A Novel Screening and Diagnostic Tool for Child and Adolescent Psychiatric Disorders for Telepsychiatry

Abstract

Background:A diagnostic tool designed as part of a telepsychiatry application for diagnosis and management of child and adolescent psychiatric disorders in India was developed considering the paucity of trained child psychiatrists and mental health professionals in India.Materials and Methods:The diagnostic tool consisted of screening and 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria-based diagnostic algorithms for 18 psychiatric disorders seen in childhood and adolescence. Accuracy of diagnoses and feasibility of use of the tool was examined by comparing it with detailed semi-structured clinical evaluations by a qualified psychiatrist with 50 psychiatric patients (children and adolescents).Statistical Analysis:Descriptive analyses and paired t-tests were conducted to compare the mean number of diagnosis generated by the two interviews. Sensitivity, specificity, positive and negative predictive values were computed for the screening and the diagnostic sub-modules of the tool, compared to the clinical diagnoses. Kappa coefficients were computed to assess agreement between the diagnoses generated by the diagnostic sub-module and the clinical diagnoses.Results:The screening sub-module had high sensitivity, high specificity and negative predictive values for all disorders. For the diagnostic sub-module, there was moderate (kappa-0.4–0.6) to substantial agreement (kappa > 0.6) for all the disorders, (except psychosis) and high sensitivity (barring a few disorders) and specificity for almost all the disorders. Positive predictive values were found to be acceptable to high for most disorders, with consistently high negative predictive values.Conclusion:The new tool was found to be comprehensive, reasonably short and feasible. Results showed acceptable level of accuracy in diagnosis generated by the tool.

Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas

“…It also allows the doctor to over-rule the recommendations and prescribe on his/her own. Although the accuracy of CDSS is not 100 per cent, it fares reasonably well when compared with clinicians’ diagnosis and diagnosis made by a structured interview as seen in the previous studies 9 10 11 and the present study. By its design of encoded knowledge base and automation, the application attempts to overcome the clinician/individual-related factors such as inadequate or lack of knowledge, training and motivation to a large extent.…”

“…In each case, the diagnostic system is logically linked to the intervention modules. The diagnostic and management modules have been found to be valid, reliable and feasible in studies conducted at nodal centre 9 10 11 .…”

Telemental Health in Low- and Middle-Income Countries: A Systematic Review

“…Of the 19 included studies, eight were conducted on the Asian continent (India [ 2 , 28 – 32 ], Syria [ 33 ], Iran [ 34 ]), three in South America (Brazil [ 35 , 36 ], Peru [ 37 ]), four in Africa (South Africa [ 23 , 38 ], Nigeria [ 39 ], Somaliland [ 40 ]), and one in Europe (Russia [ 41 ]). However, three of the studies were cross-continental collaborative studies conducted between several developed and developing countries [ 42 – 44 ].…”

“…Several mental health-related issues were discussed in the 19 included articles. More than half of these studies focused on psychiatric illness and treatment in general [ 2 , 23 , 28 – 30 , 32 , 33 , 38 , 40 , 43 , 44 ]. Depression [ 34 , 36 ] was the second most frequently discussed psychiatric topic.…”

“…The RCT is common method in medical studies, typically used to compare the outcome of two or more interventions. One central element of the method is a random allocation of patients to different interventions, which might help the researchers in identifying the actual effects of the interventions [ 28 – 31 , 34 – 37 ]. Five were identified as project evaluation studies [ 2 , 32 , 33 , 40 , 44 ].…”