Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures (original) (raw)
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Cognitive-emotion processing in psychogenic nonepileptic seizures
Epilepsy & Behavior, 2020
Background: Previous literature suggests that cognitive-emotion processing contributes to the pathogenesis of psychogenic nonepileptic seizures (PNES). Characterization of alterations in cognitive-emotion processing in PNES could inform treatment. Methods: In this descriptive, cross-sectional study, 143 patients with video electroencephalogram (EEG) confirmed PNES were prospectively recruited. Patients completed self-report questionnaires on emotion perception (Trait Meta-Mood Scale (TMMS) attention and clarity subscales) and coping style (Affective Styles Questionnaire [ASQ] concealing, adjusting, and tolerating subscales) at the time of their initial evaluation for PNES. Demographic, clinical data and measures of psychopathology severity were also obtained. The TMMS and ASQ subscale scores were compared to available normative data and between PNES subgroups (based on presence of trauma-related factors). Correlation coefficients were obtained to evaluate associations between subscale scores and measures of psychopathology. Results: Mean scores on both TMMS subscales (attention 47.0 [SD 7.4] and clarity 37.5 [SD 8.0]) and the ASQ adjusting subscale (22.2 [SD 6.3]) were significantly lower than available normative data (p b .001). Among patients with PNES, those with a history of childhood abuse or active posttraumatic stress disorder (PTSD) were found to have significantly lower scores on emotion clarity, adjustment, and tolerance subscales than those without such histories (p b .05). Degree of clarity of emotions correlated negatively with severity of depression, anxiety, stress, and illness perception (p ≤ .001). Adjustment to and tolerance of emotional states correlated negatively with severity of depression and stress (p b .01). Conclusions: Patients with PNES, especially those with active PTSD and childhood trauma, have lower clarity of their emotions and lower ability to adjust to emotional states than healthy individuals. These cognitiveemotion processing deficits are more pronounced in patients with more severe depression and reported stress. This study characterizes alterations in cognitive-emotion processing in PNES that are well-suited therapeutic targets and can therefore inform treatment interventions.
Dissociation, Stressors, and Coping in Patients of Psychogenic Nonepileptic Seizures
Indian Journal of Psychological Medicine, 2020
Background: Psychogenic nonepileptic seizures (PNES) commonly present both to neurologists and psychiatrists and include a wide range of psychopathology. In order to understand the demographics, dissociative experiences, stressful life events, abuse, and coping in these patients, this study was undertaken. Methods: This was a cross-sectional, observational study. A total of 71 patients of PNES, referred from neurology, were assessed on Dissociative Experience Scale (DES), Scale For Trauma and Abuse, Presumptive Stressful Life Events Scale (PSLES), and Ways of Coping Questionnaire to ascertain the dissociative experiences; the prevalence of trauma, abuse, and stressful life events, and the coping mechanisms. Results: Females predominated, with the duration of PNES up to 2 years. The mean ± SD total DES score was 38.14 ± 14.1, indicating high dissociation. On the PSLES, for the stressful life events in the last one year, the mean score was 98.28 ± 87.1. Marital and family conflicts an...
Emotional trauma and abuse in patients with psychogenic nonepileptic seizures
Epilepsy & Behavior, 2011
A history of childhood trauma and the presence of dissociative phenomena are considered to be the most important risk factors for psychogenic nonepileptic seizure disorder (PNESD). This case-control study investigated 20 patients with PNESD and 20 with temporal lobe epilepsy (TLE) diagnosed by video/EEG monitoring who were matched for gender and age. Patients with both conditions were not included in the study. Groups were evaluated for age at onset and at diagnosis, worst lifetime weekly seizure frequency, trauma history, and presence of dissociative phenomena. Age at onset (P = 0.007) and age at diagnosis (P b 0.001) were significantly higher in the PNESD group than the control group, as were the scores on the Dissociative Experiences Scale (P b 0.001) and Childhood Trauma Questionnaire (P = 0.014). Only the differences in scores on the Childhood Trauma Questionnaire subscales Emotional Neglect (P = 0.013) and Emotional Abuse (P = 0.014) reached statistical significance. Dissociative phenomena and a reported history of childhood trauma are more common in patients with PNESD than in those with TLE. However, only emotional neglect and abuse were associated with PNESD in this study.
The effect of stress induction on working memory in patients with psychogenic nonepileptic seizures
Epilepsy & Behavior, 2010
Although psychogenic nonepileptic seizures (PNES) are considered a stress-induced paroxysmal disintegration of cognitive functions, it remains unknown whether stress indeed impairs cognitive integrative functions, such as working memory (WM), in patients with PNES. An N-back task with emotional distracters (angry, happy, and neutral faces) was administered at baseline and after stress induction (Cold Pressor Test) to 19 patients with PNES and 20 matched healthy controls. At baseline, patients displayed increased WM interference for the facial distracters. After stress induction, group differences generalized to the no-distracter condition. Within patients, high cortisol stress responses were associated with larger stress-induced WM impairments in the no-distracter condition. These findings demonstrate that patients' cognitive integrative functions are impaired by social distracters and stress induction. Moreover, the stress-and cortisol-related generalization of the relative WM impairments offers a promising experimental model for the characteristic paroxysmal disintegration of attentional and mnemonic functions in patients with PNES associated with stress.
Epilepsy & Behavior, 2019
The objective of this study was to compare patients with intractable epilepsy with patients with psychogenic nonepileptic seizures (PNES) on the presence of psychological traumas, clinical factors, and psychological measures of somatization and dissociation. Background: Several studies have reported a high prevalence of psychological trauma in patients with PNES, while less have examined the prevalence of psychological trauma in patients with epilepsy and compared both groups. Reports have been somewhat divergent with some describing significantly higher prevalence in physical abuse, others, in emotional abuse/neglect, and others, in sexual abuse in patients with PNES compared with those in patients with epilepsy. Methods: This is a retrospective study of 96 patients (61 women, 35 men) with intractable epilepsy (2009 to 2017) and 161 patients (107 women, 54 men) with PNES (2008 to 2018). Demographic and clinical (psychological trauma, depression, anxiety, seizure frequency, and number of antiepileptic drugs) data were collected. The Trauma Symptom Inventory II and the Minnesota Multiphasic Personality Inventory 2RF were administered. Results: Patients with PNES differed significantly from those with intractable epilepsy on sexual trauma (χ 2 (5df, N = 257) =9.787, p b .002) and "other" trauma (χ 2 (5df, N = 257) = 17.9076, p b .000). On psychological measures, there was a significant difference on Somatization scores in patients with PNES (M = 59.63, SD = 11.47) and patients with intractable epilepsy (M = 53.98, SD = 11.31); t(173) = 2.8396, p = .0051, but no difference was noted on a measure of Dissociation. Subsequent principal components analysis revealed that the first 3 principal components (sexual, physical, and other trauma) explained 74.19% of the variability, and that one principal component (dissociation, somatization, demoralization) explained 61.57% of the variability. However, after adjusting for the effects of covariates, only the presence of trauma discriminated between epilepsy and PNES. Conclusions: Patients with PNES diagnoses differed from those with epilepsy on a Somatization scale but not on Dissociation or Intrusive Experiences and exhibited significantly higher rates of sexual and "other" trauma compared with those with intractable epilepsy. However, subsequent analyses revealed that a history of psychological trauma was the only condition found to discriminate between patients with PNES and those with epilepsy. These findings suggest that during initial workup and diagnosis, when patients report a history of psychological trauma (sexual or otherwise) a psychogenic nonepileptic etiology should be strongly considered in the differential diagnosis.
Epilepsy & Behavior, 2013
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.
Epilepsy & Behavior, 2019
Psychogenic nonepileptic seizures (PNES) have the appearance of epileptic seizures, yet show no epileptiform discharges in the brain. The quality of life (QOL) in patients with PNES is reportedly low and trauma eems to be a relevant risk factor. The objective of this study was to examine the difference between measures of (epilepsy-specific) QOL (Quality of Life in Epilepsy Inventory; QOLIE-31p) and psychological dysfunction (trauma symptom inventory; TSI) between patients with diagnosed PNES with self-reported trauma and those without self-reported trauma. Methods: Patients whose PNES diagnoses were through video-electroencephalogram (EEG) monitoring at the Northeast Regional Epilepsy Group between 2008 and 2018 were included. Patients who reported to have a history of psychological trauma and those who did not were assigned to separate groups. Scores from the TSI and QOLIE-31p were compared by using multivariate analysis of covariance. Results: The total sample was comprised of 217 adult patients, 148 of which self-reported as having experienced psychological trauma in the past and 69 who did not report any psychological trauma. Traumatized patients significantly differed in terms of QOL and TSI from nontraumatized patients. Traumatized patients were demonstrated to have lower scores on the subdomain "energy" of the QOLIE-31p and the total QOLIE-31p score compared to the nontraumatized group. Similarly, the traumatized group had significantly higher scores on nearly all TSI subscales with the exception of suicidality, sexual disturbances, and somatization. Conclusion: This study demonstrated significant differences between patients with PNES who have been psychologically traumatized and those who have not. In particular, patients with a history of psychological trauma present greater psychopathology and would possibly benefit from rapid identification and referral to traumabased therapy. In turn, this may result in a reduction of disease burden, increase QOL, and a reduction in healthcare costs resulting from diagnostic delays and implementation of less targeted treatments.
Epilepsy & Behavior, 2011
This prospective study investigated and compared psychiatric features of 25 consecutive patients with psychogenic nonepileptic seizures (PNES) on the basis of presence of reported trauma. The "trauma" group comprised 19 patients (76%) and the "no-trauma" group comprised 6 patients (34%). We compared history of PNES, psychiatric comorbidity, alexithymia, and symptoms of dissociation. The study clearly characterized two distinct profiles of patients with PNES on the basis of trauma history. Patients with trauma had at least one psychiatric comorbidity or antecedent (vs 0% in the no-trauma group NT, P b 0.001) and a higher median score of dissociation (P b 0.001). Patients without trauma had more frequent "frustration situations" as a factor triggering PNES and subsequent sick leaves as perpetuating factors (P = 0.001). Trauma antecedents correlated with a high rate of psychiatric comorbidity and a strong dissociative mechanism. Patients without trauma had no psychiatric comorbidity and a weaker dissociative mechanism.
Frontiers in Psychiatry
Functional seizures (FS) are seizure-like symptoms without electroencephalogram (EEG)-based epileptic activity. Those with FS often show emotion-related dysfunction and disrupted interpersonal relationships, in which posttraumatic stress disorder symptoms (PTS) may play a role. We sought to better understand trauma comorbidities and socioemotional processes in FS, including affectionate touch, a form of social connection linked to emotion regulation and awareness. We administered questionnaires online to a community sample of 89 trauma-exposed FS participants (FS diagnoses were self-reported), 51 with and 38 without clinical-level PTS (FS-PTShi, FS-PTSlo) and 216 seizure-free matched trauma-exposed controls (TCs), 91 with and 125 without clinical-level PTS (TC-PTShi, TC-PTSlo) per the Posttraumatic Stress Disorder Symptom Checklist (PCL). As hypothesized, both FS-PTShi and FS-PTSlo reported more emotional avoidance (Brief Experiential Avoidance Questionnaire), more emotion regulatio...
Skin conductance response and emotional response in women with psychogenic non-epileptic seizures
Seizure, 2020
Recent etiopathogenic models place emotional dysregulation at the core of psychogenic nonepileptic seizure (PNES). Our purpose was to assess physiological, cognitive, and behavioral emotional responses of PNES patients. Methods: This study compared three types of emotional responses to visual emotional stimuli between 34 female PNES group and 34 matched healthy controls: physiological response measured by skin conductance response (SCR) (rate, amplitude and latency) and heart rate deceleration; cognitive response measured by valence and arousal elicited by the images; and behavioural response measured by latency of ratings. The groups were characterized on psychiatric comorbidities, traumatic history, alexithymia, and dissociation. Results: Compared to controls, PNES group displayed lower SCR for all images (p = 0.038), shorter amplitude of heart rate deceleration (p = 0.024) and faster arousal rating for all images (p = 0.019), but no difference on cognitive rating of images. Within-groups analyses showed only in PNES subjects increased rate (+19.35%, p = 0.046) SCR for negative stimuli with strong arousal compared to negative with low arousal. PNES physiological response (SCR and heart rate deceleration) was negatively correlated to dissociation tendency (r=-0.48, p = 0.0083) and alexithymia (r=-0.44, p = 0.012)). For cognitive response, no correlation was found. Conclusion: These results are in favour of a lower physiological emotional response but with an over-reactivity at behavioral level contrasting with similar cognitive assessment. For strong aversive stimuli, PNES might present a trend to overreact at physiological and behavioural levels. Our results suggest that dissociation and difficulty in describing feelings are associated with an altered physiological response in PNES women only. 1. Introduction Psychogenic non-epileptic seizures (PNES) are paroxysmal repetitive episodes which may superficially resemble epileptic seizures, in relation to unconscious psychogenic processes and without excessive neuronal discharge. [1]. With respect to PNES, the prevalence is estimated at 4.9 / 100000 / year [2] with an estimated incidence between 2 and 33/100000 [3]. The main problems of this pathology are the differential diagnosis with epilepsy and the unnecessary prescription of anti-epileptics drugs [4,5] and the heavy impacts on the quality of life [1]. The etiopathogeny of PNES is complex and multifactorial, including predisposing, precipitating, and perpetuating factors. Roughly, two mechanisms are most often mentioned: a neurobiological predisposition and dissociation [6]. In addition, recent etiopathogenic models have placed emotional dysregulation at the core of this pathology [7]. Emotions are classically composed of three dimensions [8,9]: the cognitive (subjective) component, the behavioral expression/actions, and the physiological autonomic component [10]. It is currently recognized that all three spheres, cognitive, behavioral, and autonomic, are affected in PNES. Regarding the cognitive component, alexithymia (difficulty to identify and describe the emotions) reached 85% of the PNES patients [11,12] and suggest a difficulty in coping with emotions [13]. Bakvis [14,15] and Pick [16] found attentional biases in PNES patients to images conveying negative emotions. They also observed