Pick S, Mellers J D C, Goldstein L H
Department of Psychology,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK.
Neuropsychiatry Outpatients Department,Maudsley Hospital, South London and Maudsley NHS Foundation Trust,London,UK.
Psychol Med. 2017 May;47(7):1215-1229. doi: 10.1017/S0033291716003093. Epub 2017 Jan 9.
This study aimed to extend the current understanding of dissociative symptoms experienced by patients with dissociative (psychogenic, non-epileptic) seizures (DS), including psychological and somatoform types of symptomatology. An additional aim was to assess possible relationships between dissociation, traumatic experiences, post-traumatic symptoms and seizure manifestations in this group.
A total of 40 patients with DS were compared with a healthy control group (n = 43), matched on relevant demographic characteristics. Participants completed several self-report questionnaires, including the Multiscale Dissociation Inventory (MDI), Somatoform Dissociation Questionnaire-20, Traumatic Experiences Checklist and the Post-Traumatic Diagnostic Scale. Measures of seizure symptoms and current emotional distress (Hospital Anxiety and Depression Scale) were also administered.
The clinical group reported significantly more psychological and somatoform dissociative symptoms, trauma, perceived impact of trauma, and post-traumatic symptoms than controls. Some dissociative symptoms (i.e. MDI disengagement, MDI depersonalization, MDI derealization, MDI memory disturbance, and somatoform dissociation scores) were elevated even after controlling for emotional distress; MDI depersonalization scores correlated positively with trauma scores while seizure symptoms correlated with MDI depersonalization, derealization and identity dissociation scores. Exploratory analyses indicated that somatoform dissociation specifically mediated the relationship between reported sexual abuse and DS diagnosis, along with depressive symptoms.
A range of psychological and somatoform dissociative symptoms, traumatic experiences and post-traumatic symptoms are elevated in patients with DS relative to healthy controls, and seem related to seizure manifestations. Further studies are needed to explore peri-ictal dissociative experiences in more detail.
本研究旨在扩展对分离性（心因性、非癫痫性）癫痫（DS）患者所经历的分离症状的当前认识，包括心理和躯体形式类型的症状学。另一个目的是评估该组中分离、创伤经历、创伤后症状与癫痫表现之间的可能关系。
将40例DS患者与一个在相关人口统计学特征上匹配的健康对照组（n = 43）进行比较。参与者完成了几份自我报告问卷，包括多尺度分离量表（MDI）、躯体形式分离问卷 - 20、创伤经历清单和创伤后诊断量表。还进行了癫痫症状和当前情绪困扰的测量（医院焦虑抑郁量表）。
与对照组相比，临床组报告的心理和躯体形式分离症状、创伤、创伤的感知影响以及创伤后症状明显更多。即使在控制了情绪困扰之后，一些分离症状（即MDI脱离、MDI人格解体、MDI现实解体、MDI记忆障碍和躯体形式分离得分）仍有所升高；MDI人格解体得分与创伤得分呈正相关，而癫痫症状与MDI人格解体、现实解体和身份分离得分相关。探索性分析表明，躯体形式分离特别介导了报告的性虐待与DS诊断之间的关系，以及抑郁症状。
与健康对照组相比，DS患者的一系列心理和躯体形式分离症状、创伤经历和创伤后症状有所升高，并且似乎与癫痫表现有关。需要进一步研究以更详细地探索发作期的分离体验。
