Psychiatry versus general physicians: who is better at differentiating epileptic from psychogenic non-epileptic seizures?

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Author(s)
MacDonald, Tim
Hill, Aron
Phan, Thanh
Fitzgerald, Paul
Seneviratne, Udaya
Griffith University Author(s)
Year published
2012
Metadata
Show full item recordAbstract
Objective: To determine how accurately psychiatry and general medical doctors can differentiate epileptic and
psychogenic non-epileptic seizures based on videotaped events (closest proxy to witnessed events). This study aims
to establish how confidently this distinction can be made, the reasons why a particular diagnosis is reached, and
inter-rater agreement.
Methods: 18 videos of patients demonstrating a heterogeneous mixture of epileptic and psychogenic non-epileptic
seizures were collected and ordered in a random mix. These videos were shown to groups of general physicians,
medical registrars and residents (n=19) as well ...
View more >Objective: To determine how accurately psychiatry and general medical doctors can differentiate epileptic and psychogenic non-epileptic seizures based on videotaped events (closest proxy to witnessed events). This study aims to establish how confidently this distinction can be made, the reasons why a particular diagnosis is reached, and inter-rater agreement. Methods: 18 videos of patients demonstrating a heterogeneous mixture of epileptic and psychogenic non-epileptic seizures were collected and ordered in a random mix. These videos were shown to groups of general physicians, medical registrars and residents (n=19) as well as to psychiatrists and psychiatry registrars (n=8) who were provided with a questionnaire. Results: A total of 27 doctors participated in the study. The overall percentage of correct diagnoses was 55.4%. There were no significant differences in correct diagnosis rates between psychiatry and general medical doctors. There was poor inter-rater agreement (Kappa = 0.159). Neither group was particularly confident in reaching a diagnosis, and diverse reasons underpinned the diagnoses given. Conclusion: Among the participants, merely observing an epileptic or non-epileptic event is insufficient to establish a definitive diagnosis. The results indicate poor diagnostic accuracy and agreement among psychiatry and general medical doctors. This may have important implications for both education and clinical practice.
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View more >Objective: To determine how accurately psychiatry and general medical doctors can differentiate epileptic and psychogenic non-epileptic seizures based on videotaped events (closest proxy to witnessed events). This study aims to establish how confidently this distinction can be made, the reasons why a particular diagnosis is reached, and inter-rater agreement. Methods: 18 videos of patients demonstrating a heterogeneous mixture of epileptic and psychogenic non-epileptic seizures were collected and ordered in a random mix. These videos were shown to groups of general physicians, medical registrars and residents (n=19) as well as to psychiatrists and psychiatry registrars (n=8) who were provided with a questionnaire. Results: A total of 27 doctors participated in the study. The overall percentage of correct diagnoses was 55.4%. There were no significant differences in correct diagnosis rates between psychiatry and general medical doctors. There was poor inter-rater agreement (Kappa = 0.159). Neither group was particularly confident in reaching a diagnosis, and diverse reasons underpinned the diagnoses given. Conclusion: Among the participants, merely observing an epileptic or non-epileptic event is insufficient to establish a definitive diagnosis. The results indicate poor diagnostic accuracy and agreement among psychiatry and general medical doctors. This may have important implications for both education and clinical practice.
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Journal Title
Australasian Psychiatry
Volume
20
Issue
5
Copyright Statement
MacDonald et al, Psychiatry versus general physicians: who is better at differentiating epileptic from psychogenic non-epileptic seizures?, Australasian Psychiatry, 20(5) 379–383, 2012. Copyright 2012 The Authors. Reprinted by permission of SAGE Publications.
Subject
Central Nervous System
Medical and Health Sciences
Psychology and Cognitive Sciences