Differences in relatives' and patients' illness perceptions in functional neurological symptom disorders compared with neurological diseases

Abstract

ObjectiveThe illness perceptions of the relatives of patients with functional neurological symptom disorders (FNSD) have been little studied.We aimed to compare illness perceptions of relatives of patients with FNSD to those held by patients themselves. We used control pairs with neurological diseases (ND) to examine the specificity of the findings to FNSD. Material and methodsPatients with FNSD (functional limb weakness and psychogenic non-epileptic seizures) and patients with ND causing limb weakness and epilepsy, and their relatives, completed adapted versions of the Illness Perception Questionnaire Revised (IPQ-R). ResultsWe included 112 pairs of patients with FNSD and their relatives and 680 ND patient and relative pairs. Relatives of patients with FNSD were more likely to endorse psychological explanations and, in particular stress as a causal factor than patients with FNSD (p <.001).Relatives of FNSD patients were also more pessimistic about the expected duration of the disorder and perceived a greater emotional impact than patients themselves (p <.001).However, the latter two differences between patients and relatives were also found in ND pairs. ConclusionThe main difference in illness perceptions between relatives and patients with FNSD was a tendency for relatives to see psychological factors as more relevant than patients. Some oOther differences were observed between FNSD relatives and patients but the same differences were also seen in ND pairs. These other differences were therefore not and are therefore not specific to FNSD. Discussion about possibly relevant psychological factors with patients suffering from FNSD may be helped by including relatives.

Predicting first attendance at psychiatry appointments in patients with dissociative seizures

“…This finding may also indicate that is helpful to include a carer in the consultation. A study of carer beliefs in dissociative seizures showed that they tended to have views which were likely to be more conducive to psychological treatment than the patient [25].…”

“…Studies of non-attendance after referral to secondary specialist medical care from primary care suggest that young age (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), males, low socio-economic status, longer delay to appointment, transport and rapport are factors associated with missed appointments [15,16]. Reasons often given by patients for non-attendance include forgetting, apathy, illness, work commitments and clerical errors [17].…”

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“…Patient and physician perspectives, collected through qualitative interviews and surveys, can inform new research directions, highlight conceptual struggles, and on-the-ground areas for improvement in clinician training, diagnosis, and treatment (42–47). Education programs that involve direct contact with patients, outside of the clinic, have been shown to reduce stigma perceptions of “otherness” promoting deeper understanding and appreciation for these disorders (48).…”

Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis

“…In view of the fact that patients and relatives often have a different perspective on the seizures (Reuber et al, 2011, Whitehead et al, 2015a, Whitehead et al, 2015b), the views of both parties on how typical a particular attack was should be recorded. Another way of assessing typicality which has been proposed is to consider whether ‘all automatisms in induced seizures had been noted in at least some spontaneous seizures, and at least some automatisms in spontaneous seizures were noted in induced seizures’ (Walczak et al, 1994).…”