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.