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The aetiology of psychogenic non-epileptic seizures: risk factors and comorbidities Volume 21, numéro 6, December 2019

TEST YOURSELF

(1) Which statement regarding the prevalence of psychogenic non-epileptic seizures (PNES) is correct?

A. PNES is diagnosed in over 20% of patients referred to epilepsy units with apparently refractory epilepsy.

B. PNES account for less than 1% of convulsive seizures that present to emergency departments.

C. PNES that look like syncope (“pseudosyncope”) are found in about 50% of patients with recurrent syncope of unknown cause.

D. Over 50% of patients with PNES have additional epilepsy.

 

(2) Which statement regarding PNES and psychological trauma is correct?

A. Psychological traumatization through abuse or stressful life events is very common amongst patients with PNES.

B. Childhood trauma can have both biological and psychosocial long-term effects that predispose to PNES.

C. Although it is common, psychological trauma is not always found in all patients with PNES.

D. All of the above are true.

E. None of the above are true.

 

(3) In cases when a previous epilepsy diagnosis is revised to PNES,

A. antiepileptic medication should be continued in case additional epilepsy was missed.

B. antiepileptic medication should be continued in order to reassure the patient.

C. antiepileptic medication should be withdrawn because it is ineffective and can cause harm.

D. antiepileptic medication should be changed to a substance with mood-stabilizing effect (e.g. valproic acid or lamotrigine).

 

(4) PNES occurring in the context of post-traumatic stress disorder (PTSD)

A. Confirm the diagnosis; PNES exclusively occur in the context of PTSD.

B. Contradict the PTSD diagnosis because the two diagnoses are mutually exclusive.

C. Always involve so-called “flashback” experiences relating to the trauma.

D. Can be alleviated through PTSD-specific treatment approaches.

 

(5) The following feature(s) can be found in both borderline personality disorder patients and in patients with PNES:

A. Emotion dysregulation.

B. High rates of childhood trauma.

C. Unstable interpersonal relationships.

D. All of the above.

 

(6) Which one of the following statements regarding the comorbidity of epilepsy and PNES is true?

A. Epilepsy and PNES usually start at the same time.

B. Epilepsy almost always precedes the onset of PNES.

C. PNES invariably start only once epilepsy has resolved through medication or surgery.

D. In patients that have both PNES and epileptic seizures it is always easy to differentiate the two.

 

(7) A history of mild traumatic brain injury in patients with seizures

A. suggests that seizures are most likely epileptic.

B. is relatively common in patients with PNES.

C. is always pathophysiologically irrelevant.

D. is always indicative of deep psychological traumatization associated with the injury.

 

(8) Which of the following comorbidies is not particularly common in patients with PNES?

A. Cancer.

B. Migraine.

C. Sleep disturbances.

D. Epilepsy.

 

(9) Which statement regarding cognitive complaints in patients with PNES is correct?

A. Cognitive complaints are usually the result of reduced effort or malingering.

B. PNES patients almost always have some degree of intellectual disability.

C. Cognitive problems are often due to attentional dysfunction.

D. Dissociative amnesia is very common amongst patients with PNES.

 

(10) Careful assessment of risk factors and comorbidities serves primarily to:

A. Conclusively diagnose seizures as either PNES or epilepsy.

B. Devise individual treatment plans.

C. Refer patients to another, more relevant specialty.

D. Prove to the patient that there is no “organic” disease.

 

 

 

 

 

 

 

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Answers

(1) A.

 

(2) D.

 

(3) C.

 

(4) D.

 

(5) D.

 

(6) B.

 

(7) B.

 

(8) A.

 

(9) C.

 

(10) B.

 

 

 

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