Case Reports in Psychiatry / 2014 / Article / Tab 1

Case Report

Quality Improvement Opportunities in Caring for Patients with Nonepileptic Seizures

Table 1

Patient, provider, and system factors contributing to care for patients with nonepileptic seizures and characteristics triggering psychiatric or psychological referral.

FactorsLess suited towards referralMore suited towards referral

Patient and family factorsBelief in stigmatization of psychiatric care and that it may not be helpfulAcceptance that psychiatric referral can be helpful and is not stigmatizing
Belief in external locus of control of symptomsBelief in internal locus of control of symptoms
Fair to good insight and awareness of psychosocial stressorsPoor to fair insight and awareness of psychosocial stressors
More emotionally supportive and more physically present family and or friendsLess emotionally supportive and less physically present family and or friends

Provider factors
 Neurologist (referring  physician) factorsComfortable and/or has sufficient time and energy to manage psychiatric comorbiditiesLess comfortable and has insufficient time to manage psychiatric comorbidities
 Psychiatrist (receiving  physician) factorsNot as interested in care of patients with neurological disorders or not believing that psychiatric/psychological interventions may be helpful Comfortable with and has predilection to manage affectively challenging patients

System factorsLack of availability of psychiatrists and psychologists locallyAvailability of psychiatrists and psychologists as well as opportunities to build “shared appointments” with neurologists
Inability of neurologists and psychiatrists to dedicate sufficient time to care coordination for patients with NESAbility of neurologists and psychiatrists to communicate effectively and have regular meetings and or open channels of communication regarding care coordination for patients with NES