Patients with psychogenic nonepileptic seizures, alone or epilepsy-associated, share a psychological profile distinct from that of epilepsy patients

Abstract

The aim of this study was twofold: 1 - to identify a psychological profile of patients with psychogenic nonepileptic seizures (PNESs) that is possibly distinct from that of subjects affected by epileptic seizures (ESs) alone; 2 - to detect the possible differences between the clinical features and psychological profile of patients affected by PNESs alone and those of subjects in whom PNESs are associated with epileptic seizures (ES/PNES patients). We assessed the psychological profiles of 2 different groups of subjects. The first group was of 38 patients who had all developed PNESs after epileptic seizures (ES\PNES, group 1). The second group was of 31 patients with PNESs alone (PNES, group 2). We compared the psychological findings of each of these 2 groups with those of 2 control groups, composed of patients who matched groups 1 and 2 for sex, age, and educational level, but who were affected only by ESs (groups 1C and 2C). Finally, we considered possible differences between the ictal symptoms and signs of PNESs occurring in ES/PNES and in PNES patients. Both the ES/PNES group and the PNES group revealed higher percentages of Somatoform Disorders and Cluster B Personality Disorders (DSM-III-R diagnoses) than the ES patients in the control groups. The scores obtained on the Psychophysiological Distress Scale of the Cognitive Behavioural Assessment Battery (CBA) followed the same pattern. Among PNES ictal phenomena, autonomic symptoms and signs were significantly more frequent in the PNES than in the ES/PNES group. The occurrence of PNESs mimicking generalised tonic-clonic ESs (GTC-PNESs) was significantly associated with a low academic level. The results of this study suggest that the patients with PNESs alone and those affected by PNESs and ESs share the same psychological profile, which is different from that of patients with ESs alone. However, some differences between ES/PNES and PNES patients were found in the clinical semiology of their PNESs. Our findings could have implications for the diagnosis and for the treatment of patients with PNESs.

Excitatory and inhibitory conversive experiences: neurobiological features involving positive and negative conversion symptoms

“…Desynchronization of information integration circuits leads to an emotion regulation and executive control failure where PFC and other related areas are unable to stop the underlying limbic avalanche (Lanius et al, 2014b). In this context, high emotional reactivity arises, consistent with well-known clinical features and personality manifestations in conversion patients suffering from pseudoseizures (Galimberti et al, 2003;Almis et al, 2013).…”

Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

“…Studies comparing anxiety in individuals with PNESs and epilepsy have failed to identify clear and consistent differences, although the prevalence rates of anxiety disorders have been found to be approxi-mately twice as high in both groups as in the general population [25,26]. Some studies showed similar mean levels of self-reported anxiety in patients with epilepsy or PNESs [27,28], whereas others found significant [29] or trend-level differences [30].…”

Video‐EEG Study of Psychogenic Nonepileptic Seizures: Differential Characteristics in Patients with and without Epilepsy

“…Although previous studies have reported a high prevalence (5%-50%) of ES in PNES patients (PNES/ES) (Sigurdardottir and Olafsson, 1998;Benbadis et al, 2001;Martin et al, 2003), few authors investigated PNES and PNES/ES patients separately to determine the possible influence of this comorbidity on psychological and clinical aspects (Devinsky et al, 1996;Owczarek and Jederzejczak, 2001;Reuber et al, 2002;Kuyk et al, 2003;Galimberti et al, 2003).…”