Appendix e-2: Screening questionnaire and excluded items

53 questionnaire items for PNES screening

1)How old were you when you had your FIRSTevent/episode/seizure? (Not including seizures which occurred due to high fever as a child)

2)How many events/episodes/seizures have you had in the LAST 4 WEEKS?

3)Do you suffer from FIBROMYALGIA?

  1. All of the time
  2. Most of the time
  3. Some of the time
  4. Never
  5. I don’t know

(HPLP16-nutrition) The following questions refer to your present health habits. How often do you . . .

Never,Sometimes,Often, Routinely

4)Eat breakfast? ...... 1234

5)Eat three regular meals a day?...... 1234

6)Choose foods without preservatives

or other additives?...... 1234

7)Include roughage or fiber, such as

whole grains, raw fruits, raw vegetables

in your diet?...... 1234

8)Plan or select daily meals to include

the “basic four” food groups?...... 1234

9)Read labels to identify the nutrients in

packaged food?...... 1234

(CASE18-epilepsy-understanding) Please indicate how much you agree or disagree with the following statements.

Strongly Disagree

/ Slightly
Disagree / Slightly
Agree /

Strongly Agree

10) I am confident in my ability to understand medical materials. / 1 / 2 / 3 / 4
11) I am confident in my ability to understand my doctor’s instructions. / 1 / 2 / 3 / 4
12) I know that I will be able to actively participate in decisions about my treatment. / 1 / 2 / 3 / 4
13) I am confident that I am able to deal with any unexpected health problems. / 1 / 2 / 3 / 4

(BRIQ21-limiting behavior and practical support seeking) The statements below refer to things that you may or may not have done to manage your symptoms. Please indicate how often you have done the following since your current illness began.

Not at all

/ Rarely / Some days /

Most days

/

Every day

14) I have avoided physical exercise. / 1 / 2 / 3 / 4 / 5
15) I have put parts of my life on hold / 1 / 2 / 3 / 4 / 5
16) I have avoided my usual activities. / 1 / 2 / 3 / 4 / 5
17) I have gone to bed during the day / 1 / 2 / 3 / 4 / 5
18) I have not been able to carry on with my usual level of activity / 1 / 2 / 3 / 4 / 5
19) I haven’t slowed down, I’ve just carried on as normal / 1 / 2 / 3 / 4 / 5
20) I have taken time out from my usual activities so that I can get back to normal quicker / 1 / 2 / 3 / 4 / 5
21) I have relied on my family or friends to look after me / 1 / 2 / 3 / 4 / 5
22) I have asked for help from my family or friends / 1 / 2 / 3 / 4 / 5
23) I have made sure I have someone to look after me / 1 / 2 / 3 / 4 / 5
24) I have tried to find someone to help me out / 1 / 2 / 3 / 4 / 5

(MHLC34-chance and other people) Please read each numbered statement on the left and circle one response on the right to indicate how much you agree or disagree with the statement.

Strongly disagree

/ Moderately disagree / Slightly disagree /

Slightly agree

/

Moderately agree

/

Strongly agree

25) As to my condition, what will be will be / 1 / 2 / 3 / 4 / 5 / 6
26) Most things that affect my condition happen to me by chance / 1 / 2 / 3 / 4 / 5 / 6
27) Luck plays a big part in determining how my condition improves / 1 / 2 / 3 / 4 / 5 / 6
28) Whatever improvement occurs with my condition is largely a matter of good fortune / 1 / 2 / 3 / 4 / 5 / 6
29) If my condition worsens, it's a matter of fate / 1 / 2 / 3 / 4 / 5 / 6
30) If I am lucky, my condition will get better / 1 / 2 / 3 / 4 / 5 / 6
31) Other people play a big role in whether my condition improves, stays the same, or gets worse / 1 / 2 / 3 / 4 / 5 / 6
32) In order for my condition to improve, it is up to other people to see that the right things happen / 1 / 2 / 3 / 4 / 5 / 6
33) The type of help I receive from other people determines how soon my condition improves / 1 / 2 / 3 / 4 / 5 / 6

(ZUNG Self-rated depression scale36): We were not able to obtain permission from the publishers of this scale to display these 20 items (#34—53).

Excluded questionnaire items

  1. Please check any of the following events you have experienced:
  2. Death of a loved one (family or friend)
  3. Physical assault as an adult
  4. Sexual assault as an adult
  5. Physical abuse as a child
  6. Sexual abuse as a child
  7. Near death experience
  8. Witness to physical or sexual assault
  9. Witness to death
  10. Divorce
  11. Adultery committed by your spouse, fiancé, or significant other
  12. Participation in warfare
  1. Have you ever had a seizure in the physician’s office?
  2. Have you ever seen someone having a seizure?
  3. Do you work in healthcare?
  4. Do any of your close friends or family members work in healthcare?
  5. Do you suffer from mental illness such as depression, anxiety, schizophrenia, or bipolar disorder?
  6. Does anyone in your family see a psychiatrist?
  7. Does anyone in your family suffer from mental illness?
  8. Compared to others how stressed are you?
  9. How do you handle stress?
  10. Do you receive the attention you deserve?
  11. How many physicians have you visited in the past year?

13. How many conditions do you suffer from?