{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T09:39:45Z","timestamp":1766137185111,"version":"3.48.0"},"reference-count":42,"publisher":"BMJ","issue":"5","funder":[{"name":"NIHR HTA"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,2,14]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>There is currently limited research exploring healthcare professionals\u2019 (HCPs) experiences of working with patients with dissociative seizures (DS). Existing studies do not focus on the role of psychiatrists in treating this complex condition. The objective of this study was to gain an understanding of UK-based psychiatrists\u2019 experiences of the DS patient group. Against the backdrop of a UK-wide randomised controlled trial (RCT), the focus was broadened to encompass issues arising in everyday practice with the DS patient group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, participants and methods<\/jats:title>\n                    <jats:p>A qualitative study using semistructured interviews was undertaken with 10 psychiatrists currently working with DS patients within the context of a large RCT investigating treatments for DS. Thematic analysis was used to identify key themes and subthemes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The psychiatrists were working in Liaison or Neuropsychiatry services in England.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The key themes identified were other HCPs\u2019 attitudes to DS and the challenges of the DS patient group. There is a clear knowledge gap regarding DS for many HCPs and other clinical services can be reluctant to take referrals for this patient group. Important challenges posed by this patient group included avoidance (of difficult emotions and help), alexithymia and interpersonal difficulties. Difficulties with alexithymia meant DS patients could struggle to identify triggers for their seizures and to express their emotions. Interpersonal difficulties raised included difficulties in attachment with both HCPs and family members.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A knowledge gap for HCPs regarding DS has been identified and needs to be addressed to improve patient care. Given the complexity of the patient group and that clinicians from multiple disciplines will come into contact with DS patients, it is essential for any educational strategy to be implemented across the whole range of specialties, and to account for those already in practice as well as future trainees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"ISRCTN05681227\" ext-link-type=\"isrctn\" specific-use=\"clinicaltrial pre-results\">ISRCTN05681227<\/jats:ext-link>\n                      ;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT02325544\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\">NCT02325544<\/jats:ext-link>\n                      ; Pre-results.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026493","type":"journal-article","created":{"date-parts":[[2019,5,9]],"date-time":"2019-05-09T09:29:20Z","timestamp":1557394160000},"page":"e026493","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Exploring psychiatrists\u2019 perspectives of working with patients with dissociative seizures in the UK healthcare system as part of the CODES trial: a qualitative study"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"isrctn05681227","registry":"10.18810\/isrctn","type":"preResults"},{"clinical-trial-number":"nct02325544","registry":"10.18810\/clinical-trials-gov","type":"preResults"},{"clinical-trial-number":"isrctn05681227","registry":"10.18810\/isrctn"},{"clinical-trial-number":"nct02325544","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-7310","authenticated-orcid":false,"given":"Harriet","family":"Jordan","sequence":"first","affiliation":[{"name":"Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3986-2698","authenticated-orcid":false,"given":"Sarah","family":"Feehan","sequence":"additional","affiliation":[{"name":"Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8078-8146","authenticated-orcid":false,"given":"Iain","family":"Perdue","sequence":"additional","affiliation":[{"name":"Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7348-7505","authenticated-orcid":false,"given":"Joanna","family":"Murray","sequence":"additional","affiliation":[{"name":"Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9387-3035","authenticated-orcid":false,"given":"Laura H","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,5,9]]},"reference":[{"key":"2025121401050366000_9.5.e026493.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.10.022"},{"key":"2025121401050366000_9.5.e026493.2","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1002\/epi4.12060","article-title":"PNES around the world: where we are now and how we can close the diagnosis and treatment gaps-an ILAE PNES Task Force report","volume":"2","author":"Kanemoto","year":"2017","journal-title":"Epilepsia Open"},{"key":"2025121401050366000_9.5.e026493.3","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.yebeh.2015.03.015","article-title":"Epidemiology of psychogenic nonepileptic seizures","volume":"46","author":"Asadi-Pooya","year":"2015","journal-title":"Epilepsy Behav"},{"key":"2025121401050366000_9.5.e026493.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2011.03276.x"},{"key":"2025121401050366000_9.5.e026493.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2007.12.010"},{"key":"2025121401050366000_9.5.e026493.6","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.46.6.1499"},{"key":"2025121401050366000_9.5.e026493.7","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/j.yebeh.2011.01.029","article-title":"Illness perceptions of health care workers in relation to epileptic and psychogenic nonepileptic seizures","volume":"20","author":"Worsley","year":"2011","journal-title":"Epilepsy Behav"},{"key":"2025121401050366000_9.5.e026493.8","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/epi.13952","article-title":"Access to diagnostic and therapeutic facilities for psychogenic nonepileptic seizures: An international survey by the ILAE PNES Task Force","volume":"59","author":"Hingray","year":"2018","journal-title":"Epilepsia"},{"key":"2025121401050366000_9.5.e026493.9","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2010.233114"},{"key":"2025121401050366000_9.5.e026493.10","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1111\/epi.14189","article-title":"Health care practitioners' perceptions of psychogenic nonepileptic seizures: a systematic review of qualitative and quantitative studies","volume":"59","author":"Rawlings","year":"2018","journal-title":"Epilepsia"},{"key":"2025121401050366000_9.5.e026493.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2009.11.001"},{"key":"2025121401050366000_9.5.e026493.12","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.seizure.2016.07.014","article-title":"What patients say about living with psychogenic nonepileptic seizures: a systematic synthesis of qualitative studies","volume":"41","author":"Rawlings","year":"2016","journal-title":"Seizure"},{"key":"2025121401050366000_9.5.e026493.13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.yebeh.2008.03.001","article-title":"Primary care and emergency physician attitudes and beliefs related to patients with psychogenic nonepileptic spells","volume":"13","author":"Shneker","year":"2008","journal-title":"Epilepsy Behav"},{"key":"2025121401050366000_9.5.e026493.14","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.yebeh.2005.09.013","article-title":"The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures","volume":"8","author":"O\u2019Sullivan","year":"2006","journal-title":"Epilepsy Behav"},{"key":"2025121401050366000_9.5.e026493.15","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.ejpn.2018.05.007","article-title":"Paediatricians' attitudes to and management of functional seizures in children","volume":"22","author":"Nielsen","year":"2018","journal-title":"Eur J Paediatr Neurol"},{"key":"2025121401050366000_9.5.e026493.16","doi-asserted-by":"publisher","DOI":"10.1186\/s12883-015-0350-0"},{"key":"2025121401050366000_9.5.e026493.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.b3496","article-title":"Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study","volume":"339","author":"Lewin","year":"2009","journal-title":"BMJ"},{"key":"2025121401050366000_9.5.e026493.18","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-015-0709-y","article-title":"Criteria for reporting the development and evaluation of complex interventions in healthcare: revised guideline (CReDECI 2)","volume":"16","author":"M\u00f6hler","year":"2015","journal-title":"Trials"},{"key":"2025121401050366000_9.5.e026493.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7262.694"},{"key":"2025121401050366000_9.5.e026493.20","unstructured":"Rubin H , Rubin I . Qualitative interviewing: a method to the madness. Thousand Oaks CA: Sage Publications, 1995."},{"key":"2025121401050366000_9.5.e026493.21","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"2025121401050366000_9.5.e026493.22","doi-asserted-by":"crossref","unstructured":"Rommelfanger KS , Factor SA , LaRoche S , et al . Disentangling stigma from functional neurological disorders: conference report and roadmap for the future. Front Neurol 2017;8.doi:10.3389\/fneur.2017.00106","DOI":"10.3389\/fneur.2017.00106"},{"key":"2025121401050366000_9.5.e026493.23","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.seizure.2011.09.012","article-title":"Illness perceptions of neurologists and psychiatrists in relation to epilepsy and nonepileptic attack disorder","volume":"21","author":"Whitehead","year":"2012","journal-title":"Seizure"},{"key":"2025121401050366000_9.5.e026493.24","doi-asserted-by":"crossref","first-page":"353","DOI":"10.5698\/1535-7511-15.6.353","article-title":"What are we communicating when we present the diagnosis of PNES?","volume":"15","author":"Dworetzky","year":"2015","journal-title":"Epilepsy Curr"},{"key":"2025121401050366000_9.5.e026493.25","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12106"},{"key":"2025121401050366000_9.5.e026493.26","doi-asserted-by":"publisher","DOI":"10.1016\/S1525-5050(03)00104-5"},{"key":"2025121401050366000_9.5.e026493.27","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12356"},{"key":"2025121401050366000_9.5.e026493.28","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1017\/S1092852917000797","article-title":"Occupational therapy for functional neurological disorders: a scoping review and agenda for research","volume":"23","author":"Gardiner","year":"2018","journal-title":"CNS Spectr"},{"key":"2025121401050366000_9.5.e026493.29","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2012-303062"},{"key":"2025121401050366000_9.5.e026493.30","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306618"},{"key":"2025121401050366000_9.5.e026493.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2005.06.006"},{"key":"2025121401050366000_9.5.e026493.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2012.01.009"},{"key":"2025121401050366000_9.5.e026493.33","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2018-300029"},{"key":"2025121401050366000_9.5.e026493.34","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.yebeh.2014.02.016","article-title":"Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety","volume":"33","author":"Dimaro","year":"2014","journal-title":"Epilepsy Behav"},{"key":"2025121401050366000_9.5.e026493.35","doi-asserted-by":"publisher","DOI":"10.1053\/seiz.2000.0421"},{"key":"2025121401050366000_9.5.e026493.36","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181e39658"},{"key":"2025121401050366000_9.5.e026493.37","doi-asserted-by":"publisher","DOI":"10.1016\/S1059-1311(02)00290-X"},{"key":"2025121401050366000_9.5.e026493.38","doi-asserted-by":"publisher","DOI":"10.1192\/pb.bp.107.018424"},{"key":"2025121401050366000_9.5.e026493.39","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.yebeh.2014.07.001","article-title":"Providers' perspectives on treating psychogenic nonepileptic seizures: frustration and hope","volume":"37","author":"McMillan","year":"2014","journal-title":"Epilepsy Behav"},{"key":"2025121401050366000_9.5.e026493.40","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.seizure.2017.06.004","article-title":"Psychogenic nonepileptic seizures: namibian healthcare providers' perceptions and frustrations","volume":"50","author":"du Toit","year":"2017","journal-title":"Seizure"},{"key":"2025121401050366000_9.5.e026493.41","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edn. United States: American Psychiatric Association, 2013.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"2025121401050366000_9.5.e026493.42","unstructured":"World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines: World Health Organization, 1992."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-026493","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T09:05:15Z","timestamp":1765703115000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-026493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,5,9]]},"published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1136\/bmjopen-2018-026493"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-026493","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2019,5]]}}}