050 ‘Mass hysteria’: a case of history repeating? Assessment and treatment for a group of children affected by medically unexplained symptoms

Abstract

Background Four classmates in the same school developed Non-Epileptic Seizures (NES) and were referred to a specialist service for treatment. We report the impact of treatment of the index case which incorporated psychological therapy and seizure management. Methods The 14 year old girl who first developed NES was the first child referred, and following assessment and formulation, underwent treatment. Treatment incorporated identification and alleviation of any predisposing/precipitating factors, followed by rehabilitation and behavioural management strategies. Education about NES and management advice to the school was a key intervention. Treatment goals include reduction in the frequency of NES at home and at school and return to age appropriate activities. Achievement of individual goals were monitored via weekly Goal Based Outcome measures (GBO’s) as well as monitoring of severity and impairment weekly on a Likert scale. Results Following 15 sessions of individual and systemic cognitive behaviour therapy, including 6 school contacts, her NES were almost fully resolved. Outcome data for NES frequency, GBO’s and quality of life will be presented. NES frequency also reduced significantly from 40 a day to 1 a month. Even before individual treatment was commenced in the other 3 children, there were marked reductions in the numbers of NES reported by the school. It was clear that the other girls affected by NES had a range of presenting concerns and or/history of medically unexplained symptoms (e.g. ADHD; Intellectual Disability; systemic issues) which subsequently required assessment and intervention. Conclusion Groups of children presenting with medically unexplained physical symptoms have been described –often previously called ‘mass hysteria’, and we propose that these 4 cases represent a small example of a similar phenomenon. Encouragingly, effective treatment of the index case was effective in significantly reducing the severity of the additional cases.