Group therapy for patients with psychogenic nonepileptic seizures: A pilot study

Department of Psychiatry and Behavioral Medicine, Stanford University Medical Center, Stanford, CA 94305, USA.
Epilepsy & Behavior (Impact Factor: 2.26). 08/2008; 13(4):624-9. DOI: 10.1016/j.yebeh.2008.06.013
Source: PubMed


Great advances have been made in the diagnosis of people with psychogenic nonepileptic seizures (PNES) since the advent of video/EEG monitoring. However, treatment options for this population have lagged significantly. This pilot study was undertaken to evaluate whether group therapy done with a psychodynamic focus would offer a useful intervention. Twelve patients entered the study and seven completed at least 75% of the 32 weekly sessions. The Beck Depression Inventory and the Global Severity Index of the Symptom Checklist-90 showed improvement as well as an overall decrease in PNES frequency. The data suggest that group therapy focusing on interpersonal issues may benefit patients with PNES.

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    • "Group therapies have focused on psychoeducational approaches to intervention, using a multisession group approach (Myers & Zaroff, 2004; Zaroff et al., 2004) with mixed results on seizure occurrence but improvement in psychological well-being (Zaroff et al., 2004). Group therapy with a psychodynamic focus, which conceptualized the seizures as an expression of unconscious/ hidden emotions, has been undertaken (Barry et al., 2008), but with only small numbers of patients. Pilot data from seven female patients completing at least 75% of 32 weekly 90-min–long sessions suggest, based on measures of depression, global symptom severity, and PNES frequency, that there may be some benefit in using this approach as an adjunct to individual psychotherapy. "
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    ABSTRACT: The International League Against Epilepsy (ILAE) Neuropsychobiology Commission gave the charge to provide practical guidance for health professionals for the pharmacologic and nonpharmacologic treatment of patients with psychogenic nonepileptic seizures (PNES). Using a consensus review of the literature, an international group of clinician-researchers in epilepsy, neurology, neuropsychology, and neuropsychiatry evaluated key management approaches for PNES. These included the following: presentation of the diagnosis, early phase treatment, psychological and pharmacologic interventions, and maintenance management. The aim of this report is to provide greater clarity about the range and current evidence base for treatment for patients with PNES, with the intention of improving the care of patients with PNES and patients who develop PNES as a comorbidity of epilepsy.
    Epilepsia 03/2013; 54(s1). DOI:10.1111/epi.12106 · 4.57 Impact Factor
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    • "A few studies have evaluated group psychotherapy in the treatment of PNES. Barry et al66 reported on the efficacy of a 32-week-long psychodynamically oriented group psychotherapy, which had as a goal the conscious and verbal expression of emotional distress, obviating the need for somatic displays of stress. Development of assertive coping strategies instead of passive avoidant behavior was emphasized. "
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    ABSTRACT: Psychogenic nonepileptic seizures (PNES) can significantly affect an individual's quality of life, the health care system, and even society. The first decade of the new millennium has seen renewed interest in this condition, but etiological understanding and evidence-based treatment availability remain limited. After the diagnosis of PNES is established, the first therapeutic step includes a presentation of the diagnosis that facilitates engagement in treatment. The purpose of this review is to present the current evidence of treatments for PNES published since the year 2000 and to discuss further needs for clinical treatment implementation and research. This article reviews clinical trials that have evaluated the efficacy of structured, standardized psychotherapeutic and psychopharmacological interventions. The primary outcome measure in clinical trials for PNES is event frequency, although it is questionable whether this is the most accurate indicator of functional recovery. Cognitive behavioral therapy has evidence of efficacy, including one pilot randomized, controlled trial where cognitive behavioral therapy was compared with standard medical care. The antidepressant sertraline did not show a significant difference in event frequency change when compared to placebo in a pilot randomized, double-blind, controlled trial, but it did show a significant pre- versus posttreatment decrease in the active arm. Other interventions that have shown efficacy in uncontrolled trials include augmented psychodynamic interpersonal psychotherapy, group psychodynamic psychotherapy, group psychoeducation, and the antidepressant venlafaxine. Larger clinical trials of these promising treatments are necessary, while other psychotherapeutic interventions such as hypnotherapy, mindfulness-based therapies, and eye movement desensitization and reprocessing may deserve exploration. Flexible delivery of treatment that considers the heterogeneous backgrounds of patients is emphasized as necessary for successful outcomes in clinical practice.
    Neuropsychiatric Disease and Treatment 12/2012; 8:585-98. DOI:10.2147/NDT.S32301 · 1.74 Impact Factor
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