OBJECTIVE Patients with psychogenic nonepileptic events (PNEE) exhibit heterogenous symptoms and are best diagnosed with long-term video-electroencephalogram (vEEG) data. While extensive univariate data suggest psychological tests may confirm the etiology of PNEE, the multivariate discriminant utility of psychological tests is less clear. The current study aggregated likelihood ratios of multiple psychological tests to evaluate incremental and discriminant utility for PNEE. METHODS Veterans with vEEG-diagnosed PNEE (n = 166) or epileptic seizures (n = 92) completed self-report measures and brief neuropsychological evaluations during the 4-day vEEG hospitalization. Receiver operating characteristic (ROC) curves identified discriminating psychological tests and corresponding cut-scores (0.85 minimum specificity). Likelihood ratios from the remaining cut-scores were sequentially linked using the sample base rate of PNEE (64%) and alternative base rates (10%, 20%, 30%, 40%) to estimate posttest probabilities (PTP) of test combinations. RESULTS The Health Attitudes Survey, Health History Checklist, and Minnesota Multiphasic Personality Inventory-2-Restructured Form scales FBS-r, RC1, MLS, and NUC were identified as discriminating indicators of PNEE. Average PTPs were ≥90% when three or more indicators out of six administered were present at the sample base rate. Regardless of PNEE base rate, PTP for PNEE was ≥98% when all discriminating indicators were present and 92-99% when five of six indicators administered were present. PTPs were largely consistent with observed positive predictive values, particularly as indicators present increased. SIGNIFICANCE Aggregating psychological tests identified PNEE with a high degree of accuracy, regardless of PNEE base rate. Combining psychological tests may be useful for confirming the etiology of PNEE.

中文翻译：

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在退伍军人样本中使用心理测试组合对心因性非癫痫事件进行临床鉴定

目的 心因性非癫痫事件 (PNEE) 患者表现出异质性症状，最好通过长期视频脑电图 (vEEG) 数据进行诊断。虽然广泛的单变量数据表明心理测试可以确认 PNEE 的病因，但心理测试的多变量判别效用尚不清楚。当前的研究汇总了多项心理测试的似然比，以评估 PNEE 的增量和判别效用。方法 被 vEEG 诊断为 PNEE（n = 166）或癫痫发作（n = 92）的退伍军人在 4 天的 vEEG 住院期间完成了自我报告测量和简短的神经心理学评估。接收者操作特征 (ROC) 曲线确定了区分心理测试和相应的分数（最小特异性为 0.85）。使用 PNEE 的样本基本率 (64%) 和替代基本率 (10%、20%、30%、40%) 将剩余分数的似然比按顺序联系起来，以估计测试组合的后测概率 (PTP)。结果 健康态度调查、健康史检查表和明尼苏达多相人格量表-2-重组形式量表 FBS-r、RC1、MLS 和 NUC 被确定为 PNEE 的鉴别指标。当以样本基准率存在六项指标中的三项或更多指标时，平均 PTP ≥ 90%。无论 PNEE 基础率如何，当所有区分指标都存在时，PNEE 的 PTP ≥ 98%，当管理的六个指标中有五个存在时，PTP 为 92-99%。PTP 与观察到的阳性预测值基本一致，特别是随着指标的增加。意义 无论 PNEE 基本比率如何，汇总心理测试都可以高度准确地识别 PNEE。结合心理测试可能有助于确认 PNEE 的病因。