Pseudo Seizures

Specialties School

Published

Friends,

Have you ever had a student present with Pseudo Seizures ? I have a student who has these and no basis for it. Phy. has ruled out Epliepsy. Normal EEG. I am stumped as to why ???

I would love to hear from you to see if you have ever experienced this ??

Thank you.

Specializes in Psychiatric / Forensic Nursing.

By definition, PNES (Psychogenic NonEpileptic Seizures) is a psychiatric disorder; more specifically it is a conversion disorder, which falls under the diagnostic category of somatic symptom disorders. In practice however, the term "seizures" is confusing to patients, families and caregivers. The American Psychiatric Association recommends that it is probably best to replace the word "seizures" with more general terms that so not imply epilepsy, such as "episodes" or "events".

Factitious disorder and malingering imply that the patient is purposely deceiving the caregiver (i.e., faking the symptoms). The difference between factitious disorder and malingering is that, in malingering, the reason for the deception is tangible and rationally understandable such as avoiding schoolwork, evading punishment, or being seen as different (attention-seeking). In factitious disorder, the motivation is a pathologic need for the sick role.

How many of our students (and fellow faculty, for that matter) have reaped rich rewards from their role in the family of "the sick one"? All human beings need some semblance of control over their own world, their own destiny. When this is threatened (rules, requirements, testing, schedules, etc.) people will revert to their past learned successes, such as "having a seizure".

The response from the Nurse of preventing harm and phoning the parents is more than just crisis management. I might add to the nurse's technique is to remove the audience.

As a behaviorist and Psychiatric Nurse, I know that all behavior has meaning. "Faking it" has no place in the lexicon of professional caregivers. That said, the specific behavior must be addressed; reinforce it to preserve it or ignore it to increase the likelihood that it will die of neglect (the behavior, not the student. Sorry)

Specializes in School Nursing.

Thank you EKUGRAD ! You have totally described this to a T. I gained an enormous amount of wisdom from your response. EXCELLENT :yes:

By definition, PNES (Psychogenic NonEpileptic Seizures) is a psychiatric disorder; more specifically it is a conversion disorder, which falls under the diagnostic category of somatic symptom disorders. In practice however, the term "seizures" is confusing to patients, families and caregivers. The American Psychiatric Association recommends that it is probably best to replace the word "seizures" with more general terms that so not imply epilepsy, such as "episodes" or "events".

Factitious disorder and malingering imply that the patient is purposely deceiving the caregiver (i.e., faking the symptoms). The difference between factitious disorder and malingering is that, in malingering, the reason for the deception is tangible and rationally understandable such as avoiding schoolwork, evading punishment, or being seen as different (attention-seeking). In factitious disorder, the motivation is a pathologic need for the sick role.

How many of our students (and fellow faculty, for that matter) have reaped rich rewards from their role in the family of "the sick one"? All human beings need some semblance of control over their own world, their own destiny. When this is threatened (rules, requirements, testing, schedules, etc.) people will revert to their past learned successes, such as "having a seizure".

The response from the Nurse of preventing harm and phoning the parents is more than just crisis management. I might add to the nurse's technique is to remove the audience.

As a behaviorist and Psychiatric Nurse, I know that all behavior has meaning. "Faking it" has no place in the lexicon of professional caregivers. That said, the specific behavior must be addressed; reinforce it to preserve it or ignore it to increase the likelihood that it will die of neglect (the behavior, not the student. Sorry)

I had a kid trying to "fake" a nosebleed yesterday with red paint, so, while I MOSTLY agree with your well written post (really, thank you! :) ) I reserve the right as a SN to utilize "faking it."

Welcome to the SN Board.

We wear Pink on Wednesdays, which is today.

Specializes in school nurse.

Unfortunately, some are quick to "pathologize" everything that our snowflakes do. I had a conversation with a nurse who said "we don't use the term 'frequent flyers'- they're just kids trying to get their needs met."

Well, yes. But in many cases the need is to get out of math class.

Specializes in kids.

How many of our students (and fellow faculty, for that matter) have reaped rich rewards from their role in the family of "the sick one"? All human beings need some semblance of control over their own world, their own destiny. When this is threatened (rules, requirements, testing, schedules, etc.) people will revert to their past learned successes, such as "having a seizure".

THIS!!! (bolding is mine)

Been in this role for 20+ years, I still cannot wrap my head around the thought of needing a neurologist for a first time headache, a gastroenterologist for a bout of diarrhea...I have seen more than my fair share of parent who insist on big time hospitals and having their identity so driven by their child's illness.

I'm not talking about a chronically ill kids or a cancer diagnosis etc. I am talking about everyday life people!

I had a patient in a hospital setting have pseudo seizures so that he could keep getting ativan. This went in for 3 rounds. During one of his active seizures I pressed the edge of my scissors on the nailbed of his thumb. He yelled ow, snatched his hand back and sat up. I cured him! No more seizures!!! He did get a psych consult though.

I have had a female teen who has had several pseudoseizures--all occur when she is upset or just looking for attention. They look so real sometimes!

Specializes in School Health.

I had a high school student my first year as a school nurse who had them . He would give the appearance of having tonic-clinic seizures without any EEG changes. He also had other mental illness issues including depression and episodes of acute psychosis including hallucinations. They usually occurred when he was under stress.

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