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2019 HSR&D/QUERI National Conference Abstract

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4135 — Time Between Somatization Symptoms and Diagnosis: A Time to Event Analysis of Diagnosing Psychogenic Seizures

Lead/Presenter: Daniela Galluzzo,  COIN - West Haven
All Authors: Galluzzo D (VA Connecticut Healthcare System, Connecticut), Goulet J (VA Connecticut Healthcare System, Connecticut), Argraves S (VA Connecticut Healthcare System, Connecticut) Jackson Shaheed E (VA Connecticut Healthcare System, Connecticut) Hitchins A (VA Connecticut Healthcare System, Connecticut) Cheung KH (VA Connecticut Healthcare System, Connecticut) Brandt C (VA Connecticut Healthcare System, Connecticut) Pugh MJ (University of Utah, VA Salt Lake City Healthcare System, Utah) Altalib H (VA Connecticut Healthcare System, Connecticut)

Objectives:
To explore access to and coordination of care of somatization disorders, psychogenic non-epileptic seizures (PNES) was identified in a virtual cohort study. Unlike other somatization disorders, PNES is not a diagnosis of exclusion. Video electroencephalogram provides a definitive diagnosis.

Methods:
Our cohort of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans with PNES were extracted from the Women Veteran Cohort Study. Cases were identified from 2003-2016. Pearson chi-squared and log rank time to event analyses, were conducted using SPSS version 24.

Results:
This cohort comprised 527 Veterans with PNES, of which 91 (14%) were women. Prior to PNES diagnosis the following medical and psychiatric comorbidities were reported: traumatic brain injury (TBI) in 353 (68%); childhood abuse in 153 (37%), and intimate partner violence in 26 (6%). Of the 350 Veterans with PNES who engaged in psychotherapy, 86 (16%) were treated mood disorder, 25 (5%) for anxiety disorder, and 239 (45%) for PTSD. A large proportion of Veterans with PNES used high level VA care: 160 (45%) were admitted to the hospital and 205 (39%) visited an emergency room at least once prior to diagnosis of PNES. Suicidality was common including 99 (19%) documented suicide attempts. Men and women experienced similar delays to diagnosis, with an average time from event onset to diagnosis of 42 months for men and 50 months for women (p = 0.11). Veterans experienced a greater delay in diagnosis through the VA system, roughly 80% of Veterans were diagnosed within four years in the private sector, compared to six years through VA care.

Implications:
Veterans with PNES often have multiple medical and psychiatric comorbidities and significant delay in diagnosis. Veterans are diagnosed early in non-VA facilities compared to VA facilities. Further analyses are needed to determine the root causes of delay in VA care.

Impacts:
Despite the establishment of the VA Epilepsy Center of Excellence, many Veterans experience a significant delay in diagnosis. Veterans with PNES require multidisciplinary care, particularly between neurology and mental health care.