Catastrophising and repetitive negative thinking tendencies in patients with psychogenic non-epileptic seizures or epilepsy

[Expectations and expectancies as a core principle in functional somatic symptoms: Evidence and clinical implications]

Expectation and expectancies play a central role in current etiological models of functional somatic symptoms and their clinical manifestations as functional disorders, bodily distress disorder and somatic symptom disorder. Their effects have been shown with respect to symptom development, symptom persistence and treatment outcomes. Handling expectations and expectancies is therefore an important task in their prevention and management, from primary care to psychotherapy. This review presents current evidence concerning the role of expectation and expectancies in the etiology and maintenance of functional somatic symptoms, and how to address them in transdisciplinary treatment.

Evaluation of the relationships between psychiatric comorbidity and seizure semiology in psychogenic non-epileptic seizure patients

Psychogenic non-epileptic seizures (PNES) are episodic events that bear a resemblance to epileptic seizures (ES) in their outward manifestations, yet they lack pathological electroencephalographic (EEG) activity during the ictal phase. In the Diagnostic and Statistical Manual 5th Edition (DSM-5), PNES is designated as "Functional Neurological Symptom Disorder with seizures". Individuals diagnosed with PNES commonly present with concurrent psychiatric disorders, notably depression, panic disorder, and chronic anxiety. This phenomenon renders PNES a shared affliction within the domains of neurology and psychiatry, thereby mandating the implementation of diverse therapeutic approaches in the management of the condition. Indeed, identifying the presence of concurrent psychiatric disorders in a patient with PNES during the early stages is crucial for devising an appropriate treatment plan. In this study, an assessment was conducted to examine the correlation between PNES semiology and psychiatric disorder comorbidity, to elucidate whether semiological characteristics serve as predictors for the presence of comorbid psychiatric disorders. The PNES patients enrolled were divided into two subgroups based on the presence or absence of accompanying psychiatric disorders (onlyPNES and PNES+). The study assessed disparities in semiological characteristics between the two subgroups of PNES and the results obtained indicate that individual variations in semiotic features are not influenced by the presence of psychiatric comorbidity.

Co-rumination and intrapersonal cognitive processes predict distress: Longitudinal evidence from the COVID-19 pandemic

Perseverative thinking and catastrophizing have well established associations with fear and distress. However, less is known about the impact of interpersonal dynamics, such as co-rumination, on these intrapersonal cognitive processes and subsequent stress. The present study addresses this knowledge gap. A sample of 433 adults from across the United States was recruited online and completed measures of co-rumination, perseverative thinking, catastrophizing, and demographic characteristics early in the COVID-19 pandemic, and the COVID Stress Scales (CSS) at six month follow up. Co-rumination, perseverative thinking, catastrophizing, and CSS scores were correlated in the expected direction. Regression analyses revealed all three independently predicted CSS worry about the dangerousness of COVID-19 subscale. Co-rumination was the strongest predictor of CSS worry about the socioeconomic impact and CSS compulsive checking scales. Perseverative thinking and catastrophizing predicted CSS traumatic stress symptoms subscale. Finally, perseverative thinking was the strongest predictor of CSS xenophobia subscale. Structural equation modelling indicated that co-rumination had a significant indirect effect on CSS scores through perseverative thinking and catastrophizing. Interpersonal dynamics, such as co-rumination, are relevant for understanding stress and are promising targets for intervention research to prevent or attenuate fears and distress, in addition to traditional intrapersonal cognitive processes such as perseverative thinking and catastrophizing.

Characterisation of psychological and neurocognitive processes accompanying functional seizures

OBJECTIVES

To examine the relationship between clinical, psychological, and cognitive characteristics of adults with functional seizures.

METHODS

This study describes baseline characteristics of one-hundred and seven participants with a documented diagnosis of functional seizures recruited to the Re-PROGRAM randomised controlled trial. Participants completed a semi-structured interview, neuropsychological assessment, and questionnaire measures via Telehealth.

RESULTS

Participants reported low levels of trust in body sensations, high levels of negative ruminative thinking, dissociation, somatisation, anxiety, depression, severe levels of functional impairment, and poor quality of life. At a group level, they had normal neurocognitive function, including mental control, processing speed, attention, and executive function. Anxiety (73%), depression (68%), post-traumatic stress disorder (49%), migraine (63%) and chronic pain (52%) were common comorbidities. Forty-three percent reported a family history of dementia. Somatic symptoms were associated with depression, anxiety, dissociation, ruminative negative thinking, and lower scores on the 'Not-distracting' interoception scale. Poorer psychosocial functioning was associated with depression and dissociation. Reduced mental quality of life was associated with higher levels of depression, anxiety, dissociation, ruminative negative thinking, and lower scores on the 'Trusting' interoception scale. There were no associations between the clinical or psychological variables and seizure frequency or seizure classification. Neither cognitive impairment nor failure on effort testing were associated with the clinical or psychological factors, quality of life or psychosocial functioning.

SIGNIFICANCE

This study highlights the burden of psychiatric and physical comorbidity; and the relationship between psychological factors and functional impairment in a large cohort of patients with functional seizures despite normal cognitive function.

Characteristics and outcomes of youth with functional seizures attending intensive interdisciplinary pain treatment

Functional seizures (FS) can be debilitating and negatively impact quality of life. Yet intervention research for FS is limited, especially for youth. This study examined clinical characteristics and outcomes of youth with FS (13-23 years) presenting to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States. Sixty youth (mean age = 16.5 years; 83.3 % female) met inclusion criteria. At intake, comorbid chronic pain, somatic symptoms, autonomic dysfunction, eating and weight disturbances, and mental health concerns were common. Despite this high symptom burden, youth with FS reported significant improvements in functioning measured with the Functional Disability Inventory, t(53) = 9.80, p <.001, d = 1.32; depression measured with the Center for Epidemiological Studies - Depression Scale for Children, t(53) = 6.76, p <.001, d = 0.91; anxiety measured with the Spence Children's Anxiety Scale, t(53) = 3.97, p < .001, d = 0.53; and catastrophizing measured with the Pain Catastrophizing Scale for Children, t(53) = 6.44, p <.001, d = 0.86, following completion of the program, suggesting that IIPT may be an effective treatment option for highly disabled and emotionally distressed youth with FS. Future research is needed to continue to refine best practices for youth with FS to reduce suffering and improve outcomes.

Differentiating between epileptic and functional/dissociative seizures using semantic content analysis of transcripts of routine clinic consultations

The common causes of Transient Loss of Consciousness (TLOC) are syncope, epilepsy, and functional/dissociative seizures (FDS). Simple, questionnaire-based decision-making tools for non-specialists who may have to deal with TLOC (such as clinicians working in primary or emergency care) reliably differentiate between patients who have experienced syncope and those who have had one or more seizures but are more limited in their ability to differentiate between epileptic seizures and FDS. Previous conversation analysis research has demonstrated that qualitative expert analysis of how people talk to clinicians about their seizures can help distinguish between these two TLOC causes. This paper investigates whether automated language analysis - using semantic categories measured by the Linguistic Inquiry and Word Count (LIWC) toolkit - can contribute to the distinction between epilepsy and FDS. Using patient-only talk manually transcribed from recordings of 58 routine doctor-patient clinic interactions, we compared the word frequencies for 21 semantic categories and explored the predictive performance of these categories using 5 different machine learning algorithms. Machine learning algorithms trained using the chosen semantic categories and leave-one-out cross-validation were able to predict the diagnosis with an accuracy of up to 81%. The results of this proof of principle study suggest that the analysis of semantic variables in seizure descriptions could improve clinical decision tools for patients presenting with TLOC.

Performance of the GAD-7 in adults with dissociative seizures

PURPOSE

Little is known about the accuracy of the GAD-7, a self-report anxiety measure, in detecting generalised anxiety disorder (GAD) in people with dissociative seizures (DS). We evaluated the reliability, validity and uniformity of the GAD-7 using a diagnosis of GAD on the Mini-International Neuropsychiatric Interview as a reference.

METHODS

We assessed 368 adults with DS at the pre-randomisation phase of the CODES trial. Factor analysis for categorical data assessed GAD-7 uniformity. Diagnostic accuracy was assessed by estimating the area under the curve (AUC). We evaluated discriminant validity, reviewed data on convergent validity and calculated internal consistency. We explored correlations between GAD-7 scores and monthly DS frequency, frequency of severe seizures and measures of behavioural and emotional avoidance.

RESULTS

Internal consistency of the GAD-7 was high (α = 0.92). Factor analysis elicited one main factor and general measurement invariance. Diagnostic accuracy was fair (AUC = 0.72) but the best balance of sensitivity and specificity occurred at a cut-off of ≥12 and still had a specificity rate of only 68%. Discriminant and convergent validity were good. GAD-7 scores correlated positively with DS frequency, severe seizure frequency, behavioural and emotional avoidance (all p < 0.001).

CONCLUSION

Findings regarding internal consistency and factor structure parallel previous psychometric evaluations of the GAD-7. Correlations between GAD-7 scores and DS occurrence/severity and avoidance are evidence of the concept validity of GAD-7 and provide further support for a fear-avoidance treatment model for DS. However, the utility of the GAD-7 as a diagnostic instrument for generalised anxiety disorder is limited in patients with DS.