Providers' perspectives on treating psychogenic nonepileptic seizures: Frustration and hope
Epilepsy & Behavior (Impact Factor: 2.26). 08/2014; 37C:276-281. DOI: 10.1016/j.yebeh.2014.07.001
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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- "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. "
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.
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ABSTRACT: This article is part of a Special 15th Anniversary Issue. Copyright © 2014 Elsevier Inc. All rights reserved.
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ABSTRACT: The aim of the study was to explore the life experiences of South Africans who have been diagnosed as having PNES, with a focus on the aspects of the challenges which these individuals face, as well as the resources and coping strategies which are either made available to them or used by them in order to cope with PNES. Ten semi-structured interviews were analysed by means of thematic analysis in order to explore themes around challenges and resources for those diagnosed with PNES. Various challenges were revealed by participants, as well as the resources used in order to deal with these challenges associated with being diagnosed with PNES. Some of the challenges included unexpected seizures, medical professionals, belief systems as well as family. However, resources to counteract these challenges were social support, medical professional as well as religion and spirituality. Although many challenges are encountered by those who are diagnosed with PNES, there are substantial resources from which these individuals draw in order to live fulfilling and satisfactory lives. As more information and research is accumulated, more resources may become available to benefit these individuals and allow them to recover from PNES. It should be noted that medical professionals were described as both a challenge as well as a resource for people with PNES. Therefore, we can conclude that these individuals are key in the experiences of those who have been diagnosed with PNES, and that they play a role on not only a diagnostic level, but also in providing support, information, as well as therapeutic benefits. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.