Introduction: Functional dissociative seizures (FDS) are episodes that resemble epileptic seizures, but are caused by different biopsychosocial factors. The way in which these patients cope with the challenges of their condition has been considered an important maintaining factor. The aim of this systematic review is to identify the coping strategies used by adult patients with FDS, and the measures used to assess them. Methods: The review was conducted following the PRISMA guidelines. A search was conducted in Pubmed, Cochrane Library, Scielo, Science Direct and Lilacs databases. Results: Eleven articles met the inclusion criteria and were integrated into a narrative synthesis. FDS patients use more avoidance and emotion-focused strategies than the general population. Their excessive use has been related to greater psychopathology, poorer quality of life and greater distress in the face of stress. On the other hand, the diversity of coping assessment instruments reflects the heterogeneity of the field. Conclusions: More research is needed to understand the coping strategies of FDS patients and to offer more personalized and effective treatment.

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Keywords:
Functional dissociative seizures, psychogenic non-epileptic seizures, coping, systematic review

01_RSP_30(2)_23050_Estrategias

Asadi-Pooya, A. A. (2021). Incidence and prevalence of psychogenic nonepileptic seizures (functional seizures): A systematic review and an analytical study. International Journal of Neuroscience, 133(6), 598-603. https://doi.org/10.1080/00207454.2021.1942870

Asadi-Pooya, A. A., Myers, L., Valente, K., Restrepo, A. D., D’Alessio, L., Sawchuk, T., Homayoun, M., Bahrami, Z., Alessi, R., Aroni Paytan, A., Kochen, S., Buchhalter, J., Taha, F., Lazar, L. M., Pick., & Nicholson, T. (2019). Sex differences in demographic and clinical characteristics of psychogenic nonepileptic seizures: A retrospective multicenter international study. Epilepsy & Behavior, 97, 154-157. https://doi.org/10.1016/j.yebeh.2019.05.045

Bagherzade, A., Mani, A., Firoozabadi, A., & Asadipooya, A. (2015). Positive and negative affects and coping strategies in patients with psychogenic non-epileptic seizure, temporal lobe epilepsy and control groups. Biomedical and Pharmacology Journal, 8(1), 133-139. https://acortar.link/225sNB

Bakvis, P., Spinhoven, P., Zitman, F. G., & Roelofs, K. (2011). Automatic avoidance tendencies in patients with psychogenic non-epileptic seizures. Seizure, 20(8), 628-634. https://doi.org/10.1016/j.seizure.2011.06.006

Baslet, G., Tolchin, B., & Dworetzky, B. A. (2017). Altered responsiveness in psychogenic nonepileptic seizures and its implication to underlying psychopathology. Seizure, 52, 162-168. https://doi.org/10.1016/j.seizure.2017.10.011

Beghi, M., Negrini, P. B., Perin, C., Peroni, F., Magaudda, A., Cerri, C., & Cornaggia, C. M. (2015). Psychogenic non-epileptic seizures: So-called psychiatric comorbidity and underlying defense mechanisms.  Neuropsychiatric Disease and Treatment, 11, 2519-2527. https://doi.org/10.2147/NDT.S82079

Brown, R. J., Bouska, J. F., Frow, A., Kirkby, A., Baker, G. A., Kemp, S., Burness, C., & Reuber, M. (2013). Emotional dysregulation, alexithymia, and attachment in psychogenic nonepileptic seizures. Epilepsy & Behavior, 29(1), 178-183. https://doi.org/10.1016/j.yebeh.2013.07.019

Brown, R. J., & Reuber, M. (2016a). Psychological and psychiatric aspects of psychogenic non-epileptic seizures (PNES): A systematic review. Clinical Psychology Review, 45, 157-182. https://doi.org/10.1016/j.cpr.2016.01.003

Brown, R. J., & Reuber, M. (2016b). Towards an integrative theory of psychogenic non-epileptic seizures (PNES). Clinical Psychology Review, 47, 55-70. https://doi.org/10.1016/j.cpr.2016.06.003

Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267-283. https://doi.org/10.1037/0022-3514.56.2.267

Cronje, G., & Pretorius, C. (2013). The coping styles and health related quality of life of South African patients with psychogenic nonepileptic seizures. Epilepsy & Behavior, 29(3), 581-584. https://doi.org/10.1016/j.yebeh.2013.09.045

Cullingham, T., Kirkby, A., Sellwood, W., & Eccles, F. J. R. (2019). Avoidance in nonepileptic attack disorder: A systematic review and meta-analyses. Epilepsy & Behavior, 95, 100-111. https://doi.org/10.1016/j.yebeh.2019.03.004

Dempster, M., Howell, D., & McCorry, N. K. (2015). Illness perceptions and coping in physical health conditions: A meta-analysis. Journal of Psychosomatic Research, 79(6), 506-513. https://doi.org/10.1016/j.jpsychores.2015.10.006

Diprose, W., Sundram, F., & Menkes, D. B. (2016). Psychiatric comorbidity in psychogenic nonepileptic seizures compared with epilepsy. Epilepsy & Behavior, 56, 123-130. https://doi.org/10.1016/j.yebeh.2015.12.037

Duangdao, K. M., & Roesch, S. C. (2008). Coping with diabetes in adulthood: a meta-analysis.  Journal of Behavioral Medicine, 31(4), 291-300. https://doi.org/10.1007/s10865-008-9155-6

Endler, N. S., & Parker, J. (1990). Coping inventory for stressful situations. Multi-Health systems Incorporated.

Fiszman, A., Alves-Leon, S. V., Nunes, R. G., D’Andrea, I., & Figueira, I. (2004). Traumatic events and posttraumatic stress disorder in patients with psychogenic nonepileptic seizures: A critical review. Epilepsy & Behavior, 5(6), 818-825. https://doi.org/10.1016/j.yebeh.2004.09.002

Folkman, S., & Lazarus, R. S. (1988). Manual for the Ways of Coping Questionnaire. Consulting Psychologists Press.

Folkman, S., & Moskowitz, J. T. (2004). Coping: Pitfalls and promise. Annual Review of Psychology, 55, 745-774. https://doi.org/10.1146/annurev.psych.55.090902.141456

Frances, P. L., Baker, G. A., & Appleton, P. L. (1999). Stress and avoidance in pseudoseizures: Testing the assumptions. Epilepsy Research, 34(2), 241-249. https://doi.org/10.1016/S0920-1211(98)00116-8

Gargiulo, A. J., Sarudiansky, M., Videla, A., Lombardi, N., Korman, G. P., Oddo, S., & D’Alessio, L. (2022). Perceived stress, resilience, and stress coping in patients with drug resistant epilepsy and functional dissociative seizures. Seizure, 101, 141-148. https://doi.org/10.1016/j.seizure.2022.08.002

Goldstein, L. H., Drew, C., Mellers, J., Mitchell-O’Malley, S., & Oakley, D. A. (2000). Dissociation, hypnotizability, coping styles and health locus of control: Characteristics of pseudoseizure patients. Seizure, 9(5), 314-322. https://doi.org/10.1053/seiz.2000.0421

Goldstein, L. H., & Mellers, J. D. (2006). Ictal symptoms of anxiety, avoidance behaviour, and dissociation in patients with dissociative seizures. J Neurol Neurosurg Psychiatry, 77(5), 616-621. https://doi.org/10.1136/jnnp.2005.066878

Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022). Functional neurological disorder: New subtypes and shared mechanisms. The Lancet Neurology, 21(6), 537-550. https://doi.org/10.1016/s1474-4422(21)00422-1

Hetzel-Riggin, M. D., & Wilber, E. L. (2010). To dissociate or suppress? Predicting automatic vs. conscious cognitive avoidance. Journal of Trauma & Dissociation, 11(4), 444-457. https://doi.org/10.1080/15299732.2010.495376

Hingray, C., El-Hage, W., Duncan, R., Gigineishvili, D., Kanemoto, K., LaFrance, W. C., de Marinis, A., Paul, R., Pretorius, C., Téllez-Zenteno, J. F., Wiseman, H., & Reuber, M. (2018). Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force. Epilepsia, 59(1), 203-214. https://doi.org/10.1111/epi.13952

Indranada, A. M., Mullen, S. A., Duncan, R., Berlowitz, D. J., & Kanaan, R. A. (2018). The association of panic and hyperventilation with psychogenic non-epileptic seizures: A systematic review and meta-analysis. Seizure, 59, 108-115. https://doi.org/10.1016/j.seizure.2018.05.007

Jones, B., Reuber, M., & Norman, P. (2016). Correlates of health-related quality of life in adults with psychogenic nonepileptic seizures: A systematic review. Epilepsia, 57(2), 171-181. https://doi.org/10.1111/epi.13268

Kato, T. (2015). Frequently used coping scales: A meta-analysis. Stress Health, 31(4), 315-323. https://doi.org/10.1002/smi.2557

Labudda, K., Frauenheim, M., Illies, D., Miller, I., Schrecke, M., Vietmeier, N., Brandt, C., & Bien, C. G. (2018). Psychiatric disorders and trauma history in patients with pure PNES and patients with PNES and coexisting epilepsy. Epilepsy & Behavior, 88, 41-48. https://doi.org/10.1016/j.yebeh.2018.08.027

LaFrance, W. C., Jr., Baker, G. A., Duncan, R., Goldstein, L. H., & Reuber, M. (2013). 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, 54(11), 2005-2018. https://doi.org/10.1111/epi.12356

Lanzillotti, A. I., Sarudiansky, M., Lombardi, N. R., Korman, G. P., & D’Alessio, L. (2021). Updated review on the diagnosis and primary management of psychogenic nonepileptic seizure disorders. Neuropsychiatric Disease and Treatment, 17, 1825-1838. https://doi.org/10.2147/NDT.S286710

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.

Libbon, R., Baker, S., Watson, M., Natvig, C., Strom, L., & Mikulich, S. (2020). Sex effects on coping, dissociation, and PTSD in patients with non-epileptic seizures.  Current Psychiatry Reports, 22(12), 69. https://doi.org/10.1007/s11920-020-01192-x

Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine, 151(4), 65-94. https://doi.org/10.7326/0003-4819-151-4-200908180-00136

Myers, L., Fleming, M., Lancman, M., Perrine, K., & Lancman, M. (2013). Stress coping strategies in patients with psychogenic non-epileptic seizures and how they relate to trauma symptoms, alexithymia, anger and mood. Seizure, 22(8), 634-639. https://doi.org/10.1016/j.seizure.2013.04.018

Myers, L., Sarudiansky, M., Korman, G., & Baslet, G. (2021). Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders. Epilepsy & Behavior Reports, 16, 100478. https://doi.org/10.1016/j.ebr.2021.100478

Myers, L., Trobliger, R., Bortnik, K., & Lancman, M. (2018). Are there gender differences in those diagnosed with psychogenic nonepileptic seizures? Epilepsy & Behavior, 78, 161-165. https://doi.org/10.1016/j.yebeh.2017.10.019

Orzechowska, A., Blizniewska-Kowalska, K., Galecki, P., Szulc, A., Plaza, O., Su, K. P., Georgescu, D., & Galecka, M. (2022). Ways of coping with stress among patients with depressive disorders.  Journal of Clinical Medicine, 11(21), 6500. https://doi.org/10.3390/jcm11216500

Ottenbreit, N. D., & Dobson, K. S. (2004). Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42(3), 293-313. https://doi.org/10.1016/S0005-7967(03)00140-2

Pérez, D. L., & LaFrance, W. C., Jr. (2016). Nonepileptic seizures: An updated review. CNS Spectrums, 21(3), 239-246. https://doi.org/10.1017/S109285291600002X

Pick, S., Mellers, J. D., & Goldstein, L. H. (2016). Emotion and dissociative seizures: A phenomenological analysis of patients’ perspectives. Epilepsy & Behavior, 56, 5-14. https://doi.org/10.1016/j.yebeh.2015.12.010

Pretorius, C., & Sparrow, M. (2015). Life after being diagnosed with psychogenic non-epileptic seizures (PNES): A South African perspective. Seizure, 30, 32-41. https://doi.org/10.1016/j.seizure.2015.05.008

Reuber, M. (2009). The etiology of psychogenic non-epileptic seizures: Toward a biopsychosocial model. Neurologic Clinics, 27(4), 909-924. https://doi.org/10.1016/j.ncl.2009.06.004

Richardson, E. M., Schuz, N., Sanderson, K., Scott, J. L., & Schuz, B. (2017). Illness representations, coping, and illness outcomes in people with cancer: A systematic review and meta-analysis. Psychooncology, 26(6), 724-737. https://doi.org/10.1002/pon.4213

Sandín, B., & Chorot, P. (2003). Cuestionario de Afrontamiento del Estrés (CAE): desarrollo y validación preliminar. [The Coping Strategies Questionnaire: Development and preliminary validation]. Revista de Psicopatología y Psicología Clínica, 8, 39-54. https://doi.org/10.5944/rppc.vol.8.num.1.2003.3941

Sawant, N. S., & Umate, M. S. (2021). Dissociation, stressors, and coping in patients of psychogenic nonepileptic seizures. Indian Journal of Psychological Medicine, 43(6), 479-484. https://doi.org/10.1177/0253717620956460

Scévola, L., Teitelbaum, J., Oddo, S., Centurión, E., Loidl, C. F., Kochen, S., & D’Alessio, L. (2013). Psychiatric disorders in patients with psychogenic nonepileptic seizures and drug-resistant epilepsy: A study of an Argentine population. Epilepsy & Behavior, 29(1), 155-160. https://doi.org/10.1016/j.yebeh.2013.07.012

Scévola, L., Wolfzun, C., Sarudiansky, M., Areco Pico, M. M., Ponieman, M., Gonzalez Stivala, E., Korman, G., Kochen, S., & D’Alessio, L. (2021). Psychiatric disorders, depression and quality of life in patients with psychogenic non-epileptic seizures and drug resistant epilepsy living in Argentina. Seizure,  92, 174-181. https://doi.org/10.1016/j.seizure.2021.09.004

Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: A review and critique of category systems for classifying ways of coping. Psychological Bulletin, 129(2), 216-269. https://doi.org/10.1037/0033-2909.129.2.216

Snyder, C. R., & Pulvers, K. M. (2001). Dr. Seuss, the coping machine, and “Oh the places you’ll go”. In Snyder, C. R. (Ed.), Coping with stress: Effective people and processes (pp. 3-29). Oxford University Press.

Testa, S. M., Krauss, G. L., Lesser, R. P., & Brandt, J. (2012). Stressful life event appraisal and coping in patients with psychogenic seizures and those with epilepsy. Seizure, 21(4), 282-287. https://doi.org/10.1016/j.seizure.2012.02.002

Wolfzun, C., Korman, G. P., & Sarudiansky, M. (2022). Calidad de vida en pacientes con epilepsia y crisis no epilépticas psicógenas: una revisión sistemática. Interdisciplinaria. Revista de Psicología y Ciencias Afines, 39(2), 89-104. http://hdl.handle.net/11336/161215

Zeng, R., Myers, L., & Lancman, M. (2018). Post-traumatic stress and relationships to coping and alexithymia in patients with psychogenic non-epileptic seizures. Seizure, 57, 70-75. https://doi.org/10.1016/j.seizure.2018.03.011