The Utility of Telepsychology in the Treatment of Patients with Psychogenic Nonepileptic Seizures During the Covid19 Pandemic
Abstract number :
1.417
Submission category :
6. Cormorbidity (Somatic and Psychiatric)
Year :
2021
Submission ID :
1886451
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Becky Tilahun, PhD - Neurological Institute; Nicolas Thompson, MA – Department of Quantitative Health Sciences – Cleveland Clinic; Jocelyn Bautista, MD – Epilepsy Center – Cleveland Clinic; Lauren Sankary, JD – Cleveland Clinic; Susan Stanton, PA – Cleveland Clinic; Vineet Punia, MD – Epilepsy Center – Cleveland Clinic
Rationale: Behavioral interventions successfully treat psychogenic nonepileptic seizures (PNES) (1-2), but poor treatment adherence is a known challenge in PNES care. The scarcity of conversion disorder therapists in local vicinities, symptom related restrictions, and other barriers may contribute to the high attrition in the treatment of patients with PNES. The current study examines whether the higher utilization of telepsychology during the Covid19 pandemic in the treatment of PNES patients was associated with higher attendance of counseling sessions compared to the in-office format. In addition, the impact of the Covid19 pandemic on treatment adherence of PNES patients was examined by comparing treatment completion rates before and after the Covid19 pandemic.
Methods: Patients with PNES diagnosis were enrolled in an outpatient 12-week manualized Neurobehavioral Therapy (NBT) counseling program as in-office and telepsychology patients. Visit data as well as demographic information were extracted from the department's administration registry. Patients utilized three visit types: telepsychology only; in-office only; and a mixed visit type. Six-month follow-up data was used to examine the effect of visit type on partial (6+ visits) and full (12+ visits) completion of the manualized counseling program.
Results: Of the 286 patients who scheduled NBT appointments from July 2019 to September 2020, 153 scheduled in-office visits exclusively, 104 scheduled telepsychology visits exclusively, and 29 scheduled a combination of in-office and telepsychology visits. Sixty-two percent of the patients lived locally (≤ 50 miles from clinic), and 36.4 percent lived between 41 and 270 miles. Multivariable logistic regression models for whether the patient completed 6+ or 12+ visits showed, telepsychology-only patients and patients who attended both visit types were significantly more likely to complete 6+ or 12+ visits, compared to in-office only patients (Table 1). There was no significant difference in treatment completion rates between patients seen during the pre-Covid19 pandemic and during Covid19.
Conclusions: Delivering PNES care using a home-based telepsychology platform is associated with a better success rate in PNES patient care. Utilizing telepsychology may enhance the care of patients with PNES during the current pandemic and beyond.
References:
1.LaFrance WC Jr, Baird GL, Barry JJ, Blum AS, Frank Webb A, Keitner GI, Machan JT, Miller I, Szaflarski JP; NES Treatment Trial (NEST-T) Consortium. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014 Sep;71(9):997-1005. doi: 10.1001/jamapsychiatry.2014.817. PMID: 24989152.
2. Tolchin B, Dworetzky BA, Martino S, Blumenfeld H, Hirsch LJ, Baslet G. Adherence with psychotherapy and treatment outcomes for psychogenic nonepileptic seizures. Neurology. 2019;92(7):e675-e679.
Funding: Please list any funding that was received in support of this abstract.: No Funding was received for this project.
Cormorbidity (Somatic and Psychiatric)