Abstracts

Rationale: People living with epileptic seizures (ESs) commonly live with anxiety and depression as do people with psychogenic non-epileptic spells (PNESs). Additionally, many patients with PNESs have impaired stress perception, dissociative tendencies and additional symptoms of mental illness. Earlier studies have shown that PNESs is more impactful than ESs on quality of life. Since both groups of patients are referred for video-EEG (vEEG) telemetry to clarify diagnosis and treatment options, we administer various psychometric assessments to patients upon admission to the epilepsy monitoring unit (EMU) to aid our assessment of emotional state and quality of life.Methods: Shortly after admission to the EMU, patients capable of understanding basic questions and writing their responses are asked to complete the GAD-7 anxiety screen, PHQ-9 depression screen, PSS-10 (Perceived Stress Scale), DES-T (Dissociative Experiences Scale-Taxon), and QOLIE-10-P (Quality of Life in Epilepsy) assessment. CGI-S (Clinical Global Impression-Severity) is recorded by a licensed provider of the epilepsy team. Scores are calculated according to the individual form instructions and included in the patients medical record. Psychiatry evaluation is requested when scores indicate moderate to severe anxiety or depression, as well as when episodes captured by vEEG are confirmed to be non-epileptic and likely psychogenic in nature by the interpreting epileptologist. Due to small sample sizes for the period of our retrospective review, not all measurement distributions were normally distributed so we have reported median interquartile range (IQR). Consequently, to test the difference between our 2 groups, the non-parametric Wilcoxon rank-sum test was used.Results: Over an 11-month period, psychometric assessments were administered to 69 inpatients in our EMU. Of these, 25 patients whose diagnosis could not be fully defined as epileptic or psychogenic non-epileptic were excluded from the analysis. With the use of vEEG telemetry, we were able to definitively diagnose ESs in 19 patients and PNESs in 25 patients. As demonstrated in Table 1, the PNESs group had higher anxiety, depression, and dissociative scores (all p-values <0.01), and demonstrated more psychopathology on CGI-S assessment (p <0.001). Patients with PNESs also reported significantly increased stress perception (p<0.001) compared to patients with ESs. Quality of life was reported as significantly lower among patients with PNESs (p=0.047) compared to patients with ESs.Conclusions: Our findings support that patients with PNESs score more poorly than patients with ESs in a broad array of psychometric measures that assess anxiety, depression, perceived stress, dissociation, psychopathology and quality of life. These findings emphasize that this is a serious mental health issue that must be addressed by EMU providers.