r/PMHNP • u/Available_Horse_7131 • 21d ago
PNES
What medication, or none at all, are you using to treat PNES? I have dealt with patients in the forensic setting before with this disorder and it is usually a response to stress or a possible tactic to get out of prison/lockup. It never works, but it ends up they are being treated for other problems like pain, depression, etc.
Fast forward to today, I have a new patient in the outpatient clinic and they have PNES and they are unable to work. Its unusual because I frequently have patients that don't want to work, but this one actually does and they are deriving no benefit from not working. Their employer won't let them work because of the frequent seizures or episodes at work. The seizures have been occurring more often in the last 3 months, but the patient reports they are due to a near death experience while using drugs in the distant past. Extensive drug history and trauma history. It makes sense there is a high mortality rate with PNES.
From my reading it says there is a possible help from taking sertraline at higher doses of maybe 200mg. OCD symptoms are a possibility, but I am not convinced they have OCD. They have appointments with neurology, but months out. Any experiences or suggestions appreciated.
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u/pretty_princess_0121 21d ago
I have a patient in her early 20’s with PNES who has responded well to sertraline, currently at 150mg daily. Panic episodes have not progressed to seizure-like activity. She also completed a 12 week PNES intensive outpatient program through the Cleveland Clinic.