Engaging psychiatrists in the diagnosis of psychogenic nonepileptic seizures. What can they contribute?
PURPOSE
To investigate if psychiatrists could predict the diagnosis of psychogenic nonepileptic seizures (PNES) by reviewing videos of seizures of various types and to compare the accuracy and the criteria leading to the diagnosis used by psychiatrists with those used by epileptologists.


METHODS
Four board-certified psychiatrists were asked to review 23 videos capturing representative events of 21 unselected consecutive patients admitted to an epilepsy center for long-term video-EEG monitoring. All raters were blind to EEG and clinical information. They were requested to (1) rate the videos for quality and content; (2) choose among four diagnoses: (a) epileptic seizures; (b) PNES; (c) Other nonepileptic seizures (syncope, movement disorder, migraine, etc.); (d) "Cannot Say"; and (3) explain in their own words the main reasons leading to the diagnosis of choice. The results were compared to those of four blind epileptologists who independently reviewed the same cases. The inter-rater reliability was tested with the Kappa statistic.


RESULTS
All psychiatrists were concordant and correct in 3/23 video-events, compared to 8/23 among epileptologists. Despite widespread disagreement among themselves and frequent failures as a group, individual psychiatrists scored a comparable number of correct diagnoses as did individual epileptologists. The comments provided to justify the diagnosis of choice differed from neurologists, varied among raters, and reflected considerable attention to body movements and body language.


CONCLUSION
Psychiatrists, as a group, are less reliable than neurologists in differentiating seizure types on video but, as individuals, can be quite accurate in making the correct diagnosis because they are more attuned to capture the subtleties of human behaviour, of subjective experiences, as the effects of hidden internal conflicts and can contribute a new lexicon in defining PNES.
['Beghi|Massimiliano|M|', 'Erba|Giuseppe|G|', 'Cornaggia|Cesare Maria|CM|', 'Giussani|Giorgia|G|', 'Bianchi|Elisa|E|', 'Porro|Gianni|G|', 'Russo|Michela|M|', 'Beghi|Ettore|E|']
D000293:Adolescent D000328:Adult D003291:Conversion Disorder D004569:Electroencephalography D005260:Female D006801:Humans D008297:Male D011570:Psychiatry D011602:Psychophysiologic Disorders D012640:Seizures D018709:Statistics, Nonparametric D014741:Video Recording D055815:Young Adult
Psychiatrists Psychogenic nonepileptic seizures Video Monitoring Epileptic seizures Semiology