Long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

• Published in: Epilepsia (Copenhagen) Vol. 59; no. 1; pp. e18 - e22
• Main Authors: Tolchin, Benjamin, Dworetzky, Barbara A., Baslet, Gaston
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-01-2018
• Subjects: compliance; conversion disorder; Convulsions & seizures; Diagnosis; functional neurological symptom disorder; Health risk assessment; nonepileptic attack disorder; Patients; PNES; Risk factors; Seizures; Survival analysis; PNES; nonepileptic attack disorder; functional neurological symptom disorder; compliance; conversion disorder
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/epi.13969

Summary
We conducted a prospective cohort study, examining long‐term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures (PNES). Subjects diagnosed with documented PNES were scheduled for 4 psychiatric visits. Survival analysis was performed, and covariates were assessed for association with time to nonadherence using Cox proportional hazard regression analysis. One hundred twenty‐three subjects were recruited and followed for up to 17 months. Eighty percent of subjects attended the first outpatient visit, 42% attended the second, 24% attended the third, and only 14% remained adherent through the fourth visit. Two covariates were associated with nonadherence: (1) a prior diagnosis of PNES (hazard ratio 1.57, P‐value .046); (2) a lower score on the Brief Illness Perception Questionnaire (BIPQ), signifying lower concern about one's illness (hazard ratio 0.77 for every 10‐point increment on the 80‐point scale, P‐value .008). Adherence with psychiatric treatment among patients with PNES is initially reasonably good but worsens rapidly over visits 2‐4. Risk factors for nonadherence include a history of a prior diagnosis of PNES, and a lower level of concern about the illness as assessed by a lower score on the BIPQ.