A Case Report of Psychogenic Non-epileptic Seizures in a 29-Year-Old Male With Schizophrenia

Psychogenic non-epileptic seizures (PNES) involve episodes of movement, sensation, or behaviors that may appear clinically similar to epileptic seizures but without cortical electroencephalographic activity that defines epileptic seizures. This case report involves a 29-year-old male with a history...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-04, Vol.15 (4), p.e37078
Main Authors: Banks, Evan M, Plattes, Maggie M
Format: Article
Language:English
Subjects:
Antipsychotics
Behavior modification
Case reports
Catatonia
Coma
Convulsions & seizures
Cysts
Diabetes
Emergency medical care
Epilepsy
Flexibility
Hallucinations
Hospitalization
Insulin
Neurology
Patients
Post traumatic stress disorder
Psychiatry
Psychology
Psychotropic drugs
Schizophrenia
Severe acute respiratory syndrome coronavirus 2
Sex crimes
Sexual abuse
Sleep
Suicidal behavior
Suicides & suicide attempts
Tomography
Young adults
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Summary:Psychogenic non-epileptic seizures (PNES) involve episodes of movement, sensation, or behaviors that may appear clinically similar to epileptic seizures but without cortical electroencephalographic activity that defines epileptic seizures. This case report involves a 29-year-old male with a history of type I diabetes mellitus, schizophrenia, and a prior suicide attempt via insulin overdose. He was admitted to the emergency department after being found unresponsive on the floor in his bedroom. Given the nature of his prior suicide attempt, he was initially treated for hypoglycemic coma. After arrival at the emergency department, he was noted to have normal blood glucose but displayed symptoms of acute psychosis and was transferred to the behavioral health unit, where subsequent paroxysmal episodes with seizure-like features were observed. He then underwent video-electroencephalography monitoring to evaluate for epilepsy. After no epileptic activity was recorded, he was transferred back to the behavioral health unit and treated for underlying schizophrenia and suspected PNES. After showing gradual improvement on antipsychotic medication, no further seizure-like activity was observed. His stay was complicated by a SARS-CoV-2 infection, which he recovered from without complication, and he was released on day 11. Extensive education was provided for the patient and his family on recognizing the symptoms of PNES and the importance of adherence to antipsychotic medication to avoid psychiatric decompensation and PNES recurrence. This case report highlights the challenge of diagnosing and treating a patient with PNES with underlying psychiatric comorbidities and a history of insulin overdose.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.37078