Psychogenic non-epileptic seizures (PNES) are episodes of motor, sensory, and/or cognitive seizures without detectable epileptic activity. The integrative cognitive model conceptualizes PNES as an activation of learned mental representations of a seizure often combined with concurrent physiological arousal. PNES are not treatable by antiepileptic medications and are often accompanied by psychiatric and medical comorbidities, complicating treatment following diagnosis. Further, individuals with PNES often incur greater medical costs through hospital admissions and emergency department visits. Multidisciplinary care including behavioral health interventions like cognitive behavior therapy have demonstrated initial success at reducing seizure frequency but impacts on healthcare utilization are unknown. Patients at a Midwestern PNES clinic (N = 588) received multidisciplinary care from epileptologists, psychologists, and social workers between 2016 and 2023. In Study 1, a latent class analysis was run on theoretically informed clinical presentations, revealing that a two-class model fit best (Low Comorbidity and Mixed Presentation). Study 2 expanded on this with additional PTSD diagnoses assigned based on screening measures; however, the consequent two-class model from Study 2 did not fit better than that of Study 1. Study 3 utilized conditional probabilities of the Mixed Presentation class to significantly predict healthcare utilization over time while statistically controlling for time-, patient-, and provider-level covariates via multilevel models. This finding was robust to additional healthcare confounds included in a post hoc analysis. Findings revealed that despite the significant impacts of the two-class model, patients with PNES were more homogeneous in clinical presentation than theorized. Increasing comorbidities may still remain impactful on healthcare utilization for this sample. Care could thus focus on proper referrals for these presentations and increased training to support emergency department staff in responding to PNES symptoms.
","abstract_html":"<p>Psychogenic non-epileptic seizures (PNES) are episodes of motor, sensory, and/or cognitive seizures without detectable epileptic activity. The integrative cognitive model conceptualizes PNES as an activation of learned mental representations of a seizure often combined with concurrent physiological arousal. PNES are not treatable by antiepileptic medications and are often accompanied by psychiatric and medical comorbidities, complicating treatment following diagnosis. Further, individuals with PNES often incur greater medical costs through hospital admissions and emergency department visits. Multidisciplinary care including behavioral health interventions like cognitive behavior therapy have demonstrated initial success at reducing seizure frequency but impacts on healthcare utilization are unknown. Patients at a Midwestern PNES clinic (N = 588) received multidisciplinary care from epileptologists, psychologists, and social workers between 2016 and 2023. In Study 1, a latent class analysis was run on theoretically informed clinical presentations, revealing that a two-class model fit best (Low Comorbidity and Mixed Presentation). Study 2 expanded on this with additional PTSD diagnoses assigned based on screening measures; however, the consequent two-class model from Study 2 did not fit better than that of Study 1. Study 3 utilized conditional probabilities of the Mixed Presentation class to significantly predict healthcare utilization over time while statistically controlling for time-, patient-, and provider-level covariates via multilevel models. This finding was robust to additional healthcare confounds included in a post hoc analysis. Findings revealed that despite the significant impacts of the two-class model, patients with PNES were more homogeneous in clinical presentation than theorized. Increasing comorbidities may still remain impactful on healthcare utilization for this sample. Care could thus focus on proper referrals for these presentations and increased training to support emergency department staff in responding to PNES symptoms.</p>","abstract_has_math":false,"creators":["Tu, Joseph W."],"institution":null,"degree_name":"Doctor of Philosophy (PhD)","degree_level":"Open Access Dissertation","degree_discipline":"Psychology","degree_department":null,"school":null,"contributors":["Angela Staples, PhD, Chair","Ellen Koch, PhD","Elissa Patterson, PhD"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2025,"date_issued":"2025-01-01T08:00:00Z","date_published":"2025-01-01T08:00:00Z","updated_at":"2026-07-24T02:17:53Z","subjects":["Psychology"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://commons.emich.edu/theses/1320","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Angela Staples, PhD, Chair","Ellen Koch, PhD","Elissa Patterson, PhD"]},{"key":"dc:creator","label":"Author","values":["Tu, Joseph W."]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.available","label":"Dc Date Available","values":["2025-10-10T07:00:00Z"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Psychology"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Open Access Dissertation"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Philosophy (PhD)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Psychology"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://commons.emich.edu/theses/1320"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Psychogenic non-epileptic seizures (PNES) are episodes of motor, sensory, and/or cognitive seizures without detectable epileptic activity. The integrative cognitive model conceptualizes PNES as an activation of learned mental representations of a seizure often combined with concurrent physiological arousal. PNES are not treatable by antiepileptic medications and are often accompanied by psychiatric and medical comorbidities, complicating treatment following diagnosis. Further, individuals with PNES often incur greater medical costs through hospital admissions and emergency department visits. Multidisciplinary care including behavioral health interventions like cognitive behavior therapy have demonstrated initial success at reducing seizure frequency but impacts on healthcare utilization are unknown. Patients at a Midwestern PNES clinic (N = 588) received multidisciplinary care from epileptologists, psychologists, and social workers between 2016 and 2023. In Study 1, a latent class analysis was run on theoretically informed clinical presentations, revealing that a two-class model fit best (Low Comorbidity and Mixed Presentation). Study 2 expanded on this with additional PTSD diagnoses assigned based on screening measures; however, the consequent two-class model from Study 2 did not fit better than that of Study 1. Study 3 utilized conditional probabilities of the Mixed Presentation class to significantly predict healthcare utilization over time while statistically controlling for time-, patient-, and provider-level covariates via multilevel models. This finding was robust to additional healthcare confounds included in a post hoc analysis. Findings revealed that despite the significant impacts of the two-class model, patients with PNES were more homogeneous in clinical presentation than theorized. Increasing comorbidities may still remain impactful on healthcare utilization for this sample. Care could thus focus on proper referrals for these presentations and increased training to support emergency department staff in responding to PNES symptoms.
"]},{"key":"dc:title","label":"Title","values":["Latent classes of comorbid clinical presentations for patients with psychogenic non-epileptic seizures"]}]}],"canonical_facts":{"dc:contributor":["Angela Staples, PhD, Chair","Ellen Koch, PhD","Elissa Patterson, PhD"],"dc:creator":["Tu, Joseph W."],"dc:date.available":["2025-10-10T07:00:00Z"],"dc:description.abstract":["Psychogenic non-epileptic seizures (PNES) are episodes of motor, sensory, and/or cognitive seizures without detectable epileptic activity. The integrative cognitive model conceptualizes PNES as an activation of learned mental representations of a seizure often combined with concurrent physiological arousal. PNES are not treatable by antiepileptic medications and are often accompanied by psychiatric and medical comorbidities, complicating treatment following diagnosis. Further, individuals with PNES often incur greater medical costs through hospital admissions and emergency department visits. Multidisciplinary care including behavioral health interventions like cognitive behavior therapy have demonstrated initial success at reducing seizure frequency but impacts on healthcare utilization are unknown. Patients at a Midwestern PNES clinic (N = 588) received multidisciplinary care from epileptologists, psychologists, and social workers between 2016 and 2023. In Study 1, a latent class analysis was run on theoretically informed clinical presentations, revealing that a two-class model fit best (Low Comorbidity and Mixed Presentation). Study 2 expanded on this with additional PTSD diagnoses assigned based on screening measures; however, the consequent two-class model from Study 2 did not fit better than that of Study 1. Study 3 utilized conditional probabilities of the Mixed Presentation class to significantly predict healthcare utilization over time while statistically controlling for time-, patient-, and provider-level covariates via multilevel models. This finding was robust to additional healthcare confounds included in a post hoc analysis. Findings revealed that despite the significant impacts of the two-class model, patients with PNES were more homogeneous in clinical presentation than theorized. Increasing comorbidities may still remain impactful on healthcare utilization for this sample. Care could thus focus on proper referrals for these presentations and increased training to support emergency department staff in responding to PNES symptoms.
"],"dc:identifier":["https://commons.emich.edu/theses/1320"],"dc:subject":["Psychology"],"dc:title":["Latent classes of comorbid clinical presentations for patients with psychogenic non-epileptic seizures"],"thesis:degree_discipline":["Psychology"],"thesis:degree_level":["Open Access Dissertation"],"thesis:degree_name":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-24T02:17:53Z"}