Certain symptoms that appear in psychogenic nonepileptic seizures (PNES) are similar to those in epileptic seizures, such as loss of normal function or loss of self-control in sensory, motor, and cognitive functions. The name PNES originated from a viewpoint intending to differentiate PNES from epileptic seizures; however, it is not an officially defined psychiatric diagnosis. It involves various pathological conditions that are central to the diagnosis of dissociative disorder or conversion disorder in general psychiatric diagnoses. It is difficult to attribute the cause of PNES to a single psychological factor as derived from the terminology of "psychogenic," and PNES are rather believed to develop and become chronic because of complexed multiple factors that affect each other, including biopsychosocial vulnerabilities and trauma. The quality of life of patients with PNES decreases owing to the high doses of antiepileptic drugs and repetitive examinations without appropriate psychiatric treatment over a long period of time from the first attack until a definite diagnosis is achieved. It is not rare that a patient continues to suffer from PNES without visiting a psychiatrist for various reasons even after the diagnosis is confirmed. Neurological considerations, such as seizure symptomatology and electroencephalography (EEG), and psychiatric considerations are necessary for the diagnosis and treatment of PNES, respectively. The development of long-term video EEG monitoring has revealed that some of the signs of seizure previously considered to be characteristic of PNES are not necessarily distinctive features. Notifying the patient regarding the diagnosis plays a significant part in treatment, and PNES sometimes disappear even without intervention or further treatment. The aim of standard psychiatric treatment and environmental adjustment through multi-professional collaboration include the acquisition of stress-coping skills, proper expression of unpleasant emotions, self-affirmation, and increasing levels of activity. Various methods are used in full-scale psychotherapy for PNES, and cognitive behavioral therapy has been attracting attention as a treatment method, supported by high-quality studies that have demonstrated its effectiveness. Psychiatrists are expected to play a central role in the comprehensive treatment of PNES that requires seamless linkage from diagnosis to treatment. To this end, psychiatrists should have up-to-date knowledge about PNES and epilepsy to eliminate their prejudice and misunderstandings about PNES.
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