The question bank is the fastest way to start, but PMHNP Helper also includes board-review planning, student resources, and plain-English guidance for psychiatric nurse practitioner students who are still learning the exam landscape.
A 28-year-old woman is referred for psychiatric evaluation after video-EEG monitoring during a 3-day admission revealed no epileptiform activity during four observed clinical events that had previously been diagnosed as seizures. During the monitored events, she exhibited bilateral asynchronous limb movements with side-to-side head shaking, pelvic thrusting, eye closure with resistance to passive eye opening, and episodes lasting 3 to 7 minutes. She remained responsive to verbal commands during two of the four events, though she reported amnesia for the episodes afterward. Her neurologist noted preserved pupillary reflexes, absence of postictal confusion proportional to event duration, and no tongue biting or incontinence. She has a history of childhood sexual abuse and was diagnosed with PTSD at age 19. She has been taking two antiepileptic medications for the past 4 years with no seizure reduction. Her neurological examination between events is completely normal. Which of the following assessment findings is most consistent with this presentation?
Explanation
PNES (psychogenic nonepileptic seizures), classified as functional neurological symptom disorder in DSM-5, is diagnosed by video-EEG showing no epileptiform activity during captured clinical events combined with characteristic semiology. Key PNES features include asynchronous movements, pelvic thrusting, forceful eye closure, prolonged duration, and preserved responsiveness. Trauma history and PTSD are common comorbidities, and PNES should be distinguished from malingering as it is not consciously produced.
Key Takeaway
Video-EEG monitoring capturing habitual events without epileptiform correlates is the gold standard for diagnosing PNES, and characteristic semiological features such as asynchronous movements, eye closure, and prolonged duration help distinguish these events from epileptic seizures.