Abstracts

Rationale: Psychiatric assessment of psychogenic nonepileptic seizures (PNES) is critical,¹ though gaps exist in participation by psychiatrists due to a lack of agreed-upon approaches to the condition.² Authors³ have suggested psychiatrists identify predisposing, precipitating, and perpetuating factors of PNES to guide therapeutics. Biopsychosocial underpinnings of PNES are recognized,⁴ yet these have not been systematically incorporated into psychiatric assessments. Comparing the acceptability of various psychiatric assessment approaches to PNES is warranted. Methods: An electronically-delivered, 2-item survey was distributed to three cohorts at an academic medical center (Cleveland Clinic) with large epilepsy and consultation psychiatry services: 1) epilepsy group (epileptologists, epilepsy fellows, epilepsy advanced nurse practitioners; n=30); 2) consultation psychiatry group (staff-level psychiatrists with experience consulting on PNES; n=19); and 3) psychiatry trainee group (psychiatry residents; n=30). The survey featured a clinical vignette of a typical PNES patient on an epilepsy monitoring unit (Table 1). Respondents were asked to rank in order of preference between three psychiatric assessment approaches: Multiaxial, Narrative, and Biopsychosocial (BPS) Psychiatric Assessments (Table 2). Respondents were also asked to briefly explain rationale for choice. Results: The epilepsy group (response rate: 43%, 13/30) preferred the BPS Assessment (69%) over the Multiaxial (23%) and Narrative (8%) Assessments; reasons included comprehensive nature, high detail, and explicit therapeutic targets. The consultation psychiatry group (response rate: 58%, 11/19) preferred the Narrative Assessment (55%) over the BPS (27%) and Multiaxial (18%) Assessments; reasons included brevity and ease of comprehension. The psychiatry trainee group (response rate: 53%, 16/30), preferred the Multiaxial (44%) and Narrative (38%) Assessments over the Biopsychosocial (19%) Assessment; reasons included ease of use, brevity, and familiarity. Conclusions: Preliminary sampling of epileptologists, consultation psychiatrists, and psychiatry residents reveals varying priorities and preferences in the psychiatric evaluation of patients with PNES. Differences may be explained by persistently poor understanding of PNES risk factors, psychiatric training gaps, or both. Further directions are discussed, including psychiatric educational initiatives as well as testing of the various assessment types with mental health referral populations such as psychotherapists. References 1) LaFrance WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia. 2013; 45(Suppl. 1):53-67 2) Smith BJ. Closing the Major Gap in PNES Research. Epilepsy Currents. 2014; 14(2):63-67 3) Reuber M, Howlett S, Khan A, Grunewald RA. Non-Epileptic Seizures and Other Functional Neurological Symptoms: Predisposing, Precipitating, and Perpetuating Factors. Psychosomatics. 2007; 48(3):230-238 4) Reuber M. The Etiology of Psychogenic Non-Epileptic Seizures: Toward a Biopsychosocial Model. Neurol Clin. 2009; 27:909-92