Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome

Objective: To investigate the patterns of occurrence of psychogenic pseudos eizures (PPS) of 45 consecutive patients during a 6-month period after diag nosis, and to determine whether psychiatric and neurologic variables identi fied previously in PPS patient series can predict their recurrence after di agnosis, and whether any of these variables are associated with a particula r outcome pattern. Method: Postdiagnosis PPS recurrence was assessed twice: during the first month and during a period ranging from the second to the sixth month. Outcome was categorized as follows: class I, complete cessatio n of PPS; class II, PPS only during one of the two observation periods; and class III, persistent PPS during the two observation periods. The authors used a logistic regression model to identify predictors of PPS recurrence ( versus no PPS) among four neurologic and nine psychiatric variables, and co mpared their frequency among the three outcome classes. Results: Class I, n = 13 (29%); class II, n = 12 (27%); and class III, n = 20 (44%). The prese nce of an abnormal MR image predicted PPS recurrence during the second obse rvation period with a 75% accuracy. The presence of all nine psychiatric va riables predicted PPS recurrence during both the first and second observati on periods with a 93% and an 89% accuracy respectively. Patients with a cla ss III outcome had a markedly higher frequency of recurrent major depressio n, dissociative and personality disorders, and a history of chronic abuse. Patients with a class II outcome displayed a notably higher frequency of de nial of stressors and psychosocial problems, refusal of treatment recommend ations, and new somatic symptoms after disclosure of diagnosis. Conversely, one episode of major depression was the one common diagnosis in patients w ith a class I outcome. Conclusions: PPS outcome after disclosure of diagnos is can be predicted by the presence of certain psychiatric characteristics. More than one psychopathogenic mechanism appears to operate in PPS.