title: Psychiatry versus general physicians: who is better at differentiating epileptic from psychogenic non-epileptic seizures?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Monash University, Melbourne, and Department of Psychiatry, Alfred Health, Melbourne, VIC, Australia. tmacdonald@ausdoctors.net
authors.forename: Tim
authors.initials: T
authors.lastname: MacDonald
authors.forename: Aron
authors.initials: A
authors.lastname: Hill
authors.forename: Thanh
authors.initials: T
authors.lastname: Phan
authors.forename: Paul
authors.initials: P
authors.lastname: Fitzgerald
authors.forename: Udaya
authors.initials: U
authors.lastname: Seneviratne
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D003937:Diagnosis, Differential; D004827:Epilepsy / Q000175:diagnosis; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D015588:Observer Variation; D011570:Psychiatry / Q000706:statistics & numerical data*; D012640:Seizures / Q000175:diagnosis*; D013001:Somatoform Disorders / Q000175:diagnosis*; D014743:Videotape Recording