Psychogenic nonepileptic seizures in youth warrant ‘repeated psychiatric assessment’

Youth with psychogenic nonepileptic seizures experienced an increased risk for numerous psychiatric disorders compared with those with epilepsy and healthy controls, according to results of a nationwide matched cohort study.

Researchers emphasized the importance of “a careful psychiatric evaluation” for enhancing and individualizing treatment among those with psychogenic nonepileptic seizures (PNES).

“Previous research has suggested that emotional disorders and adjustment disorders are common in children and adolescents with PNES; however, recent studies indicate an occurrence of a wider spectrum of psychiatric disorders, including neurodevelopmental disorders,” Anne Sofie Hansen, MD, of the departments of psychiatry and clinical medicine at Aalborg University Hospital in Denmark, and colleagues wrote in Neurology. “At present, existing studies mainly comprise adult or small pediatric populations recruited from highly specialized treatment units with no large-scale population-based studies addressing the full range of psychiatric disorders in children and adolescents diagnosed with PNES. Thus, the full range of psychiatric disorders present in children and adolescents with PNES is inadequately described, and further knowledge is needed to qualify multidisciplinary management.”

In the current study, the researchers sought to determine the spectrum of and risk for psychiatric disorders in childhood-onset PNES. They analyzed data from 384 children and adolescents with validated PNES, 1,152 with epilepsy and 1,920 with neither, termed healthy controls, all of whom were aged 5 to 17 years at time of diagnosis, between January 1996 and December 2014. Prevalent psychiatric disorder before index, defined as date of diagnosis or corresponding date for healthy controls, and incident psychiatric disorder 2 years after index served as outcomes. The researchers calculated RRs and adjusted them for potential confounders.

Results showed prevalent psychiatric disorders among 39.8% (n = 153) and incident psychiatric disorders among 39.1% (n = 150) of children and adolescents with PNES. Those with PNES experienced an increased risk for any psychiatric disorder for both prevalent and incident diagnoses compared with those with epilepsy and healthy controls. Numerous specific psychiatric disorders had elevated RRs, with adjustment disorders (17.5%), somatic symptom and related disorders (12.5%), neurodevelopmental disorders (11.5%), emotional disorders (10.7%) and intellectual disabilities (6.8%) being the most frequent prevalent psychiatric disorders among those with PNES. The most common incident disorders among those with PNES included adjustment disorders (12.5%), emotional disorders (9.9%), somatic symptom disorders (9.1%), psychotic disorders (7.4%) and neurodevelopmental disorders (6.5%).

“This study provides evidence that childhood-onset PNES is associated with a wide spectrum of psychiatric disorders, underscoring the need for a careful psychiatric assessment to optimize and individualize the treatment plan,” Hansen and colleagues wrote. “The high risk [for] psychiatric disorders following the PNES diagnosis indicates a need for systematic follow-up with a repeated psychiatric assessment to ensure continued suitability of the provided treatment.”