Recent diagnostic and treatment advances in psychogenic nonepileptic seizures (PNES) have the potential to improve care for patients, but little is known about the current state of PNES care delivery in the Veterans Health Administration (VA). We conducted semistructured interviews with 74 health-care clinicians and workers in the VA, eliciting provider perceptions of PNES care. Data were analyzed according to principles of Grounded Theory. The results revealed variation in care and two emergent domain themes of frustration and hope. Frustration was manifest in subthemes including Complexity, Patient Acceptance, Uncertainty About Treatment, Need for Evidence-based Treatment, and Failure of Cross-Disciplinary Collaboration between neurologists and mental health providers. Hope encompassed subthemes of Positive Attitudes, Developing Cross-Disciplinary Treatment, and Specific PNES Care. Increased resources for diagnosing, treating, and researching PNES have improved awareness of the disorder. More research is needed to understand patients' and caregivers' perceptions of PNES care.
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"Understanding not only patient characteristics but also provider approaches and in-therapy processes that may influence treatment compliance remains critical. Unfortunately, although several studies have focused on PNES perceptions and attitudes by patients , physicians , and entire epilepsy teams [9,10], very little attention has been directed at community psychotherapists. One study of a small group of therapists who had treated patients with PNES suggested that therapeutic success depended on adjusting their approach to the degree of trauma; these providers understood and tolerated high amounts of emotional dysregulation and affective displays of distress, conceptualizing the condition as a form of nonverbal communication requiring nuanced interpretation by the therapist . "
[Show abstract][Hide abstract]ABSTRACT: Management of psychogenic nonepileptic seizures (PNES) is complex, requiring multidisciplinary care. A standardized assessment and formulation approach to PNES is lacking, yet use of a comprehensive model may alleviate problems such as mental health aftercare noncompliance. Although a biopsychosocial (BPS) approach to PNES balancing predisposing, precipitating, and perpetuating (PPP) variables has been described and has been recently tested in pilot form, it is unclear how this assessment style is perceived among community mental health practitioners such as psychotherapists (including psychologists, counselors, and social workers). We predicted preference of a comprehensive "BPS/PPP" assessment style by those most involved in PNES care (i.e., community psychotherapists). One hundred and forty-three community-based social workers and counselors completed a survey featuring a fictional PNES case followed by assessment style options ("Multiaxial," "Narrative," and "BPS/PPP"). Respondents clearly preferred the robust BPS/PPP approach over less-comprehensive multiaxial and narrative assessments (p<0.0001). Reasons for choosing the BPS/PPP by respondents include ease of organization, clear therapeutic goals, and comprehensive nature. This assessment of acceptability of a BPS/PPP approach to PNES assessment among community mental health practitioners may provide a patient-centered mechanism to enhance referrals from the neurological to mental health setting. Implications and future directions are explored.
Full-text · Article · Mar 2016 · Epilepsy & Behavior
"These studies highlighted several themes in patients' responses to the diagnosis , particularly feelings of confusion about the nature of the disorder, relief, and feeling like a 'normal' person again (i.e., due to not having a chronic neurological condition). Issues relating to provision and patients' experiences of treatment have also been examined qualitatively2021222324. Other authors have adopted qualitative techniques when investigating the experiences and understanding of patients with DS about their disorder. "
[Show abstract][Hide abstract]ABSTRACT: Quantitative research has indicated that patients with dissociative seizures (DS) show altered responses to emotional stimuli, in addition to considerable emotional distress and dysregulation. The present study sought to further explore emotional processes in this population, to extend previous findings and provide a phenomenological insight into patients' perspectives on these issues. Semi-structured interviews were carried out with 15 patients with DS and the principles of interpretative phenomenological analysis (IPA) were adopted in data analysis. Key themes elicited included: i) general emotional functioning; ii) adverse (stressful/traumatic) life experiences; iii) the role of emotions in DS; (iv) relating to others; and v) resilience, protective factors and coping mechanisms. The clinical and theoretical implications of the findings are discussed.
Full-text · Article · Jan 2016 · Epilepsy & Behavior