Inpatient psychiatric consultation for newly-diagnosed patients with psychogenic non-epileptic seizures.

OBJECTIVE

To evaluate the prevalence and utilization of inpatient psychiatric consultation (IPC) for patients newly-diagnosed with psychogenic non-epileptic seizures (PNESs).

METHODS

One hundred seventy-three epilepsy centers certified by the National Association of Epilepsy Centers were surveyed with the question, "Does your epilepsy center routinely obtain an inpatient psychiatric consultation for PNES patients in the Epilepsy Monitoring Unit (EMU)?" Additional comments were optional. A separate, single-center evaluation of self-reported psychiatric comorbidities compared with IPC diagnoses in 26 consecutively hospitalized patients with vEEG-confirmed PNESs from a tertiary care center was retrospectively reviewed.

RESULTS

Ninety-seven epilepsy centers responded to the survey. Forty-one of the 97 (42.3%) responded "yes", confirming routine use of IPC at their center. Sixty-two of the 97 (63.9%) included elective comments, with the most common being the use of case-by-case assessment to determine the necessity of IPC (56.4%). At the single center where IPC was requested for 26 newly-diagnosed patients, 7/26 (26.9%) refused evaluation by a psychiatrist. There was not a significant difference between the mood or anxiety disorder diagnosed by IPC and those self-reported by the patients. Only one patient received a change in drug treatment from IPC. None of the patients were a suicide threat prior to discharge.

CONCLUSIONS

Almost half of the surveyed epilepsy centers utilized IPC routinely. However, based on our study results, we suggest that routine IPC is not necessary in patients newly-diagnosed with PNESs and that a case-by-case evaluation would ensure that the minority of patients with acute psychiatric risks receive timely diagnosis and treatment. The value of IPC should be further evaluated in a larger, multi-center study.