Personality disorders in dysthymia and major depression.

OBJECTIVE: The purpose of the present study was to investigate the comorbidity of personality disorders in patients with primary dysthymia compared to those with episodic major depression. METHOD: A total of 177 out-patients with primary dysthymia and 187 outpatients with episodic major depression were administered a structured diagnostic interview for DSM-III-R Axis II disorders. In addition, all of these patients completed the BDI, and those with the appropriate level of education also completed the Minnesota Multiphasic Personality Inventory (MMPI). RESULTS: A significantly higher proportion of dysthymic patients than patients with major depression met the criteria for a personality disorder, for borderline, histrionic, avoidant, dependent, self-defeating types and for personality disorders of clusters B and C. Further analysis revealed that the above differences were mainly due to the subgroup of patients with 'early-onset dysthymia'. Finally, patients with a personality disorder, both dysthymics and those with major depression, had significantly higher scores on the BDI and on the majority of the MMPI scales compared to those without a personality disorder. CONCLUSION: The data indicated that (i) dysthymia--mainly that of early onset--is associated with significantly higher personality disorder comorbidity than episodic major depression, and (ii) the presence of a personality disorder is related to more severe overall psychopathology.     

Presurgical adjustment in male transsexuals with and without hormonal treatment

The effects on hormonal treatment on the adjustment of adult males requesting sex reassignment surgery were examined in two studies. In study 1, the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 19 patients who received no hormonal therapy and 22 patients who received 12 or more months of estrogen and medroxyprogesterone acetate treatment were compared. Patients receiving hormonal therapy not only showed significantly less psychopathology, but their scores on MMPI scales indicating neurotic and study 2, using correlational techniques to assess the effects of both hormonal treatment and cross-dressing on psychopathology. Length of hormonal treatment was related to emotional adjustment on four clinical scales of the MMPI. Scores indicating greater adjustment were associated with longer periods of treatment. Length of full-time cross-dressing, on the other hand, was not associated with patients' level of adjustment. These findings have important implications for those involved in personality evaluation of transsexuals and for future research. A more rigorous criteria for psychopathology may be required for those persons already exposed to hormonal therapy. It if further suggested that personality research with presurgical transsexuals include a drug hormone history.     

Trait versus state aspects of the MMPI during the early course of schizophrenia.

Scores on the Minnesota Multiphasic Personality Inventory (MMPI)-168 item version were examined during periods of clinical remission and of psychosis for recent-onset schizophrenia patients (n = 19) and at comparable time intervals for demographically matched normal participants (n = 19). To determine diagnostic specificity, MMPIs for participants with bipolar affective disorder in remission (n = 12) were also examined. Methods for distinguishing between stable vulnerability indicators, mediating vulnerability factors and episode indicators of psychopathology were adapted from Nuechterlein and Dawson (1984). MMPI scales Pa, Sc and validity scale F showed a combination of trait and state qualities, characteristic of mediating vulnerability factors. These scales reflect changes that occur during psychotic episodes but also apparently tap personality characteristics that endure into periods of clinical remission. Unexpectedly, some MMPI scales that are not typically associated with psychotic disorders (i.e. Hs, D, and Hy) were significantly higher in schizophrenia patients across psychotic and clinically remitted states than in normal participants. In clinical remission, higher scores on scales Hs, D and Hy, showed some specificity to schizophrenia relative to bipolar disorder. While MMPI-168 scales Pd and Pt fit the pattern for vulnerability indicators, it was uncertain whether they belonged to the 'stable' versus 'mediating' subtype. MMPI scores that continue to be higher in remission than in a normal sample may reflect either enduring vulnerability factors or the impact of schizophrenia and the individuals' attempts to cope with the disorder. Studies of first-degree relatives will be needed to provide converging evidence that certain personality characteristics reflect genetic predisposition to schizophrenia.     

Psychopathologie et répercussions de la douleur chronique : conséquences pour la pratique clinique et recommandations thérapeutiques

Objectives

The first aim of this paper was to analyze the Minnesota Multiphasic Personality Inventory (MMPI)-2 profiles of chronic pain patients using a hierarchical cluster method, in order to find subgroups of patients with differing psychopathological profiles and then to assess variations in the intensity and repercussions of pain among the subgroups. The Visual Analogue Scale (VAS) is a measurement technique commonly used in the assessment of intensity and repercussions of pain in chronic pain patients. The second aim was to examine the relationship between VAS measures of repercussions and scale scores on the MMPI-2. The final goal was to give recommendations to improve therapeutic decision-making for each patient. The best-known classification, the P.A.I.N. cluster typology, is based on the first version of the Minnesota Multiphasic Personality Inventory (MMPI). Keller and Butcher reviewed the data on patients with chronic pain obtained from the first version of the MMPI. In the same publication, they used a hierarchical cluster analysis, basing their process of agglomeration on the MMPI clinical scales of the second version (MMPI-2) to classify the patients into different groups whose members shared characteristics on the MMPI clinical scales. In Table 1, we have summarized and classified cluster labels used in the literature with the MMPI-2 since Keller and Butcher's MMPI-2 work.

Patients and methods

Patients (148) went into hospital for a one-day assessment. The assessment included the validated French version of the MMPI-2 and Visual Analogue Scale for pain intensity and repercussions. The local ethics committee approved this study, conducted in agreement with the declaration of Helsinki. We used a hierarchical cluster method to establish subgroups of patients with different psychopathological profiles and evaluated variations between the subgroups on measures of intensity and repercussions of pain.

Results

Figs. 1 to 2 show scale profiles for three- and four-cluster hierarchical analyses. A three-cluster solution best fitted the data (Fig. 1 and Table 2). The three clusters, which were of approximately equal size, were: (1) “Within Normal Limits”; (2) “Conversion-V”; and (3) “General Elevation”. We found significant differences between the “General Elevation” and “Within Normal Limits” clusters on the VAS measures of activity, sadness and depression. The only significant difference between the “Within Normal Limits” and “Conversion-V” clusters was on the activity scale. Patients in the “General Elevation” cluster were in the most urgent need of psychiatric help – it could be called a high distress, high disturbance cluster as Baker has described it. The four-cluster analysis of the MMPI-2 clinical scales (Fig. 2 and Table 2) gave four patterns showing the same “Conversion-V” and “Within Normal Limits”, but the “General Elevation” divided into a “Hypochondriac Depressive” cluster with 2-D scale elevated but with 1-Hs at the same level as the depressive scale, and the rest of “General Elevation” cluster could be split in a five-cluster solution into two very small subgroups, a “Psychotic V” cluster with a true V-shaped psychotic pattern with scores above those of the V-shaped neurotic triad scales, and a “Depressive General Elevation” cluster where the 2-D scale was the highest score in the profile but with all other scales also elevated except 9-Ma

Conclusions

These results showed that, firstly, different profiles of psychopathology were found even though there were no significant differences between the clusters in the level of pain intensity and pain duration; secondly, patients reporting more repercussions on the VAS measures showed profiles with more psychopathology. They were the patients most in need of psychological treatment. Finally, these results and the recommendations given could improve the therapeutic decision for each patient's subgroup.     

Relationship between semiology of psychogenic nonepileptic seizures and Minnesota Multiphasic Personality Inventory profile

Subtypes of psychogenic nonepileptic seizures (PNES) have emerged via classification of seizure semiology, psychological variables, or both. PNES subtypes that differ with respect to etiology may be amenable to targeted treatment strategies. The aim of the present study was to investigate the relationship between semiology type and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profile among patients with PNES. We did so by modifying a classification scheme proposed by Selwa et al. Our main hypothesis was that there would be significant associations of semiology-based subtypes with psychological profiles among patients with PNES. We found significant differences in mean scores on MMPI-2 clinical scales 1 (Hypochondriasis) and 3 (Hysteria) and Harris-Lingoes subscales D5 (Brooding) and Sc5 (Lack of Ego Mastery, Defective Inhibition) across PNES subtypes (catatonic, minor motor, major motor). The results of the present study enhance understanding of the nosology of PNES by identifying psychopathological correlates of semiology-based subtypes of PNES. Our study also may inform the methodology of future investigations of psychopathology among patients with PNES by providing support for content-based interpretation of the MMPI.     

Psychopathologies in patients with nonepileptic seizures with and without comorbid epilepsy: how different are they?

The underlying psychopathology in patients with nonepileptic seizures (NES) is diverse and poorly understood. The prevalence of epilepsy in NES patients is higher than in the general population, so epilepsy can be understood as a risk factor for NES. The question emerges if psychopathology differs in NES patients with and without epilepsy. Retrospective data concerning psychopathology and personality in both groups show two differences: (1) somatoform disorders are more prevalent in NES-only patients and (2) personality disorders are more typical in NES patients with epilepsy and resemble the pattern of psychopathology found in epilepsy-only patients. If true, then NES in epilepsy patients may be associated with an epilepsy condition. Consequently, in studies of psychopathology in epilepsy patients, patients with comorbid nonepileptic seizures have to be included.     

Dexamethasone suppression test and MMPI scales

In 42 major depressive inpatients, we analyzed the relationship between dexamethasone suppression test (DST) results and Minnesota Multiphasic Personality Inventory (MMPI) scales. Cortisol levels following DST were positively correlated with the depression as well as the social introversion MMPI scale scores, and negatively correlated with the hypomania scale scores. DST nonsuppressor depressives (n = 15) exhibited significantly higher scores on the social introversion scale and significantly lower scores on the hypomania subscale than DST suppressors (n = 27). Moreover, stepwise discriminant analysis using the hypomania score was able to correctly classify 71% of the sample according to DST dichotomy, whereas the association of other scales did not significantly improve the classification. Therefore, these results support a relationship between DST and depressive/manic psychopathology rather than anxious psychopathology.     

Patients with coexistent psychogenic pseudoepileptic and epileptic seizures: a psychological profile

Despite significant advances in epileptology, the differential diagnosis of epileptic and pseudoepileptic seizures continues to be a considerable challenge. The problem becomes even more complicated when epileptic and psychogenic pseudoepileptic seizures coexist in the same patient. Appropriate psychological measures may be helpful in the diagnosis and may improve knowledge about aetiological factors which can provoke psychogenic pseudoepileptic seizures. The purpose of this paper is to present the psychological profile of patients with mixed seizures (epileptic and psychogenic pseudoepileptic) developed on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) and to discuss the personality differences between patients with psychogenic epileptic seizures and epileptic patients. In patients with diagnosed epilepsy and/or suspected psychogenic pseudoepileptic seizures long-term video-monitoring was performed. On the basis of the gathered data the patients were divided into three groups: group I (N= 32 : 25 F and 7 M) had coexistent psychogenic pseudoepileptic and epileptic seizures, group II (N= 38 : 30 F and 8 M) had psychogenic pseudoepileptic seizures only and group III (N= 36 : 18 F and 8 M) had epileptic seizures only and was treated as the control group. All three groups were given the MMPI. Comparison of the averaged personality profiles of the three groups revealed significant differences (P< 0.0001) in hypochondriasis (Hs) and hysteria (Hy), similarity of the profiles of groups I and II, and significantly higher Hs and Hy scores than D (Depression) scores (P< 0.001). Unlike groups I and II, group III (the epileptic group) had significantly higher D scores than Hs and Hy scores (P< 0.01). Our findings suggest that conversion, manifested in the typically elevated Hs and Hy scores as compared to D scores, is present in both groups of patients demonstrating pseudoepileptic seizures but absent in the patients with epilepsy where the Hs and Hy to D ratio is reversed. Patients with mixed seizures and patients with psychogenic pseudoepileptic seizures only have similarly shaped profiles.     

Minnesota Multiphasic Personality Inventory profile characteristics of schizotypal personality disorder

The goal of the present study was to determine whether precursors for psychopathology can be found in personality dimensions of the general population. Two hundred and 62 university students were compared with 41 schizophrenic patients and 18 patients with schizotypal personality disorder (SPD) on the Minnesota Multiphasic Personality Inventory (MMPI). Schizotypal personality disorder patients showed significantly elevated Pt and Si scales compared with the schizophrenic patients. Schizophrenia and SPD groups generally produced two-point codetypes of 6-8/8-6, 2-6/6-2, 7-8/8-7, and 7-8/8-7, 2-7/7-2, 6-8/8-6. A total of 77.5% of students had no codetype with a T-value of > or = 70, although the frequency of codetypes of spike 5, spike 0 and 2-7/7-2 was relatively high in the student group compared with the general population. Discriminant function analysis of the MMPI profiles revealed significant variance among the three groups. The overall rate of correct classification of the subjects into schizophrenia, SPD or university students was 90.3%. The first coefficient, mainly defined by a negative weight on the Sc scale, best distinguished the patients with either schizophrenia or SPD from the students. The second coefficient, defined by negative weights on the Sc and Si scales, and positive weights on the F and Ma scales identified patients with schizophrenia and SPD patients. The Harris-Lingoes subscales, which are supposed to provide the profile patterns characteristic of schizotypy, well discriminated the three groups. These results suggest the usefulness of the MMPI subscales for the detection of subjects with the SPD trait.     

MMPI-2 profiles of persons with multiple chemical sensitivity

We compared the MMPI-2 profiles of adults with multiple chemical sensitivity (MCS), epileptic seizures (ES), and nonepileptic seizures (NES). Both NES and MCS are medically unexplained conditions. In previous studies profiles associated with NES were elevated on scales Hs and Hy, compared with profiles associated with ES. We predicted that profiles associated with MCS would be elevated on Hs and Hy compared with the ES group. Patients with ES and NES were diagnosed after intensive EEG monitoring using published criteria. MCS was diagnosed if there was a complaint of illness in response to multiple common odors at levels that are not noxious to most people. All the MCS cases had legal claims for injury related to chemical exposures. The results showed that on MMPI-2 scales Hs, D, and Hy the MCS group had means significantly higher than both the ES and NES groups. Fake Bad Scale scores were elevated in 11 MCS cases, and regression-based estimates of Fake Bad Scale scores showed elevation in the MCS group compared with both seizure groups. We conclude that MMPI-2 data, obtained from people seeking financial compensation, indicate that there is a strong psychological component to MCS symptoms.     

Measuring Outcome in Psychogenic Nonepileptic Seizures: How Relevant Is Seizure Remission?

PURPOSE: To examine whether seizure remission is a comprehensive marker of outcome in psychogenic nonepileptic seizures (PNESs). METHODS: A postal questionnaire was returned by 147 patients with PNESs a mean of 4.2 years after diagnosis (mean age at follow-up, 38.1 years). The proportion of patients who were "unproductive" (receiving health-related state benefits) at follow-up was determined, with a comparison of markers of ongoing psychopathology (Global Severity Index, anxiety and depression scores of the Symptom Checklist 90, Somatization Index DSM of the SOMS-2) in three outcome groups: group 1, continuing seizures; group 2, seizures stopped but patients "unproductive;" and group 3, seizures stopped, patients "productive." RESULTS: Of the patients, 71.4% continued to have seizures, and 28.6% had achieved seizure remission; 60.0% of patients with continuing seizures and 42.7% of patients in remission were "unproductive" (difference, NS). Ongoing psychopathology was related to the factor "group membership" with higher values in groups 2 and 3 than in group 1 (GSI, p < 0.001; anxiety, p = 0.01; depression, p = 0.02; Somatization Index DSM, p < 0.001). Across all patients and in the subgroup with PNESs and additional epilepsy, differences were significant only between groups 2 and 3, not between groups 1 and 2. In patients with PNESs alone, differences were significant only between groups 1 and 2. CONCLUSIONS: Seizure remission is not a comprehensive measure of good medical or psychosocial outcome in PNESs. Nearly half the patients who become seizure free remain unproductive. Many of these patients continue to report symptoms of psychopathology. Seizure control should not be the only focus of treatment in clinical practice or outcome observation in research studies.     

MMPI-2 Profiles of Persons with Multiple Chemical Sensitivity

We compared the MMPI-2 profiles of adults with multiple chemical sensitivity (MCS), epileptic seizures (ES), and nonepileptic seizures (NES). Both NES and MCS are medically unexplained conditions. In previous studies profiles associated with NES were elevated on scales Hs and Hy, compared with profiles associated with ES. We predicted that profiles associated with MCS would be elevated on Hs and Hy compared with the ES group. Patients with ES and NES were diagnosed after intensive EEG monitoring using published criteria. MCS was diagnosed if there was a complaint of illness in response to multiple common odors at levels that are not noxious to most people. All the MCS cases had legal claims for injury related to chemical exposures. The results showed that on MMPI-2 scales Hs, D, and Hy the MCS group had means significantly higher than both the ES and NES groups. Fake Bad Scale scores were elevated in 11 MCS cases, and regression-based estimates of Fake Bad Scale scores showed elevation in the MCS group compared with both seizure groups. We conclude that MMPI-2 data, obtained from people seeking financial compensation, indicate that there is a strong psychological component to MCS symptoms.     

Psychological profiles in patients with medically refractory epilepsy.

The aim of this study was to explore whether patients with epilepsy show characteristic psychological profiles which might be risk factors for epileptic seizures. The instruments used in the case-control study were the Millon Behavioural Health Inventory (MBHI) and the Arnett Inventory of Sensation Seeking (AISS). A sample of hospitalized patients with medically refractory epilepsy (n = 15) and a sample of healthy controls (n = 15) matched on age and gender. Compared to the controls, the patients with epilepsy showed different psychological profiles. The patients with epilepsy showed significantly higher scores on the basic coping styles MBHI Inhibition style and MBHI Sensitivity style, and lower scores on the MBHI Sociability and the MBHI Confidence. The epilepsy group also exhibited elevated scores on the MBHI psychogenic attitude scales Chronic tension, Recent stress, Pre-morbid pessimism, Social alienation and Somatic anxiety. The patient group had lower sensation-seeking scores on the AISS Novelty scale, the AISS Intensity scale and in AISS Total scores. Some patients with medically refractory epilepsy show dysfunctional coping styles. These factors should be taken into consideration in treatment and rehabilitation planning. The findings point to psychological risk factors for eliciting epileptic seizures.     

Stability in MMPI among adoptees with high and low genetic risk for schizophrenia and with low Communication Deviance of their adoptive parents

Stability has been considered an important aspect of vulnerability to schizophrenia. The temporal stability of the scales in the Minnesota Multiphasic Personality Inventory (MMPI) was examined, using adoptees from the Finnish Adoptive Family Study of Schizophrenia. Adoptees who were high-risk (HR) offspring of biological mothers having a schizophrenia spectrum disorder (n=28) and low-risk (LR) controls (n=46) were evaluated using 15 MMPI scales at the initial assessment (HR, mean age 24 years; LR, mean age 23 years) and at the follow-up assessment after a mean interval of 11 years. Stability of the MMPI scales was also assessed in the groups of adoptees, assigned according to the adoptive parents'(n=44) communication style using Communication Deviance (CD) scale as an environmental factor. Initial Lie, Frequency, Correction, Psychopathic Deviate, Schizophrenia, Manifest Hostility, Hypomania, Phobias, Psychoticism, Religious Fundamentalism, Social Maladjustment, Paranoid Schizophrenia, Golden–Meehl Indicators, Schizophrenia Proneness and 8–6 scale scores significantly predicted the MMPI scores at the follow-up assessment indicating stability in the characteristics of thinking, affective expression, social relatedness and volition. Low CD in the family had an effect on the stabilization of personality traits such as social withdrawal and restricted affectivity assessed by Correction and Hostility.     

Economical screening for emotional disturbance in epilepsy: Anticipating Minnesota multiphasic personality inventory profile elevations by means of the Washington psychosocial seizure inventory

This study examined the ability of the Washington Psychosocial Seizure Inventory (WPSI) to identify patients with elevated (abnormal) scores on scales of the Minnesota Multiphasic Personality Inventory (MMPI). A sample of 407 adults with epilepsy who were administered both inventories was randomly divided into principal (n = 250) and cross-validation (n = 157) subsamples. Scores of 5 or more on the WPSI Emotional Adjustment Scale best identified the presence of one or more MMPI scale elevations, with 82% accuracy on cross-validation. Scores on the Emotional Adjustment Scale of 12 or more best identified the presence of two or more MMPI scale elevations, with 80% accuracy on cross-validation. High correlations were obtained between several WPSI and MMPI scales. This study suggests that the 132-item WPSI may be useful in screening for emotional disturbances in adults with epilepsy, and in determining when further emotional evaluation via clinical interview or additional testing may be warranted.     

Correlation of thyroxine and thyroid-stimulating hormone with personality measurements: a study in psychosomatic patients and healthy subjects

A comparative study performed in psychosomatic patients and healthy subjects reveals different profiles of thyroxine (T4) and thyroid-stimulating hormone (TSH) correlations with personality measurements (Minnesota Multiphasic Personality Inventory (MMPI); Sensation-Seeking Scale (SSS), and Susceptibility to Punishment Scale (SP). Three distinct sets of results may be enumerated, namely: (1) a negative correlation between sensation-seeking and TSH; (2) a positive correlation between the most indicative scales predisposing to depression-anxiety (hypochondriasis, depression, social introversion, susceptibility to punishment) and T4, and (3) the Hypomania Scale (Ma) showed a significant negative correlation with T4 in the patient group and a positive but nonsignificant relationship in the healthy group.     

Study of psychopathology in patients with chronic non-lesional epilepsy: a Minnesota multiphasic personality inventory profile controlled study

OBJECTIVE: Psychiatric morbidity and psychopathology have been widely assessed in patients with epilepsy. However, the issue of whether people with epilepsy are at increased risk for psychopathology remains highly controversial. These disorders are not evaluated in a systematic manner in patients with non-lesional epilepsy, so they could be underestimated. The objective is to evaluate personality disorders in patients with non-lesional epilepsy. METHODS: In this study, we investigated the presence of personality disorders in 63 patients with chronic non-lesional (idiopathic and cryptogenic) epilepsy and in 40 unrelated and randomly selected controls by means of Minnesota Multiphasic Personality Inventory (MMPI) and DSM-IV criteria for the different personality disorders. RESULTS: The overall scores were significantly higher in the patients in the subscales of schizophrenia, depression, hysteria, mania, paranoia, psychasthenia and psychopathic deviate. However, the differences in the proportion of patients with clinically significant scores occurred only for schizophrenia (57 vs. 20%), depression (55 vs. 15%), psychasthenia (28 vs. 10%) and paranoia (14 vs. 0%). According to DSM-IV criteria, only 11 patients met the criteria of schizotypal personality. We found excellent concordance for paranoid personality and depression between the two instruments of diagnosis. However, we did not find cases with either antisocial or avoidant personality. We also found a significant link between poor control of epilepsy and high scores in both paranoia and psychopathic deviate. CONCLUSIONS: In comparison with the DSM-IV criteria for such personality disorders, the MMPI was oversensitive in detecting schizotypal features. However, the MMPI correctly classified the remaining personality disorders, especially depression and paranoid personality. On the basis of these results, we conclude that psychopathology is overrepresented in patients with chronic non-lesional epilepsy and that, in determined variables, this is due to the severity of the condition rather than to the type and duration of epilepsy. The approach to patients with chronic epilepsy should include neurobehavioural scales.     

Clinical and psychosocial characteristics of children with nonepileptic seizures

Objective:

The aim of this study is to present a comprehensive profile of clinical and psychosocial characteristics of children with psychogenic nonepileptic seizures and to assess the short-term outcome of these patients.

Materials and Methods:

The subjects were consecutive cases of children with a diagnosis of nonepileptic seizures (N=17, mean age = 10.7 years, S.D. = 1.26) and two groups of control groups matched on age and sex: true seizure group and healthy controls. All the children were recruited from the out-patient services of the Department of Pediatrics of a tertiary care teaching hospital in North India. Detailed history taking and clinical examination was done in the case of every child. A standard 18 channel EEG was done in all the children and a video EEG was done in 12 cases of children with nonepileptic seizures. The Childhood Psychopathology Measurement Schedule (CPMS) and Life Events Scale for Indian Children (LESIC) were used to measure the children''s emotional and behavioral functioning at home, and the number of life events and the stress associated with these events in the preceding year and the year before that. Short-term outcome was examined three to six months after the diagnosis of nonepileptic seizures was made.

Results:

Unresponsiveness without marked motor manifestations was the most common “ictal” characteristic of the nonepileptic seizures. Pelvic thrusting, upper and lower limb movements, head movements, and vocalization were observed in less than one-third of the patients. Increased psychosocial stress and significantly higher number of life events in the preceding year were found to characterize children with nonepileptic seizures, as compared to the two control groups. The nonepileptic seizures and true seizures groups had a higher proportion of children with psychopathology scores in the clinically significant maladjustment range, as compared to those in the healthy control group. A majority of the patients (82.4%) either recovered completely or had more than 50% reduction in the frequency of their symptoms, after three to six months of initiation of therapy.

Conclusions:

Psychosocial stress is common among children with nonepileptic seizures. Confirmatory diagnosis by video EEG, along with prompt psychosocial intervention, often results in a favorable outcome for most children with nonepileptic seizures.