Psychiatric comorbidity in psychogenic nonepileptic seizures compared with epilepsy

Objectives: Psychogenic nonepileptic seizures (PNESs) are closely linked with psychological distress, but their etiology is not well-understood. We reviewed psychiatric comorbidity in PNESs and epileptic seizures (ESs) with an aim to assist understanding, diagnosis, and management of PNESs. Methods: A search of Web of Science, MEDLINE (PubMed), PsycINFO, and Scopus identified 32 relevant studies on the prevalence of psychiatric comorbidity in PNESs. We used meta-analysis to compare psychiatric comorbidity between PNESs and ESs. Results: Samples with PNESs had high rates of psychiatric comorbidity overall (53-100%), notably including post-traumatic stress disorder (PTSD), depression, and personality and anxiety disorders. Compared with ESs, samples with PNESs had more psychiatric comorbidity overall (RR: 1.30, 95% CI: 1.14-1.48, p < 0.0001) with significantly elevated risks found for PTSD, personality disorder, and anxiety but not depression. Conclusions: Psychiatric disorders are more common in PNESs than ESs. Because of methodological limitations of available studies, causality cannot be established; prospective longitudinal designs are required. (C) 2015 Elsevier Inc. All rights reserved.