title: Neurologist assessment of reactions to the diagnosis of psychogenic nonepileptic seizures: relationship to short- and long-term outcomes.
abstract: OBJECTIVE
  To determine the relationship between neurologist assessment of reactions to the diagnosis of PNESs and outcomes at 6-12 months and at 5-10 years.
  
  
  METHODS
  Two hundred thirty-eight patients with psychogenic nonepileptic seizures (PNES) were recruited into a long-term follow-up study. At diagnosis and 6-12 months post diagnosis, doctors recorded their assessments of patient and caregiver reactions to the diagnosis of PNESs.
  
  
  RESULTS
  At baseline, 92/238 patients (38.7%) and 73/106 caregivers (68.9%) were assessed as having understood and accepted the diagnosis, while 6.7% of patients and 10.4% of caregivers reacted with anger. At 6-12 months, patient acceptance rose to 57.7%, with caregiver acceptance static at 70.8%. Attendance at follow-up was predicted by the presence of a caregiver at baseline: only one patient who came with a caregiver at baseline did not attend at 6-12 months (OR: 123.80, p < 0.001). Outcome at 6-12 months was predicted by patient acceptance at baseline (OR: 2.85, p = 0.006) and at 6-12 months (OR: 13.83, p < 0.001) and by caregiver acceptance at 6-12 months (OR: 10.77, p < 0.001). Presentation to primary or secondary care with attacks at 5-10 years was predicted by caregiver acceptance at 6-12 months (OR: 3.50, p = 0.007).
  
  
  CONCLUSIONS
  Patient understanding and acceptance of the diagnosis of PNESs are linked to outcome at 6-12 months. The beliefs of caregivers may be important for outcome in the longer term, particularly with respect to health-care use.
authors.affiliation: Department of Neurology, Christchurch Hospital, Christchurch 8011, New Zealand. Electronic address: roderick.duncan@cdhb.health.nz.
authors.forename: Roderick
authors.initials: R
authors.lastname: Duncan
authors.affiliation: NHS Lothian, Department of Clinical Neuropsychology, Astley Ainslie Hospital, Edinburgh EH9 2HL, Scotland, UK.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Graham
authors.affiliation: Scottish Epilepsy Centre, Glasgow G51 4QD, Scotland, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Oto
mesh_terms: D000328:Adult; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009462:Neurology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011602:Psychophysiologic Disorders / Q000175:diagnosis / Q000523:psychology*; D012640:Seizures / Q000175:diagnosis / Q000523:psychology*
keywords: PNESs; Pseudoseizures; Psychogenic nonepileptic attack disorder; Psychogenic nonepileptic seizures