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

BMC Research Notes

Minali Sharma¹  Vineet Kumar¹  B Nithya¹  Anurati Mehta¹  Aarzoo Gupta¹  Ruchita Shah¹  Subho Chakrabarti¹  Savita Malhotra¹ 

[1]Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India

关键词: Feasibility;    Diagnostic accuracy;    Adult psychiatric disorders;    Telepsychiatry application;   

Others  :  1136438
DOI  :  10.1186/1756-0500-7-508

 received in 2014-03-14, accepted in 2014-07-31,  发布年份 2014

【 摘 要 】

Background

A 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.

Results

The 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.

Conclusions

The 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.

【 授权许可】

   
2014 Malhotra et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Reddy MV, Chandrasekar CR: Prevalence of mental and behavioural disorders in India: A metaanalysis. Indian J Psychiatr 1998, 40:149-157.
• [2]Ganguli HC: Epidemiological finding on prevalence of mental disorders in India. Indian J Psychiatr 2000, 42:14-20.
• [3]World Health Organization: Mental Health Atlas-2011. [http://www.who.int/mental_health/publications/mental_health_atlas_2011/en/index.html webcite]
• [4]Thirunavukarasu M: Closing the treatment gap. Indian J Psychiatr 2011, 53(3):199-201.
• [5]Ministry of Health and Family Welfare, Government of India: National Mental Health Programme for India. [http://mohfw.nic.in/WriteReadData/l892s/9903463892NMHP%20detail.pdf webcite]
• [6]Nagaraja D, Murthy P: Mental Health Care and Human Rights. India: National Human Rights Commission, New Delhi and National Institute of Mental Health and Neuro Sciences, Bangalore; 2008.
• [7]American Psychiatric Association: Telepsychiatry via Videoconferencing. [http://www.telepsychiatry.com/apa.pdf webcite]
• [8]Hilty DM, Marks SL, Urness D, Yellowlees PM, Nesbitt TS: Clinical and educational telepsychiatry applications: a review. Can J Psychiatry 2004, 49:12-23.
• [9]Shore JH: Telepsychiatry: videoconferencing in the delivery of psychiatric care. Am J Psychiatry 2013, 170:256-262.
• [10]Sharan P, Malhotra S: Telepsychiatry: The Bridge across the Access Gap in Child and Adolescent Mental Health. J Indian Assoc Child Adolesc Ment Health 2007, 3:18-20.
• [11]World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders. Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.
• [12]Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998, 59:22-33.
• [13]Sharma VK, Lepping P, Cummins AGP, Copeland JRM, Parhee R, Mottram P: The Global Mental Health Assessment Tool - Primary Care Version (GMHAT/PC). Development, reliability and validity. World Psychiatr 2004, 3(2):115-119.
• [14]Sharma VK, Jagawat S, Midha A, Jain A, Tambi A, Mangwani LK, Sharma B, Dubey P, Satija V, Copeland JR, Lepping P, Lane S, Krishna M, Pangaria A: The Global Mental Health Assessment Tool-validation in Hindi: A validity and feasibility study. Indian J Psychiatr 2010, 52(4):316-319.
• [15]World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research. Geneva: World Health Organization; 1993.
• [16]American Psychiatric Association: Diagnostic and Statistical Manual Of Mental Health Disorders (4th Ed). Washington DC: American Psychiatric Association; 1994.
• [17]Statistical Package for Social Sciences, version fifteen (SPSS-15) SPSS Inc.. Chicago, IL, USA;
• [18]Murthy RS, Wig NN: Psychiatric diagnosis and classification in developing countries. In Psychiatric diagnosis and classification. Edited by Maj M, Gaebel W, Lopez-Ibor JJ, Sartorius N. UK: John, Wiley & Sons Ltd; 2002:249-279.
• [19]Spitzer RL, Fleiss JL: A re-analysis of the reliability of psychiatric diagnosis. Br J Psychiatry 1974, 125:341-347.
• [20]Aboraya A, Rankin E, France C, El-Missiry A, John C: The reliability of psychiatric diagnosis revisited: The clinician’s guide to improve the reliability of psychiatric diagnosis. Psychiatry 2006, 3(1):41-50.
• [21]Krishna M, Lepping P, Sharma VK, Copeland JRM, Lockwood L, Williams M: Epidemiological and clinical use of GMHAT-PC (Global Mental Health assessment tool – primary care) in cardiac patients. Clin Pract Epidemiol Ment Health 2009, 5:7. doi:10.1186/1745-0179-5-7
• [22]Wittchen HU, Essau CA, Rief W, Fichter MM: Assessment of somatoform disorders and comorbidity pattern with the CIDI-findings in psychosomatic inpatients. Int J Meth Psych Res 1993, 3(2):87-100.
• [23]Broadhead WE, Leon AC, Weissman MM, Barrett JE, Blacklow RS, Gilbert TT, Keller MB, Olfson M, Higgins MS: Development and validation of the SDSS-PC screen for multiple mental disorders in primary care. Arch Fam Med 1995, 4:211-219.
• [24]Arciniegas DB: New-Onset Bipolar Disorder in Late Life: A Case of Mistaken Identity. Am J Psychiatry 2006, 163:198-203.
• [25]Catania JA, Binson D, Canchola J, Pollack LM, Hauck W, Coates TJ: Effects of interviewer gender, interviewer choice, and item wording on responses to questions concerning sexual behavior. Public Opin Quart 1996, 60:345-375.
• [26]Donker T, van Straten A, Marks I, Cuijpers P: A Brief Web-Based Screening Questionnaire for Common Mental Disorders: Development and Validation. J Med Internet Res 2009, 11(3):e19. doi:10.2196/jmir.1134
• [27]Leon AC, Portera L, Olfson M, Weissman MM, Kathol RG, Farber L, Sheehan DV, Pleil AM: False Positive Results: A Challenge for Psychiatric Screening in Primary Care. Am J Psychiatry 1997, 154:1462-1464.
• [28]Nease DE, Malouin JM: Depression screening: a practical strategy. J Fam Practice 2003, 52(2):118-126.
• [29]Leon AC, Portera L, Olfson M, Kathol R, Farber L, Lowell KN, Sheehan DV: Diagnostic Errors of Primary Care Screens for Depression and Panic Disorder. The Int J Psychiatr Med 1999, 29(1):1-11.
• [30]Peters L, Andrews G: Procedural validity of the computerized version of the Composite International Diagnostic Interview (CIDI-Auto) in the anxiety disorders. Psychol Med 1995, 25(6):1269-1280.
• [31]Wittchen HU: Reliability and Validity Studies Of The WHO Composite International Diagnostic Interview (CIDI): A Critical Review. J Psychiatr Res 1994, 28(I):57-84.