@article{94ef93bcf5544d3c8cfa6e140c37c261,
title = "Millon clinical multiaxial inventory assessments of patients manifesting either psychogenic or epileptic seizures",
abstract = "Previous investigations utilizing the Minnesota Multiphasic Personality Inventory have observed personality differences between patients with epilepsy (ES) and those with psychogenic seizures (PS). This research utilized a shorter, easier-to-administer instrument, the Millon Clinical Multiaxial Inventory (MCMI), to evaluate 27 PS patients and 22 ES patients. Based on the results of EEG/video monitoring, patients were assigned to either strictly ES or strictly PS groups. PS patients scored significantly higher on MCMI Axis I scale of Anxiety, Somatoform, and Dysthymia as well as the Axis II pathological personality disorder, Borderline. Only the Axis I scales, however, showed clinically elevated base rate scores. Classification rules developed from these results correctly indentified 74\% of the PS and 72\% of the ES patients. These results suggest that MCMI may be a useful instrument for the evaluation of patients with PS.",
keywords = "EEG/video monitoring, Epilepsy, Millon Clinical Multiaxial Inventory, Psychogenic seizures",
author = "Thompson, \{Paul M.\} and Batzel, \{Lawrence W.\} and Wilkus, \{Robert J.\}",
note = "Funding Information: success rate of 74\% PS and 72\% ES identification using the MCMI falls between these two previous MMPI studies. The comparability between this and our earlier MMPI research (6) most likely reflects not only correspondence of the two inventories but also the great degree of similarity in patient populations between the studies. For example, the average age of seizure onset for PS and ES patients was 24.5 and 15.2 years in the current study versus 22.92 and 12.2 years observed in the earlier report. Both studies noted that seizure onset in PS patients started significantly later than in ES patients. PS patients exhibited mostly nonconvulsive attacks in both investigations. PS patients with nonconvulsive spells are more likely to be emotionally disturbed compared to those who manifest convulsive-like spells (9). Compared with ES patients, those with PS had significantly elevated scales on both inventories. PS patients responding to the MMPI had higher scores on scales of Hypochondriasis, Hysteria, Psychopathic deviant, and Schizophrenia, whereas those responding to the MCMI demonstrated higher scores for Axis I scales of Anxiety, Dysthymia, Somatoform, and one Axis II scale, Borderline. The personality differences between the groups may actually be underrepresented here, since many of the ES patients had the additional pressure of also being candidates for epilepsy surgery. Published correlations between the two inventories (7) for the above scales range between 0.37 and 0.50. It seems reasonable to assume that the observed differences between scales for the two instruments reflect, in part, the measurement of different aspects of personality. In this regard, it is important to note that three of the four MCMI scales that statistically distinguished the PS and ES groups were Axis I disorders, and only these three had average scores at a base rate of 75 or greater, suggesting the presence of the disorder (7). Axis I disorders are considered to be acute, reactive, and briefer in duration than Axis II basic and pathological personality disorders. This finding may relate to the fact that, on average, the PS patients in this study had their disorder about one-half as long as the ES patients. However, we observed no relationship between length of disorder and severity of Axis I or Axis II scores. The Axis I profiles are similar to those of depressed patients (10). The PS patients' scores suggest that, on average, they were experiencing a high level of tension, had a tendency to express their discomfort through physical channels, and likely had strong feelings of discouragement, guilt, futility, and low self-esteem (7). While documenting the psychological stress of PS patients, the data are also encouraging. We observed no relationship between the duration of PS symptomotology and severity of Axis I or Axis II scores. That is, patients did not display, or over time appear to develop, elevations on the harder-to-treat Axis II scales for basic personality patterns or pathological personality disorders. These observations are consistent with the notion that PS themselves might have some ameliorative, albeit maladaptive, function, since patients did not worsen with time. The results imply possible directions for treatment. For example, Axis I symptomatology may often be reactive, precipitated by external events. It is not uncommon for PS patients to report a history of abuse. PS may represent a response to a currently abusive relationship or perceived threat in a current situation for previously abused patients. Although not all PS patients are likely to have abuse in their backgrounds, other stressful environmental circumstances may help precipitate PS. An accurate understanding of the patient's relationships, work, and social support structure is therefore important in the treatment of these patients. Although the cause-effect relationship among prior experience, psychological profile, and PS is not clear from this study, the elevated scales do suggest that PS patients may benefit from treatments that are aimed at decreasing stress and guilt while developing initiative and improving self-esteem. The MCMI appears to be a useful inventory in the evaluation of PS patients. It yielded similar results to those previously reported for the MMPI. The MCMI has the advantage of being shorter and easier to administer than the MMPI, and division of the MCMI into Axis I and Axis II disorders possibly allowed for additionally insight into the personality characteristics of this disorder. Acknowledgment: This research was supported by NIH grant NS17111.",
year = "1992",
doi = "10.1016/S0896-6974(05)80121-5",
language = "English",
volume = "5",
pages = "226--230",
journal = "Journal of Epilepsy",
issn = "0896-6974",
publisher = "Elsevier B.V.",
number = "4",
}