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Psychogenic nonepileptic seizures in children — Psychological presentation, treatment, and short-term outcomes

Abstract Purpose The purpose of this study was to better understand the etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting. Method We performed a retrospective analysis of 32 sequentially referred children for suspected PNESs to a neurology ps...

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Published in:Epilepsy & behavior 2015-11, Vol.52 (Pt A), p.49-56
Main Authors: Sawchuk, Tyson, Buchhalter, Jeffrey
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description Abstract Purpose The purpose of this study was to better understand the etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting. Method We performed a retrospective analysis of 32 sequentially referred children for suspected PNESs to a neurology psychology service over a 6-year period. After excluding non-PNES paroxysmal events (related to anxiety or migraine), 29 patients were identified with final diagnosis of PNESs. Charts were examined for presenting symptom data, demographics, comorbidities, neurological diagnoses and investigations, as well as psychological assessment, management, and outcome. Treatment consisted of education around diagnosis and of individual psychological treatment, which, in most cases, was cognitive behavioral therapy up to 14 sessions. Additional mental health services including psychiatric medication, family therapy, and admission to day or inpatient treatment were also utilized in a smaller number of cases. Total treatment periods ranged from 4 weeks to 12 months. Results The majority of patients identified were adolescent (90%), Caucasian (72%), and female (76%). Preceding psychology referral, point of entry into medical care for PNESs was primarily through the emergency department (66%) or outpatient neurology clinic referral (31%). Whereas 39% of parents described significant internalizing symptoms in their child (BASC-2), patients themselves tended to underreport anxiety or depression as demonstrated by only 16% endorsement on the BYI-II. By contrast, MACI personality assessment response patterns for adolescents demonstrated high levels of psychic tension/anxiety (65%), depressive affect (55%), and maladaptive personality traits including inhibition (45%), submissiveness (35%), and introversion (30%). Appropriate psychological treatment was associated with high rates of full remission (no new events, n = 17, 59%) and partial remission (50% or greater reduction in events, n = 6, 21%) as self-reported at discharge. Accurate diagnosis and referral to psychology also led to a sevenfold reduction in PNES-related emergency department visits one year after initial psychology visit compared with the preceding year. Conclusions This study suggests that appropriate care for PNESs reduces inappropriate medical investigation and therapy, expedites rates of remission, and decreases health-care utilization in a pediatric setting.
doi_str_mv 10.1016/j.yebeh.2015.08.032
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Method We performed a retrospective analysis of 32 sequentially referred children for suspected PNESs to a neurology psychology service over a 6-year period. After excluding non-PNES paroxysmal events (related to anxiety or migraine), 29 patients were identified with final diagnosis of PNESs. Charts were examined for presenting symptom data, demographics, comorbidities, neurological diagnoses and investigations, as well as psychological assessment, management, and outcome. Treatment consisted of education around diagnosis and of individual psychological treatment, which, in most cases, was cognitive behavioral therapy up to 14 sessions. Additional mental health services including psychiatric medication, family therapy, and admission to day or inpatient treatment were also utilized in a smaller number of cases. Total treatment periods ranged from 4 weeks to 12 months. Results The majority of patients identified were adolescent (90%), Caucasian (72%), and female (76%). Preceding psychology referral, point of entry into medical care for PNESs was primarily through the emergency department (66%) or outpatient neurology clinic referral (31%). Whereas 39% of parents described significant internalizing symptoms in their child (BASC-2), patients themselves tended to underreport anxiety or depression as demonstrated by only 16% endorsement on the BYI-II. By contrast, MACI personality assessment response patterns for adolescents demonstrated high levels of psychic tension/anxiety (65%), depressive affect (55%), and maladaptive personality traits including inhibition (45%), submissiveness (35%), and introversion (30%). Appropriate psychological treatment was associated with high rates of full remission (no new events, n = 17, 59%) and partial remission (50% or greater reduction in events, n = 6, 21%) as self-reported at discharge. Accurate diagnosis and referral to psychology also led to a sevenfold reduction in PNES-related emergency department visits one year after initial psychology visit compared with the preceding year. Conclusions This study suggests that appropriate care for PNESs reduces inappropriate medical investigation and therapy, expedites rates of remission, and decreases health-care utilization in a pediatric setting.</description><identifier>ISSN: 1525-5050</identifier><identifier>EISSN: 1525-5069</identifier><identifier>DOI: 10.1016/j.yebeh.2015.08.032</identifier><identifier>PMID: 26409129</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Anxiety - psychology ; Child ; Children ; Depression - psychology ; Dissociative seizure ; Emergency Medical Services ; Epilepsy ; Family Therapy ; Female ; Humans ; Male ; Millon Adolescent Clinical Inventory ; Neurology ; Nonepileptic event ; Personality ; Personality Tests ; PNESs ; Pseudoseizure ; Psychotherapy ; Referral and Consultation ; Retrospective Studies ; Seizures - diagnosis ; Seizures - psychology ; Seizures - therapy ; Socioeconomic Factors ; Somatoform Disorders - diagnosis ; Somatoform Disorders - psychology ; Somatoform Disorders - therapy ; Treatment Outcome</subject><ispartof>Epilepsy &amp; behavior, 2015-11, Vol.52 (Pt A), p.49-56</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-20a0478428a23e063e84c1b5c19d2cfaa95267c7736d5fd79f3d025f353781ed3</citedby><cites>FETCH-LOGICAL-c414t-20a0478428a23e063e84c1b5c19d2cfaa95267c7736d5fd79f3d025f353781ed3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26409129$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sawchuk, Tyson</creatorcontrib><creatorcontrib>Buchhalter, Jeffrey</creatorcontrib><title>Psychogenic nonepileptic seizures in children — Psychological presentation, treatment, and short-term outcomes</title><title>Epilepsy &amp; behavior</title><addtitle>Epilepsy Behav</addtitle><description>Abstract Purpose The purpose of this study was to better understand the etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting. Method We performed a retrospective analysis of 32 sequentially referred children for suspected PNESs to a neurology psychology service over a 6-year period. After excluding non-PNES paroxysmal events (related to anxiety or migraine), 29 patients were identified with final diagnosis of PNESs. Charts were examined for presenting symptom data, demographics, comorbidities, neurological diagnoses and investigations, as well as psychological assessment, management, and outcome. Treatment consisted of education around diagnosis and of individual psychological treatment, which, in most cases, was cognitive behavioral therapy up to 14 sessions. Additional mental health services including psychiatric medication, family therapy, and admission to day or inpatient treatment were also utilized in a smaller number of cases. Total treatment periods ranged from 4 weeks to 12 months. Results The majority of patients identified were adolescent (90%), Caucasian (72%), and female (76%). Preceding psychology referral, point of entry into medical care for PNESs was primarily through the emergency department (66%) or outpatient neurology clinic referral (31%). Whereas 39% of parents described significant internalizing symptoms in their child (BASC-2), patients themselves tended to underreport anxiety or depression as demonstrated by only 16% endorsement on the BYI-II. By contrast, MACI personality assessment response patterns for adolescents demonstrated high levels of psychic tension/anxiety (65%), depressive affect (55%), and maladaptive personality traits including inhibition (45%), submissiveness (35%), and introversion (30%). Appropriate psychological treatment was associated with high rates of full remission (no new events, n = 17, 59%) and partial remission (50% or greater reduction in events, n = 6, 21%) as self-reported at discharge. Accurate diagnosis and referral to psychology also led to a sevenfold reduction in PNES-related emergency department visits one year after initial psychology visit compared with the preceding year. Conclusions This study suggests that appropriate care for PNESs reduces inappropriate medical investigation and therapy, expedites rates of remission, and decreases health-care utilization in a pediatric setting.</description><subject>Adolescent</subject><subject>Anxiety - psychology</subject><subject>Child</subject><subject>Children</subject><subject>Depression - psychology</subject><subject>Dissociative seizure</subject><subject>Emergency Medical Services</subject><subject>Epilepsy</subject><subject>Family Therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Millon Adolescent Clinical Inventory</subject><subject>Neurology</subject><subject>Nonepileptic event</subject><subject>Personality</subject><subject>Personality Tests</subject><subject>PNESs</subject><subject>Pseudoseizure</subject><subject>Psychotherapy</subject><subject>Referral and Consultation</subject><subject>Retrospective Studies</subject><subject>Seizures - diagnosis</subject><subject>Seizures - psychology</subject><subject>Seizures - therapy</subject><subject>Socioeconomic Factors</subject><subject>Somatoform Disorders - diagnosis</subject><subject>Somatoform Disorders - psychology</subject><subject>Somatoform Disorders - therapy</subject><subject>Treatment Outcome</subject><issn>1525-5050</issn><issn>1525-5069</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><recordid>eNqFkctu1TAQhiMEohd4AiTkJYsmjO04lwVIqKKAVKlIwNrysSc9PiR2sB2kw6oPwRP2SXA4bRdsWNkjff-M5puieEGhokCb17tqjxvcVgyoqKCrgLNHxTEVTJQCmv7xw1_AUXES4w6AUsHp0-KINTX0lPXHxfw57vXWX6OzmjjvcLYjzikXEe2vJWAk1hG9taMJ6MjtzW9ySIz-2mo1kjkj6JJK1rszkgKqNOX6jChnSNz6kMqEYSJ-SdpPGJ8VTwY1Rnx-954W3y7efz3_WF5effh0_u6y1DWtU8lAQd12NesU4wgNx67WdCM07Q3Tg1K9YE2r25Y3Rgym7QdugImBC952FA0_LV4d-s7B_1gwJjnZqHEclUO_RElbnptzxkRG-QHVwccYcJBzsJMKe0lBrqrlTv5VLVfVEjqZVefUy7sBy2ZC85C5d5uBNwcA85o_LQYZtUWn0diAOknj7X8GvP0nr0frVunfcY9x55fgskFJZWQS5Jf12uuxqQCo-5ryPwMbp8k</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Sawchuk, Tyson</creator><creator>Buchhalter, Jeffrey</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20151101</creationdate><title>Psychogenic nonepileptic seizures in children — Psychological presentation, treatment, and short-term outcomes</title><author>Sawchuk, Tyson ; Buchhalter, Jeffrey</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-20a0478428a23e063e84c1b5c19d2cfaa95267c7736d5fd79f3d025f353781ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Anxiety - psychology</topic><topic>Child</topic><topic>Children</topic><topic>Depression - psychology</topic><topic>Dissociative seizure</topic><topic>Emergency Medical Services</topic><topic>Epilepsy</topic><topic>Family Therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Millon Adolescent Clinical Inventory</topic><topic>Neurology</topic><topic>Nonepileptic event</topic><topic>Personality</topic><topic>Personality Tests</topic><topic>PNESs</topic><topic>Pseudoseizure</topic><topic>Psychotherapy</topic><topic>Referral and Consultation</topic><topic>Retrospective Studies</topic><topic>Seizures - diagnosis</topic><topic>Seizures - psychology</topic><topic>Seizures - therapy</topic><topic>Socioeconomic Factors</topic><topic>Somatoform Disorders - diagnosis</topic><topic>Somatoform Disorders - psychology</topic><topic>Somatoform Disorders - therapy</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sawchuk, Tyson</creatorcontrib><creatorcontrib>Buchhalter, Jeffrey</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Epilepsy &amp; behavior</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sawchuk, Tyson</au><au>Buchhalter, Jeffrey</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Psychogenic nonepileptic seizures in children — Psychological presentation, treatment, and short-term outcomes</atitle><jtitle>Epilepsy &amp; behavior</jtitle><addtitle>Epilepsy Behav</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>52</volume><issue>Pt A</issue><spage>49</spage><epage>56</epage><pages>49-56</pages><issn>1525-5050</issn><eissn>1525-5069</eissn><abstract>Abstract Purpose The purpose of this study was to better understand the etiologies, features, and care outcomes of psychogenic nonepileptic seizures (PNESs) in a pediatric setting. Method We performed a retrospective analysis of 32 sequentially referred children for suspected PNESs to a neurology psychology service over a 6-year period. After excluding non-PNES paroxysmal events (related to anxiety or migraine), 29 patients were identified with final diagnosis of PNESs. Charts were examined for presenting symptom data, demographics, comorbidities, neurological diagnoses and investigations, as well as psychological assessment, management, and outcome. Treatment consisted of education around diagnosis and of individual psychological treatment, which, in most cases, was cognitive behavioral therapy up to 14 sessions. Additional mental health services including psychiatric medication, family therapy, and admission to day or inpatient treatment were also utilized in a smaller number of cases. Total treatment periods ranged from 4 weeks to 12 months. Results The majority of patients identified were adolescent (90%), Caucasian (72%), and female (76%). Preceding psychology referral, point of entry into medical care for PNESs was primarily through the emergency department (66%) or outpatient neurology clinic referral (31%). Whereas 39% of parents described significant internalizing symptoms in their child (BASC-2), patients themselves tended to underreport anxiety or depression as demonstrated by only 16% endorsement on the BYI-II. By contrast, MACI personality assessment response patterns for adolescents demonstrated high levels of psychic tension/anxiety (65%), depressive affect (55%), and maladaptive personality traits including inhibition (45%), submissiveness (35%), and introversion (30%). Appropriate psychological treatment was associated with high rates of full remission (no new events, n = 17, 59%) and partial remission (50% or greater reduction in events, n = 6, 21%) as self-reported at discharge. Accurate diagnosis and referral to psychology also led to a sevenfold reduction in PNES-related emergency department visits one year after initial psychology visit compared with the preceding year. Conclusions This study suggests that appropriate care for PNESs reduces inappropriate medical investigation and therapy, expedites rates of remission, and decreases health-care utilization in a pediatric setting.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26409129</pmid><doi>10.1016/j.yebeh.2015.08.032</doi><tpages>8</tpages></addata></record>
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subjects Adolescent
Anxiety - psychology
Child
Children
Depression - psychology
Dissociative seizure
Emergency Medical Services
Epilepsy
Family Therapy
Female
Humans
Male
Millon Adolescent Clinical Inventory
Neurology
Nonepileptic event
Personality
Personality Tests
PNESs
Pseudoseizure
Psychotherapy
Referral and Consultation
Retrospective Studies
Seizures - diagnosis
Seizures - psychology
Seizures - therapy
Socioeconomic Factors
Somatoform Disorders - diagnosis
Somatoform Disorders - psychology
Somatoform Disorders - therapy
Treatment Outcome
title Psychogenic nonepileptic seizures in children — Psychological presentation, treatment, and short-term outcomes
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