Neuropsychiatry Clinic, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Social Sciences, Academic College Tel-Aviv-Jaffa, Tel-Aviv, Israel.
Neuropsychiatry Clinic, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Psychosomatics. 2020 Jul-Aug;61(4):353-362. doi: 10.1016/j.psym.2020.02.006. Epub 2020 Feb 24.
Psychogenic nonepileptic seizures (PNES) represent one of the most sizable treatment challenges in neuropsychiatry. Although the underlying mechanism is far from being understood, several interventions have been suggested. However, patients with comorbid psychiatric diagnoses and epilepsy are excluded from most intervention studies.
To To present a within-group posttreatment vs pretreatment study representing the retrospective clinical results of an integrative psychotherapy model.
We present the clinical results of 22 patients with PNES diagnosed in an epilepsy center and treated in our neuropsychiatry clinic using an integrative rehabilitative psychotherapy. Therapy included presenting the diagnosis, psychoeducation, seizure reduction behavioral techniques, and coping with past and present stressors. Insomuch as integrative biopsychosocial psychotherapy is based on an individualized treatment protocol for each patient, treatment was individualized and case specific.
By the end of treatment, 36% of patients had become seizure free and a further 54% achieved a major seizure reduction (reduction of more than 70%). Seventy-two percent of patients kept at least 70% seizure reduction at follow-up. Global Assessment of Functioning scores improved from a mean of 43.09 to a mean of 72.81 at the end of treatment and 69.72 at follow-up. In addition, we present 3 case descriptions that emphasize the individualized nature of psychotherapeutic decisions.
Our results support the feasibility and effectiveness of biopsychosocial based integrative psychotherapy for PNES and set principles for future treatment and prospective clinical trials in the field of individualized psychotherapy.
心因性非癫痫性发作（PNES）是神经精神病学中最具挑战性的治疗之一。尽管其潜在机制尚不清楚，但已经提出了几种干预措施。然而，大多数干预研究都排除了伴有精神科诊断和癫痫的患者。
介绍一项针对 22 例在癫痫中心诊断为 PNES 并在我们的神经精神病学诊所接受综合康复心理治疗的患者的治疗后与治疗前的单组研究，以展示回顾性临床结果。
我们介绍了在癫痫中心诊断为 PNES 并在我们的神经精神病学诊所使用综合康复心理治疗的 22 例患者的临床结果。治疗包括介绍诊断、心理教育、减少发作的行为技术以及应对过去和现在的压力源。由于综合生物心理社会心理治疗是基于每位患者的个体化治疗方案，因此治疗是个体化和具体病例的。
治疗结束时，36%的患者发作停止，54%的患者发作明显减少（减少超过 70%）。72%的患者在随访时至少保持 70%的发作减少。治疗结束时，总体功能评估评分从平均 43.09 分提高到平均 72.81 分，随访时为 69.72 分。此外，我们还介绍了 3 个案例描述，强调了心理治疗决策的个体化性质。
我们的结果支持基于生物心理社会的综合心理治疗对 PNES 的可行性和有效性，并为个体化心理治疗领域的未来治疗和前瞻性临床试验设定了原则。
