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Book: Psychogene nicht-epileptische Anfälle

Reuber, Markus / House, Allan / Brown, Richard / Howlett, Stephanie

eine Information für Patienten, Angehörige und Fachkräfte im Gesundheitswesen

(Informationen zur Epilepsie)

2017

Title translation	NEST - Non-epileptic seizures treatment
Institution	Stiftung Michael
Author's details	Stiftung Michael ; Autoren NEST: Non-Epileptic Seizures Treatment Group Prof. Markus Reuber, Prof. Allan House, Dr. Richard Brown, Stephanie Howlett
Series title	Informationen zur Epilepsie
Keywords	Diagnose, Ursache ; Epilepsie ; Psychogene nicht-epileptische Anfälle
Language	German
Size	32 Seiten
Edition	Auflage 2017
Publisher	Bethel-Verlag
Publishing place	Bielefeld
Publishing country	Germany
Document type	Book
HBZ-ID	HT019663326
ISBN	978-3-935972-52-9 ; 3-935972-52-0
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Changes in Emotion Processing following Brief Augmented Psychodynamic Interpersonal Therapy for Functional Neurological Symptoms.

Williams, Isobel Anne / Howlett, Stephanie / Levita, Liat / Reuber, Markus

Behavioural and cognitive psychotherapy

2018 Volume 46, Issue 3, Page(s) 350–366

Abstract: Background: Functional neurological symptoms (FNS) are considered non-volitional and often very disabling, but are not explainable by neurological disease or structural abnormalities. Brief Augmented Psychodynamic Interpersonal Therapy (BAPIT) was ... ...

Abstract	Background: Functional neurological symptoms (FNS) are considered non-volitional and often very disabling, but are not explainable by neurological disease or structural abnormalities. Brief Augmented Psychodynamic Interpersonal Therapy (BAPIT) was adapted to treat the putative emotion processing deficits thought to be central to FNS aetiology and maintenance. BAPIT for FNS has previously been shown to improve levels of distress and functioning, but it is unknown whether improvements on such measures correlate with changes in emotion processing ‒ which this treatment focuses on. Aim: To determine (a) whether the recently developed Emotional Processing Scale-25 can be used to demonstrate BAPIT-associated changes in patients with FNS, and (b) whether changes in the EPS-25 are associated with changes in previously validated outcome measures. Method: 44 patients with FNS completed questionnaires including the EPS-25 and measures of clinical symptomology (health-related quality of life (SF-36), somatic symptoms (PHQ-15), psychological distress (CORE-10) and illness understanding (BIPQ)) pre- and post-therapy. Results: At group level, emotion processing improved following therapy (p = .049). Some measures of clinical symptomology also improved, namely health-related quality of life (p = .02) and illness understanding (p = .01). Improvements in the EPS-25 correlated with improvements in mental health-related quality of life and psychological distress. Conclusions: Emotion processing and some measures of clinical symptomology improved in patients with FNS following BAPIT. The EPS-25 demonstrated changes that correlated with previously validated outcome measures. The EPS-25 is a suitable measure of psychotherapy-associated change in the FNS patient population.
MeSH term(s)	Adult ; Behavioral Symptoms/psychology ; Behavioral Symptoms/therapy ; Emotions ; Female ; Humans ; Male ; Medically Unexplained Symptoms ; Psychotherapy/methods ; Quality of Life ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2018-01-25
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	1168441-0
ISSN	1469-1833 ; 1352-4658 ; 0141-3473
ISSN (online)	1469-1833
ISSN	1352-4658 ; 0141-3473
DOI	10.1017/S1352465817000807
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Article ; Online: A multicenter evaluation of a brief manualized psychoeducation intervention for psychogenic nonepileptic seizures delivered by health professionals with limited experience in psychological treatment.

Wiseman, Hannah / Mousa, Saafi / Howlett, Stephanie / Reuber, Markus

Epilepsy & behavior : E&B

2016 Volume 63, Page(s) 50–56

Abstract: Rationale: The aim of this study was to add to our understanding of the impact of psychoeducation on patients' acceptance of the diagnosis of psychogenic nonepileptic seizures (PNESs), the frequency of their seizures, and their quality of life. The ... ...

Abstract	Rationale: The aim of this study was to add to our understanding of the impact of psychoeducation on patients' acceptance of the diagnosis of psychogenic nonepileptic seizures (PNESs), the frequency of their seizures, and their quality of life. The study also aimed to evaluate the effectiveness of brief manualized psychoeducation interventions for PNESs, delivered by a more diverse range of clinicians and in a wider range of treatment settings. Method: The final sample consisted of 25 patients diagnosed with PNESs by a neurologist specializing in the treatment of seizure disorder and referred to the psychotherapy service. The study included patients from four centers, using a manualized psychoeducation intervention delivered over 4 sessions by specialist epilepsy nurses and assistant psychologists. All patients completed self-measure questionnaires for Seizure Frequency, Impaired Functioning (WSAS), Psychological Distress (CORE-OM), Illness Perception (BIPQ), Health-Related Quality of Life: general (ED-QOL) and epilepsy-specific (NewQOL-6D), Symptom Attribution, and patient's perception of usefulness and relevance of the intervention. All measures were collected at baseline and after the completion of the fourth session. Results: All measures improved from baseline to postintervention, but this improvement was only significant for CORE-OM (p<.05) and BIPQ (p<.01). Out of the 25 patients who completed the intervention information, 6 out of 25 (24%) had been seizure-free for the past month, and an additional 6 out of 25 (24%) had achieved seizure frequency reduction. Consequently, upon completion of the intervention, 12 out of 25 patients (48%) were either seizure-free or experienced fewer seizures compared with the start of the intervention. Conclusion: The evidence suggests that brief manualized psychoeducation intervention can reduce PNES frequency, improve the psychological distress, and have an effect on patients' illness perceptions that should help them engage with a more extended psychotherapy program if that was necessary. The intervention was carried out successfully by staff with relatively little training in delivering psychological interventions. Further controlled studies are required to provide proof of efficacy.
MeSH term(s)	Health Personnel ; Humans ; Patient Education as Topic ; Psychophysiologic Disorders/psychology ; Psychophysiologic Disorders/therapy ; Psychotherapy ; Quality of Life ; Seizures/psychology ; Seizures/therapy ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2016-08-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010587-3
ISSN	1525-5069 ; 1525-5050
ISSN (online)	1525-5069
ISSN	1525-5050
DOI	10.1016/j.yebeh.2016.07.033
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Article ; Online: Emotion processing and psychogenic non-epileptic seizures: A cross-sectional comparison of patients and healthy controls.

Novakova, Barbora / Howlett, Stephanie / Baker, Roger / Reuber, Markus

Seizure

2015 Volume 29, Page(s) 4–10

Abstract: Purpose: This exploratory study aimed to examine emotion-processing styles in patients with psychogenic non-epileptic seizures (PNES), compared to healthy individuals, and to explore associations of emotion processing with other psychological measures ... ...

Abstract	Purpose: This exploratory study aimed to examine emotion-processing styles in patients with psychogenic non-epileptic seizures (PNES), compared to healthy individuals, and to explore associations of emotion processing with other psychological measures and seizure frequency, using the new Emotional Processing Scale (EPS-25), which had not previously been used in this patient group. Methods: Fifty consecutive patients with PNES referred for psychotherapy completed a set of self-report questionnaires, including the Emotional Processing Scale (EPS-25), Clinical Outcome in Routine Evaluation (CORE-10), Short Form-36 (SF-36), Patient Health Questionnaire (PHQ-15), and Brief Illness Perception Questionnaire (BIPQ). Responses on the EPS-25 were compared to data from 224 healthy controls. Results: Patients with PNES had greater emotion processing deficits across all dimensions of the EPS-25 than healthy individuals (suppression/unprocessed emotion/unregulated emotion/avoidance/impoverished emotional experience). Impaired emotion processing was highly correlated with psychological distress, more frequent and severe somatic symptoms, and a more threatening understanding of the symptoms. Emotion processing problems were also associated with reduced health-related quality of life on the mental health (but not the physical health) component of the SF-36. The unregulated emotions sub-scale of the EPS was associated with lower seizure frequency. Conclusion: The results showed clear impairments of emotion processing in patients with PNES compared to healthy individuals, which were associated with greater psychological distress and reduced mental health functioning. These findings seem to support the face validity of the EPS-25 as a measure for PNES patients and its potential as a tool to assess the effectiveness of psychological interventions.
MeSH term(s)	Adolescent ; Adult ; Aged ; Cross-Sectional Studies ; Emotions ; Female ; Humans ; Male ; Middle Aged ; Psychophysiologic Disorders/therapy ; Psychotherapy ; Seizures/etiology ; Seizures/psychology ; Seizures/therapy ; Self Report ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2015-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1137610-7
ISSN	1532-2688 ; 1059-1311
ISSN (online)	1532-2688
ISSN	1059-1311
DOI	10.1016/j.seizure.2015.03.007
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Article ; Online: Non-epileptic attack disorder: the importance of diagnosis and treatment.

Dickson, Jon Mark / Peacock, Marian / Grünewald, Richard A / Howlett, Stephanie / Bissell, Paul / Reuber, Markus

BMJ case reports

2017 Volume 2017

Abstract: A 50-year-old woman was taken to hospital by emergency ambulance during her first seizure. She was admitted to hospital, treated with intravenous diazepam, diagnosed with epilepsy and started on antiepileptic drug (AED) therapy. This was ineffective so ... ...

Abstract	A 50-year-old woman was taken to hospital by emergency ambulance during her first seizure. She was admitted to hospital, treated with intravenous diazepam, diagnosed with epilepsy and started on antiepileptic drug (AED) therapy. This was ineffective so she was referred to a tertiary centre where she underwent video EEG and was diagnosed with non-epileptic attack disorder. Her experience of the diagnosis was positive; it allowed her to understand what was happening to her and to understand the link between her seizures, adverse childhood experiences and the death of her mother. She stopped taking AEDs and she was referred to a psychologist which led to a significant improvement in her functioning and quality of life. We present this case as a good example of the benefits of accurate diagnosis, clear explanation and access to specialist care.
MeSH term(s)	Disease Management ; Female ; Humans ; Middle Aged ; Quality of Life ; Seizures/diagnosis ; Seizures/psychology ; Seizures/therapy ; Stress, Psychological/diagnosis ; Stress, Psychological/psychology ; Stress, Psychological/therapy
Language	English
Publishing date	2017-03-01
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2016-218278
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Article: An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures.

Howlett, Stephanie / Reuber, Markus

Psychotherapy (Chicago, Ill.)

2009 Volume 46, Issue 1, Page(s) 125–138

Abstract: Nonepileptic seizures (NES) are one of the most common functional (medically unexplained) symptoms seen by neurologists. Although most experts consider psychotherapy the treatment of choice, few therapeutic approaches have been described in detail. Given ...

Abstract	Nonepileptic seizures (NES) are one of the most common functional (medically unexplained) symptoms seen by neurologists. Although most experts consider psychotherapy the treatment of choice, few therapeutic approaches have been described in detail. Given that NES occur in the context of many different psychopathologies, it remains uncertain whether there is 1 intervention that can benefit all comers or whether it is necessary to offer individualized psychotherapy. This article describes an approach grounded in psychodynamic interpersonal therapy but augmented with elements of cognitive-behavioral therapy, somatic trauma therapy, and the involvement of caregivers and family members. The approach was developed in the setting of a specialist psychotherapy service for patients with functional neurological disorders presenting to British hospital-based neurologists. The authors have previously shown that it is associated with significant improvements in psychological functioning, health-related functioning, and a symptom count. Three case reports illustrate how the treatment can be adapted to meet different patients' needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Language	English
Publishing date	2009-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	281564-3
ISSN	1939-1536 ; 0033-3204
ISSN (online)	1939-1536
ISSN	0033-3204
DOI	10.1037/a0015138
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Article ; Online: Long-term outcome of brief augmented psychodynamic interpersonal therapy for psychogenic nonepileptic seizures: seizure control and health care utilization.

Mayor, Rebecca / Howlett, Stephanie / Grünewald, Richard / Reuber, Markus

Epilepsia

2010 Volume 51, Issue 7, Page(s) 1169–1176

Abstract: Purpose: Most neurologists endorse psychotherapy as the treatment of choice for psychogenic nonepileptic seizures (PNES), but its effectiveness remains unproven, and there are no previous reports of long-term outcome after psychotherapy. This study ... ...

Abstract	Purpose: Most neurologists endorse psychotherapy as the treatment of choice for psychogenic nonepileptic seizures (PNES), but its effectiveness remains unproven, and there are no previous reports of long-term outcome after psychotherapy. This study aimed to establish the outcome of brief augmented psychodynamic interpersonal therapy (PIT) for 47 patients with PNES in terms of seizures and health care utilization 31-65 months (median 50 months) after diagnosis. Methods: Participants completed questionnaires before starting therapy (Clinical Outcomes in Routine Evaluation Outcome Measure [CORE-OM]; Patient Health Questionnaire [PHQ15]; Short-Form Health Survey [SF-36]). Forty-seven of 66 consecutive patients (71%) also completed a follow-up questionnaire about current seizure frequency, employment status, and health care utilization 42 months after the end of therapy (range 12-61 months). Factors associated with seizure outcome and predictors of seizure cessation were evaluated. Results: At follow-up, 25.5% of patients had become seizure-free; a further 40.4% achieved a seizure reduction of >50%. Logistic regression showed "economic activity" status to be the only significant baseline predictor of seizure cessation (p < 0.021). Health care utilization declined significantly from baseline to follow-up (p < 0.039), suggesting minimum expected annual health care expenditure savings of pound245 ($408). Discussion: These results indicate that this intervention is associated with a significant improvement in seizure frequency and health care utilization, suggesting that a randomized controlled study of the intervention is justified.
MeSH term(s)	Adult ; Aged ; Delivery of Health Care/trends ; Delivery of Health Care/utilization ; Epilepsy/therapy ; Female ; Follow-Up Studies ; Humans ; Interpersonal Relations ; Male ; Middle Aged ; Psychotherapy/methods ; Psychotherapy/trends ; Seizures/psychology ; Seizures/therapy ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2010-07
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/j.1528-1167.2010.02656.x
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Article ; Online: Psychogenic nonepileptic seizures and health-related quality of life: the relationship with psychological distress and other physical symptoms.

Lawton, Gemma / Mayor, Rebecca J / Howlett, Stephanie / Reuber, Markus

Epilepsy & behavior : E&B

2009 Volume 14, Issue 1, Page(s) 167–171

Abstract: This study explores the relationship between the frequency of psychogenic nonepileptic seizures (PNES) and health-related quality of life (HRQoL), as well as the effect of psychological distress and other physical symptoms on this relationship. Data were ...

Abstract	This study explores the relationship between the frequency of psychogenic nonepileptic seizures (PNES) and health-related quality of life (HRQoL), as well as the effect of psychological distress and other physical symptoms on this relationship. Data were collected on 96 patients with PNES. Correlations of seizure frequency with HRQoL, psychological distress, and physical symptoms were computed. Partial correlations of seizure frequency with HRQoL while controlling for psychological distress and physical symptoms were also computed. Seizure frequency was found to be significantly related to subjective HRQoL, although the relationship with HRQoL was rendered nonsignificant when the effects of psychological distress and the number of other physical symptoms were taken into account. The results of this study suggest that summary scores of HRQoL are not independently related to frequency of PNES and that there is a close association between PNES frequency, levels of psychological distress, and number of other physical symptoms experienced.
MeSH term(s)	Adult ; Female ; Health Surveys ; Humans ; Male ; Mental Health ; Quality of Life ; Seizures/psychology ; Socioeconomic Factors ; Somatoform Disorders/psychology ; Stress, Psychological/physiopathology ; Stress, Psychological/psychology ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2009-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010587-3
ISSN	1525-5069 ; 1525-5050
ISSN (online)	1525-5069
ISSN	1525-5050
DOI	10.1016/j.yebeh.2008.09.029
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Article ; Online: Psychologic treatment of patients with psychogenic nonepileptic seizures.

Reuber, Markus / Howlett, Stephanie / Kemp, Steven

Expert review of neurotherapeutics

2005 Volume 5, Issue 6, Page(s) 737–752

Abstract: Psychogenic nonepileptic seizures are relatively common, often disabling and costly to patients and society. Most authorities consider psychologic treatment as the therapeutic intervention of choice. This review is intended primarily for psychologists ... ...

Abstract	Psychogenic nonepileptic seizures are relatively common, often disabling and costly to patients and society. Most authorities consider psychologic treatment as the therapeutic intervention of choice. This review is intended primarily for psychologists and therapists who treat patients with psychogenic nonepileptic seizures, and for neurologists who make the diagnosis and wish to find out more about psychologic treatment options. The first section describes the nature and etiology of psychogenic nonepileptic seizures. General questions regarding the psychologic treatment of patients with psychogenic nonepileptic seizures are addressed, before discussing specific therapeutic approaches. The final part summarizes the authors' views on optimal treatment and the direction of future research.
MeSH term(s)	Comorbidity ; Humans ; Patient Selection ; Psychophysiologic Disorders/complications ; Psychophysiologic Disorders/epidemiology ; Psychophysiologic Disorders/etiology ; Psychophysiologic Disorders/therapy ; Psychotherapy/methods ; Psychotropic Drugs/therapeutic use ; Seizures/epidemiology ; Seizures/etiology ; Seizures/therapy
Chemical Substances	Psychotropic Drugs
Language	English
Publishing date	2005-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2112534-X
ISSN	1744-8360 ; 1473-7175
ISSN (online)	1744-8360
ISSN	1473-7175
DOI	10.1586/14737175.5.6.737
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Article: Engagement in psychological treatment for functional neurological symptoms--Barriers and solutions.

Howlett, Stephanie / Grünewald, Richard A / Khan, Aijaz / Reuber, Markus

Psychotherapy (Chicago, Ill.)

2007 Volume 44, Issue 3, Page(s) 354–360

Abstract: This naturalistic study explores how many patients with functional neurological symptoms referred for specialist psychotherapy engage with and complete treatment, and whether routinely recorded demographic or clinical features predict engagement. Of 77 ... ...

Abstract	This naturalistic study explores how many patients with functional neurological symptoms referred for specialist psychotherapy engage with and complete treatment, and whether routinely recorded demographic or clinical features predict engagement. Of 77 consecutive patients referred, 14.3% were considered unsuitable for therapy and excluded from between group comparisons, 23.4% did not attend any appointments, 20.8% unilaterally discontinued therapy, and 41.6% completed treatment. 66.6% of patients starting therapy completed. Older patients were more likely to engage in or complete therapy (p = .05). There were no significant differences between groups in terms of specific functional symptoms, comorbidity, predisposing, precipitating and perpetuating, or social factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
Language	English
Publishing date	2007-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	281564-3
ISSN	1939-1536 ; 0033-3204
ISSN (online)	1939-1536
ISSN	0033-3204
DOI	10.1037/0033-3204.44.3.354
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