Development of a novel diagnostic system for a telepsychiatric application: a pilot validation study

Abstract

BackgroundA net-based, decision support system for diagnostic assessment and management of psychiatric disorders, developed as part of a telepsychiatry service, which aims to deliver mental health care to underserved population of remote areas in India is described. This paper presents the development and preliminary results of diagnostic validation of the application, intended for use among adult patients. The bilingual (English and Hindi) diagnostic tool consists of a core diagnostic section comprising a screening sub-module and criteria-based diagnostic sub-modules for 18 adult psychiatric disorders, and additional sections covering background information. The diagnostic tool of the application was examined among 100 consecutive consenting adult outpatients, by comparing it with detailed semi-structured clinical assessments led by a consultant psychiatrist, on accuracy of diagnoses generated, and examining the feasibility of its use.ResultsThe screening sub-module had high sensitivity and high specificity, low positive predictive values, but high negative predictive values for most disorders. For the diagnostic sub-modules, there was moderate (kappa = 0.4-0.6), to substantial agreement (kappa > 0.6) between diagnoses generated by the tool and consultants’ diagnoses, for all the disorders except dysthymia. Sensitivity was high barring a few disorders. Specificity was high for all the disorders, positive predictive values were acceptable to high for most disorders, and negative predictive values were consistently high. Completion rate was 100%; average time taken was five minutes for screening alone, and 30 minutes for complete assessment with screening and criteria-based evaluation. A majority of the patients, their relatives, and interviewers were satisfied with the interview.ConclusionsThe preliminary results indicated that despite some limitations, the new diagnostic system was reasonably comprehensive, time-efficient and feasible, with an acceptable level of diagnostic accuracy. Hence, it appeared to be suitable for use as a telepsychiatric application.

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

“…A structured diagnostic and management system for adult psychiatric patients has been developed separately and has already been reported. [ 12 ] This paper describes the development of the diagnostic tool intended for use on children and adolescents with psychiatric disorders. It also presents preliminary results on the accuracy of diagnoses generated by the tool and data on its feasibility of use by non-mental health professionals on children and adolescents with psychiatric disorders.…”

Review of key telepsychiatry outcomes

“…Two studies compared the accuracy of diagnoses made using the SCID [59,60] , two studies evaluated reliability of child assessments [42,61] , four studies evaluated reliability of neuropsychological assessments [62][63][64][65] , and three studies evaluated reliability of measures of depressive symptom severity [66][67][68] . The remaining studies evaluated a range of targets such as alcohol use severity [69] , diagnostic accuracy [70][71][72] , competency to stand trial [73] , psychosis [26] , and adult autism [21] . The majority of studies report moderate to high level of agreement between raters using telepsychiatry and FTF regardless of instrument, provider, or setting type.…”

A systematic review of measures of HIV/AIDS stigma in paediatric HIV‐infected and HIV‐affected populations

“…As HIV-infected adolescents are the only group of PLWHA among whom the death rate continues to increase, it is critical that we evaluate factors shaping the lives of these youth [41]. Adolescence is a developmental stage in which the opinions and perceived judgments of peers hold particularly strong weight.…”

“…Moreover, the long-term impact of stigma on HIV-infected children as they become adolescents and adults has not been studied among the large populations of children currently growing up with HIV in resource-limited settings. As HIVinfected adolescents are the only group of PLWHA among whom the death rate continues to increase, it is critical that we evaluate factors shaping the lives of these youth [41]. Adolescence is a developmental stage in which the opinions and perceived judgments of peers hold particularly strong weight.…”