医疗人员对心因性非痫性发作的观点研究：基于定性与定量研究的系统回顾_Journal of Epilepsy

Authors：

 GreggH. Rawlings , MarkusReuber , 林岷涛　译 , 熊维希　慕洁　审

Corresponding author：

GreggH. Rawlings, Email: ghrawlings1@sheffield.ac.uk

Keywords：

分离性障碍发作; 医疗保健专业人员; 非痫性发作; 非癫痫性抽搐; 定性研究

DOI：

10.7507/2096-0247.20190039

Video：

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近期一篇关于心因性非痫性发作（Psychogenic nonepileptic seizures，PNES）的系统分析表明，该类患者总是会有不愉快的就医经历，因此详细了解其中相互关系至关重要。文章旨在探究医疗人员对 PNES 的态度与看法。系统性检索截至到 2017 年 11 月前发表在 3 个主要数据库的文章（Web of Science、PubMed、CINAHL），并回顾 1997 年以后发表的定性或定量的方法学研究。基于扎根理论来解释数据，使用 Mixed Methods Appraisal Tool 进行质量评价。总共 30 篇独立文章，其中包含了至少 3 900 名专业人员的观点。在分析中出现了 5 个解释性概念：① 不确定性，医疗人员表示他们对 PNES 的许多方面都感到不确定，包括诊断和治疗；② 理解，医疗人员对 PNES 的理解是基于二元论，他们认为 PNES 与心理精神因素的关系极大；③ 挫折感与挑战性，对 PNES 患者的诊断治疗被认为是有挑战性的，并令人感到沮丧的；④ 责任，医疗人员对于“谁应该为 PNES 患者的治疗负责”是有争论的；⑤ 预后与残疾，与癫痫相比，医疗人员普遍认为 PNES 症状相对较轻，致残率也没有癫痫高，并且与自身的自制力有关。尽管有一些医师对 PNES 有较深刻的理解，但是仍有一部分医师的观点需要更新和提高。有一部分研究在调查中是直接询问医师“对 PNES 疾病的观点”，这样的研究存在局限性。此外，有一些学科专业的医师并没有被研究调查（如精神健康专业医师）。研究还表明，对医师们进行 PNES 额外教学训练是有必要的，但同时也需要改变医师们对 PNES 的态度。

Citation： GreggH. Rawlings, MarkusReuber, 林岷涛　译, 熊维希　慕洁　审. 医疗人员对心因性非痫性发作的观点研究：基于定性与定量研究的系统回顾. Journal of Epilepsy, 2019, 5(3): 220-230. doi: 10.7507/2096-0247.20190039 Copy

1.	Reuber M, Rawlings G. Nonepileptic seizures-subjective phenomena. Handb Clin Neurol Elesvier, 2016, 139: 283-296.
2.	Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). Clin Psychol Rev, 2016, 47: 55-70.
3.	Kanemoto K, Lafrance WC, Duncan R, et al. PNES around the world: where we are now and how we can close the diagnosis and treatment gaps-an ILAE PNES Task Force report. Epilepsia Open, 2017, 2(3): 307-316.
4.	Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav, 2011, 20(2): 308-311.
5.	Rawlings GH, Reuber M. What patients say about living with psychogenic nonepileptic seizures: a systematic synthesis of qualitative studies. Seizure, 2016, 41: 100-111.
6.	Reuber M, Rawlings GH, Schachter S. In our words: personal accounts of living with non-epileptic seizures (the Brainstorms Series). New York, NY: Oxford University Press, 2018.
7.	Dixon-Woods M, Agarwal S, Jones D, et al. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy, 2005, 10(1): 45-53.
8.	Pace R, Pluye P, Bartlett G, et al. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud, 2011, 49(1): 47-53.
9.	Hingray C, El-Hage W, Duncan R, et al. Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: an international survey by the ILAE PNES Task Force. Epilepsia, 2018, 59(1): 203-214.
10.	Aatti Y, Schwan R, Maillard L, et al. A cross-sectional survey on French psychiatrists’ knowledge and perceptions of psychogenic nonepileptic seizures. Epilepsy Behav, 2016, 60: 21-26.
11.	Sahaya K, Dholakia SA, Lardizabal D, et al. Opinion survey of health care providers towards psychogenic non epileptic seizures. Clin Neurol Neurosurg, 2012, 114(10): 1304-1307.
12.	O’Sullivan SS, Sweeney BJ, McNamara B. The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures. Epilepsy Behav, 2006, 8(1): 256-260.
13.	Shneker BF, Elliott JO. Primary care and emergency physician attitudes and beliefs related to patients with psychogenic nonepileptic spells. Epilepsy Behav, 2008, 13(1): 243-247.
14.	La France WC Jr, de Marinis AJ, Webb AF, et al. Comparing standard medical care for nonepileptic seizures in Chile and the United States. Epilepsy Behav, 2012, 25(2): 224-229.
15.	LaFrance WC, Rusch MD, Machan JT. What is " treatment as usual” for nonepileptic seizures? Epilepsy Behav, 2008, 12(3): 388-394.
16.	Valente KD, Rzezak P, LaFrance WC Jr. Standard medical care for psychogenic nonepileptic seizures in brazil. Epilepsy Behav, 2015, 45: 128-135.
17.	Mayor R, Smith PE, Reuber M. Management of patients with nonepileptic attack disorder in the United Kingdom: a survey of health care professionals. Epilepsy Behav, 2011, 21(4): 402-406.
18.	Valente KD, De Paola L, Palmini A, et al. The approach to patients with psychogenic nonepileptic seizures in epilepsy surgery centers regarding diagnosis, treatment, and education. Epilepsy Behav, 2017, 68: 78-83.
19.	Whitehead K, Kandler R, Reuber M. Patients’ and neurologists’ perception of epilepsy and psychogenic nonepileptic seizures. Epilepsia, 2013, 54(4): 708-717.
20.	Mc Millan KK, Pugh MJ, Hamid H, et al. Providers’ perspectives on treating psychogenic nonepileptic seizures: frustration and hope. Epilepsy Behav, 2014, 37: 276-281.
21.	du Toit A, Pretorius C. Psychogenic nonepileptic seizures: Namibian healthcare providers’ perceptions and frustrations. Seizure, 2017, 50: 43-52.
22.	Dworetzky BA. What are we communicating when we present the diagnosis of PNES? Epilepsy Curr, 2015, 15(6): 353-357.
23.	Asadi-Pooya A. Psychogenic nonepileptic seizures in adult neurology clinics in southern iran: a survey of neurologists. Iran J Neurol, 2016, 15(2): 100-102.
24.	Harden CL, Burgut FT, Kanner AM. The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists. Epilepsia, 2003, 44(3): 453-456.
25.	Lafrance W, Baker G, Duncan R, et al. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League against Epilepsy Nonepileptic Seizures Task Force. Epilepsia, 2013, 54: 2005-2018.
26.	Altalib HH, Elzamzamy K, Pugh MJ, et al. Communicating diagnostic certainty of psychogenic nonepileptic seizures-a national study of provider documentation. Epilepsy Behav, 2016, 64(Pt): 4-8.
27.	Robson CM, Lian OS. " Are you saying she’s mentally ill then?” Explaining medically unexplained seizures in clinical encounters. Forum Qual Sozialforschung, 2016, 17(1): Art. 2.
28.	Monzoni CM, Duncan R, Gruenewald R, et al. How do neurologists discuss functional symptoms with their patients: a conversation analytic study. J Psychosom Res, 2011, 71: 377-383.
29.	Whitehead K, Reuber M. Illness perceptions of neurologists and pschiatrists in relation to epilepsy and nonepileptic attack disorder. Seizure, 2012, 21(2): 104-109.
30.	Quinn MC, Schofield MJ, Middleton W. Permission to speak: therapists’ understandings of psychogenic nonepileptic seizures and their treatment. J Trauma Dissociation, 2010, 11(1): 108-123.
31.	Jimenez XF, Bautista JF, Tesar GE. Diagnostic assessment and case formulation in psychogenic nonepileptic seizures: a pilot comparison of approaches. Epilepsy Behav, 2015, 45: 164-168.
32.	Jimenez XF, Bautista JF, Tilahun BS, et al. Bridging a clinical gap in psychogenic nonepileptic seizures: mental health provider preferences of biopsychosocial assessment approaches. Epilepsy Behav, 2016, 56: 149-152.
33.	Worsley C, Whitehead K, Kandler R, et al. Illness perceptions of health care workers in relation to epileptic and psychogenic nonepileptic seizures. Epilepsy Behav, 2011, 20(4): 668-673.
34.	Monzoni CM, Duncan R, Gruenewald R, et al. Are there interactional reasons why doctors may find it hard to tell patients that their physical symptoms may have emotional causes? A conversation analytic study in neurology outpatients. Patient Educ Couns, 2011, 85: e189-200.
35.	Acton EK, Tatum WO. Inpatient psychiatric consultation for newly-diagnosed patients with psychogenic non-epileptic seizures. Epilepsy Behav, 2013, 27(1): 36-39.
36.	Specht U, Thorbecke R. Should patients with psychogenic nonepileptic seizures be allowed to drive? Recommendations of German experts. Epilepsy Behav, 2009, 16(3): 547-550.
37.	Morrison I, Razvi SSM. Driving regulations and psychogenic non-epileptic seizures: perspectives from the United Kingdom. Seizure, 2011, 20: 177-180.
38.	Benbadis SR, Blustein JN, Sunstad L. Should patients with psychogenic nonepileptic seizures be allowed to drive? Epilepsia, 2000, 41(7): 895-897.
39.	Mahmud S, Hwang ST. Understanding variability in driving recommendations for patients with seizures. Epilepsy Behav, 2017, 77: 44-49.
40.	Reuber M. The etiology of psychogenic non-epileptic seizures: toward a biopsychosocial model. Neurol Clin, 2009, 27(4): 909-924.
41.	Bourne T, Vanderhaegen J, Vranken R, et al. Doctors’ experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data. BMJ Open, 2016, 6(7): e011711.
42.	Reuber M. Communicating the diagnosis. In: Psychogenic nonepileptic seizures: toward the integration of care. Dworetzky B, Baslet G, editors. New York, NY: Oxford University Press, 2017: 179-201.
43.	Devinsky O, Gazzola D, LaFrance WJ. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol, 2011, 7: 210-220.
44.	Wyatt C, Laraway A, Weatherhead S. The experience of adjusting to a diagnosis of non-epileptic attack disorder (NEAD) and the subsequent process of psychological therapy. Seizure, 2014, 23(9): 799-807.
45.	Thompson R, Isaac CL, Rowse G, et al. What is it like to receive a diagnosis of nonepileptic seizures? Epilepsy Behav, 2009, 14(3): 508-515.
46.	O’Sullivan SS, Redwood RI, Hunt D, et al. Recognition of psychogenic non-epileptic seizures: a curable neurophobia? J Neurol Neurosurg Psychiatry, 2013, 84(2): 228-231.
47.	Seneviratne U, Ding C, Bower S, et al. Video-based training improves the accuracy of seizure diagnosis. J Neuro Neurosurg Psychiatry, 2014, 85(4): 466-470.
48.	Jenkins L, Cosgrove J, Ekberg K, et al. A brief conversation analytic communication intervention can change history-taking in the seizure clinic. Epilepsy Behav, 2015, 52(Pt A): 62-67.
49.	Jenkins L, Cosgrove J, Chappell P, et al. Neurologists can identify diagnostic linguistic features during routine seizure clinic interactions: results of a one-day teaching intervention. Epilepsy Behav, 2016, 64(Pt A): 257-261.
50.	Jenkins L, Reuber M. A conversation analytic intervention to help neurologists identify diagnostically relevant linguistic features in seizure patients’ talk. Res Lang Soc Interact, 2014, 47: 266-279.

1. Reuber M, Rawlings G. Nonepileptic seizures-subjective phenomena. Handb Clin Neurol Elesvier, 2016, 139: 283-296.
2. Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures (PNES). Clin Psychol Rev, 2016, 47: 55-70.
3. Kanemoto K, Lafrance WC, Duncan R, et al. PNES around the world: where we are now and how we can close the diagnosis and treatment gaps-an ILAE PNES Task Force report. Epilepsia Open, 2017, 2(3): 307-316.
4. Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav, 2011, 20(2): 308-311.
5. Rawlings GH, Reuber M. What patients say about living with psychogenic nonepileptic seizures: a systematic synthesis of qualitative studies. Seizure, 2016, 41: 100-111.
6. Reuber M, Rawlings GH, Schachter S. In our words: personal accounts of living with non-epileptic seizures (the Brainstorms Series). New York, NY: Oxford University Press, 2018.
7. Dixon-Woods M, Agarwal S, Jones D, et al. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy, 2005, 10(1): 45-53.
8. Pace R, Pluye P, Bartlett G, et al. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. Int J Nurs Stud, 2011, 49(1): 47-53.
9. Hingray C, El-Hage W, Duncan R, et al. Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: an international survey by the ILAE PNES Task Force. Epilepsia, 2018, 59(1): 203-214.
10. Aatti Y, Schwan R, Maillard L, et al. A cross-sectional survey on French psychiatrists’ knowledge and perceptions of psychogenic nonepileptic seizures. Epilepsy Behav, 2016, 60: 21-26.
11. Sahaya K, Dholakia SA, Lardizabal D, et al. Opinion survey of health care providers towards psychogenic non epileptic seizures. Clin Neurol Neurosurg, 2012, 114(10): 1304-1307.
12. O’Sullivan SS, Sweeney BJ, McNamara B. The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures. Epilepsy Behav, 2006, 8(1): 256-260.
13. Shneker BF, Elliott JO. Primary care and emergency physician attitudes and beliefs related to patients with psychogenic nonepileptic spells. Epilepsy Behav, 2008, 13(1): 243-247.
14. La France WC Jr, de Marinis AJ, Webb AF, et al. Comparing standard medical care for nonepileptic seizures in Chile and the United States. Epilepsy Behav, 2012, 25(2): 224-229.
15. LaFrance WC, Rusch MD, Machan JT. What is " treatment as usual” for nonepileptic seizures? Epilepsy Behav, 2008, 12(3): 388-394.
16. Valente KD, Rzezak P, LaFrance WC Jr. Standard medical care for psychogenic nonepileptic seizures in brazil. Epilepsy Behav, 2015, 45: 128-135.
17. Mayor R, Smith PE, Reuber M. Management of patients with nonepileptic attack disorder in the United Kingdom: a survey of health care professionals. Epilepsy Behav, 2011, 21(4): 402-406.
18. Valente KD, De Paola L, Palmini A, et al. The approach to patients with psychogenic nonepileptic seizures in epilepsy surgery centers regarding diagnosis, treatment, and education. Epilepsy Behav, 2017, 68: 78-83.
19. Whitehead K, Kandler R, Reuber M. Patients’ and neurologists’ perception of epilepsy and psychogenic nonepileptic seizures. Epilepsia, 2013, 54(4): 708-717.
20. Mc Millan KK, Pugh MJ, Hamid H, et al. Providers’ perspectives on treating psychogenic nonepileptic seizures: frustration and hope. Epilepsy Behav, 2014, 37: 276-281.
21. du Toit A, Pretorius C. Psychogenic nonepileptic seizures: Namibian healthcare providers’ perceptions and frustrations. Seizure, 2017, 50: 43-52.
22. Dworetzky BA. What are we communicating when we present the diagnosis of PNES? Epilepsy Curr, 2015, 15(6): 353-357.
23. Asadi-Pooya A. Psychogenic nonepileptic seizures in adult neurology clinics in southern iran: a survey of neurologists. Iran J Neurol, 2016, 15(2): 100-102.
24. Harden CL, Burgut FT, Kanner AM. The diagnostic significance of video-EEG monitoring findings on pseudoseizure patients differs between neurologists and psychiatrists. Epilepsia, 2003, 44(3): 453-456.
25. Lafrance W, Baker G, Duncan R, et al. Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: a staged approach: a report from the International League against Epilepsy Nonepileptic Seizures Task Force. Epilepsia, 2013, 54: 2005-2018.
26. Altalib HH, Elzamzamy K, Pugh MJ, et al. Communicating diagnostic certainty of psychogenic nonepileptic seizures-a national study of provider documentation. Epilepsy Behav, 2016, 64(Pt): 4-8.
27. Robson CM, Lian OS. " Are you saying she’s mentally ill then?” Explaining medically unexplained seizures in clinical encounters. Forum Qual Sozialforschung, 2016, 17(1): Art. 2.
28. Monzoni CM, Duncan R, Gruenewald R, et al. How do neurologists discuss functional symptoms with their patients: a conversation analytic study. J Psychosom Res, 2011, 71: 377-383.
29. Whitehead K, Reuber M. Illness perceptions of neurologists and pschiatrists in relation to epilepsy and nonepileptic attack disorder. Seizure, 2012, 21(2): 104-109.
30. Quinn MC, Schofield MJ, Middleton W. Permission to speak: therapists’ understandings of psychogenic nonepileptic seizures and their treatment. J Trauma Dissociation, 2010, 11(1): 108-123.
31. Jimenez XF, Bautista JF, Tesar GE. Diagnostic assessment and case formulation in psychogenic nonepileptic seizures: a pilot comparison of approaches. Epilepsy Behav, 2015, 45: 164-168.
32. Jimenez XF, Bautista JF, Tilahun BS, et al. Bridging a clinical gap in psychogenic nonepileptic seizures: mental health provider preferences of biopsychosocial assessment approaches. Epilepsy Behav, 2016, 56: 149-152.
33. Worsley C, Whitehead K, Kandler R, et al. Illness perceptions of health care workers in relation to epileptic and psychogenic nonepileptic seizures. Epilepsy Behav, 2011, 20(4): 668-673.
34. Monzoni CM, Duncan R, Gruenewald R, et al. Are there interactional reasons why doctors may find it hard to tell patients that their physical symptoms may have emotional causes? A conversation analytic study in neurology outpatients. Patient Educ Couns, 2011, 85: e189-200.
35. Acton EK, Tatum WO. Inpatient psychiatric consultation for newly-diagnosed patients with psychogenic non-epileptic seizures. Epilepsy Behav, 2013, 27(1): 36-39.
36. Specht U, Thorbecke R. Should patients with psychogenic nonepileptic seizures be allowed to drive? Recommendations of German experts. Epilepsy Behav, 2009, 16(3): 547-550.
37. Morrison I, Razvi SSM. Driving regulations and psychogenic non-epileptic seizures: perspectives from the United Kingdom. Seizure, 2011, 20: 177-180.
38. Benbadis SR, Blustein JN, Sunstad L. Should patients with psychogenic nonepileptic seizures be allowed to drive? Epilepsia, 2000, 41(7): 895-897.
39. Mahmud S, Hwang ST. Understanding variability in driving recommendations for patients with seizures. Epilepsy Behav, 2017, 77: 44-49.
40. Reuber M. The etiology of psychogenic non-epileptic seizures: toward a biopsychosocial model. Neurol Clin, 2009, 27(4): 909-924.
41. Bourne T, Vanderhaegen J, Vranken R, et al. Doctors’ experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data. BMJ Open, 2016, 6(7): e011711.
42. Reuber M. Communicating the diagnosis. In: Psychogenic nonepileptic seizures: toward the integration of care. Dworetzky B, Baslet G, editors. New York, NY: Oxford University Press, 2017: 179-201.
43. Devinsky O, Gazzola D, LaFrance WJ. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol, 2011, 7: 210-220.
44. Wyatt C, Laraway A, Weatherhead S. The experience of adjusting to a diagnosis of non-epileptic attack disorder (NEAD) and the subsequent process of psychological therapy. Seizure, 2014, 23(9): 799-807.
45. Thompson R, Isaac CL, Rowse G, et al. What is it like to receive a diagnosis of nonepileptic seizures? Epilepsy Behav, 2009, 14(3): 508-515.
46. O’Sullivan SS, Redwood RI, Hunt D, et al. Recognition of psychogenic non-epileptic seizures: a curable neurophobia? J Neurol Neurosurg Psychiatry, 2013, 84(2): 228-231.
47. Seneviratne U, Ding C, Bower S, et al. Video-based training improves the accuracy of seizure diagnosis. J Neuro Neurosurg Psychiatry, 2014, 85(4): 466-470.
48. Jenkins L, Cosgrove J, Ekberg K, et al. A brief conversation analytic communication intervention can change history-taking in the seizure clinic. Epilepsy Behav, 2015, 52(Pt A): 62-67.
49. Jenkins L, Cosgrove J, Chappell P, et al. Neurologists can identify diagnostic linguistic features during routine seizure clinic interactions: results of a one-day teaching intervention. Epilepsy Behav, 2016, 64(Pt A): 257-261.
50. Jenkins L, Reuber M. A conversation analytic intervention to help neurologists identify diagnostically relevant linguistic features in seizure patients’ talk. Res Lang Soc Interact, 2014, 47: 266-279.

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医疗人员对心因性非痫性发作的观点研究：基于定性与定量研究的系统回顾

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