Pseudoseizures and screening for sexual abuse

[Lev, MSN, RN, NP]

Just wondering if this is common practice in anybody's workplace. I read that there is a fairly high incidence between the two. Pseudoseizures are seen as symptom of a form of conversion disorder where patients express their psychological distress, shame of traumatic event, or inability to verbally communicate with physical symptoms. Anyone have any stories to share?

[rearviewmirror, BSN, RN]

I never thought of relating those two, but without more data and research studies, I'm completely unaware of their connections. Pseduseizures, however, I do know that can be treated excellently with ammonia :)

[Whispera, MSN, RN]

While ammonia may stop a pseudo seizure, it doesn't eliminate the person's reason for having the pseudo seizure. It's my experience that the seizures are the person's response to being unable to cope with something that was (or still is) traumatic. They are not able, for whatever reason, to show emotions related to the trauma, so their brains do something else with it all. Sometimes it's an extreme need for someone to care. It's usually not a conscious choice!

[madwife2002, BSN, RN]

I have witness this many years ago, a young girl who was experiencing horrible pseudoseisures which we eventually got under control until her father appeared. Later on she told us that her father had been sexually abusing her for years! I will never forget her

[Anna Flaxis, BSN, RN]

I would imagine that any sort of severe emotional trauma, not just sexual abuse, could manifest as pseudoseizures.

Generally speaking, in the ER, we treat the distress, but it's not really our role to tease out a psych diagnosis- we're not very skilled at it for one thing, and it could easily destroy the therapeutic relationship when a poor communicator gives the patient the impression that it's "all in their head". We will treat the distress and get the appropriate consults/follow-up. That's not very holistic of us, but the system isn't really set up in a way where we can address the patient's needs holistically. We just do what we can to address the immediate needs and steer the person in the right direction for further evaluation and follow up.