Del Bene Victor A, Arce Rentería Miguel, Maiman Moshe, Slugh Mitch, Gazzola Deana M, Nadkarni Siddhartha S, Barr William B
NYU Comprehensive Epilepsy Center, Department of Neurology, NYU School of Medicine, NY, New York 10016, United States; Ferkauf Graduate School of Psychology, Clinical Health Psychology Program, Yeshiva University, Bronx, NY 10461, United States.
NYU Comprehensive Epilepsy Center, Department of Neurology, NYU School of Medicine, NY, New York 10016, United States; Fordham University, Psychology Department, Bronx, NY 10485, United States.
Epilepsy Behav. 2017 Jul;72:43-50. doi: 10.1016/j.yebeh.2017.04.023. Epub 2017 May 30.
The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a self-report instrument, previously shown to differentiate patients with epileptic seizures (ES) and psychogenic non-epileptic seizures (PNES). At present, the odds of MMPI-2-RF scale elevations in PNES patients, as well as the diagnostic predictive value of such scale elevations, remain largely unexplored. This can be of clinical utility, particularly when a diagnosis is uncertain.
After looking at mean group differences, we applied contingency table derived odds ratios to a sample of ES (n=92) and PNES (n=77) patients from a video EEG (vEEG) monitoring unit. We also looked at the positive and negative predictive values (PPV, NPV), as well as the false discovery rate (FDR) and false omission rate (FOR) for scales found to have increased odds of elevation in PNES patients. This was completed for the overall sample, as well as the sample stratified by sex.
The odds of elevations related to somatic concerns, negative mood, and suicidal ideation in the PNES sample ranged from 2 to 5 times more likely. Female PNES patients had 3-6 times greater odds of such scale elevations, while male PNES patients had odds of 5-15 times more likely. PPV rates ranged from 53.66% to 84.62%, while NPV rates ranged from 47.52% to 90.91%. FDR across scales ranged from 15.38% to 50%, while the FOR ranged from 9.09% to 52.47%.
Consistent with prior research, PNES patients have greater odds of MMPI-2-RF scale elevations, particularly related to somatic concerns and mood disturbance. Female PNES patients endorsed greater emotional distress, including endorsement of suicide related items. Elevations of these scales could aid in differentiating PNES from ES patients, although caution is warranted due to the possibility of both false positives and the incorrect omissions of PNES cases.
明尼苏达多相人格调查表第二版修订版（MMPI-2-RF）是一种自陈式量表，此前研究表明其能够区分癫痫发作（ES）患者和精神性非癫痫发作（PNES）患者。目前，PNES患者中MMPI-2-RF量表升高的几率以及此类量表升高的诊断预测价值在很大程度上仍未得到充分研究。这在临床中可能具有实用价值，尤其是在诊断不确定时。
在观察了组间均值差异后，我们将列联表得出的优势比应用于来自视频脑电图（vEEG）监测单元的92例ES患者和77例PNES患者样本。我们还研究了阳性和阴性预测值（PPV、NPV），以及发现PNES患者中升高几率增加的量表的错误发现率（FDR）和错误遗漏率（FOR）。这是针对整个样本以及按性别分层后的样本完成的。
PNES样本中与躯体担忧、消极情绪和自杀观念相关的量表升高几率高出2至5倍。女性PNES患者此类量表升高的几率高出3至6倍，而男性PNES患者高出5至15倍。PPV率在53.66%至84.62%之间，而NPV率在47.52%至90.91%之间。各量表的FDR在15.38%至50%之间，而FOR在9.09%至52.47%之间。
与先前研究一致，PNES患者MMPI-2-RF量表升高的几率更高，特别是与躯体担忧和情绪障碍相关。女性PNES患者表现出更大的情绪困扰，包括对与自杀相关项目的认同。这些量表的升高有助于区分PNES患者和ES患者，不过鉴于存在假阳性以及PNES病例被错误遗漏的可能性，仍需谨慎。
