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(Abst. 1.178), 2015The utility of Prolonged Exposure Therapy (PET) in the treatment of patients who are dually diagnosed with PNES and PTSD

Lorna Myers, Urmi Vaidya, Maria Lizardo

Rationale: The percentage of patients with PNES who exhibit post-traumatic stress disorder features ranges from 22-100%. Prolonged exposure therapy is an empirically validated form of cognitive behavioral therapy designed to treat post-traumatic stress disorder (PTSD). Our premise is that PET has the potential to be a useful treatment modality for patients dually diagnosed with PNES/PTSD.

Methods: Video-EEG monitoring was utilized to confirm a diagnosis of PNES in 7 adults. PTSD was diagnosed through neuropsychological testing. Patients were enrolled in a 12-15 week prolonged exposure program. Symptoms were assessed with the Beck Depression Inventory II and Post Traumatic Stress Diagnostic Scale (PDS). Scoring for the BDI II: 0--13: minimal depression, 14--19: mild, 20--28: moderate, 29--63: severe. The PDS cut-offs for symptom severity are:≤ 10 mild,≥11 and ≤20 moderate, ≥21 and ≤35 moderate to severe, ≥ 36 severe. Seizure frequency was noted every week of treatment. Seizure recurrence was monitored through post-treatment follow ups. Pre and post treatment scores were compared using the Wilcoxon Signed Rank test.

Results: At treatment initiation, 5/7 patients were in the severely depressed range, 1 in the moderate range and 1 in the mild range. Four patients were in the severe range for PTSD symptomatology and 3 in the moderate to severe range. By the final session, patients had experienced a significant reduction in depressive symptoms (W-value= 1; p≤ 0.05) and in post-traumatic symptomatology (W-value = 0; p≤ 0.05). Seizure frequency diminished at the time of treatment discharge in all patients (W-value=0; p≤ 0.05). Follow up revealed sustained or improved seizure control with the exception of one patient who had returned to baseline at 23 month follow up. One patient experienced a progressive reduction from 15-20 seizures per day, to 3-4 per week at 8 months and seizure freedom at 10 months.

Conclusions: Administration of PE to 7 patients with PNES and PTSD resulted in significant improvements in depression and post-traumatic stress symptomatology and reduction in seizures in all patients which was sustained at follow up with the exception of one patient. Five are now working or in school.