional Neurological Symptoms

Psychogenic nonepileptic seizures (PNES) are the most frequent type of paroxysmal events misdiagnosed as epileptic seizures. Neurologists are usually the initial contact in the care of patients with these events, as they are often able to recognize or suspect that they are not epileptic seizures and conduct a diagnostic evaluation. Unfortunately, many neurologists (and epileptologists) continue to believe that their work is finished when the diagnosis of PNES is established. In fact, the neurologists’ role only begins when the diagnosis is made. This chapter highlights the various roles that neurologists should play in the care of PNES patients during and following a diagnostic evaluation. It emphasizes the need for follow-up visits which ensure the patients’ understanding and acceptance of the diagnosis. The neurologist should promote continuity of care, allow for management of other functional neurological symptoms and neurological comorbidities, ensure rational pharmacological therapy with antiepileptic drugs, promote communication among healthcare providers, and avoid iatrogenic interventions.

scholarly journals Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures

Neurology ◽  
2019 ◽  
Vol 92 (7) ◽  
pp. e675-e679 ◽  
Author(s):  
Benjamin Tolchin ◽  
Barbara A. Dworetzky ◽  
Steve Martino ◽  
Hal Blumenfeld ◽  
Lawrence J. Hirsch ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Childhood Abuse ◽  
Odds Ratio ◽  
Care Center ◽  
Medium Effect ◽  
Psychogenic Nonepileptic Seizures ◽  
History Of ◽  
Nonepileptic Seizures

ObjectiveWe conducted a prospective cohort study of patients with psychogenic nonepileptic seizures (PNES) to examine the association between adherence with psychotherapy and outcomes, including significant (≥50%) reduction in PNES frequency, PNES freedom, improvement in quality of life, and reduction in emergency department (ED) utilization.MethodsA total of 105 participants were referred to receive psychotherapy either at Brigham and Women's Hospital or with a local therapist. We called participants at 12–24 months follow-up and obtained detailed follow-up data from 93 participants (89%). Participants were considered adherent with psychotherapy if they attended at least 8 sessions within a 16-week period starting at the time of referral.ResultsAdherence with psychotherapy was associated with reduction in seizure frequency (84% in adherent group vs 61% in nonadherent, p = 0.021), improvement in quality of life (p = 0.044), and reduction in ED utilization (p = 0.040), with medium effect sizes; there was no difference in PNES freedom. The association between adherence and ≥50% reduction in PNES frequency persisted when controlling for potential confounders in a multivariate model. Psychotherapy nonadherence was associated with baseline characteristics of self-identified minority status (odds ratio 7.47, p = 0.019) and history of childhood abuse (odds ratio 3.30, p = 0.023).ConclusionsOur study is limited in that it cannot establish a causal relationship between adherence with psychotherapy and outcomes, and the results may not generalize beyond the single quaternary care center study site. Among participants with documented PNES, adherence with psychotherapy was associated with reduction in PNES frequency, improvement in quality of life, and decrease in ED visits.

scholarly journals Psychogenic nonepileptic seizures: to the issue of diagnosis and patient management (with a case report)

2021 ◽  
Vol 13 (2) ◽  
pp. 147-156
Author(s):  
N. I. Shova ◽  
D. V. Alekseeva ◽  
V. A. Mikhailov
Keyword(s):  
Case Report ◽  
Clinical Case ◽  
Brain Magnetic Resonance Imaging ◽  
Epileptic Seizures ◽  
Differential Diagnostics ◽  
Resonance Imaging ◽  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures ◽  
Dissociative Seizures

Establishing misdiagnosis “epilepsy” is a common event comprising 25% total cases of “pharmacoresistant” forms. Eventually, the majority of cases resulted in diagnosing psychogenic nonepileptic seizures, or functional seizures, conversion seizures, and dissociative seizures. Here we review publications assessing psychogenic non-epileptic seizures. The scientific resources for analysis were selected in Russian (eLibrary) and international (Pubmed/MEDLINE, Google Scholar) databases, as well as in open access resources. We also present a clinical case of a patient diagnosed with epilepsy. In particular, the patient was admitted to the hospital with complains of paroxysmal conditions starting as headache, nausea proceeding with speech arrest and decreased mindfulness of what happens in personal life. He also informed about at least two episodes of disorientation described as “missed public transport stop” and “finding himself in unfamiliar place”. The patient underwent examination (electroencephalography, brain magnetic resonance imaging) and dynamic follow-up to verify origin of such conditions. As a result, he was diagnosed with psychogenic non-epileptic seizures. Administering proper therapy allowed to achieve stabilized condition and arrest seizures. The criteria provided in the review as well as clinical case report may help clinical practitioners to timely conduct differential diagnostics and deliver specialized medical aid.

Stress Incidence and Appraisal in Patients With Psychogenic Nonepileptic Seizures

2008 ◽  
Author(s):  
Mollie R. Sprung ◽  
S. Marc Testa ◽  
Gregory L. Krauss ◽  
Ronald P. Lesser ◽  
Jung Geum Im ◽  
...  
Keyword(s):  
Psychogenic Nonepileptic Seizures ◽  
Nonepileptic Seizures

Awareness of Pregnant Women for COVID-19 Infection

2020 ◽  
Author(s):  
Erhan Okuyan ◽  
Emre Gunakan ◽  
Sertaç Esin
Keyword(s):  
Pregnant Women ◽  
Respiratory Diseases ◽  
Prospective Observational Study ◽  
Information Source ◽  
Home Birth ◽  
Patient Characteristics ◽  
Emotional Status ◽  
Prevention Method ◽  
And Behavior

Covid outbreak has been getting worse and spread affected all over the world. Pregnant patients are also vulnerable to respiratory diseases. We aimed to evaluate the awareness, emotional status, and behavior of pregnant during the COVID outbreak. This study's main benefit is to analyze the knowledge and understanding of pregnant women about the pandemic and draw attention to the prevention issues that need improvement. This research is a prospective observational study that 199 patients subjected to a questionnaire including 29 questions about patient characteristics, pregnancy information, knowledge about COVID19-infection, behavioral and emotional changes. 130 (65.3) of the patients stated an above-average knowledge level. Television was the most frequent information source (75.4%, n:150) and was the only information source for 90 (45.1%) of the patients. Sixty-nine patients used more than one information source. More than one prevention method uses by 149 (75%) of the patients. Washing hands (n:183, 92.0%) and cleaning the house (n:122, 61.3%) were the most preferred methods. Only 55 (27.6%) of the patients used a mask for prevention. 88(44.2%) of the patients stated that they preferred a shorter hospital stay, and 75 (37.7%) of the patients indicated that they postponed or avoided the pregnancy follow-up visits due to the COVID-19 issue. Pregnant women seem to be aware and stressed of COVID-19, but knowledge of what to do seems insufficient. Patients informed of risks of COVID infection, unplanned hospital admission, and chances of avoiding necessary visits and home birth demands.

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