马文 金丽日

提 要 对患者人际互动过程的会话分析在临床诊断中的作用已获证实，其中最具代表性的是，对患者会话中互动特征、话题特征和语言特征的分析能够有效鉴别临床上不易鉴别的痫性发作和心因性非痫性发作。对汉语痫性发作和心因性非痫性发作患者的会话特征分析证实：患者会话中提供发作信息的主动性、陈述的努力程度、否定性表达的使用等特征对于鉴别诊断痫性发作与心因性非痫性发作具有重要价值。研究也进一步表明，会话分析在医学临床诊断中具有实际的应用价值，通过病史记录阶段的医患沟通特征的会话分析，能够为某些神经系统疾病的鉴别诊断提供借鉴。

关键词 癫痫;会话分析;诊断性应用会话分析;痫性发作;心因性非痫性发作

中图分类号 H002 文献标识码 A 文章编号 2096-1014（2021）06-0059-08

DOI 10.19689/j.cnki.cn10-1361/h.20210605

Analysis of Conversational Features in Differential Diagnosis of Epilepsy

Ma Wen and Jin Liri

Abstract Epilepsy is a neurological disorder that affects the central nervous system and causes seizures or periods of unusual behavior， sensations， and sometimes loss of awareness. In clinical diagnosis， a conversation analysis approach to patients interaction has proved to be an effective method to diagnose epilepsy. Most typically， the interactional， topical， and linguistic features in patients talk are analyzed to help the differentiation of epileptic seizure （ES） and psychogenic non-epileptic seizure （PNES）， two types of epilepsy that are difficult to be distinguished in clinical practice. With a conversation analysis of the talks of Chinese patients with ES and PNES， this study shows that the initiative of providing seizure information， the efforts of presentation， and the use of negative expressions in patients talk are of great value in differentiating ES from PNES. The study also indicates that conversation analysis has practical and applicational value in medical clinical diagnosis， which can provide a reference for differential diagnosis of some neurological diseases through an analysis of doctor-patient interactions in medical history records.

Keywords epilepsy; conversation analysis; diagnostic applied conversation analysis; epileptic seizure; psychogenic nonepileptic seizure

一、引 言

人類的语言沟通必须具备生理基础。发达的大脑与灵活的发音器官，使人类具备了语言的产生和理解所需要的抽象思维能力和发出复杂声音的能力。在人体的几大生理系统中，神经系统和呼吸系统（包括呼吸道和肺）与语言的关系最为密切，神经系统和发音器官出现了障碍，就可能引发语言和沟通上的异常。那么，语言及沟通上的某些表现或特征是否可以作为诊断相关疾病的重要标志呢？显然，语言特征与某些疾病诊断关系密切，比如，对儿童进行早期语言筛查，可以及时鉴别诊断语言障碍并加以干预，对成人失语症患者进行语言能力的评估亦然。……