Table 1

Communicating the diagnosis of dissociative seizures: experience-based dos and don’ts

DoDon’t
Preparation
  • Arrange appropriate setting for the communication (time, place, people).

  • Find out as much as you can about the patient (from patient and records).

  • Find out what the patient has been told about the diagnosis.

  • Spring the diagnosis on the patient in an inappropriate setting.

  • Dodge the communication of the diagnosis.

  • Delegate the communication to the most junior member of the team.

Explanation
  • Be attentive, engage the patient.

  • Take your time.

  • Demonstrate you understand the disabling nature of the problem.

  • Give it a name.

  • Explain reasons for diagnosis (observations).

  • Provide an explanatory model (like a reflex).

  • Say why it is not epilepsy (if appropriate).

  • Say frequently seen after trauma (not always).

  • Check patient’s understanding.

  • Explain how psychotherapy can work (retraining the brain).

  • Explain diagnosis to relevant others (if possible).

  • Dominate the conversation.

  • Go faster than the patient can follow.

  • Minimise the problem or imply malingering/factitious process.

  • Avoid naming or using ‘pseudoseizure’.

  • Only say what it is not or say ‘good news’.

  • Say ’the seizures are due to stress’.

  • Continue antiepileptic drugs if pure dissociative seizures.

  • Insist on trauma disclosure.

  • Say ‘you need to see a psychiatrist’.

  • Consider or present antidepressants as an alternative to psychotherapy.

After communication of the diagnosis
  • Reflect on the interaction (do it better next time).

  • Record what explanation given.

  • Consolidate the patient’s understanding (letter to patient, leaflet, websites, patient groups).

  • Communicate the diagnosis and explanation to other health professionals.

  • Document things in writing that were never discussed with the patient.

  • Discharge the patient immediately after the delivery of the diagnosis.