Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Psychoigenic Seizures

Convulsive Disorder

Seizure: When a psychogenic seizure is diagnosed, a troubled past is often present, and when that person gets injured, some anxiety, depression and pain will increase.

This does not, however, imply that all of their past problems must now be addressed. For non-injury problems, the patients will require private care or care from a community mental health system.

There is a reluctance on the part of insures to authorize psychological care due to concerns that this may increase financial exposure; the fear that all of the patient’s problems will be tied to the injury even of it is not a causative or contributing factor.

seizureSo how do you handle this? Comparatively simple and direct:
a. You should not avoid an MRI because of what can be found, and for similar reasons, you should never avoid a psychological examination/ diagnosis even if an organize basis of the seizure is not expected.

b. The pre-existing problems will often be the bulk of what is bothering this patient since it is a domino effect, and the injury allows the others to fall into play.

c. Authorize care for the exacerbation of the problems, and make it clear to the treating doctor that the patient needs to be referred back to his/her community for care of the longstanding issues.

d. The doctors’ notes should reflect that he is not addressing those pre-existing problems, merely the problems with mood, anxiety and pain that are associated with the injury.

e. Care related to injury should be specifically delineated and targeted and not extend over countless months *unless* the patient is going through a series of procedures which complicates his/her adaptation.

Overall, when you receive a psychological exam that indicates appreciable pre-existing problems, do not run from authorizing care for injury related problems; merely define the *limits* of the care that is authorized.

Medscape

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