Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures.

Previous studies have provided evidence for a vigilant attentional bias toward threat stimuli and increased basal diurnal cortisol levels in patients with psychogenic nonepileptic seizures (PNES). Because cortisol levels may be predictive of threat vigilance, we reanalyzed previous data on threat vigilance in 19 unmedicated patients with PNES and found a positive correlation between baseline cortisol levels and attentional bias scores for threat stimuli (r=0.49, P=0.035). There was no such relationship in healthy matched controls (n=20) or in patients with epileptic seizures (n=17). These findings provide the first evidence linking an endocrine stress marker to increased threat sensitivity in PNES and support new integrated psychoneurobiological models of PNES.