Telepsychiatry: Promise, potential, and challenges

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian Journal of Psychiatry 03/2013; 55(1):3-11. DOI: 10.4103/0019-5545.105499
Source: PubMed


Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called 'Mental Health Gap'. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store-forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.

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    • "laşılacağı gibi, acil müdahale gerektiren durumlarda kullanılamaz. Aktarılan bilgiler, veri kayıtlarından video görüntülere kadar değişen bir yelpazede olabilir. İnternet üzerinden hizmet veren sosyal destek gruplarının yaygınlığı ; maluliyet, kanser, depresyon, intahar ve cinsel istismar gibi konularda teropötik destek sağladığı ortaya konmuştur (Malhotra ve ark. 2013)."
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    ABSTRACT: Telepsychiatry is an application brought out by modern day health system, and beneficial both to the patient and clinician. In recent years, growing usage of portable computers and development of secure communication systems has paved the way for telepsychiatry undertaking in desired place and time. The acceleration of telepsychiatry will increase in proportion to the development of adequate technology, making of legal arrangements, and ensuring the satisfaction of patients, psychiatrists and third companies. Taking into account the experiences acquired thus far, changing economical and social parameters, as well as expectations of growing health care system; clinicians are well advised to prepare for an adaptive platform designed for telepsychiatry in near future.
    06/2015; 7(2):136-148. DOI:10.5455/cap.20150320123914
    • "Telepsychiatry holds promise to further such objectives. Of the two types of communication technologies, the literature has focused more on video-conferencing (synchronous) as a mode of communication.[7] Synchronous telepsychiatry requires additional infrastructure, funds and synchronous presence of psychiatrist. "
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    ABSTRACT: Context:There is a paucity of published telepsychiatry results in India.Aims:This study was conducted to assess the feasibility of asynchronous telepsychiatry and to study the referral patterns.Settings and Design:This study was conducted in the telemedicine unit of a tertiary care center and design was retrospective analysis of 94 cases, which were diagnosed and treated by telepsychiatry.Materials and Methods:All 94 patients who were referred between January 2007 and August 2013 for telepsychiatry consultations were retrospectively analyzed to assess the referral pattern and feasibility.Statistical Analysis Used:Comparisons between demographic parameters and psychiatric diagnosis was done using Chi-square test.Results:In 89 out of 94 (95%) patients it was possible to make a definitive diagnosis and recommend appropriate treatment only on the basis of data received from the primary care physician by telepsychiatry. This indicates the feasibility of telepsychiatry. The most common problems for which referrals were made included schizophrenia and other psychotic disorders, mood disorders and substance related disorders.Conclusions:This study demonstrates the feasibility of Asynchronous telepsychiatry. Additional Indian studies should be conducted to build the evidence base for the best use of asynchronous telepsychiatry.
    Indian Journal of Psychological Medicine 07/2014; 36(3):299-301. DOI:10.4103/0253-7176.135384
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    ABSTRACT: A net-based application, which enables users to diagnose and manage common psychiatric disorders independently, was developed. Diagnostic accuracy and reliability of the application were compared with the Mini International Neuropsychiatric Interview among 274 adult outpatients. The screening sub-module of the application had high sensitivity, specificity and negative predictive values for most disorders, but low positive predictive values for several disorders. The criteria-based diagnostic sub-module demonstrated moderate to substantial agreement (kappa>0.50) for all 4 broad categories and 10 of the 18 individual disorders included. Diagnostic agreement was, however, low (kappa<0.4) for most of the disorders comprising the broad category of 'neurotic and stress-related disorders'. Low sensitivity was also observed among these disorders, though specificity, and positive and negative predictive values were high for most disorders. Inter-rater reliability of the application's diagnoses was high. Symptom-severity and functional status scores correlated significantly with those on standard scales. Average time taken was 5min for screening and 20min for detailed diagnostic assessment. A majority of the patients, their relatives and interviewers were satisfied with the assessment. The results suggest that with further refinement the application could be suitable for use as a net-based diagnostic tool for psychiatric disorders.
    09/2015; DOI:10.1016/j.psychres.2015.09.020
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