Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that v...Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencingbased telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.展开更多
AIM: To conduct a review of the telepsychiatry literature.METHODS: We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health"...AIM: To conduct a review of the telepsychiatry literature.METHODS: We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health", "telecare", "telemedicine", "e-health", and "videoconferencing". To meet criteria for inclusion, studies had to:(1) be published in a peer-reviewed journal after the year 2000;(2) be written in English;(3) use videoconferencing technology for the provision of mental health assessment or treatment services; and(4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in Pub Med(Medline database), Ovid medline, Psych Info, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories:(1) satisfaction;(2) reliability;(3) treatment outcomes;(4) implementation outcomes;(5) cost effectiveness; and(6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion.RESULTS: Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry.CONCLUSION: A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.展开更多
Few studies examine the benefits from geriatric telepsychiatry in rural retirement communities.Objectives:1.To demonstrate that using telepsychiatry(a)standard approaches to psychiatric evaluation would yield diagnose...Few studies examine the benefits from geriatric telepsychiatry in rural retirement communities.Objectives:1.To demonstrate that using telepsychiatry(a)standard approaches to psychiatric evaluation would yield diagnoses in Diagnostic and Statistical Manual of Mental Disorders(DSM-V);(b)psychotherapies and pharmacotherapy could be effectively administered.2.To examine the relationships among cognition,mood,agitation and functions at baseline and the response to treatment over time.Design:Prospective longitudinal study.Measures:Geriatric Depression scale(GDS),Mini Mental State Exam(MMSE),Barthel Index(BI),Pittsburgh Agitation Scale(PAS).Setting:Video Teleconferencing.Interventions:Psychotherapy,psychopharmacology.Participants:428 Seniors over 55,met criteria for at least one DSM-V diagnosis.Results:Treatments were administered for a full range of psychiatric diagnoses and age-related medical conditions.The most frequently prescribed pharmacological agents were:antidepressants(78%)antipsychotics(64%),memory enhancers(38%).Participants(66%)received psychotherapy:individual(31%),couple(7%),family(13%).Variation in the MMSE scores were observed:55%remained stable,11%declined,18%improved.GDS Scores improved from baseline to 26 weeks(p=0.02,d=0.99:95%CI 0.39-1.56).PAS scores declined from baseline to 52 weeks(McNemar’s S=11.27,p=0.0008,d=1.17:95%CI 0.63-1.68).Function(BI)at week 26 was not statistically significantly different from baseline(t(26)=1.66,p=0.11,d=0.65:95%CI-0.16-1.42).Participants maintained independence(64.5%)at 52 weeks(McNemar’s S=6.23,p=0.013,d=0.79:95%CI 0.19-1.36)Conclusion:This study demonstrates the feasibility and benefit of providing a full complement of services via telepsychiatry to seniors and provides a rationale for more comprehensive reimbursement plans.展开更多
Depression is a serious medical condition and is a leading cause of disability worldwide.Current depression diagnostics and assessment has significant limitations due to heterogeneity of clinical presentations,lack of...Depression is a serious medical condition and is a leading cause of disability worldwide.Current depression diagnostics and assessment has significant limitations due to heterogeneity of clinical presentations,lack of objective assessments,and assessments that rely on patients'perceptions,memory,and recall.Digital phenotyping(DP),especially assessments conducted using mobile health technologies,has the potential to greatly improve accuracy of depression diagnostics by generating objectively measurable endophenotypes.DP includes two primary sources of digital data generated using ecological momentary assessments(EMA),assessments conducted in real-time,in subjects'natural environment.This includes active EMA,data that require active input by the subject,and passive EMA or passive sensing,data passively and automatically collected from subjects'personal digital devices.The raw data is then analyzed using machine learning algorithms to identify behavioral patterns that correlate with patients'clinical status.Preliminary investigations have also shown that linguistic and behavioral clues from social media data and data extracted from the electronic medical records can be used to predict depression status.These other sources of data and recent advances in telepsychiatry can further enhance DP of the depressed patients.Success of DP endeavors depends on critical contributions from both psychiatric and engineering disciplines.The current review integrates important perspectives from both disciplines and discusses parameters for successful interdisciplinary collaborations.A clinically-relevant model for incorporating DP in clinical setting is presented.This model,based on investigations conducted by our group,delineates development of a depression prediction system and its integration in clinical setting to enhance depression diagnostics and inform the clinical decision making process.Benefits,challenges,and opportunities pertaining to clinical integration of DP of depression diagnostics are discussed from interdisciplinary perspectives.展开更多
文摘Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencingbased telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
文摘AIM: To conduct a review of the telepsychiatry literature.METHODS: We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health", "telecare", "telemedicine", "e-health", and "videoconferencing". To meet criteria for inclusion, studies had to:(1) be published in a peer-reviewed journal after the year 2000;(2) be written in English;(3) use videoconferencing technology for the provision of mental health assessment or treatment services; and(4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in Pub Med(Medline database), Ovid medline, Psych Info, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories:(1) satisfaction;(2) reliability;(3) treatment outcomes;(4) implementation outcomes;(5) cost effectiveness; and(6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion.RESULTS: Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry.CONCLUSION: A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.
文摘Few studies examine the benefits from geriatric telepsychiatry in rural retirement communities.Objectives:1.To demonstrate that using telepsychiatry(a)standard approaches to psychiatric evaluation would yield diagnoses in Diagnostic and Statistical Manual of Mental Disorders(DSM-V);(b)psychotherapies and pharmacotherapy could be effectively administered.2.To examine the relationships among cognition,mood,agitation and functions at baseline and the response to treatment over time.Design:Prospective longitudinal study.Measures:Geriatric Depression scale(GDS),Mini Mental State Exam(MMSE),Barthel Index(BI),Pittsburgh Agitation Scale(PAS).Setting:Video Teleconferencing.Interventions:Psychotherapy,psychopharmacology.Participants:428 Seniors over 55,met criteria for at least one DSM-V diagnosis.Results:Treatments were administered for a full range of psychiatric diagnoses and age-related medical conditions.The most frequently prescribed pharmacological agents were:antidepressants(78%)antipsychotics(64%),memory enhancers(38%).Participants(66%)received psychotherapy:individual(31%),couple(7%),family(13%).Variation in the MMSE scores were observed:55%remained stable,11%declined,18%improved.GDS Scores improved from baseline to 26 weeks(p=0.02,d=0.99:95%CI 0.39-1.56).PAS scores declined from baseline to 52 weeks(McNemar’s S=11.27,p=0.0008,d=1.17:95%CI 0.63-1.68).Function(BI)at week 26 was not statistically significantly different from baseline(t(26)=1.66,p=0.11,d=0.65:95%CI-0.16-1.42).Participants maintained independence(64.5%)at 52 weeks(McNemar’s S=6.23,p=0.013,d=0.79:95%CI 0.19-1.36)Conclusion:This study demonstrates the feasibility and benefit of providing a full complement of services via telepsychiatry to seniors and provides a rationale for more comprehensive reimbursement plans.
文摘Depression is a serious medical condition and is a leading cause of disability worldwide.Current depression diagnostics and assessment has significant limitations due to heterogeneity of clinical presentations,lack of objective assessments,and assessments that rely on patients'perceptions,memory,and recall.Digital phenotyping(DP),especially assessments conducted using mobile health technologies,has the potential to greatly improve accuracy of depression diagnostics by generating objectively measurable endophenotypes.DP includes two primary sources of digital data generated using ecological momentary assessments(EMA),assessments conducted in real-time,in subjects'natural environment.This includes active EMA,data that require active input by the subject,and passive EMA or passive sensing,data passively and automatically collected from subjects'personal digital devices.The raw data is then analyzed using machine learning algorithms to identify behavioral patterns that correlate with patients'clinical status.Preliminary investigations have also shown that linguistic and behavioral clues from social media data and data extracted from the electronic medical records can be used to predict depression status.These other sources of data and recent advances in telepsychiatry can further enhance DP of the depressed patients.Success of DP endeavors depends on critical contributions from both psychiatric and engineering disciplines.The current review integrates important perspectives from both disciplines and discusses parameters for successful interdisciplinary collaborations.A clinically-relevant model for incorporating DP in clinical setting is presented.This model,based on investigations conducted by our group,delineates development of a depression prediction system and its integration in clinical setting to enhance depression diagnostics and inform the clinical decision making process.Benefits,challenges,and opportunities pertaining to clinical integration of DP of depression diagnostics are discussed from interdisciplinary perspectives.
