Rohit Gupta1, Divyani Garg2, Nand Kumar3, Mamta Bhushan Singh4, Garima Shukla4, Vinay Goyal4, Ravindra Mohan Pandey5, Achal Kumar Srivastava6. 1. CSIR-Institute of Genomics and Integrative Biology, New Delhi, India. 2. Department of Neurology, Lady Hardinge Medical College, New Delhi, India. 3. Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. 4. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. 5. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India. 6. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: achalsrivastava@hotmail.com.
Abstract
PURPOSE: Psychogenic non-epileptic seizures (PNES) offer an immense diagnostic and therapeutic challenge. We sought to determine socioeconomic, psychological and demographic factors in PNES compared to age and gender matched epilepsy patients as well as healthy controls. We also examined psychiatric co-morbidities in PNES and epilepsy patients. METHODS: We conducted a case-control study at a tertiary centre in India with three groups including PNES only, age and gender matched epilepsy only and healthy participants. Factors including marital status, family type, education level and psychiatric comorbidities etc. were compared between the three groups. Details of PNES semiology, duration of event and disease were collected. Psychiatric assessment included MINI International Diagnostic Interview based on DSM-IV criteria and Holmes-Rahe Social Readjustment Scale for stress evaluation. The modified Kuppuswamy scale was used to assess socio-economic status. RESULTS: We enrolled 100 PNES patients (mean age 26.1 ± 10.8 years), 100 epilepsy patients (23.5 ± 9.6 years) and 100 healthy controls (28.9 ± 11.0 years). Ninety per cent of participants were female. Significant factors associated with PNES included family history of epilepsy [OR 20.3 (2.6-155.6) (p = 0.004)], low education including literate/illiterate status [OR 14.1 (2.5-78.9) (p = 0.003)], interpersonal conflict [OR 2.4 (1.1-6.0) (p = 0.05)] and presence of psychiatric comorbidity [OR 60.5 (24.1-152.2) (p < 0.001)] of which major depression was the most common. The current suicide risk was significantly elevated in PNES compared to epilepsy patients (p < 0.001). PNES disease duration correlated with presence of current depression, dysthymia and suicidality but not with other psychiatric comorbidities. CONCLUSIONS: Our results highlight that several socio-economic and demographic factors are associated with occurrence of PNES. High rates of psychiatric comorbidities including current suicide risk emphasise the need for a collaborative neuropsychiatric approach.
PURPOSE: Psychogenic non-epileptic seizures (PNES) offer an immense diagnostic and therapeutic challenge. We sought to determine socioeconomic, psychological and demographic factors in PNES compared to age and gender matched epilepsypatients as well as healthy controls. We also examined psychiatric co-morbidities in PNES and epilepsypatients. METHODS: We conducted a case-control study at a tertiary centre in India with three groups including PNES only, age and gender matched epilepsy only and healthy participants. Factors including marital status, family type, education level and psychiatric comorbidities etc. were compared between the three groups. Details of PNES semiology, duration of event and disease were collected. Psychiatric assessment included MINI International Diagnostic Interview based on DSM-IV criteria and Holmes-Rahe Social Readjustment Scale for stress evaluation. The modified Kuppuswamy scale was used to assess socio-economic status. RESULTS: We enrolled 100 PNES patients (mean age 26.1 ± 10.8 years), 100 epilepsypatients (23.5 ± 9.6 years) and 100 healthy controls (28.9 ± 11.0 years). Ninety per cent of participants were female. Significant factors associated with PNES included family history of epilepsy [OR 20.3 (2.6-155.6) (p = 0.004)], low education including literate/illiterate status [OR 14.1 (2.5-78.9) (p = 0.003)], interpersonal conflict [OR 2.4 (1.1-6.0) (p = 0.05)] and presence of psychiatric comorbidity [OR 60.5 (24.1-152.2) (p < 0.001)] of which major depression was the most common. The current suicide risk was significantly elevated in PNES compared to epilepsypatients (p < 0.001). PNES disease duration correlated with presence of current depression, dysthymia and suicidality but not with other psychiatric comorbidities. CONCLUSIONS: Our results highlight that several socio-economic and demographic factors are associated with occurrence of PNES. High rates of psychiatric comorbidities including current suicide risk emphasise the need for a collaborative neuropsychiatric approach.