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Addressing issues related to geropsychiatry and the well-being of older adults
Mrs. J. is a 64-year-old woman admitted to the epilepsy monitoring unit (EMU) for evaluation of increased seizure activity. She has a medical history of hypertension, seizures, and depression. Mrs. J. has been treated pharmacologically for 17 years with multiple medications including levetiracetam (Keppra® ), valproic acid (Depakene® ), phenytoin (Dilantin® ), and topiramate (Topamax® ). She currently lives in a three-bedroom house with her husband and their four grandchildren, ages 14, 12, 9, and 7. Her son (the father of her grandchildren) is currently incarcerated and the mother of the children left 2 years ago. Mrs. J. is unemployed because of her frequent seizures, and her husband works nights at a factory in town. She stated that she has anywhere from four to nine seizures per day that present as whole body shaking and loss of awareness. Mrs. J. reported feeling stressed about her family's current situation.
During her stay on the EMU, it was determined that Mrs. J. does not have epilepsy, but she is experiencing psychogenic non-epileptic seizures (PNES). She was told that she did not have epileptic seizures, but that she had non-epileptic events or episodes. She became visibly upset by the diagnosis and was in disbelief. She stated, "How could this be? I have had epilepsy for 17 years! Are you saying that my doctors lied to me?" Later Mrs. J. informed her nurse that she wanted to commit suicide and that she had a plan to do so. She was then placed on suicide precautions and later transferred to a psychiatric unit.
What Are Psychogenic Non-Epileptic Seizures?
PNES are a form of functional neurological symptom disorder. The term "conversion disorder," which previously was associated with PNES, was changed to "functional neurological symptom disorder" in the Diagnostic and Statistical Manual of Mental Disorders , 5th edition (American Psychiatric Association, 2013 ). In PNES, the non-epileptic events resemble epileptic seizures, but they are not due to a dysfunction of the brain. The events the patient experiences are due to a psychological process. The symptoms are not under voluntary control; patients are not "faking" seizures or intentionally trying to be deceptive (Benbadis, 2013 )....