Abstracts

Rationale: Approximately 5-20% of patients treated in outpatient centers and 10-40% treated at epilepsy monitoring units are diagnosed with non-epileptic seizures (NES; 1, 2). NES is more common among young adults and women (1). Psychiatric illness is also reported including anxiety, depression, schizophrenia, PTSD, a history of suicide attempts, and drug and alcohol abuse (3, 4). Rates of conversion disorder are reported to range from 68-71% (3, 5). In addition, sexual or physical abuse is believed to be an important risk factor in the development of NES (6, 7, 8). Given the complexity of the psychological comorbidities of NES, the purpose of the current study was to further explore the psychological structure and better understand the relationship to the medical presentation. Although psychological factors are also prevalent in the epilepsy (ES) population, this study is an attempt to differentiate between the two groups using the Personality Assessment Inventory (PAI), a self-report questionnaire developed to assess emotional and psychiatric function (9). Previous research has used the MMPI; however, the PAI presents several advantages. It is based on DSM-IV criteria, has 22 non-overlapping clinical scales, and the normative sample includes patients from inpatient and outpatient medical settings.Methods: Retrospective chart review of 172 admissions to Yale University’s Epilepsy Monitoring Unit was conducted. Review by an epileptologist of the events captured on VEEG resulted in two diagnostic groups (ES = 132, NES = 31). Nine patients were excluded. The majority of the sample was female and Caucasian. A significant gender difference in the NES group was found (p <.01); females were overrepresented in this study. Mean age was 38.2 years. Patients completed the PAI during inpatient VEEG, which also included neuropsychological evaluation.Results: Clinically significant symptoms were identified based on PAI elevations of greater than 70. Chi-square analysis of the groups showed significant differences in the prevalence of clinical symptoms in NES in depression, anxiety, somatization, conversion, and traumatic stress (p < .01). Significant differences were not found for self-report of suicidal ideation, alcohol and drug use or gender effects. The two groups differed significantly on FSIQ (ES: M = 93.03, SD = 15.27; NES: M = 89.10, SD = 15.17; p < .05).Conclusions: The current study found significant differences in elevations of psychiatric symptoms between the NES and ES groups using the PAI. Specifically, the NES group had clinical elevations in depression, anxiety, somatization, traumatic stress, and conversion, which confirms findings from previous studies. The PAI indices reflecting self-report of suicidal ideation and substance use were not significantly different. Both groups had a higher prevalence of psychiatric symptoms than the normal population; however, the NES group displayed significantly greater elevations suggesting psychiatric symptoms may play a larger role in their clinical presentation. Future research should examine psychiatric symptoms in the NES population using a larger sample from both outpatient and inpatient settings.