Abstracts

Rationale: Previous literature suggests that cognitive-emotion processing deficits contribute to psychogenic non-epileptic seizures (PNES). Characterization of these deficits in PNES and their association to relevant clinical variables is limited. We hypothesize that PNES subjects have difficulty with emotion awareness and emotion-behavior management and that underlying psychopathology (including past history of trauma) mediates these difficulties. Improved understanding of these deficits can inform treatment. Methods: One hundred and forty-three patients with video-EEG confirmed PNES completed self-report questionnaires during their initial evaluation to assess emotional intelligence (Trait Meta-Mood Scale [TMMS] subscales: attention and clarity) and emotion-behavior management (Affective Style Questionnaire [ASQ] subscales: concealing, adjusting and tolerating). Data from healthy controls was used to compare performance in these scales. Demographic data and clinical history from PNES patients were obtained through a semi-structured interview. Other self-report measures of psychopathology severity were also completed. This study was approved by the institutional review board. Results: The internal reliability of all TMMS and ASQ subscales ranged from acceptable to very good (Cronbach’s alpha 0.65-0.87) in our sample. TMMS attention and clarity subscales had means of 47.0 (SD 7.4) and 37.5 (SD 8.0), respectively. ASQ concealing, adjusting and tolerating subscales had means of 22.2 (SD 6.3), 17.4 (SD 5.7), and 15.5 (SD 4.1), respectively. Both TMMS subscales and the ASQ adjusting subscale showed significantly lower means than available normative data (p<0.0001), and women had lower mean attention scores in our sample (p=0.04). Mean scores on emotion attention, clarity, adjusting, and tolerating subscales were lower for PNES patients with a history of childhood abuse versus those without it (p=0.004). However, sexual abuse did not lead to significant differences in subscale scores, and physical abuse led to lower scores on emotion clarity and higher scores on emotion concealing (p=0.02). Patients with active post-traumatic stress disorder (PTSD) had lower scores in the emotion clarity, adjusting and tolerating subscales and higher scores in the emotion concealing subscale (p=0.02). Degree of clarity of emotions and adjustment to emotional states correlated negatively with severity of depression, anxiety, and illness perception (p=0.001). Degree of clarity of emotions correlated negatively with somatic complaints (p=0.045).  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 cognitive-emotion processing deficits are more pronounced in patients with more severe depression, anxiety and illness perception.  This study characterizes alterations in cognitive-emotion processing in PNES that are well-suited therapeutic targets and can inform treatment interventions.  Funding: There was no funding received in support of this abstract.