Mökleby Kjell, Blomhoff Svein, Malt Ulrik Fr, Dahlström Astri, Tauböll Erik, Gjerstad Leif
Department of Psychosomatic and Behavioral Medicine, Rikshospitalet, University of Oslo, Oslo, Norway.
Epilepsia. 2002 Feb;43(2):193-8. doi: 10.1046/j.1528-1157.2002.20901.x.
To investigate the prevalence of psychiatric comorbidity and level of anxiety, depression, and aggression in patients with psychogenic nonepileptic seizures compared with those in patients with somatoform disorders and healthy controls.
Twenty-three patients with psychogenic nonepileptic seizures (PNESs) and 23 age- and sex-matched patients with somatoform disorders (SDs) underwent a clinical and a semistructured psychiatric interview (MINI) and filled in the Hospital Anxiety and Depression scale (HAD) and the Aggression Questionnaire (AQ). Twenty-three sex- and age-matched controls without psychopathology also underwent a clinical interview and completed the HAD and AQ.
PNES reported more minor head injuries in the past than did the two comparison groups, and more unspecific EEG dysrhythmias were observed on EEG. Twenty-one PNES patients and 18 with SDs had comorbid psychiatric diagnoses. However, the mean number of comorbid psychiatric diagnoses was higher in the PNES group (1.9 +/- 0.3 compared with 1.5 +/- 0.5 in the SD group; p = 0.003). Ten PNES patients additionally had a somatoform pain disorder, and seven had an undifferentiated somatoform disorder. Both patient groups reported significantly higher levels of anxiety, depression, and anger than did the healthy controls, but the PNES patients had significantly higher level of hostility than both comparison groups.
Increased psychiatric comorbidity is known to be associated with poorer response to regular interventions, and hostility is associated with more hostile coping patterns, often interfering with treatment compliance. Thus the increased prevalence of soft neurologic signs and comorbid psychiatric disorders and increased hostility as well in the PNES group, emphasizes that assessment and treatment of patients with PNES referred to a tertiary center requires an integrated approach involving both neurologic and psychiatric resources.
调查与躯体形式障碍患者及健康对照相比，心因性非癫痫性发作患者的精神共病患病率以及焦虑、抑郁和攻击性水平。
23例心因性非癫痫性发作（PNES）患者和23例年龄及性别匹配的躯体形式障碍（SD）患者接受了临床和半结构化精神科访谈（MINI），并填写了医院焦虑抑郁量表（HAD）和攻击性问卷（AQ）。23例无精神病理学问题、年龄及性别匹配的对照者也接受了临床访谈并完成了HAD和AQ。
与两个对照组相比，PNES患者报告过去有更多的轻度头部损伤，脑电图（EEG）上观察到更多非特异性的EEG节律异常。21例PNES患者和18例SD患者有共病的精神科诊断。然而，PNES组共病精神科诊断的平均数更高（1.9±0.3，而SD组为1.5±0.5；p = 0.003）。10例PNES患者还患有躯体形式疼痛障碍，7例患有未分化的躯体形式障碍。两个患者组报告的焦虑、抑郁和愤怒水平均显著高于健康对照，但PNES患者的敌意水平显著高于两个对照组。
已知精神共病增加与对常规干预的反应较差有关，而敌意与更具敌意的应对模式有关，常干扰治疗依从性。因此，PNES组中软性神经体征和共病精神障碍的患病率增加以及敌意增加，强调了转诊至三级中心的PNES患者的评估和治疗需要一种综合方法，涉及神经科和精神科资源。
