Personality traits, illness behaviours and psychiatric comorbidity in individuals with Psychogenic Non-Epileptic Seizures (PNES), epilepsy and other non-epileptic seizures (oNES): differentiating between the conditions

Vilyte, Gabriele (2018-03)

Thesis (MA)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: One of the most pressing issues in psychogenic non-epileptic seizure (PNES) diagnosis is to ensure that the condition is successfully differentiated from epileptic seizures (ES) and other non-epileptic seizures (oNES). Video electroencephalography (vEEG), which is considered to be the gold standard for PNES diagnosis, is largely inaccessible to most in this country. Hence, more often than not, individuals suffering from this psychiatric condition are assumed to have epilepsy and are erroneously treated with anti-epileptic drugs, which creates individual and societal financial strain, poses numerous health risks and complications, and delays access to appropriate treatment. Very little is still known about the South African PNES population and as of yet, there have been no attempts at developing any cheaper, quicker and easier to administer alternative diagnostic measures for PNES in South Africa. The study aimed to investigate if South African individuals with PNES differ from individuals with ES and oNES in terms of demographic and seizure characteristics, personality traits, illness behaviours, and depression, anxiety and post-traumatic stress disorder (PTSD) in statistically significant ways; and if so, to test if these differences can be utilised in raising suspicion of PNES as the differential diagnosis to epilepsy and oNES. Twenty-nine adults with seizure complaints were recruited using convenience sampling from two private and government hospitals with vEEG technology. A quantitative double-blind convenient sampling comparative design was used. A demographic and seizure questionnaire, the NEO Five Factor Inventory-3 (NEO-FFI-3), Illness Behaviour Questionnaire (IBQ), the Beck Anxiety Inventory – Primary Care (BAI-PC) were administered. Only data from twenty-four people from the private hospital was made available for data analysis. Cronbach’s alphas, ANOVA, Cross-tabulation, Fisher exact test, and ROC analyses results are reported. The final sample consisted of 5 PNES (21%), 16 ES (67%) and 3 oNES (13%) patients. The PNES group was found to be significantly more male and to experience significantly more monthly seizures, when comparing PNES and ES, and PNES and the combined ES and oNES group. No significant differences between groups were found in terms of age, population group, language, education, and age at first seizure. No significant differences were found between the groups on any of the NEO-FFI-3 subscales. Only item “Do you experience a lot of pain with your illness?” on the IBQ exhibited a significant difference, with PNES tending to answer “Yes” more often when compared to the other two groups. All three groups scored above the cut-off point of 5 exhibiting depression, anxiety and PTSD symptoms on the BAI-PC. However, the PNES group tended to score significantly higher than the ES and the combined group. A cut-off point of 12 was found to be optimal in predicting PNES in this seizure population using the BAI-PC. Descriptive statistics or tendencies are reported for all used measures. This study provided a greater understanding of personality domains, abnormal illness behaviours, psychiatric comorbidity and demographic and seizure factors in the PNES population and discussed the potential for these factors to be used in the future for PNES screening.

AFRIKAANSE OPSOMMING: Een van die belangrikste aspekte in die diagnose van psigogene nie-epileptiese toevalle (PNES) is om te verseker dat die toestand behoorlik onderskei word van epileptiese toevalle (ES) en ander nie-epileptiese toevalle (oNES). Video-elektroënsefalografie (vEEG) wat as dié maatstaf vir die diagnose van PNES beskou word, is meestal ontoeganklik vir die meeste mense in Suid-Afrika. Individue wat aan hierdie psigiatriese toestand ly, word dus baie dikwels verkeerdelik met anti-epileptiese middels behandel omdat aangeneem word dat hulle epilepsie het. Dit plaas finansiële druk op die individu en gemeenskap, dit lei tot verskeie gesondheidsrisiko’s en -komplikasies en vertraag toegang tot gepaste behandeling. Tans is baie min bekend oor die Suid-Afrikaanse PNES-populasie. Geen poging is ook nog aangewend om alternatiewe diagnostiese maatstawwe vir PNES in Suid-Afrika te ontwikkel wat goedkoper, vinniger en makliker is om te gebruik nie. Die studie het gepoog om vas te stel of Suid-Afrikaanse individue met PNES beduidend verskil van individue met ES en oNES wat betref kenmerke van demografie en toevalle, persoonlikheidstrekke, siektegedrag, en depressie, angs en post-traumatiese stresversteuring (PTSV); en indien wel, om te bepaal of sodanige verskille gebruik word om ʼn vermoede van PNES as die differensiële diagnose vir epilepsie en oNES te versterk. Nege en twintig volwassenes met klagtes van toevalle is met behulp van geriefsteekproefneming van twee privaat en publieke hospitale wat vEEG-tegnologie gebruik verkry. ʼn Kwantitatiewe, dubbelblinde gerieflikheids-steekproef en vergelykende ontwerp is gebruik. ʼn Vraelys oor demografie en toevalle, die NEO Five Factor Inventory-3 (NEO-FFI-3), Illness Behaviour Questionnaire (IBQ), die Beck-Anxiety Inventory – Primary Care (BAI-PC) is toegepas. Slegs data van vier en twintig mense van die privaat hospitaal is gebruik vir die data-ontleding. Cronbach se alphas, ANOVA, kruistabellering, die Fisher eksakte toets, en ROC-ontledings se resultate is gerapporteer. Die finale steekproef het uit 5 PNES- (21%), 16 ES- (67%) en 3 (13%) oNES- pasiënte bestaan. Die PNES-groep het uit beduidend meer mans bestaan en het beduidend meer maandelikse toevalle ervaar in vergelyking met die ES-groep, asook in vergelyking met die gekombineerde ES- en oNES-groep. Geen beduidende verskille wat betref ouderdom, bevolkingsgroep, taal, opleiding, en ouderdom met eerste toeval is gevind nie. Ook is geen beduidende verskille tussen die groepe gevind op enige van die subskale van die NEO-FFI-3 nie. Slegs een item van die IBQ, “Do you experience a lot of pain with your illness?” het ʼn beduidende verskil getoon, met PNES-pasiënte wat meer dikwels “Ja” geantwoord het in vergelyking met die ander twee groepe. Op die BAI-PC was al drie groepe se tellings bo die afsnypunt van 5, wat simptome van depressie, angs en PTSV aandui. Die PNES-groep het egter beduidend hoër tellings gehad as die ES-groep en die gekombineerde groep. ʼn Afsnypunt van 12 op die BAI-PC was optimaal vir die voorspelling van PNES in hierdie populasie pasiënte met toevalle. Beskrywende statistiek of tendense word vir al die maatstawwe wat gebruik is gerapporteer. Die studie het ʼn groter begrip van persoonlikheidskenmerke, abnormale siektegedrag, psigiatriese komorbiditeit en faktore van demografie en toevalle in die PNES-populasie verskaf. Die potensiaal om hierdie faktore in die toekoms vir PNES-sifting te gebruik, is ook bespreek.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103321
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