title: Psychiatric comorbidity in psychogenic nonepileptic seizures compared with epilepsy.
abstract: OBJECTIVE
  Psychogenic nonepileptic seizures (PNESs) are closely linked with psychological distress, but their etiology is not well-understood. We reviewed psychiatric comorbidity in PNESs and epileptic seizures (ESs) with an aim to assist understanding, diagnosis, and management of PNESs.
  
  
  METHODS
  A search of Web of Science, MEDLINE (PubMed), PsycINFO, and Scopus identified 32 relevant studies on the prevalence of psychiatric comorbidity in PNESs. We used meta-analysis to compare psychiatric comorbidity between PNESs and ESs.
  
  
  RESULTS
  Samples with PNESs had high rates of psychiatric comorbidity overall (53-100%), notably including posttraumatic stress disorder (PTSD), depression, and personality and anxiety disorders. Compared with ESs, samples with PNESs had more psychiatric comorbidity overall (RR: 1.30, 95% CI: 1.14-1.48, p<0.0001) with significantly elevated risks found for PTSD, personality disorder, and anxiety but not depression.
  
  
  CONCLUSIONS
  Psychiatric disorders are more common in PNESs than ESs. Because of methodological limitations of available studies, causality cannot be established; prospective longitudinal designs are required.
authors.affiliation: Whangarei Hospital, Private Bag 9742, Whangarei 0148, New Zealand. Electronic address: william.diprose@northlanddhb.org.nz.
authors.forename: William
authors.initials: W
authors.lastname: Diprose
authors.affiliation: Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Frederick
authors.initials: F
authors.lastname: Sundram
authors.affiliation: Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Waikato Clinical Campus, Private Bag 3200, Hamilton 3240, New Zealand.
authors.forename: David B
authors.initials: DB
authors.lastname: Menkes
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004827:Epilepsy / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D010551:Personality; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology
keywords: Anxiety disorder; Conversion disorder; Depression; PNES; Personality disorder; Posttraumatic stress disorder