title: Bridging a clinical gap in psychogenic nonepileptic seizures: Mental health provider preferences of biopsychosocial assessment approaches.
abstract: Management of psychogenic nonepileptic seizures (PNES) is complex, requiring multidisciplinary care. A standardized assessment and formulation approach to PNES is lacking, yet use of a comprehensive model may alleviate problems such as mental health aftercare noncompliance. Although a biopsychosocial (BPS) approach to PNES balancing predisposing, precipitating, and perpetuating (PPP) variables has been described and has been recently tested in pilot form, it is unclear how this assessment style is perceived among community mental health practitioners such as psychotherapists (including psychologists, counselors, and social workers). We predicted preference of a comprehensive "BPS/PPP" assessment style by those most involved in PNES care (i.e., community psychotherapists). One hundred and forty-three community-based social workers and counselors completed a survey featuring a fictional PNES case followed by assessment style options ("Multiaxial," "Narrative," and "BPS/PPP"). Respondents clearly preferred the robust BPS/PPP approach over less-comprehensive multiaxial and narrative assessments (p<0.0001). Reasons for choosing the BPS/PPP by respondents include ease of organization, clear therapeutic goals, and comprehensive nature. This assessment of acceptability of a BPS/PPP approach to PNES assessment among community mental health practitioners may provide a patient-centered mechanism to enhance referrals from the neurological to mental health setting. Implications and future directions are explored.
authors.affiliation: Department of Psychiatry and Psychology, Cleveland Clinic Foundation, USA; NeuroEthics Program, Cleveland Clinic Foundation, USA. Electronic address: jimenex2@ccf.org.
authors.forename: Xavier F
authors.initials: XF
authors.lastname: Jimenez
authors.affiliation: Epilepsy Center, Cleveland Clinic Foundation, USA; Department of Neurology, Cleveland Clinic Foundation, USA.
authors.forename: Jocelyn F
authors.initials: JF
authors.lastname: Bautista
authors.affiliation: Department of Psychiatry and Psychology, Cleveland Clinic Foundation, USA; Epilepsy Center, Cleveland Clinic Foundation, USA.
authors.forename: Bikat S
authors.initials: BS
authors.lastname: Tilahun
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic Foundation, USA.
authors.forename: Youran
authors.initials: Y
authors.lastname: Fan
authors.affiliation: NeuroEthics Program, Cleveland Clinic Foundation, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Ford
authors.affiliation: Department of Psychiatry and Psychology, Cleveland Clinic Foundation, USA; Epilepsy Center, Cleveland Clinic Foundation, USA.
authors.forename: George E
authors.initials: GE
authors.lastname: Tesar
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D008603:Mental Health; D011584:Psychology; D011613:Psychotherapy / Q000379:methods*; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: Biopsychosocial; Case formulation; Psychiatric assessment; Psychogenic nonepileptic seizures