Abstracts

Rationale: Psychogenic Non-Epileptic Attacks (PNEA) are frequently associated with psychiatric co-morbidity. Co-morbidity with epilepsy has received attention, though knowledge of general medical conditions is more limited. We sought to characterize the medical co-morbid profiles of patients with PNEA at the time of diagnosis. Methods: Records were retrospectively reviewed from 26 consecutive PNEA patients at a single tertiary care epilepsy center in Florida. All patients received a final diagnosis of PNEA following video-EEG monitoring interpreted by an epileptologist (WOT). All patients were identified while on the EMU and were evaluated by a psychiatrist experienced in PNEA. Demographics, medications on admission, outcome with respect to neurological and psychiatric diagnoses, and medical co-morbidities were examined. The presence of medical conditions was examined for their prevalence. Results: A total of 26 (15=female; mean age=40.4) consecutive records were reviewed. A mean exposure to 4.4 AEDs and 3.5 psychiatric medicines were noted on admission. Of 19 patients who had inpatient psychiatric consultation, there was no statistical difference between the 89.5% with self-reported mood disorder compared to 84.2% that received a formal Axis I diagnosis (p=0.783). 15/19 (78.9%) patients reported depression and 7/15 (46.7%) had an Axis I diagnoses of the same. 7/19 (36.8%) reported anxiety and 5/7 (71.4%) had the same Axis I diagnosis. In only 1/19, the inpatient psychiatric diagnosis differed from the outpatient psychiatrist s impression and in only 1/26 (4%) case did recommendations for medication change. PNEA patients had an average of 5.3 non-psychiatric diagnoses and there was no gender-specific difference between the average number of comorbid medical conditions (p=0.8691). Patients above the age of 40 had on average 6.9 other medical co-morbidities; patients below age 40 had 3.3, respectively (p=0.0129). Most (N=17) reported diagnoses that were based upon subjective symptomatology; 7/26 (26.9%) had chronic pain; 3/26 (11.5%) irritable bowel syndrome, 3/26 (11.5%) sleep apnea, and 2/26, (7.69%) fibromyalgia. In this cohort, 19.2% of the patients had co-morbid epilepsy. Of the 26 patients 16 (61.5%) had at least one comorbidity and 4 (15.4%) had > 1 conditions. Potential objective medical conditions were reported in (3/26) were compared to subjective diagnoses (15/26), the difference was significant (p=0.0096). Conclusions: In-patient psychiatric consultation rarely changed existent diagnosis or treatment. >60% of patients with PNEA report medical co-morbidities, more were > 40 years of age, and nearly 2/3rds based upon subjective symptoms with chronic pain the most common reported condition.