Psychiatric Disorders in Children and Adolescents With Psychogenic Nonepileptic Seizures

Anne Sofie Hansen; Charlotte Ulrikka Rask; Ann-Eva Christensen; Maria Rodrigo-Domingo; Jakob Christensen; René Ernst Nielsen

doi:10.1212/WNL.0000000000012270

Psychiatric Disorders in Children and Adolescents With Psychogenic Nonepileptic Seizures

Neurology. 2021 Aug 3;97(5):e464-e475. doi: 10.1212/WNL.0000000000012270. Epub 2021 May 24.

Authors

Anne Sofie Hansen¹, Charlotte Ulrikka Rask², Ann-Eva Christensen², Maria Rodrigo-Domingo², Jakob Christensen², René Ernst Nielsen²

Affiliations

¹ From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark. ansoha@rn.dk.
² From Psychiatry (A.S.H., A.-E.C., M.R.-D., R.E.N.), Aalborg University Hospital; Department of Clinical Medicine (A.S.H., R.E.N.), Aalborg University; Department of Child and Adolescent Psychiatry (C.U.R.), Research Unit, and Department of Neurology (J.C.), Aarhus University Hospital; and Department of Clinical Medicine (C.U.R., J.C.), Aarhus University, Denmark.

PMID: 34031196
DOI: 10.1212/WNL.0000000000012270

Abstract

Objective: Knowledge regarding psychiatric disorders in children and adolescents with psychogenic nonepileptic seizures (PNES) is limited. This study outlines the spectrum and risk of psychiatric disorders in childhood-onset PNES.

Methods: We performed a nationwide matched cohort study of children and adolescents with PNES 5 to 17 years of age at the time of diagnosis between January 1, 1996, and December 31, 2014. Two matched comparison groups were included: children and adolescents with epilepsy (ES) and children and adolescents without PNES or epilepsy, called healthy controls (HC). Outcomes were prevalent psychiatric disorders before index (i.e., date of diagnosis or corresponding date for HC) and incident psychiatric disorders 2 years after index. Relative risks (RRs) were calculated and adjusted for potential confounders.

Results: We included 384 children and adolescents with validated PNES, 1,152 with ES, and 1,920 HC. Among the cases of PNES, 153 (39.8%) had prevalent psychiatric disorders and 150 (39.1%) had incident psychiatric disorders. Compared to the ES and HC groups, children and adolescents with PNES had elevated risks of both prevalent psychiatric disorders (adjusted RR_PNES/ES 1.87, 95% confidence interval [CI] 1.59-2.21, adjusted RR_PNES/HC 5.54, 95% CI 4.50-6.81) and incident psychiatric disorders (adjusted RR_PNES/ES 2.33, 95% CI 1.92-2.83, adjusted RR_PNES/HC 8.37, 95% CI 6.31-11.11). A wide spectrum of specific psychiatric disorders displayed elevated RRs.

Conclusions: Children and adolescents with PNES are at higher risk of a wide range of psychiatric disorders compared to children and adolescents with ES and HC. A careful psychiatric evaluation is warranted to optimize and individualize treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Affective Symptoms / complications
Affective Symptoms / epidemiology
Child
Child, Preschool
Cohort Studies
Denmark / epidemiology
Dissociative Disorders / complications*
Dissociative Disorders / psychology*
Electroencephalography
Female
Humans
Incidence
International Classification of Diseases
Male
Mental Disorders / complications*
Mental Disorders / epidemiology
Mental Disorders / psychology*
Parents
Prevalence
Registries
Risk Assessment
Seizures / complications*
Seizures / psychology*