Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; CHRU de Nancy, Département de Neurologie, Nancy, France.
UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France.
Seizure. 2020 Aug;80:227-233. doi: 10.1016/j.seizure.2020.06.001. Epub 2020 Jun 8.
This study aimed to describe the quality of adherence to mental health care follow-up and the mental health caregiver-patient relationship after diagnosis of psychogenic non-epileptic seizures (PNES).
We conducted an ancillary study of a multicenter prospective study. Patients (n = 108) received a standardized diagnostic explanation of PNES following video-EEG. They were referred to their community mental health centers or to a private psychiatrist/psychologist, who received written information about PNES and the study. Data collected about adherence to care (follow-up started or not, consensual and those who withdrew non-consensually, ongoing follow-up) were cross-tabulated from patients and care structures by telephone at 6, 12, 18 and 24 months after diagnosis. At M24, we collected reasons for stopping follow-up by phone using a predefined 9-item questionnaire. We also assessed the perception of the caregiver-patient relationship among patients who started follow-up and their mental health caregivers with a simple questionnaire based on five dimensions: feeling comfortable, continuity of care, content of therapy sessions, effectiveness of therapy sessions, and the patient's overall assessment of the follow-up.
From M6 to M24, ongoing follow-up decreased from 64.8 to 25.8%, while the "not following initial recommandations" group of patients (those who never started follow-up and those who withdrew non-consensually) increased from 35.2 to 64.9%. We found two main reasons for stopping follow-up: lack of interest and feeling better. Adherent patients had an overall more positive view of their therapy than caregivers.
Only a third of PNES patients adhered to a mental health care program and felt comfortable in the caregiver-patient relationship. Solutions need to be found to help patients understand the interest of follow-up therapy and help mental health caregivers improve their feeling of competence.
本研究旨在描述精神健康护理随访的依从性质量和诊断为心因性非癫痫性发作（PNES）后的精神健康护理人员-患者关系。
我们进行了一项多中心前瞻性研究的辅助研究。患者（n=108）在视频-EEG 后接受了 PNES 的标准化诊断解释。他们被转介到他们的社区心理健康中心或私人精神科医生/心理学家，后者收到了关于 PNES 和研究的书面信息。通过电话在诊断后 6、12、18 和 24 个月收集有关护理依从性（是否开始随访、共识和非共识退出、持续随访）的数据，这些数据由患者和护理结构交叉制表。在 M24，我们使用预定义的 9 项问卷通过电话收集停止随访的原因。我们还通过基于五个维度的简单问卷评估了开始随访的患者及其心理健康护理人员对护理人员-患者关系的看法：舒适感、护理连续性、治疗课程内容、治疗课程效果以及患者对随访的总体评估。
从 M6 到 M24，持续随访从 64.8%降至 25.8%，而“不遵循初始建议”的患者组（从未开始随访和非共识退出的患者）从 35.2%增至 64.9%。我们发现停止随访的两个主要原因是缺乏兴趣和感觉好转。依从性患者对治疗的总体看法比护理人员更积极。
只有三分之一的 PNES 患者坚持心理健康护理计划，并对护理人员-患者关系感到舒适。需要找到解决方案，帮助患者理解随访治疗的兴趣，并帮助心理健康护理人员提高他们的能力感。
