Long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures

Epilepsia. 2018 Jan;59(1):e18-e22. doi: 10.1111/epi.13969. Epub 2017 Dec 7.


We conducted a prospective cohort study, examining long-term adherence with psychiatric treatment among patients with psychogenic nonepileptic seizures (PNES). Subjects diagnosed with documented PNES were scheduled for 4 psychiatric visits. Survival analysis was performed, and covariates were assessed for association with time to nonadherence using Cox proportional hazard regression analysis. One hundred twenty-three subjects were recruited and followed for up to 17 months. Eighty percent of subjects attended the first outpatient visit, 42% attended the second, 24% attended the third, and only 14% remained adherent through the fourth visit. Two covariates were associated with nonadherence: (1) a prior diagnosis of PNES (hazard ratio 1.57, P-value .046); (2) a lower score on the Brief Illness Perception Questionnaire (BIPQ), signifying lower concern about one's illness (hazard ratio 0.77 for every 10-point increment on the 80-point scale, P-value .008). Adherence with psychiatric treatment among patients with PNES is initially reasonably good but worsens rapidly over visits 2-4. Risk factors for nonadherence include a history of a prior diagnosis of PNES, and a lower level of concern about the illness as assessed by a lower score on the BIPQ.

Keywords: PNES; compliance; conversion disorder; functional neurological symptom disorder; nonepileptic attack disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Electroencephalography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance / psychology*
  • Psychophysiologic Disorders* / complications
  • Psychophysiologic Disorders* / rehabilitation
  • Psychotherapy / instrumentation
  • Psychotherapy / methods*
  • Seizures* / complications
  • Seizures* / psychology
  • Seizures* / rehabilitation
  • Treatment Outcome
  • Young Adult