Pseudo-seizures: can you share your experience and insight?

TinyNurse, RN · Aug 22, 2006

hold their arm up above their face during the seizure and let it drop............... does it land other than their face? ok then..

VickyRN, MSN, DNP, RN · Aug 22, 2006

I saw a resident once open an ammonia "smelling salts" under the nose of a 12-year-old patient on the pediatric floor who was having frequent tonic-clonic-type "seizures" of dubious origin. This intervention clearly demonstrated that she was merely attention-seeking as the seizure "activity" abruptly stopped when he put the ammonia under her nose. I don't know if this would be a recommended practice in the psychiatric setting, however :eek:

Morgan314 · Aug 23, 2006

I saw the ammonia "smelling salt" method used on an inpatient unit once, but we don't have any in our clinic. The patient has not had "seizures" during any encounters I've had with him until a family member mentioned the word, then he suddenly gave a jerk and he said it was a seizure. His therapist says he had a seizure during one of her sessions. Thank you both for your responses.

Noryn · Aug 23, 2006

hold their arm up above their face during the seizure and let it drop............... does it land other than their face? ok then..

rofl dont do that. We had a paramedic crew do that one time, which by the way is very common, and for whatever reason the patients hand fell directly on the nose and there was blood everywhere. I was about to get excited when I saw the pt, thinking they may have a bad injury but the paramedic crew although embarassed was honest and told me what happened.

Usually if you see enough seizures you can tell most fake seizures but there are some good actors out there. I always used ammonia. I love putting IVs in while someone is having one of these, their whole body is twitching but for some miraculous reason that arm you are sticking is as still as it can be.

Most of the time it is some form of attention seeking behavior, so I would dwell into their life a bit to see what is going on. Typically these patients are very manipulative.

EricJRN, MSN, RN · Aug 23, 2006

Keep in mind that a diagnosis of pseudoseizures does not mean that the patient is an intentionally deceptive malingerer.

NurseyBaby'05, BSN, RN · Aug 23, 2006

That's true. A lot of times their subconscious is coming through. It doesn't lessen the urge to wring their necks when it's the third time you've run to their bedside in 30 minutes (Especially when the "seizures" seem to coincide with arguments with loved ones. :angryfire)and you can't get to your poor trach patient that needs suctioned. The one time you don't go will be the time the pt gets hurt. Boy, could I use a kick in the butt smiley! :chuckle

lovinghands · Aug 24, 2006

I generally swipe my hand a couple times near their face and if their eyes track the movement then I have a good idea what I'm dealing with.

Btw, they recently renamed this activity to "seizures of a psychogenic nature." The word police is another rant for a different day...

NurseyBaby'05, BSN, RN · Aug 24, 2006

Be careful though. I've had a few that were combative.

JessicRN · Aug 24, 2006

rofl dont do that. We had a paramedic crew do that one time, which by the way is very common, and for whatever reason the patients hand fell directly on the nose and there was blood everywhere. I was about to get excited when I saw the pt, thinking they may have a bad injury but the paramedic crew although embarassed was honest and told me what happened.
Usually if you see enough seizures you can tell most fake seizures but there are some good actors out there. I always used ammonia. I love putting IVs in while someone is having one of these, their whole body is twitching but for some miraculous reason that arm you are sticking is as still as it can be.
Most of the time it is some form of attention seeking behavior, so I would dwell into their life a bit to see what is going on. Typically these patients are very manipulative.

We do the slap face test all the time but not on a pt who is activly seizing but the one who is "post ictal" only we hold our hand over the face to catch the hand that hits the face.

Melina · Sep 2, 2006

I would like to learn more about how to offer support to a patient who comes to our outpatient clinic. Thank you.

Maybe it's just me, but how does any of this answer the original post? I understand the importance of determining whether seizures are 'real' or not, but where does the OP go from there? I know little about somatoform disorders, but I do remember reading that cognitive behavioral therapy can help with the underlying anxiety that is often present. Is your clinic primary or mental health?

~Mel'