[Dissociative seizures: a manual for neurologists for communicating the diagnosis].
The great physical resemblance between epileptic and dissociative seizures and a diagnosis of epilepsy that had been made years ago and usually had been treated unsuccessfully makes it difficult for both physician and patient to communicate the diagnosis of dissociative seizures. A direct referral to psychotherapy treatment is rarely accepted by patients. Intermediate steps, which are based on cooperation between neurologists and psychotherapists, are necessary. The approach that we use to communicate diagnosis and motivation for psychotherapeutic treatment includes eight steps: 1. Welcome and introduction; 2. Jointly watching a video of documented seizures; 3. The message that the seizures are not of epileptic origin, 4. Development of an alternative disease concept; 5. Motivation for a conversation with a representative from psychosomatics; 6. Responding to the fear of "going crazy"; 7. If necessary, briefly touching on the subject of sexual violence; 8. More recommendations and conclusion of the conversation. The manual was discussed and practiced with the attending neurologist in two sessions and is now being regularly used by two neurologists with concomitant supervision.
Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 8, 79104 Freiburg, Deutschland. kurt.fritzsche@uniklinik-freiburg.de
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Baumann
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Schulze-Bonhage
D003142:Communication; D003299:Cooperative Behavior; D003937:Diagnosis, Differential; D004213:Dissociative Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D004827:Epilepsy / Q000175:diagnosis; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008370:Manuals as Topic; D008611:Mentors; D009042:Motivation; D009462:Neurology; D010348:Patient Care Team; D010353:Patient Education as Topic / Q000379:methods*; D010817:Physician-Patient Relations; D011613:Psychotherapy; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy