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Patients with psychogenic nonepileptic seizures (PNES) often report symptoms of dissociation. However, it is unclear how these symptoms relate to psychotherapeutic treatment, for example, with cognitive-behavioral therapy (CBT). Here, we investigated the degree of overlap between symptoms of dissociation and other psychiatric features that are more traditional targets for CBT. We used a hierarchical linear regression to measure the variance associated with dissociative symptoms (as assessed by the Dissociative Experiences Scale - DES) among 46 individuals with PNESs. The regression predictor variables are indices of participants' self-rated mood, self-efficacy, quality of life, locus of control, and life outlook (e.g., optimism). Results revealed that 70.2% of the variance associated with DES score was explained by psychological distress and locus of control. The other factors examined did not make a significant contribution to the regression model. These results suggest that traditional CBT targets - mood symptoms, mood distress, and dysfunctional beliefs about locus of control - overlap substantially with self-reported dissociative symptoms., (Published by Elsevier Inc.)

Understanding stress and coping among individuals with psychogenic nonepileptic seizures (PNES) may have important treatment implications. 40 patients with PNES, 20 with epilepsy (EPIL), and 40 healthy control (HC) participants reported the frequency of various stressful life events (both positive and negative) and appraised the distress these events induced. They also described their habitual coping behaviors. PNES patients reported no more frequent stressful life events than EPIL patients or HC. In addition, the stressors they experienced are not objectively more severe. However, they reported more severe distress due to negative life events, especially in the domains of work, social functioning, legal matters, and health. PNES patients also engaged in less planning and active coping than HC. Neither of these two coping behaviors was associated with distress ratings. The PNES group did not engage in more denial than either group. However, greater denial among PNES patients was associated with greater perceived distress. Coping in PNES is characterized by elevated levels of perceived distress and fewer action strategies than are normally employed to reduce the impact of a stressor. These findings may inform cognitive behavioral therapy of PNES patients., (Published by Elsevier Ltd.)

The Personality Assessment Inventory (PAI) is a widely used self-report questionnaire designed to detect and quantify dimensions of adult psychopathology. Previous studies that examined the ability of the PAI to differentiate between patients with psychogenic nonepileptic seizures (PNES) and those with epilepsy (EPIL) have yielded inconsistent results. We compared the full PAI profiles of 62 patients with PNES, 55 with EPIL, and 45 normal control (NC) participants to determine the diagnostic accuracy of the PAI. We also sought to highlight psychopathologic symptoms that may inform psychological treatment of patients with PNES or epilepsy. PNES and EPIL patients reported more somatic concerns and symptoms of anxiety and depression than did NC persons. PNES patients reported more unusual somatic symptoms, as well as greater physical symptoms of anxiety and depression than did patients with EPIL. Classification accuracy of the "NES Indicator" was not much better than chance, whereas the Conversion subscale alone had reasonable sensitivity (74%) and specificity (67%). Overall, the PAI demonstrated only moderate classification accuracy in an epilepsy monitoring unit sample. However, the inventory appears to identify specific psychopathological symptoms that may be targets of psychological/psychiatric intervention., (Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.)

Some individuals with psychogenic nonepileptic seizures (PNES) are seen as having adopted a "sick role" that relinquishes them of responsibility for meeting stressful life demands. Thus, patients with PNES may have positive, albeit unrecognized, attitudes toward seizures, or perhaps illness in general. Because such covert attitudes may not be amendable to self-report, the current study used the Implicit Association Test (IAT), a methodology by which attitudes toward illness and disability can be inferred from performance on an ostensibly neutral task. Individuals with PNES did not have a reduced interference effect when responding to sickness-related and pleasant words on the same response key. Exploratory analyses revealed that a pronounced somatic focus and higher extraversion were associated with more neutral attitudes toward illness among patients with PNES. This IAT methodology found little support for the notion that patients with PNES harbor positive attitudes toward illness. Limitations of the IAT methodology are reviewed and recommendations are provided., (Published by Elsevier Inc.)

Purpose: Patients with psychogenic nonepileptic seizures (PNES) rate their health-related quality of life (HRQOL) more poorly than those with epileptic seizures (ES). This has been explained in part by mood state. We sought to investigate whether HRQOL differences between diagnostic groups (PNES vs. ES) can be explained by additional, perhaps chronic, aspects of mood and personality. An understanding of these relationships may inform treatment designed to improve HRQOL in ES or PNES., Methods: One-hundred fourteen individuals (69 ES and 45 PNES) completed the quality of life in Epilepsy-89. The profile of mood states (POMS) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were employed to measure current and chronic mood symptoms, respectively. Multiple regression analyses determined the contribution of chronic mood symptoms to HRQOL beyond the variance accounted for by current mood state and seizure diagnosis., Results: Similar to previous reports, individuals with PNES reported poorer HRQOL than those with ES. Current mood state was strongly related to HRQOL and appeared to moderate the relationship between seizure diagnosis and HRQOL. However, when more chronic psychological symptoms, such as somatization and emotional distress, were included in a model, the moderating role of mood state was not significant., Conclusion: Analyzed independently, mood state is related to HRQOL, but when chronic indicators of psychological symptoms are included in a model mood is related to HRQOL, but, the moderating effect of mood is no longer significant. Treatments designed to improve HRQOL among individuals with intractable seizures should also address chronic psychological distress and symptoms associated with high levels of somatization.

The aim of this study was to determine the degree to which subjective ratings of neurocognitive ability accurately reflect objectively measured neuropsychological functioning in patients diagnosed with epileptic (ES, n = 45) or psychogenic nonepileptic (PNES; n = 37) seizures. Patients received a battery of neuropsychological tests, measures of current mood state, and the Quality of Life In Epilepsy-89 questionnaire. Results indicated that subjective ratings of neuropsychological functioning were only partially accurate within each group. Patients with ES accurately rated their memory function, but overestimated language and attention abilities. Patients with PNES accurately rated attention, but underestimated memory and overestimated language. In both groups, poorer self-reported neurocognitive functioning was strongly related to poorer mood state; however, mood state did not predict objectively measured neurocognitive abilities. Given the inaccuracies that exist in patient self-report, results highlight the importance of a comprehensive neuropsychological assessment when evaluating the neurocognitive status of individuals with seizures.