Abstracts

The assessment and diagnosis of psychogenic non-epileptic seizures (NES) in inpatient epilepsy programs is very common (20-50% of admissions). The underlying etiology of NES can reflect a variety of conditions as denoted by the DSM-IV. The aim of this study was to determine the most common psychiatric diagnoses of NES in a comprehensively evaluated sample of patients. The sample consisted of 58 consecutive admissions to the adult inpatient epilepsy unit who were eventually diagnosed with NES via video-EEG monitoring. The determination of a psychogenic etiology was made after ruling out physiological causes, history review, neuropsychological and personality assessment (i.e., PAI), as well as psychiatric and/or psychological consultation. DSM-IV diagnoses were made by either a consulting psychiatrist or psychologist. There were 58 NES patients (67% female) with an average age, education, and WAIS-III Full Scale IQ of 36.5, 13.2, and 94.0, respectively. Personality testing using the PAI showed a clinical elevation on the Somatic Complaints scale (Mean T-score = 70.0) with Conversion being the most elevated subscale in the profile (Mean T-score = 71.0). The most common preexisting psychiatric diagnoses included Depression (50%), PTSD (13.8%), other Anxiety (17.2%), Somatoform (13.8%), and Substance Abuse/Dependence (12.1%). Sixty-five percent (65%) of the sample reported a history of physical and/or sexual abuse. The final DSM-IV diagnosis for the NES was overwhelmingly Conversion Disorder (74.1%) and Somatoform Disorder NOS (8.6%). The remaining diagnoses for the NES included various anxiety, dissociative, and factitious disorders (17.3%). In an inpatient epilepsy monitoring unit, the vast majority of NES cases confirmed by video-EEG are diagnosed as Conversion Disorder according to DSM-IV criteria. That is, the NES are thought to reflect psychological factors (unconscious or not) that are manifested by pseudoneurological symptoms or deficits. Other less common diagnoses include panic attacks and dissociation associated with PTSD and/or a primary dissociative disorder. An accurate psychiatric diagnosis of NES is important in that treatment will necessarily be dictated by the underlying psychological disorder. Furthermore, diagnostic accuracy relies on a multidisciplinary approach that considers both the patient[apos]s medical and psychosocial history and current functioning.