Published Feb 27, 2014
I guess it's preferred that "pseudoseizures" be phased out in favor of conversion disorder (pt is diagnosed with both) but we have a pt now who presented with pseudoseizure activity all day. If she were having actual clinical seizures to this degree she would not be considered medically stable, but here she is having seizure-like activity all day out in the milieu (like twenty times today) with the other patients freaking out, and the staff all split on how they are addressing it and whether they are legit or not. Now from what I've read tonight (crash course) they are real to the patient, they are not being "faked," i.e. the patient does not have control over having them. I am one of the newer nurses here and don't agree with how some of the more seasoned staff were handling her condition today. Wondering if anyone else has any words of wisdom.
Where I worked we had a female client who would fake seizures seemingly every day. The first time I thought they were real, then I learned better. Especially since she was shipped out to the ER multiple times. Pssh. What I did with her was a sternal chest rub. She would push my hand away but make it seem like part of her "seizure". Then I would pop an ammonia inhalant under her nose. That would stop her in her tracks & she would magically wake up. :-/ Even some of the doctor's in the ER she went to have her a dx of psuedoseizure. Thankfully she eventually left.
SoldierNurse22, BSN, RN
No control over them? Please. If they aren't real seizures caused by faulty neurological "wiring", then the patient most certainly knows exactly what she's doing. Otherwise, there is a different medical explanation for the seizure-like activity that needs to be sought out. Diagnosing her with a "psuedoseizure" is far from the end of the line.
We had patients who would do this on occasion. We got a psych consult and let them know it wasn't OK. Nothing like a shrink to call their bluff.
There's something wrong with your patient beyond the "pseudoseizure" itself if they're faking seizure activity.
morte, LPN, LVN
as the op stated, pseudo, doesn't mean faked. it means no neurological reason found. probably psych, but not FAKED.
No control over them? Please. If they aren't real seizures caused by faulty neurological "wiring", then the patient most certainly knows exactly what she's doing. Otherwise, there is a different medical explanation for the seizure-like activity that needs to be sought out. Diagnosing her with a "psuedoseizure" is far from the end of the line.We had patients who would do this on occasion. We got a psych consult and let them know it wasn't OK. Nothing like a shrink to call their bluff.There's something wrong with your patient beyond the "pseudoseizure" itself if they're faking seizure activity.
Right, and as I stated, "pseudoseizure" for a legitimate albeit idiopathic medical problem is no diagnosis.
In this age, surely we can do better than a cop-out excuse for a diagnosis like "psuedoseizure".
apparently, per the op, the preferred dx is conversion disorder....but this then limits further physical work ups...
Right, and as I stated, "pseudoseizure" for a legitimate albeit idiopathic medical problem is no diagnosis.In this age, surely we can do better than a cop-out excuse for a diagnosis like "psuedoseizure".
I just looked up the definition of Conversion Disorder. I feel it's about as useful as pseudoseizure. Honestly, there are times when I wish that we could just admit we don't know what's wrong instead of making up a name to go with the symptoms.
Guttercat, ASN, RN
I always look for the post-ictal response. Not that this "diagnoses" anything, but it helps narrow the list.
There is no postictal state because she isn't..."ictal."
I think it's a bit unfair to just characterize it as being something she should just knock off. We know what's wrong...she's having seizure-like activity. She isn't having seizures. The medical professionals involved in her care are treating it as a legitimate psych issue (not behavior). This person has possibly the most tragic developmental history I've read in my 16 years of human services so far, so her psych providers characterize it as being related to a dissociative state of sort.
Even in speaking to the patient, she characterizes her activity has "pseudoseizures" and states that she can feel them coming on sometimes and that if you can help intervene before she gets "too far in" then she will not go into a full-blown epsiode.
Sharing this as having felt like I reached a point where I was actually able to be therapeutic with her. I don't feel that treating her as if she should just "knock if off" is helpful nor is letting her have violent seizure-like activity all day in the milieu to the horror of the other patients. The problem still is that every staff is approaching it with a different mindset, mostly because we haven't dealt with it before. I'll add the full disclaimer that my ********-o-meter is still a work in progress.
Some people have genuine seizures, some fake seizures, some express their psychological conflicts through seizure like activity beyond their conscious control.
It's real hard at times to tell if it's a pseudo, or willful. As long as we know it's not a bonafide gran mal, we deal with minimizing reinforcement. Don't belittle the patient, or openly scoff, as that will appear as callous to the other patients. We usually transport the person to their room, quietly close the door, and regularly monitor the patient for safety. We tell the other patients that the person is being taken care of, he/she is safe, and that they'll be ok.
We had a patient at my facility who was admitted after extensive sexual/physical abuse throughout her life. She came to us from ICU and while I was getting report, the nurse informed me that she had pseudoseizures. This was my first encounter with a "pseudo" seizure. We've had other patients on the unit seize in the past, but this was new to me. I initially assumed that the seizures this patient experienced were fake until she started having them on the unit.
The seizures were very real, and they honestly looked much like a grand mal. They normally lasted less than 1 minute, the patient was exhausted after, had a h/a etc. I started doing some research on pseudoseizures because once I'd actually witnessed the sz activity there was no way that the patient was faking them. From what I could find a pseudoseizure is a defense mechanism which made sense as this particular patient's seizures were triggered by stressful situations. The next time we get a patient in who's had a history of pseudoseizures, I'll take it quite a bit more seriously.
We've also had patients come in who literally fake their own seizures, and it's pretty obvious to tell, especially while in the middle of a "seizure" the patient will ask staff "can't you tell I'm having a seizure?!". Yeah.
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