Psychologically derived non-epileptic attack disorder (PNEAD) : psychosocial influences and psychosocial effects.
Some of the most pressing problems of health care involve the presentation of
physical pathology in the absence of physical disease. Psychogenic non-epileptic
attack disorder (PNEAD) accounts for a small but significant proportion of referrals
to neurologists. Management of this condition is difficult because little is known
about what factors are important in understanding its development and maintenance.
Mismanagement of PNEAD can result in inappropriate use of anti-epileptic drugs
and neglect of psychological needs.
This thesis contains 3 studies. Study 1 examined the psychosocial factors that are
important in understanding the development and maintenance of PNEAD.
Assessments included childhood and adulthood abuse, anxiety and depression,
somatisation, parental overprotection, hypochondriacal concerns and family
dysfunction. One hundred and sixty two patients took part in this study matched for
age and sex between PNEAD and epilepsy groups. PNEAD patients recalled more
childhood and adulthood abuse than epilepsy patients and were more emotionally
distressed. Findings from this study suggest that abuse and family of origin are
involved in the development ofPNEAD.
In study 2, 30 patients with PNEAD were matched by age and gender with an
epilepsy control group. They completed questionnaires at the time of diagnosis and
3 months later measuring impact of condition, illness and symptom beliefs, family
and psychosocial functioning, and satisfaction with consultation. This study
compared PNEAD and epilepsy patients' reaction to the diagnosis of their condition.Before diagnosis there were few significant differences between PNEAD and
epilepsy patients. After diagnosis significant differences emerged between the two
groups. The diagnosis of PNEAD patients, compared with epilepsy patients, was
associated with a greater negative psychological impact. Such findings may reflect
for PNEAD patients the fact that they are not provided with an adequate explanation
for their symptoms and behaviour.
In study 3, 194 patients were matched between PNEAD and epilepsy groups by age
and gender. They had been diagnosed 12-36 months previously. This study
examined factors that may contribute to differences in impact of PNEAD vs epilepsy
by measuring family and psychosocial function, beliefs regarding illness, clinical
characteristics of attacks and satisfaction with the consultation process. Impact of
the condition was greater for PNEAD than epilepsy patients. Factors that helped to
explain such differences included the perceived psychological and physical