Sandra J. Cobb, MSN, FNP-C, RN, REEGT, PhD in nursing candidate, University of Tennessee Knoxville, College of Nursing, Knoxville, TN, USA.
Bradley V. Vaughn, MD, Professor, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
J Am Psychiatr Nurses Assoc. 2023 Jul-Aug;29(4):290-306. doi: 10.1177/10783903221107637. Epub 2022 Jul 7.
Psychogenic nonepileptic seizures (PNES) pose a heavy burden on patients' lives and the health care system. The symptoms of PNES are often debilitating and cause high rates of disability and poor quality of life. Many treatment options are available, but there is no clear consensus on best practices.
To critique and synthesize the current literature on nonpharmacologic interventions and effects on seizure frequency in patients with PNES.
An integrative review guided by the Whittemore and Knafl approach.
The review included 24 studies published from 2010 to 2020. Interventions for PNES included individualized psychotherapies, group therapies, multimodal psychotherapies, self-help therapies, and complementary and alternative medicine therapies. Individual psychotherapies such as cognitive behavioral therapy and psychoeducation were the most used treatment modalities. The most effective treatments for seizure frequency reduction were those that included multiple psychotherapy sessions with a health care provider and covered multiple domains (e.g., understanding of diagnosis, identifying triggers, and developing effective coping strategies).
Seizure frequency can be reduced in patients with PNES with multiple nonpharmacologic interventions. However, seizure frequency is not considered a comprehensive outcome measure and provides little insight into other important life domains. Further research is needed on nonpharmacologic interventions for PNES and effects on other areas of life such as sleep, employment status, global functioning, and self-efficacy.
心因性非癫痫性发作（PNES）给患者的生活和医疗保健系统带来了沉重负担。PNES 的症状常常使人衰弱，并导致高残疾率和生活质量下降。有许多治疗选择，但针对最佳实践方法尚无明确共识。
批判性评价和综合当前关于非药物干预措施以及对 PNES 患者癫痫发作频率影响的文献。
根据 Whittemore 和 Knafl 方法进行的综合评价。
综述纳入了 2010 年至 2020 年发表的 24 项研究。PNES 的干预措施包括个体化心理治疗、团体治疗、多模式心理治疗、自助治疗和补充与替代医学治疗。认知行为疗法和心理教育等个体心理治疗是最常用的治疗方法。对减少癫痫发作频率最有效的治疗方法是那些包括与医疗保健提供者进行多次心理治疗并涵盖多个领域（例如，了解诊断、识别诱因和制定有效的应对策略）的治疗方法。
可以通过多种非药物干预措施降低 PNES 患者的癫痫发作频率。然而，癫痫发作频率并不是一个全面的预后指标，对其他重要生活领域几乎没有深入了解。需要进一步研究针对 PNES 的非药物干预措施及其对睡眠、就业状况、总体功能和自我效能等其他生活领域的影响。
