A Novel Integrative Psychotherapy for Psychogenic Nonepileptic Seizures Based on the Biopsychosocial Model, 2020, Ben-Naim et al

[Andy]

Background
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.

Objective
To To present a within-group posttreatment vs pretreatment study representing the retrospective clinical results of an integrative psychotherapy model. Methods: 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.

Results
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.

Conclusions
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.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0033318220300475
Sci hub, https://sci-hub.tw/10.1016/j.psym.2020.02.006

 

[Hoopoe]

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.

The results do not support claims of effectivenes because the study is of very low quality.

Curiously, most participants have "epileptic seizures" listed as comorbidity. Presumably that means the authors believe they have both organic and psychogenic seizures. Is there a simpler explanation for this than some mysterious psychogenic cause?

 

[rvallee]

Therapy included presenting the diagnosis, psychoeducation, seizure reduction behavioral techniques, and coping with past and present stressors.

That's not therapy. And it's not novel, it's been done dozens of times in various combinations, none of which add up to anything "novel" either. Adding a fake mustache to something does not make it "novel". Pretending that the same tired old nonsense is new is just ridiculous.

 

[Mithriel]

The results do not support claims of effectivenes because the study is of very low quality.

Curiously, most participants have "epileptic seizures" listed as comorbidity. Presumably that means the authors believe they have both organic and psychogenic seizures. Is there a simpler explanation for this than some mysterious psychogenic cause?

Even back when it was called pseudoepilepsy it was commonest among people with documented biological epilepsy. I looked into it at the time and the reason the distinction was made seemed to be that pseudoepileptic seizures did not cause physical harm. One description was that people did not get burned because they missed the cooker. It made me think of ducking witches!

How could they detect a drop in psychogenic seizures if the participants also had epileptic seizures?

Of course, I don't trust their figures because BPS studies so often use awful scales and manipulate the numbers to get the result they want. That may be a fault on my part.