Cope Sarah R, Smith Jared G, King Tara, Agrawal Niruj
Neuropsychiatry Service, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
Population Health Research Institute, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
Epilepsy Behav. 2017 May;70(Pt A):238-244. doi: 10.1016/j.yebeh.2017.02.014. Epub 2017 Apr 25.
A high proportion of patients presenting at epilepsy clinics experience functional non-epileptic attacks (FNEA), and while psychological treatment is generally thought to be the required intervention, evidence regarding psychological treatment of FNEA is limited. A small number of psychoeducation treatments have been evaluated, with promising results. As part of routine care within a neuropsychiatry service, a 3-session cognitive-behavior therapy- (CBT-) informed psychoeducation group was developed. Patients with comorbid epilepsy were included. The group's effectiveness was evaluated in terms of attack frequency, mood, illness perception, dissociative experiences, and patient feedback. Pre- and post-treatment data were obtained for 19 patients. The proportion of patients experiencing attacks significantly decreased, with almost 40% of treatment completers reporting being attack-free at the end of treatment. Significant improvements were also found on level of psychological distress, illness beliefs, and understanding of the condition. No significant changes in mood or general functioning were observed. High satisfaction was reported by almost all patients. Treatment outcome was not significantly affected by the level of dissociative experiences. The results suggest that CBT-based psychoeducation group treatment can be a beneficial part of treatment for those with FNEA, even for those experiencing high levels of dissociation. Further controlled studies with larger sample sizes are required.
在癫痫门诊就诊的患者中，很大一部分经历过功能性非癫痫发作（FNEA），虽然一般认为心理治疗是必要的干预措施，但关于FNEA心理治疗的证据有限。少数心理教育治疗方法已得到评估，结果令人鼓舞。作为神经精神病学服务常规护理的一部分，开发了一种为期3节的认知行为疗法（CBT）指导的心理教育小组。纳入了合并癫痫的患者。从发作频率、情绪、疾病认知、分离体验和患者反馈等方面评估了该小组的有效性。获取了19名患者治疗前和治疗后的数据。经历发作的患者比例显著下降，近40%的治疗完成者报告在治疗结束时无发作。在心理困扰程度、疾病信念和对病情的理解方面也发现了显著改善。未观察到情绪或总体功能有显著变化。几乎所有患者都报告了高度满意度。治疗结果未受到分离体验水平的显著影响。结果表明，基于CBT的心理教育小组治疗对于FNEA患者可能是一种有益的治疗方式，即使对于那些分离体验程度较高的患者也是如此。需要进一步开展更大样本量的对照研究。
