title: Psychosocial factors and antiepileptic drug use related to delayed diagnosis of refractory psychogenic nonepileptic seizures.
abstract: OBJECTIVE
  We analyzed clinical and psychosocial factors in patients with refractory psychogenic nonepileptic seizures, seeking characteristics that could hasten diagnosis.
  
  
  BACKGROUND
  Psychogenic nonepileptic seizures remain a diagnostic challenge. Prognosis is best if patients are treated within 2 years of symptom onset. Psychosocial factors have been shown to provide important information for differential diagnosis.
  
  
  METHODS
  Over a year and 1132 consecutive patients, our hospital's Epilepsy Unit suspected 93 patients of having psychogenic nonepileptic seizures and confirmed refractory psychogenic nonepileptic seizures in 67. We referred these patients to our psychiatric consultation unit for detailed diagnostic interviews, and 53 of the patients followed through. Two months after the psychiatric evaluation we gave them a psychiatric intervention, explaining the diagnosis and treating their comorbidities. We also tracked the patients' use of antiepileptic drugs for 3 months, from just before the psychiatric evaluation until a month after they started the intervention.
  
  
  RESULTS
  Women, patients with an inadequate primary support group, and patients who had tried many antiepileptic drugs were most likely to have their diagnosis of psychogenic nonepileptic seizures delayed by >2 years after onset. A stepwise logistic regression showed that the 2 best predictors of late diagnosis were lack of availability of a primary support group and patients trying many antiepileptic drugs.
  
  
  CONCLUSIONS
  Clinicians evaluating patients with questionable seizures should raise their suspicion of psychogenic nonepileptic seizures especially in female patients with an insufficient primary support group and a history of taking multiple antiepileptic drugs.
authors.affiliation: *Consultation Liaison Psychiatry Unit, Psychiatry Department, Hospital Universitari Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universitat Autònoma de Barcelona, Barcelona, Spain †Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Amanda
authors.initials: A
authors.lastname: Rodríguez-Urrutia
authors.forename: Manuel
authors.initials: M
authors.lastname: Toledo
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Eiroa-Orosa
authors.forename: Xavier
authors.initials: X
authors.lastname: Salas-Puig
authors.forename: Estevo
authors.initials: E
authors.lastname: Santamarina
authors.forename: Sara Guila
authors.initials: SG
authors.lastname: Fidel-Kinori
authors.forename: Gemma
authors.initials: G
authors.lastname: Parramon
authors.forename: Miguel
authors.initials: M
authors.lastname: Casas
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects*; D015897:Comorbidity; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D012017:Referral and Consultation; D012640:Seizures / Q000523:psychology* / Q000628:therapy; D012737:Sex Factors; D012944:Social Support; D013997:Time Factors
chemical_list: D000927:Anticonvulsants