Abstract
We examined demographic, clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology. Prior to randomisation within the CODES RCT, we collected demographic and clinical data on 368 participants. We assessed psychiatric comorbidity using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and a screening measure of personality disorder and measured anxiety, depression, psychological distress, somatic symptom burden, emotional expression, functional impact of DS, avoidance behaviour, and quality of life. We undertook comparisons based on reported age at DS onset (<40 v. ⩾40), gender (male v. female), and DS semiology (predominantly hyperkinetic v. hypokinetic). Our cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. Two-thirds had predominantly hyperkinetic DS. Of the total, 69% had ⩾1 comorbid M.I.N.I. diagnosis (median number = 2), with agoraphobia being the most common concurrent diagnosis. Clinical levels of distress were reported by 86% and characteristics associated with maladaptive personality traits by 60%. Moderate-to-severe functional impairment, high levels of somatic symptoms, and impaired quality of life were also reported. Women had a younger age at DS onset than men. Our study highlights the burden of psychopathology and socio-economic deprivation in a large, heterogeneous cohort of patients with DS. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort.
Highlights
Dissociative seizures (DS) are paroxysmal episodes of apparent altered responsiveness or transient loss of consciousness
In terms of Index of Multiple Deprivation (IMD) scores, over 50% of participants resided in areas falling in the two highest deprivation quintiles (57% of participants from England, 51% of those from Scotland, and 86% of those from Wales) as measured by an index of the general population
We report data from 368 patients with dissociative seizures (DS) recruited for a multicentre randomised controlled trial (RCT), allowing a detailed study of psychopathology and its relationship to demographic and clinical variables in a large, wellcharacterised cohort
Summary
Dissociative seizures (DS) are paroxysmal episodes of apparent altered responsiveness or transient loss of consciousness They may be mistaken for epilepsy or syncope but are not accompanied by ictal encephalographic markers of epilepsy or physiological changes explaining unconsciousness or other associated paroxysmal behavioural and experiential alterations. Clinical, and psychological characteristics of a large cohort (n = 368) of adults with dissociative seizures (DS) recruited to the CODES randomised controlled trial (RCT) and explored differences associated with age at onset of DS, gender, and DS semiology. Our cohort was predominantly female (72%) and characterised by high levels of socio-economic deprivation. The lack of clear differences based on gender, DS semiology and age at onset suggests these factors do not add substantially to the heterogeneity of the cohort
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