Abstracts

Rationale: Prior work in our lab (Griffith et al., in press) has demonstrated significant personality differences among patients with semiology-based subtypes of PNES. Optimism (O) and pessimism (P), which have been strongly associated with outcome across a wide range of medical populations, may be particularly relevant to the management and treatment of seizure disorders. Hermann et al. (1996) and others have studied optimistic vs. pessimistic attributional style as related to depression in epilepsy. In addition, “dispositional” O and P have been defined by generalized outcome expectancies (Scheier & Carver, 1985). The purpose of this study was to explore O, P, and neuropsychological performance across semiology-based subtypes of PNES. To the best of our knowledge, no prior study has investigated O and P among PNES subtypes. Methods: Patients with PNES were classified into semiology-based subtypes (catatonic, minor motor, major motor). Our measures of optimism and pessimism were the OPS-GOE (Chang et al., 1994) and a modified version of the PSM-R (Malinchoc et al., 1994). Both O and P scores from both measures were grouped into tertiles. We used MMPI-2 Scale 2 T-scores as a measure of severity of depressive symptoms. We defined “super pessimists” as patients scoring in the highest tertile of P and the lowest tertile of O. We computed neuropsychological composite scores (verbal memory, language performance, executive functioning) for all patients.Results: On the PSM-R, but not the OPS-GOE, as expected, patients with PNES were significantly less optimistic and significantly more pessimistic than a normative sample. We found evidence for partial independence of O and P on both measures (OPS-GOE: Spearman’s rho = -.65; PSM-R: Spearman’s rho = -.57). We also found an association between PNES subtype and frequency of “super pessimists” for both measures: catatonic (0%, 29%), major motor (30%, 50%) on OPS-GOE and PSM-R respectively. PNES patients with low O had a significantly higher level of depressive symptoms than patients with high O; conversely, patients with high P had a significantly higher level of depressive symptoms than patients with low P. The catatonic subtype had better verbal memory than other PNES subtypes. In addition, we found that patients with high OPS-GOE O had significantly higher FSIQ than patients with low OPS-GOE O; moreover, patients with high OPS-GOE P had lower FSIQ had than patients with low OPS-GOE P.Conclusions: Our results support theorized relationships between O, P, and depression in the health psychology literature and extend these findings to a seizure disorder population. Of note, our results also support the finding that patients with catatonic PNES may have less psychopathology and better outcome (Selwa et al., 2000) than patients with other subtypes of PNES. Finally, we found some evidence that attributional style-based measures may be more appropriate than generalized outcome expectancy-based measures of O and P in seizure disorder populations.