Abstracts

Rationale: Psychiatric assessment of psychogenic nonepileptic seizures (PNES) is critical,1 though gaps exist in participation by psychiatrists due to a lack of agreed-upon approaches.2 Authors have suggested psychiatrists identify predisposing, precipitating, and perpetuating factors of PNES to guide therapeutics.3 Biopsychosocial underpinnings of PNES are recognized,4 yet these have not been routinely incorporated into assessments. Although preliminary evidence suggests suitability of this method amongst epileptologists,5 comparing the acceptability of this approach amongst receiving psychotherapists is warranted. It is hypothesized that multidimensional, biopsychosocial PNES assessment styles will be preferred by psychotherapists as it clarifies diagnosis and guides treatment.Methods: An electronically-delivered, IRB-approved, confidential/anonymous and uncompensated 5-item survey was distributed to two cohorts of practicing psychotherapists across the state of Ohio: 1) social worker group (n=1042); and 2) counselor group (n=500). As with the pilot version of this study5, the survey featured a clinical vignette of a typical PNES patient on an epilepsy monitoring unit (Table 1). Respondents were asked to rank in order of preference three assessment approaches: Multiaxial, Narrative, and Biopsychosocial (BPS) Assessments (Table 1). Respondents were also asked to briefly explain their ranking choices. Chi-square analysis and goodness-of-fit testing were used to assess statistical significance between preferences (Table 2).Results: 103 psychotherapists ranked BPS first and 40 ranked either Multiaxial or Narrative first (p<0.0001). Within group analyses also found statistical significance for this preference (social workers p =0.0124; counselors p <0.001). Reasons provided for preferring a BPS approach included comprehensive nature, overt treatment targets, and humanistic patient description.Conclusions: Psychotherapists receiving PNES referrals prefer a multidimensional, BPS style. Such a preference carries implications for continuity of care; use of a BPS approach may reduce patient psychotherapy noncompliance and/or high acute-care utilization if it minimizes confusion about diagnosis or goals of care. Future directions are explored, including implementation of standardized BPS assessments for PNES populations. References 1) LaFrance WC, Reuber M, Goldstein LH. Management of psychogenic nonepileptic seizures. Epilepsia. 2013; 45(Suppl. 1):53-67 2) Smith BJ. Closing the Major Gap in PNES Research. Epilepsy Currents. 2014; 14(2):63-67 3) Reuber M, Howlett S, Khan A, Grunewald RA. Non-Epileptic Seizures and Other Functional Neurological Symptoms: Predisposing, Precipitating, and Perpetuating Factors. Psychosomatics. 2007; 48(3):230-238 4) Reuber M. The Etiology of Psychogenic Non-Epileptic Seizures: Toward a Biopsychosocial Model. Neurol Clin. 2009; 27:909-92 5) Jimenez XF, Bautista JF, Tesar GE, Fan Y. Diagnostic Assessment and Case Formulation in Psychogenic Nonepileptic Seizures: A Pilot Comparison of Approaches. Epilepsy & Behavior. 2015; 45:164-168