Kanner A M, Parra J, Frey M, Stebbins G, Pierre-Louis S, Iriarte J
Department of Neurological Sciences, Rush Medical College and Rush Epilepsy Center, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
Neurology. 1999 Sep 22;53(5):933-8. doi: 10.1212/wnl.53.5.933.
To investigate the patterns of occurrence of psychogenic pseudoseizures (PPS) of 45 consecutive patients during a 6-month period after diagnosis, and to determine whether psychiatric and neurologic variables identified previously in PPS patient series can predict their recurrence after diagnosis, and whether any of these variables are associated with a particular outcome pattern.
Postdiagnosis PPS recurrence was assessed twice: during the first month and during a period ranging from the second to the sixth month. Outcome was categorized as follows: class I, complete cessation of PPS; class II, PPS only during one of the two observation periods; and class III, persistent PPS during the two observation periods. The authors used a logistic regression model to identify predictors of PPS recurrence (versus no PPS) among four neurologic and nine psychiatric variables, and compared their frequency among the three outcome classes.
Class I, n = 13 (29%); class II, n = 12 (27%); and class III, n = 20 (44%). The presence of an abnormal MR image predicted PPS recurrence during the second observation period with a 75% accuracy. The presence of all nine psychiatric variables predicted PPS recurrence during both the first and second observation periods with a 93% and an 89% accuracy respectively. Patients with a class III outcome had a markedly higher frequency of recurrent major depression, dissociative and personality disorders, and a history of chronic abuse. Patients with a class II outcome displayed a notably higher frequency of denial of stressors and psychosocial problems, refusal of treatment recommendations, and new somatic symptoms after disclosure of diagnosis. Conversely, one episode of major depression was the one common diagnosis in patients with a class I outcome.
PPS outcome after disclosure of diagnosis can be predicted by the presence of certain psychiatric characteristics. More than one psychopathogenic mechanism appears to operate in PPS.
调查45例连续患者在诊断后6个月内的心因性假性癫痫发作（PPS）发生模式，确定先前在PPS患者系列中确定的精神和神经变量是否可预测其诊断后的复发情况，以及这些变量中是否有任何一个与特定的结局模式相关。
诊断后PPS复发情况评估两次：第一个月期间以及第二个月至第六个月期间。结局分类如下：I类，PPS完全停止；II类，PPS仅在两个观察期之一出现；III类，两个观察期内PPS持续存在。作者使用逻辑回归模型在四个神经变量和九个精神变量中识别PPS复发（与无PPS相比）的预测因素，并比较它们在三个结局类别中的频率。
I类，n = 13（29%）；II类，n = 12（27%）；III类，n = 20（44%）。异常磁共振成像的存在预测第二个观察期内PPS复发的准确率为75%。所有九个精神变量的存在分别以93%和89%的准确率预测第一个和第二个观察期内PPS复发。III类结局患者复发性重度抑郁症、分离性和人格障碍以及慢性虐待史的频率明显更高。II类结局患者否认应激源和心理社会问题、拒绝治疗建议以及诊断披露后出现新的躯体症状的频率显著更高。相反，重度抑郁症发作一次是I类结局患者的常见诊断。
诊断披露后的PPS结局可通过某些精神特征的存在来预测。PPS中似乎有不止一种精神致病机制在起作用。
