title: A multisite controlled study of risk factors in pediatric psychogenic nonepileptic seizures.
abstract: OBJECTIVE
  Psychogenic nonepileptic seizures (PNES) in youth are symptoms of a difficult to diagnose and treat conversion disorder. PNES is associated with high medical and psychiatric morbidity, but specific PNES risk factors in the pediatric population are not known. We examined if youth with PNES have a distinct biopsychosocial risk factor profile compared to their siblings and if the interrelationships between these risk factors differentiate the PNES probands from the sibling group.
  
  
  METHODS
  This multisite study included 55 youth with a confirmed diagnosis of PNES (age range 8.6-18.4 years) and their 35 sibling controls (age range 8.6-18.1 years). A video EEG and psychiatric assessment confirmed the PNES diagnosis. Parents reported on each child's past and present medical/epilepsy, psychiatric, family, and educational history. Each child underwent a structured psychiatric interview, standardized cognitive and academic achievement testing, and completed self-report coping, daily stress, adversities, and parental bonding questionnaires.
  
  
  RESULTS
  Compared to their siblings, the PNES probands had significantly more lifetime comorbid medical, neurological (including epilepsy), and psychiatric problems; used more medications and intensive medical services; had more higher anxiety sensitivity, practiced solitary emotional coping, and experienced more lifetime adversities. A principal components analysis of these variables identified a somatopsychiatric, adversity, epilepsy, and cognitive component. The somatopsychiatric and adversity components differentiated the probands from the siblings, and were highly significant predictors of PNES with odds ratios of 15.1 (95% CI [3.4, 67.3], and 9.5 (95% CI [2.0, 45.7]), respectively. The epilepsy and cognitive components did not differentiate between the PNES and sibling groups.
  
  
  CONCLUSIONS
  These findings highlight the complex biopsychosocial and distinct vulnerability profile of pediatric PNES. They also underscore the need for screening the interrelated risk factors included in the somatopsychiatric and adversity components and subsequent mental health referral for confirmation of the diagnosis and treatment of youth with PNES.
authors.affiliation: Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, U.S.A.
authors.forename: Sigita
authors.initials: S
authors.lastname: Plioplys
authors.forename: Julia
authors.initials: J
authors.lastname: Doss
authors.forename: Prabha
authors.initials: P
authors.lastname: Siddarth
authors.forename: Brenda
authors.initials: B
authors.lastname: Bursch
authors.forename: Tatiana
authors.initials: T
authors.lastname: Falcone
authors.forename: Marcy
authors.initials: M
authors.lastname: Forgey
authors.forename: Kyle
authors.initials: K
authors.lastname: Hinman
authors.forename: W Curt
authors.initials: WC
authors.lastname: LaFrance
authors.forename: Rebecca
authors.initials: R
authors.lastname: Laptook
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Shaw
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Weisbrot
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Willis
authors.forename: Rochelle
authors.initials: R
authors.lastname: Caplan
mesh_terms: D000293:Adolescent; D002648:Child; D003291:Conversion Disorder / Q000523:psychology*; D003937:Diagnosis, Differential; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011602:Psychophysiologic Disorders / Q000523:psychology*; D012307:Risk Factors; D012640:Seizures / Q000523:psychology*; D035781:Siblings
keywords: Conversion disorder; Epilepsy; Nonepileptic seizures; Pediatric; Psychogenic; Risk