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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摘要
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。
引文
1Reuber M, Rawlings G. Nonepileptic seizures-subjective phenomena. Handb Clin Neurol Elesvier, 2016, 139:283-296.
2Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures(PNES). Clin Psychol Rev,2016, 47:55-70.
3Kanemoto 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.
4Duncan 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.
5Rawlings GH, Reuber M. What patients say about living with psychogenic nonepileptic seizures:a systematic synthesis of qualitative studies. Seizure, 2016, 41:100-111.
6Reuber 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.
7Dixon-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.
8Pace 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.
9Hingray 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.
10Aatti 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.
11Sahaya 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.
12O’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.
13Shneker 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.
14La 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.
15LaFrance WC, Rusch MD, Machan JT. What is “treatment as usual” for nonepileptic seizures? Epilepsy Behav, 2008, 12(3):388-394.
16Valente KD, Rzezak P, LaFrance WC Jr. Standard medical care for psychogenic nonepileptic seizures in brazil. Epilepsy Behav, 2015,45:128-135.
17Mayor 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.
19Whitehead K, Kandler R, Reuber M. Patients’ and neurologists’perception of epilepsy and psychogenic nonepileptic seizures.Epilepsia, 2013, 54(4):708-717.
20Mc Millan KK, Pugh MJ, Hamid H, et al. Providers’ perspectives on treating psychogenic nonepileptic seizures:frustration and hope. Epilepsy Behav, 2014, 37:276-281.
21du Toit A, Pretorius C. Psychogenic nonepileptic seizures:Namibian healthcare providers’ perceptions and frustrations.Seizure, 2017, 50:43-52.
22Dworetzky BA. What are we communicating when we present the diagnosis of PNES? Epilepsy Curr, 2015, 15(6):353-357.
23Asadi-Pooya A. Psychogenic nonepileptic seizures in adult neurology clinics in southern iran:a survey of neurologists. Iran J Neurol, 2016, 15(2):100-102.
24Harden 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.
25Lafrance 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.
26Altalib 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.
27Robson 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.
28Monzoni 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.
29Whitehead K, Reuber M. Illness perceptions of neurologists and pschiatrists in relation to epilepsy and nonepileptic attack disorder.Seizure, 2012, 21(2):104-109.
30Quinn 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.
31Jimenez 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.
32Jimenez 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.
33Worsley 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.
34Monzoni 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.
36Specht U, Thorbecke R. Should patients with psychogenic nonepileptic seizures be allowed to drive? Recommendations of German experts. Epilepsy Behav, 2009, 16(3):547-550.
37Morrison I, Razvi SSM. Driving regulations and psychogenic nonepileptic seizures:perspectives from the United Kingdom. Seizure,2011, 20:177-180.
38Benbadis SR, Blustein JN, Sunstad L. Should patients with psychogenic nonepileptic seizures be allowed to drive? Epilepsia,2000, 41(7):895-897.
39Mahmud S, Hwang ST. Understanding variability in driving recommendations for patients with seizures. Epilepsy Behav, 2017,77:44-49.
40Reuber M. The etiology of psychogenic non-epileptic seizures:toward a biopsychosocial model. Neurol Clin, 2009, 27(4):909-924.
41Bourne 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.
42Reuber 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.
44Wyatt 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.
45Thompson 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.
46O’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.
47Seneviratne 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.
48Jenkins 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.
49Jenkins 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.
2Brown RJ, Reuber M. Towards an integrative theory of psychogenic non-epileptic seizures(PNES). Clin Psychol Rev,2016, 47:55-70.
3Kanemoto 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.
4Duncan 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.
5Rawlings GH, Reuber M. What patients say about living with psychogenic nonepileptic seizures:a systematic synthesis of qualitative studies. Seizure, 2016, 41:100-111.
6Reuber 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.
7Dixon-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.
8Pace 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.
9Hingray 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.
10Aatti 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.
11Sahaya 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.
12O’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.
13Shneker 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.
14La 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.
15LaFrance WC, Rusch MD, Machan JT. What is “treatment as usual” for nonepileptic seizures? Epilepsy Behav, 2008, 12(3):388-394.
16Valente KD, Rzezak P, LaFrance WC Jr. Standard medical care for psychogenic nonepileptic seizures in brazil. Epilepsy Behav, 2015,45:128-135.
17Mayor 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.
19Whitehead K, Kandler R, Reuber M. Patients’ and neurologists’perception of epilepsy and psychogenic nonepileptic seizures.Epilepsia, 2013, 54(4):708-717.
20Mc Millan KK, Pugh MJ, Hamid H, et al. Providers’ perspectives on treating psychogenic nonepileptic seizures:frustration and hope. Epilepsy Behav, 2014, 37:276-281.
21du Toit A, Pretorius C. Psychogenic nonepileptic seizures:Namibian healthcare providers’ perceptions and frustrations.Seizure, 2017, 50:43-52.
22Dworetzky BA. What are we communicating when we present the diagnosis of PNES? Epilepsy Curr, 2015, 15(6):353-357.
23Asadi-Pooya A. Psychogenic nonepileptic seizures in adult neurology clinics in southern iran:a survey of neurologists. Iran J Neurol, 2016, 15(2):100-102.
24Harden 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.
25Lafrance 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.
26Altalib 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.
27Robson 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.
28Monzoni 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.
29Whitehead K, Reuber M. Illness perceptions of neurologists and pschiatrists in relation to epilepsy and nonepileptic attack disorder.Seizure, 2012, 21(2):104-109.
30Quinn 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.
31Jimenez 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.
32Jimenez 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.
33Worsley 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.
34Monzoni 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.
36Specht U, Thorbecke R. Should patients with psychogenic nonepileptic seizures be allowed to drive? Recommendations of German experts. Epilepsy Behav, 2009, 16(3):547-550.
37Morrison I, Razvi SSM. Driving regulations and psychogenic nonepileptic seizures:perspectives from the United Kingdom. Seizure,2011, 20:177-180.
38Benbadis SR, Blustein JN, Sunstad L. Should patients with psychogenic nonepileptic seizures be allowed to drive? Epilepsia,2000, 41(7):895-897.
39Mahmud S, Hwang ST. Understanding variability in driving recommendations for patients with seizures. Epilepsy Behav, 2017,77:44-49.
40Reuber M. The etiology of psychogenic non-epileptic seizures:toward a biopsychosocial model. Neurol Clin, 2009, 27(4):909-924.
41Bourne 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.
42Reuber 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.
44Wyatt 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.
45Thompson 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.
46O’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.
47Seneviratne 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.
48Jenkins 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.
49Jenkins 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.