Knowledge and emotional attitudes of health care practitioners regarding patients with psychogenic nonepileptic seizures

Saker, Thani Sheikh; Katson, Mark; Herskovitz, Sari Eran; Herskovitz, Moshe

doi:10.1055/s-0042-1758646

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Original Article • Arq. Neuro-Psiquiatr. 80 (11) • 2022 • https://doi.org/10.1055/s-0042-1758646 copy

Knowledge and emotional attitudes of health care practitioners regarding patients with psychogenic nonepileptic seizures

Conhecimento e atitudes emocionais dos profissionais de saúde acerca de pacientes com convulsão psicogênica não epiléptica

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Psychogenic nonepileptic seizures (PNESs) are paroxysmal events that resemble epileptic seizures without concomitant changes in electroencephalograms (EEGs) or any other physiological cause. These seizures are one of the most common and dramatic conversion disorders. First responders treat many PNES patients with unnecessary emergency abortive medication and sometimes even intubate them. Several of our PNES patients have complained they have experienced harsh attitudes from health care practitioners (HCPs), especially during their stay in the emergency room (ER).

Objective

To assess the emotional attitude of HCPs toward PNES patients.

Methods

We handed a questionnaire containing 23 questions regarding PNES patients to HCPs from emergency medicine, internal medicine, and neurology disciplines. The questions dealt with three categories: diagnosis, management, and emotional attitudes.

Results

Overall, 47 HCPs participated in this study: 11 ER, 18 internal medicine, and 18 neurology practitioners. The HCP from those disciplines showed high knowledge and good management practice of PNES patients. On the other hand, the HCPs agreed with most emotional attitude statements regarding PNES patients, reflecting a high percentage of negative emotional attitudes toward this group of patients. We did not find any correlation between negative emotional attitude and HCP department, profession, or seniority.

Conclusions

Although HCPs in our center perform good management practice regarding PNES patients, most reported a negative emotional attitude. This finding implies that what PNES patients feel regarding the harsh attitudes is also reflected by HCP views. Emotional attitudes towards PNES patients may not depend solely on the level of knowledge of the HCPs.

Keywords
Attitude; Seizures; Health Personnel; Health Surveys

Number	Question/statement
1	The term pseudo-seizure is appropriate to use to describe psychogenic non-epileptic seizures (PNESs).
2	Medical staff can comfortably diagnose PNES based on clinical history.
3	Medical staff can differentiate PNES from epileptic seizures once witnessing the event.
4	Diagnosis of PNES must always be confirmed by long term video-electroencephalographic monitoring.
5	Inducing the patient's events at bedside (by suggestion or doing certain maneuvers) confirms that the events are PNES.
6	If I can, I try to induce an event.
7	If prolactin or creatine kinase (CK) level is not elevated in a patient with a spell, this confirms PNES.
8	Patients with PNES have control of their seizures.
9	Patients with PNES can also have epileptic seizures.
10	PNES occurs more commonly in women.
11	PNES occurs more commonly in minorities.
12	PNES patients require attention beyond what is justified by their medical condition.
13	PNES patients misuse medical resources.
14	PNES patients waste the time of the medical staff.
15	PNES patients often arouse anger among the medical staff.
16	PNES patients are treated disrespectfully by the medical staff.
17	PNES patients are less urgent.
18	Suspected PNES patients should first be referred to a neurologist.
19	Suspected PNES patients should first be referred to a psychiatrist or psychologist.
20	ASM is the best treatment for PNES patients
21	Patients with PNES must have their driving privileges restricted like patients with epileptic seizures
22	Anti- seizure medications (ASMs) should be discontinued in patients with PNES.
23	It is difficult for PNES patients to accept the diagnosis.

Variable	Values	Frequency (n)	Valid percentage (%)	Mean	Standard deviation
Profession	Nurse	18	38.3
Profession	Doctor of Medicine	29	61.7
Gender	Male	23	48.9
Gender	Female	24	51.1
Department	Neurology	18
	Emergency Room	11
	Internal Wards	18
Seniority (years)				8.8	9.8

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[1] Address for correspondence Moshe Herskovitz (e-mail: m_herskovitz@rmc.gov.il).