Abstracts

Psychogenic non epileptic seizures (PNES) are conceived to be the result of or a response to psychologically discomforting issues. Understanding the underlying psychological concerns is critical for treating the non epileptic spells.
Psychological concerns were examined using ratings on a modified Fear Survey Schedule (FSS) by 26 patients (73% female) with complex partial seizures (CPS) and 22 age- and education-matched patients (77% female) with PNES, who had all undergone continuous video-EEG monitoring.
Overall fear ratings were found to be significantly higher in PNES than CPS patients. Group differences were most marked for animal fears (a dimension that has been associated with the emotion of disgust) and sex-related fears. There were also significant higher ratings by PNES patients on agoraphobia items and blood/death/injury items. Both groups reported considerable fear of seizures and rather high levels of distress with respect to interpersonal issues, but there were no significant differences between groups on these two dimensions. A discriminant function analysis using the six different fear dimensions classified 73% of patients correctly, with most of the variance accounted for by animal fears. The most discriminating items were fears of dirt, vomit, insects, rats, spiders and mental illness, which all broadly relate to the experience of disgust. Among PNES patients, those with a prior psychiatric history reported [italic]fewer[/italic] fears than those with no prior psychiatric history, suggesting that the FSS may capture some of the less obvious aspects of the psychopathology in PNES patients. The FSS results complemented MMPI-2 findings, which showed a pattern of repression, somatization and conversion in PNES patients who had significantly elevated scores on Scales 1(Hs) and 3 (Hy).
Together these results demonstrate the usefulness of the FSS as another tool for assessing PNES patients and highlight the importance of the emotion of disgust in these patients[rsquo] experiences.