Psychogenetic nonepileptic seizures (PNES), commonly known as nonepileptic attacks are involuntary behaviors, movement or sensation that are similar to epileptic seizures (Schachte & Andres, 2010). However, unlike epileptic seizures, PNES do not exhibit the normal electrical discharge that is largely associated with epilepsy. The origins of nonepileptic seizures are psychological rather than neurological. Usually, patients with PNES are misdiagnosed with epilepsy hence given the wrong treatment. According to Roger (2009), nearly One-fifth of seizure patients who present themselves in various epileptic clinics have psychogenetic nonepileptic seizures.
There are two main classifications of psychogenetic nonepileptic seizures namely psychogenic and physiological seizures (Elaine, 2006). Psychogenic nonepileptic seizures are psychological distresses that are physical in nature. They are grouped under psychological illnesses such as somatization disorder, conversion disorders, and hypochondriasis and psychoses anxiety disorders. Usually, symptoms associated with psychological nonepileptic are neurological in expression but psychiatric in origin.
Physiologic nonepileptic seizures are known to be caused by a number of issues such as complicated migraines, syncopal episodes, ischemic and panic attacks. Others include movement disorders vestibular symptoms, Dysautonomia, and effects of toxins or drugs (Hallett, and Cloninger, 2006).
Benefits Associated with Group Therapy Approach
There are a number of benefits a PNES patient delivers from group therapy approach. First and foremost is the improvement in seizure frequency of patients (Schachte and Andres, 2010). About 80% of patients who receive treatment in inpatient medical wards register significant improvement in their seizure rates. Research shows that about three-quarters of patients diagnosed with PNES have seizures up to their fourth year from the time of diagnosis. However, the good news is that almost half of such patients are on social security program.
On the other hand, patients in group therapy are likely to have a good group experience that can easily improve their health (Oxford University Press, 2012). For instance, group experience have been known to play a crucial role in normalizing problems, instilling hope, providing a forum for information dissemination and being a platform for new social networks.
Individual patients in group therapy have their own personal experience that is very significant in the recovery process. One such experience is the ability of patients to accept themselves (Yu-Tza, 2012). Others include interpersonal issues that are likely to provoke events related to seizure, sharing of psychosocial learning strategies and increase in psychological instigators that can promote activities related to seizure.
It is unanimously accepted that all group members must attain18 years and above and should possess the cognitive ability of providing informed consent. All members must also have EEGs or confirmatory video where the current situation of the member is diagnosed and confirmed by qualified epileptologist (Fisher &Peter, 2006). Other conditions that must be fulfilled by group members include showing the history of compliance to other therapeutic measures, ability to meet financial needs of the group and willingness to attend all group meetings. It is mandatory for each member of the group to attend at least one individual intake session and a final session at the completion of the therapy process.
Issues to be Addressed and Evidence-Based Therapy
The psychodynamic approach was used in the group intervention. Members were required to conceptualize seizure episodes as an expression of their emotional distress. Generally, the overall goal of the groups were to develop conscious and building the emotional distress of members. In this case, appropriate coping strategies were emphasized where members were encouraged to practice passive avoidance behavior as well as assert their aggressive feelings in the wake of seizures. A platform was also provided where members were allowed to discuss recent events that resulted to onset of seizures. The groups were expected to confront and share their experience. Each member of the group identified and addressed secondary and primary symptoms that are associated with seizure. Members were also encouraged to form a support network when outside their groups to discuss events that occurred in between sessions. The same issues were revisited during normal group sessions.
PNES Events During Group Therapy Activities
Nonepileptic seizures were not allowed to interfere with the normal activities of the group. In case a member was attacked by the seizures, normal sessions were allowed to continue as the co-leaders assisted the patient relax and acquire self-hypnosis (Holsman, 2009). Such event provided a good forum of discussing precipitating psychological issue related to PNES patients. Later the group members used the gained insight in applying to their own life events and those of others.
The group designed a treatment plan of 32-weeks. Members held weekly group session in which certain days were allocated for a particular activity. For instance; Thursday was a reflection day in which members took the time to reflect previous events. Sessions took a maximum of one hour and thirty minutes. Usually, the first 5 minutes were allowed for members to check in while the last 5 minutes were used to recap what had already been taught.
Patients were allowed to engage their insurance, Medicare and Medicaid for payment of their medical bills. The members were subjected to previous financial documentation which includes current pay stub, and tax returns. The highest cost was $ 75 while the lowest cost was $15.
Rules followed during Group Therapy:
- Confidentially is very important for any group activity (Yu-Tza, 2012). Members pledged to attend the meeting for at least a minimum of four days.
- Absenteeism was avoided by all means, and in case a member was to miss a particular session, he or she was supposed to report the issue to the close friend or police.
- Other rules include mutual respects, being aware of once own feelings, avoiding discussing other group members who are not at the meeting.
Several alternative treatments were used for PSES. The first alternative is based on individual therapy, which may include relaxation, medication, cognitive Behavioural therapy and dialectical behavior therapy.
Behavioral Health Prevention Plan
This was designed to enable PNES program to achieve its vision and mission. It involved all stakeholders including the PNES patients, therapists, paraprofessionals, government, public health officers and other community agencies. The plan outlined the roles and responsibilities of every stakeholder as well as defined the psychological and behavioral barriers that prevent modification of behaviors and prevention of diseases among patients. Finally, the plan suggested the recommendations necessary for disease control and behavior modification.
Measuring Goals and Treatment
Finally, it is important to measure whether the goals and treatment process was worthy to patients and other stakeholders involved. This is a crucial stage as it provides the reality on the ground. Members were allowed to participate in providing the outcome of all activities that took place during group therapy sessions. Some of the equipment used in the measurement of such outcomes includes symptom checklist-90, Beck depression inventory and the patient diary seizure frequency. Finally, members were allowed to share their experience on issues related to Anxiety.
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Hallett M,Cloninger, M.C. (2006).Psychogenic Movement Disorders: Neurology and Neuropsychiatry
Holsman, M., (2009). Symptom Validity Testing, Associated Seizure-like Semiology, and Personality Profiles Among Patients with Psychogenic Non-epileptic Seizures. London, ProQuest.
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