Presentation on theme: "Neuropsychology and PNES Robert W. Trobliger, Ph.D. Co-Director Neuropsychology Northeast Regional Epilepsy Group."— Presentation transcript:
Neuropsychology and PNES Robert W. Trobliger, Ph.D. Co-Director Neuropsychology Northeast Regional Epilepsy Group
PNES: Psychogenic Non-epileptic Seizures paroxysmal behavioral events without cerebrum-based electroencephalogram (EEG) changes, associated with a psychological rather than a physiological etiology. Zaroff, Myers, Barr, Luciano, & Devinsky, 2004
The Interview A safe place, maybe one of the first opportunities to bring up prior stressors and trauma. Which indicates how important it is for the provider to make it a safe place, to acclimiate the client to an atmosphere of trust- critical in therapy.
Comprehensive review of history – developmental, medical, psychological, educational, even vocational.
The Interview An opportunity to explore developmental and medical history – factors which might contribute to issues with cognitive functioning (which is assessed in NP testing).
The interview An opportunity to explore psychological history, including prior diagnoses and treatment.
The interview Particularly any history of abuse (physical emotional or sexual) or trauma.
The interview Stressors may initially be downplayed or not even mentioned during the interview However, signs of such may come out in completed quesitonnaires.
The Interview Educational and employment history helps determine prior levels of functioning for comparison.
The Interview -Because when patients talk about changes in cognitive functioning, we need to determine where they were before.
The Evaluation NP Testing – Psychological Examining Mood (depression, anger, fear) symptoms Anxiety (including PTSD) Coping tendencies Ability to identify and articulate emotions
NP Testing – Psychological An examination of symptoms is important in determing a diagnosis.
All of these questionnaires provide a lot of data, predominantly in the form of indices that demonstrate patterns – patterns which may be significant in that they are outside the norm.
NP Testing – Psychological More than just examining index findings – at times looking at specific answers.
Which again is part of being comprehensive in examining findings.
Because understanding how you feel is in important step in understanding why you feel a certain way.
Which in turn is related to understanding how to cope with these emotions and related difficulties.
NP Testing – psychological Coping tendencies can be ineffective or maladaptive.
Which can account at least in part for why these seizures are occuring.
The Evaluation NP Testing – Psychological Strategies can be practical expressive avoidant All are done by all of us.
However, for some, there is a need for help in developing practical strategies for coping with overwhelming stressors.
NP Testing- Psychological This is an important part of testing – to identify how the person deals with stressors, as the person may not be completely aware of such.
NP Testing – Psychological Examing coping strategies is also helpful for any therapist working with the person in determining what strategies need practice.
NP Testing The findings are useful not only at present but also for the future.
NP Testing Psychological Can be particualry important in setting up a baseline before treatment. Certainly a decrease or the absence of seizures as reported by the patient is an important barometer.
NP Testing Psychological But using pre and post testing measures is another means of describing real change in the person. Numbers and data can be helpful in marking the changes.
NP Testing Cognitive Reported difficulties typically involve problems with attention and memory, similar to those with epileptic seizures.
NP Testing – Cognitive Exploring these defictis helps underline the seriousness of the condtion.
NP Testing – Cognitive Such testing results are also supportive to the diagnosis – as deficits than cannot be accounted for by underyling organic issues (developmental history, prior TBI, ongoing chronic medical issues such as migraines, hypertension) can be attributed to PNES.
NP Testing – Cognitive Which gets back to the prior idea of hope. If the problems with attention and memory have no underlying organic causes, then changes in psychological functioning should result in changes in cognitive functioning.
NP Testing – Cognitive Results combined with the person's complaints can be used to generate recommendations
Recommendations of real, practical strategies the person can use from day one in working around their difficulties.
The Feedback An opportunity to go over the results of all the above testing.
NP Testing – Cognitive An opportunity to examine a person's strengths and weaknesses.
NP Testing – Cognitive An opportunity to examine any possible discrepancies between performances on the evaluation and the types of complaints the person has.
NP Testing – Cognitive As noted, an opportunity to discuss strategies for dealing with any experienced difficulties.
NP Testing – Psychological An opportunity to discuss how the diagnosis is confirmed (or not).
NP Testing – Psychological An opportunity to discuss the diagnosis (What does this mean?) And The prognosis (what now?)
NP Testing – Psychological An opportunity to discuss how the diagnosis was determined – based on the findings. An opportunity to discuss those findings in detail