Psychological trauma due to illness may trigger psychogenic nonepileptic attacks

Psychological trauma related to ill health may be an important trigger for psychogenic nonepileptic attacks (PNEAs) in a subset of patients, according to a recent study.The UK study was designed to investigate differences between groups of patients with early and late onset PNEAs. The study included 267 patients who presented to the investigators' clinic for evaluation and management; 241 patients experienced early-onset PNEA (occurring before 55 years of age) and 26 patients experienced late-onset PNEA (occurring after 55 years of age). Sociodemographic variables, predisposing factors, clinical semiology, and medical and psychiatric background were examined in all patients.Physical health problems occurred more often in late-onset patients compared to early-onset patients, and patients in the late-onset group were around eight times more likely to have severe health problems than those in the early-onset group. Although a similar proportion of patients in each group reported previous traumatic experiences other than abuse, more patients with late-onset PNEA reported health-related traumatic experiences (47%) compared to early-onset patients (4%). In contrast, significantly more patients in the early-onset group (32%) reported antecedent sexual abuse compared to the late-onset group (4%). The authors suggest, "These findings support the hypothesis of a basic difference between our two subpopulations, quite apart from the striking difference we found in rates of physical ill-health."The authors acknowledge that physical illness rates would be expected to be higher in the older subset of patients than in the younger subset. However, they suggest that age at onset acted as a surrogate to select a population of PNEA patients in which anxiety related to ill health was a prominent factor. Since completing the study, the authors have identified a further four patients with a history of life-threatening physical illness where health-related anxiety appears to have played a prominent part in the development of the attacks. These patients were younger than 55 years of age, with the earliest onset of attacks occurring at 42 years in a patient with a severe cardiomyopathy.Reference...