Depression, anxiety, and clinical history in Spanish-speaking American patients with psychogenic nonepileptic seizures (PNES) compared with Spanish-speaking American patients with epilepsy.

OBJECTIVE: The objective of this study was to compare Spanish-speaking American patients with epilepsy to Spanish-speaking American patients with psychogenic nonepileptic seizures (PNES) on depression, anxiety, and other clinical variables. BACKGROUND: Research on Spanish-speaking American patients with epilepsy or PNES is relatively infrequent, with only a few studies on psychopathology in these two patient groups. Studies of English-speaking patients indicate that those with PNES present with greater depression and anxiety and report poorer quality of life (QOL) when compared with persons with epilepsy (PWEs). Similarly, although psychological trauma is observed in both groups, those with PNES appear to have more traumatic exposure compared with PWEs. METHODS: This is a retrospective study of 74 Spanish-speaking PWEs (49 women, 31 men) and 34 Spanish-speaking patients with PNES (28 women, 4 men) (2004 to 2017). The diagnosis of epilepsy or PNES was confirmed with video-EEG. Demographic and clinical (psychological trauma, history of psychological treatment, etc.) data were collected, and Spanish versions of the Beck Depression Inventory - second edition (BDI-II) and Beck Anxiety Inventory (BAI) were completed by the patients. RESULTS: Patients with PWEs (M = 18.19, SD = 12.89) differed significantly from those with PNES on a measure of depression (BDI-II, (M = 24.12, SD = 11.20); t (92) = -2.22, p = 0.01). In addition, PWEs (M = 15.76, SD = 14.24) also differed significantly when compared with patients with PNES on a measure of anxiety (BAI, (M = 22.46, SD = 14.02); t (93) = -2.05, p = 0.02). Significant differences in clinical and demographic data were also noted. CONCLUSIONS: Spanish-speaking American patients with PNES were significantly more depressed and anxious and reported greater exposure to sexual trauma as compared with PWEs. Furthermore, patients with PNES tended to report more prediagnosis utilization of mental health services than PWEs. After adjusting for potential linear effects of other predictors (e.g., gender, age, seizure frequency, and psychological trauma), only a reported history of psychological trauma had a linear relationship with a depression score while higher seizure frequency and history of mental health treatment had linear relationships with an anxiety score.

Socialization characteristics in persons with epilepsy.

OBJECTIVE: The purpose of this report was to describe social behaviors and preferences in adults with epilepsy, including self-reported use of various socialization media (face-to-face and indirect communication) as well as perceived social barriers. METHODS: 1320 consecutive persons with epilepsy (PWEs) confirmed through inpatient video-EEG monitoring were administered a questionnaire on the day of their first appointment. The questionnaire was designed to assess preferences in socialization practices, frequency of interpersonal contact, use of social media, and perceived barriers to socialization. The survey was developed to gain a better understanding of the socialization behaviors and preferences of our patients for the future development of customized activities in our wellness program. RESULTS: Our sample revealed higher rates of unemployment and single status as compared to the US Census of 2012. With regard socialization however, many were quite social (86% reported daily/weekly communication with friends and family via telephone, 71% saw relatives in person weekly, 68% saw friends weekly, and 65% reported using the computer daily/weekly to socialize). Facebook® was the preferred on-line social media. Indoor/solitary activities were most common with 63% stating they watch TV/read/use the computer followed by physical exercise and spending time outdoors (36%). The frequency of socialization with friends, relatives, and coworkers decreased with the respondents' age and the longer the respondent had carried the diagnosis of epilepsy. Respondents who were taking a greater number of AEDs or were considered refractory were less likely to consider participating in socialization-enhancing activities. The primary barriers to socialization that respondents endorsed were driving prohibition and medication side-effects. Respondents expressed the greatest interest in online support groups or educational programs (31%), office-based support groups (25%), and volunteering (19%). CONCLUSION: Although the respondents indicate that they do face barriers to socialization, a majority report frequent communication with relatives and friends via phone, in-person and social media. When designing wellness interventions with this group of patients in the future, online, as well as face to face options for support appear to be desired by a number of PWEs.

Socialization characteristics in patients with psychogenic nonepileptic seizures (PNES).

OBJECTIVE: The purpose of this study was to describe social behaviors and preferences in adults with psychogenic nonepileptic seizures (PNES) including self-reported use of various socialization mediums (face-to-face and indirect communication) as well as perceived social barriers. METHODS: One hundred forty-one consecutive patients with a diagnosis of PNES that was later confirmed through inpatient video-EEG monitoring were administered a questionnaire on the day of their first outpatient appointment. The questionnaire was designed to assess preferences in socialization practices, frequency of interpersonal contact, use of social media, and perceived barriers to socialization. The survey was developed to gain a better understanding of the socialization behaviors and preferences of our patients for the future development of customized activities in our wellness program. RESULTS: Contrary to prevalent assumptions that patients with PNES tend to be socially isolated, our responders reported that they were in fact quite socially connected (72.2% reported daily communication with friends and family via telephone, 68.54% saw relatives in person weekly, 65.28% saw friends weekly, and 51.2% reported using the computer daily to socialize). Facebook was the preferred online social media. Indoor/solitary activities were most common with 57.44% stating that they watch TV/read/use the computer. The primary barriers to socialization that respondents endorsed were driving prohibition and medication side effects. Respondents expressed the greatest interest in online support groups or educational programs (29.46%), office-based support groups (28.57%), and volunteering (23.21%). CONCLUSION: Although it has been speculated that social isolation is a significant problem for patients with PNES, considerable participation in social activities was reported. Characteristics of socialization practices may be more nuanced than first believed. When addressing therapeutic interventions with this group of patients in the future, it might be beneficial to offer both distance-based options as well as face-to-face options for treatment and support depending on age and personal preference.

Cognitive differences between patients who have psychogenic nonepileptic seizures (PNESs) and posttraumatic stress disorder (PTSD) and patients who have PNESs without PTSD.

OBJECTIVES: The objective of this study was to examine cognitive and clinical differences among three groups of patients diagnosed with psychogenic nonepileptic seizures (PNESs): those with posttraumatic stress disorder (PTSD), those with a history of trauma but no PTSD, and those without a history of trauma. METHODS: Seventeen patients who were confirmed to have PTSD based on the Trauma Symptom Inventory-2 (TSI-2) and clinical interview were compared with 29 patients without PTSD who had experienced trauma and 17 patients who denied experiencing trauma. We analyzed demographic data, psychiatric information, trauma characteristics, and neuropsychological variables in these groups. RESULTS: Our study revealed that patients with PNESs with comorbid PTSD performed significantly worse on episodic verbal memory (narrative memory); had greater self-reported Total, Verbal, and Visual Memory impairments; and had higher substance abuse history and use of psychopharmacological agents compared with patients without PTSD regardless of a history of trauma. CONCLUSION: The present study showed that patients with PNESs diagnosed with PTSD exhibited memory functions that were significantly different from those in patients with PNESs who do not carry a diagnosis of PTSD (regardless of history of trauma). Furthermore, these specific cognitive findings in narrative memory are consistent with those reported in patients with PTSD alone. The present findings contribute to further identifying discrete intragroup differences within PNESs. Identifying a specific psychopathological subgroup such as PTSD will allow clinicians to accurately select treatment.

Prevalence of alexithymia in patients with psychogenic non-epileptic seizures and epileptic seizures and predictors in psychogenic non-epileptic seizures.

OBJECTIVE: The first objective of this study was to determine the prevalence rate of alexithymia (dysregulation and unawareness of emotion) in patients with psychogenic non-epileptic seizures (PNESs) and epileptic seizures (ESs). The second objective was to identify the predictors of alexithymia in patients with PNESs. METHODS: We studied 66 consecutive patients with PNESs and 35 patients with ESs with the Toronto Alexithymia Scale-20. The prevalence of alexithymia was determined in both groups. In order to identify the risk factors of alexithymia in PNES, the Trauma Symptom Inventory-II (TSI-II), the MMPI 2-RF, a clinical history, and demographic variables were studied. RESULTS: Our study revealed a prevalence of alexithymia in PNES and ES of 36.9% and 28.6%, respectively (not a significant difference). Upon examining the group with PNES, we found a significant correlation between alexithymia and Anxious Arousal (r=.497, p<.000), Intrusive Experiences (r=.541, p<.000), Dissociation (r=.421, p<.001), and Defensive Avoidance (r=.444, p<.000) from the TSI-II. Minnesota Multiphasic Personality Inventory-2-RF RCd (r=.512, p<.000), RC1 (r=.346, p<.017), RC2 (r=.355, p<.017), RC3 (r=.467, p<.001), and EID (r=.567, p<.000) also correlated significantly with alexithymia. However, stepwise regression analysis only retained Intrusive Experiences and Defensive Avoidance from the TSI-II and the cynicism RC3 scale from the MMPI 2-RF. CONCLUSION: Symptoms of psychological trauma and cynicism in patients diagnosed with PNESs were associated with alexithymia. These findings are encouraging, as they assist in better understanding the condition and in treatment design for this subset of patients.

Psychological trauma in patients with psychogenic nonepileptic seizures: trauma characteristics and those who develop PTSD.

OBJECTIVES: The first objective of this study was to examine and describe the demographic, psychiatric, and trauma characteristics of our sample with PNESs as a whole. Subsequently, a comparison between traumatized and nontraumatized patients with PNESs was performed with regard to descriptive and trauma characteristics and general psychopathology symptoms. Lastly, we analyzed the predictive value in distinguishing patients with "likely" vs. "not likely" PTSD utilizing a model derived from our patients' psychometric test results. METHODS: We collected and tallied demographic and psychiatric information and trauma characteristics on 61 patients with PNESs who had confirmed or denied having experienced trauma in their lifetime. We then studied this group with the Trauma Symptom Inventory-2 (TSI-2) and the Minnesota Multiphasic Personality Inventory-2RF (MMPI-2RF). Traumatized patients were subsequently classified as "PTSD likely" and "PTSD not likely" based on TSI-2 criteria and compared on demographic, psychiatric, and trauma characteristics and MMPI-2RF scores. RESULTS: Our study revealed that 45 out of 61 (73.8%) patients reported experiencing at least one traumatic event in their lifetime. Approximately 40% reported physical or sexual abuse followed in percentage size by loss of a significant other, psychological abuse, witnessing the abuse of others, and medical trauma. Traumatized vs. nontraumatized and "PTSD likely" and "PTSD not likely" patients differed significantly on several clinical variables, as well as MMPI-2RF scores. Scores from TSI-2 produced a model that accurately predicted "no PTSD" in 21/26 (80.77%) subjects who denied a history of PTSD and "PTSD" in 5/6 subjects (83.33%) who endorsed a history of PTSD. CONCLUSION: This study showed that overall exposure to psychological trauma is much more prevalent in patients with PNESs than in the general population with an inordinately high exposure to sexual and physical abuse as well as a variety of other types of abuse. Psychopathology was identified in the group with PNESs as a whole with discrete distinctions in clinical symptoms and characteristics of the traumatized as well as the "PTSD likely" subgroups. These findings contribute useful information in understanding intragroup differences in what is increasingly appearing to be a heterogeneous psychiatric condition composed of distinguishable subgroups.

Psychogenic non-epileptic seizures: predisposing factors to diminished quality of life.

OBJECTIVE: The objective of this study was to examine the factors that contribute to the reports of diminished quality of life (QOL) in patients with psychogenic non-epileptic seizures (PNES). METHODS: We assessed 62 patients with PNES for quality of life, anger expression and personality, and psychiatric, social and medical histories. RESULTS: Diagnosis of depression, pain syndromes, older age of onset and shorter duration of PNES correlated with poorer quality of life. Elevated anger state, trait and total anger scores correlated with worse quality of life and with Quality of Life in Epilepsy 31 subscales of emotional well-being, medication, cognitive and social effects, seizure worry, and fatigue. CONCLUSION: Our study verifies reported correlations between depression and somatic symptoms and quality of life. A novel finding is that of a relationship between quality of life in PNES and anger expression. This result has important implications for psychotherapeutic treatment of PNES in that it provides a potentially modifiable target.

Stress coping strategies in patients with psychogenic non-epileptic seizures and how they relate to trauma symptoms, alexithymia, anger and mood.

PURPOSE: The purpose of the present study was to assess stress coping strategies employed by patients with psychogenic non-epileptic seizures (PNES) and determine whether these approaches were associated with other psychopathological features. Ineffective stress coping strategies can have a variety of unhealthy consequences fueling psychopathology just as psychopathology can also have an impact on stress coping. Because of this, the study of stress coping has the potential to inform our understanding of the PNES condition and underscore a potential target for psychological treatment. METHODS: Eighty-two consecutive patients with PNES were studied using the Coping Inventory for Stressful Situations (CISS). The CISS is a self-rating coping strategies scale that has three main subscales (Task-Oriented, Emotion-Focused, and Avoidance-Oriented). Other psychological variables that were thought to potentially influence the chosen coping mechanisms including alexithymia, symptoms of post-traumatic stress disorder, anger expression and select scales from the Minnesota Multiphasic Personality Inventory 2-RF (MMPI 2-RF) were also evaluated. RESULTS: Fifty patients (60.9%) endorsed using at least one coping strategy that was 1.5 standard deviations or more away from the normal adult mean. Over 30% of the participants endorsed using elevated Emotion-Focused coping strategies (T score ≥ 65), and just over 25% endorsed underusing Task-Oriented coping strategies (T score ≤ 35). Elevations in avoidance strategies were endorsed by only 15.9% of the respondents. ANOVA comparing T scores between the coping strategies was significant (F=13.4, p=.0001) with a significantly lower Task-Oriented strategy than Emotion-Focused (p=.001) and Avoidance (p=.005) strategies. Patients with high scores of Emotion-Focused coping strategies also had significantly high scores on diverse psychopathology factors including elevations on depressive mood, intrusive experiences, anger state, and general anger scores. In contrast, those who used Task-Oriented strategies and who used Avoidance-Focused strategies had less psychopathology including low positive emotion scores (RC2). CONCLUSION: Nearly one-third of patients with PNES tended to use the less effective Emotion-Oriented coping strategies and one fourth reported underusing the more effective Task-focused strategies. Substantial differences were noted between coping strategies with a significantly lower Task-Oriented strategy than Emotion-Focused and Avoidance strategies. In addition, high Emotion-Focused coping was seen in patients with underlying psychological symptoms that were not observed in other coping strategies. This information supports the relevance of assessing stress coping in patients with PNES because it allows the identification of useful behavioral targets for the psychotherapist.