title: The role of companions in outpatient seizure clinic interactions: A pilot study.
abstract: This study explored contributions that patients' companions (seizure witnesses) make to interactions in the seizure clinic and whether the nature of the companions' interactional contributions can help with the differentiation of epilepsy and psychogenic nonepileptic seizures (PNES).
  
  
  
  Conversation analysis methods were used to examine video recordings and transcripts of neurologists' interactions with patients referred to a specialist seizure clinic and their companions.
  
  
  
  The companions' behavior correlated with interactional features previously observed to distinguish patients with epilepsy from patients with PNES. Patients with PNES, but not those with epilepsy, tended to exhibit interactional resistance to the doctor's efforts to find out more about their seizure experiences and, thereby, encouraged greater interactional contribution from companions.
  
  
  
  The contributions that companions make (in part, prompted by patient's interactional behavior) may provide additional diagnostic pointers in this clinical setting, and a number of candidate features that may help clinicians distinguish between epilepsy and PNES when the patient is accompanied by a seizure witness are described. However, companion contributions may limit the doctor's ability to identify linguistic and interactional features with previously demonstrated diagnostic potential in the conversational contributions made by patients themselves. To help offset potential diagnostic losses, doctors may need to explicitly discuss the role of the companion in the consultation when a seizure witness (or another companion) accompanies the patient.
authors.affiliation: Nelson Mandela Metropolitan University, Department of Research Capacity Development, University Way, Port Elizabeth, 6031, Eastern Cape, South Africa. Electronic address: catherinemaryrobson@gmail.com.
authors.forename: Catherine
authors.initials: C
authors.lastname: Robson
authors.affiliation: School of Social Sciences, Loughborough University, Loughborough, UK. Electronic address: p.drew@lboro.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Drew
authors.affiliation: Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK. Electronic address: markus.reuber@sth.nhs.uk.
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods* / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D033062:Friends; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012640:Seizures / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D012931:Social Environment; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology; D055815:Young Adult
keywords: Accompanied interactions; Companions; Conversation analysis; Diagnostic differentiation; Epilepsy; PNES