Abstracts

Rationale: Clinical factors including trauma and psychiatric diagnoses may help differentiate patients with psychogenic non-epileptic seizures (PNES) and epileptic seizures (ES). Sexual trauma in particular is a known risk factors for development of PNES and has emerged as the primary differentiating trauma type between PNES and ES in the general population. While veterans report trauma types similar to those in civilians, they additionally endorse military-specific traumas, including combat and military sexual trauma (MST). Given higher rates of PNES among veterans, these unique trauma types warrant further consideration. When considering psychiatric disorders in veterans, PTSD has been found to be more prevalent in those with PNES than ES, mirroring results from civilian samples, albeit with increased overall prevalence of PTSD in veterans regardless of diagnosis. Veteran studies are often performed on predominantly male samples given recruitment patterns, leaving the potential for unexamined differences in female veterans who are at higher risk both for sexual trauma and PNES. The present study examined group differences between those with PNES and ES in terms of psychiatric diagnoses, trauma histories, and psychiatric treatment among female veterans only.

Methods: The all-female sample included 90 veterans with PNES and 28 veterans with ES who presented to the epilepsy monitoring unit (EMU) at a large Veterans Affairs Medical Center between 2010 and 2020. Data were collected via chart review of electronic medical records. T-tests were used to assess group differences for continuous variables and chi-square analyses examined group differences for nominal variables.

Results: Females with PNES had a greater number of psychiatric diagnoses (M=2.5 v. 1.7; t=2.59, p=.01) and were treated with a higher number of psychotropic medications (M=1.8 v. 1.0; t=3.36, p=.001) than those with ES. History of psychiatric hospitalization trended higher in the PNES group (41.1% v. 21.4%; χ2=3.57, p=.06). While no individual psychiatric diagnosis differed between groups, anxiety (χ2=3.58, t=.06) and PTSD (χ2=2.74, p=.10) trended toward significance, with higher prevalence in PNES. Regarding trauma types, MST and childhood sexual trauma were prevalent in PNES (47.8% and 37.8%, respectively) with both MST (χ2=3.21, p=.07) and childhood sexual trauma (χ2=3.83, p=.07) trending higher in the PNES group.

Conclusions: Among female veterans, those diagnosed with PNES had more documented psychiatric diagnoses and were treated with more psychotropic medications than those with ES, suggesting a higher overall psychiatric burden in these patients. While trends in individual diagnoses were similar to those in the established literature, with rates of PTSD and anxiety trending higher among females with PNES, these differences were less pronounced than in prior studies. Consistent with its established relationship with risk for PNES, childhood sexual trauma was also high in the PNES group (37.8%), with an especially pronounced rate of MST (endorsed by nearly 50% of females with PNES), a potential risk factor warranting further investigation in larger and more evenly distributed samples.

Funding: Please list any funding that was received in support of this abstract.: No funding to report.