Perceptions in PNES: A Bidirectional Problem

Abstract

A recent systematic synthesis of qualitative research demonstrated that patients with psychogenic nonepileptic seizures (PNES) often experience unsatisfactory encounters with health-care practitioners (HCPs). It is important to understand such interactions from the perspective of those responsible for delivering care. This systematic review aimed to examine the attitudes and perceptions of HCPs toward PNES. A systematic search of 3 databases (Web of Science, PubMed, and CINAHL) was conducted in November 2017. Studies from around the world published after 1997 using qualitative or quantitative methodologies were reviewed. An interpretative stance was taken to analyze the data utilizing a grounded theory approach. The quality of studies included was assessed using the Mixed Methods Appraisal Tool. Overall, 30 separate studies capturing the views of at least 3900 professionals were included. Five concepts emerged from the analysis: (1) HCPs' responses demonstrated uncertainty about many aspects of PNES, including diagnosis and treatment; (2) HCPs understood PNES in dualistic terms, perceiving the condition as largely associated with psychological factors; (3) patients with PNES were considered challenging and frustrating; (4) HCPs held mixed or contested views about who is responsible for treating patients with PNES; and (5) PNES was viewed as less severe or disabling than epilepsy and associated with a greater degree of volition. Although some HCPs have an excellent understanding of PNES, the views of many give rise to concern. The number of qualitative studies that directly ask HCPs about their perceptions of PNES is limited. Moreover, some professional groups (ie, mental health specialists) are underrepresented in current research. This study reveals a demand for additional training. However, effort is needed also to change the attitudes of some practitioners toward PNES.

Neurology specialists’ visual interpretation of psychogenic nonepileptic seizures: Contemplating their etiology and existing challenges

“…The reasons behind the difficulties of providing direct and effective care for patients with PNES are bidirectional: both the HCPs and the patients can play some part in the mismanagement of the disorder [14]. On the one hand, HCPs can be ill-prepared to perform the first steps towards a diagnosis because of a lack of experience or materials (video EEG) -these issues were discussed in the previous section.…”

“…Data from questionnaires and interviews with HCPs suggest that issues like uncertainty, lack of understanding or difficulties in sharing responsibility might often undermine effective care of PNES [11,12]. On the other hand, providing the patient comprehensive information about the disorder, individually tailoring the diagnostic and treatment pathways are encouraged steps as they can build a trusting patient-specialist relationship and possibly improve patient outcomes [13,14]. This idea has recently been reflected in a collection of written personal accounts from over 90 healthcare providers [15].…”