Abstracts

Rationale: Psychogenic non-epileptic seizures (PNES) are common in both civilians and in U.S. Veterans cared for at Veterans Affairs Medical Centers (VAMCs). There is limited information on the psychiatric co-morbidity of patients with PNES and there are only retrospective studies within the VAMC. Understanding psychiatric co-morbidities in patients with PNES is important as it can inform the design of effective therapies. We report preliminary results from a multicenter study. Methods: COVE (Characteristics of Veterans with Epilepsy) is an ongoing cross-sectional study with prospective enrollment, including all Veterans admitted to the epilepsy monitoring units (EMUs) of the Portland Oregon, San Francisco California, and Madison Wisconsin VAMC Epilepsy Centers of Excellence. Evaluations include the Structured Clinical Interview for DSM IV (SCID I and II), PTSD checklist (PCL), and Beck Depression Inventory (BDI). SCID interviews were performed by study psychologists/psychiatrists after training and review. Final EMU diagnoses were classified by study neurologists using standardized definitions. For this report we included only patients with EMU discharge diagnoses of PNES, or epileptic seizures (ES). Patients with both PNES and ES were excluded, as were those with other diagnoses. This analysis includes the first 40 ES and 40 PNES patients with completed SCID evaluations. Fisher's exact test (categorical data), and Wilcoxon tests (numeric data) were used to compare the PNES and ES groups. Results: Age and gender were similar in the PNES and ES groups. At least one axis I diagnosis was recorded in 90% of patients with PNES vs. 58% of patients with ES (p < 0.01). There was a median of three axis I diagnoses in the PNES group vs. one in the ES group (p < 0.0001). Post-traumatic stress disorder (PTSD) and major depression were the most common axis I diagnoses within the PNES group, each recorded in more than half of PNES patients (Table). Between group differences were greatest for PTSD (p < 0.0001) and panic disorder (p < 0.01). Also, the severity of current PTSD symptoms (PCL) was greater in Veterans with PNES+PTSD as compared to those with ES+PTSD (64.0 vs. 50.6; p=0.01). The severity of current depression (BDI) was the same for both groups. Personality disorders (PD) were diagnosed in 43% of patients with PNES vs. 20% of patients with ES (p < 0.05; SCID II). Obsessive-compulsive PD and Dependent PD were the most common axis II diagnoses. Conclusions: As compared to patients with ES, patients with PNES were much more likely to be diagnosed with PTSD, and their current PTSD symptoms were more severe. Major depression was common in both groups and the severity of current depressive symptoms was similar. PD was also more common in patients with PNES vs. ES. These results are consistent with a retrospective chart-review of psychiatric co-morbidities in Veterans with PNES, and have implications regarding the causes and potential treatments for PNES. Funding: Supported by grant 5101CX000721 from the Department of Veterans Affairs.