Telepsychiatry in South Africa – present and future

The recent progress in telepsychiatry results from advancing technology and videoconferencing as an effective alternative to classic face-to-face psychiatric interaction, in terms of both results and cost-effectiveness. The wide range of applications of telepsychiatry is outlined – in particular, emergency, forensic, prison and adolescent psychiatry. Attitudes of patients and the providers of psychiatric services are discussed, and a short account is given of the place of tele-education in psychiatric teaching. The advantages of telepsychiatry are outlined and its limitations. Lastly, the limited experience and relevance of telepsychiatry in South Africa (and hence for other developing countries) are presented. The conclusion is that telepsychiatry is well established, its successes documented, and that it should be applied in planning future public health services in South Africa

Effectiveness of Telepsychiatry Among Geriatric Participants with Age-Related Hearing Loss

Presbycusis (hearing loss that occurs with age) affects 30% of adults aged 65 to 74, yet hearing loss is rarely considered when developing novel treatment deliveries. For example, research shows that telepsychiatry improves depression symptoms among geriatric patients similarly to traditional forms of therapy, however, there is no literature on effectiveness of telepsychiatry in geriatrics with presbycusis. The objective of this study is to assess whether, compared to face-to-face psychotherapy, telepsychiatry produces superior outcomes assessed by the Beck Depression Inventory II, among depressed geriatric patients suffering from presbycusis. We will conduct a randomized controlled trial among elderly individuals with depressive disorders and presbycusis who will be randomly allocated to 8 weekly, 60-minute manual sessions of Behavioral Activation Therapy for Depression either in the clinic or in the participants’ home, using telepsychiatry. This study will help guide future therapies directed towards the growing geriatric population, many of whom suffer from presbycusis

Comparing In-Person to Videoconference-Based Cognitive Behavioral Therapy for Mood and Anxiety Disorders: Randomized Controlled Trial

Background: Cognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment. Objective: The present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort. Methods: A total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction.Results: Retention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P<.001, d=1.41), anxiety (P<.001, d=1.14), stress (P<.001, d=1.81),and quality of life (P<.001, d=1.17). There were no significant differences between treatment conditions regarding symptoms of depression (P=.165, d=0.37), anxiety (P=.41, d=0.22), stress (P=.15, d=0.38), or quality of life (P=.62, d=0.13). There were no significant differences in client rating of the working alliance (P=.53, one-tailed, d=–0.26), therapist ratings of the working alliance (P=.60, one-tailed, d=0.23), or client ratings of satisfaction (P=.77, one-tailed, d=–0.12). Fisher’s Exact P was not significant regarding differences in reliable change from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.41, P=.26), anxiety (P=.60, P=.99), or quality of life (P=.65, P=.99) but was significant for symptoms of stress in favor of the videoconferencing condition (P=.03, P=.035). Difference between conditions regarding clinically significant change was also not observed from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.67, P=.30), anxiety (P=.99, P=.99), stress (P=.19, P=.13), or quality of life (P=.99, P=.62). Conclusions: The findings of this controlled trial indicate that CBT was effective in significantly reducing symptoms of depression, anxiety, and stress and increasing quality of life in both in-person and videoconferencing conditions, with no significant differences being observed between the two

Telehealth Handbook

The Centre for Telehealth (CT@M) Handbook is a resource for the growing number of people working in the field of telehealth, with a particular focus on applications in the area of mental health and addictions. It is intended to provide Site Coordinators and others with practical information, guidelines, and forms for clinical and evaluation purposes

The Empirical Evidence for Telemedicine Interventions in Mental Disorders

Problem and Objective: This research derives from the confluence of several factors, namely, the prevalence of a complex array of mental health issues across age, social, ethnic, and economic groups, an increasingly critical shortage of mental health professionals and the associated disability and productivity loss in the population, and the potential of telemental health (TMH) to ameliorate these problems. Definitive information regarding the true merit of telemedicine applications and intervention is now of paramount importance among policymakers, providers of care, researchers, payers, program developers, and the public at large. This is necessary for rational policymaking, prudent resource allocation decisions, and informed strategic planning. This article is aimed at assessing the state of scientific knowledge regarding the merit of telemedicine interventions in the treatment of mental disorders (TMH) in terms of feasibility/acceptance, effects on medication compliance, health outcomes, and cost. Materials and Methods: We started by casting a wide net to identify the relevant studies and to examine in detail the content of studies that met the eligibility criteria for inclusion. Only studies that met rigorous methodological criteria were included. Necessary details include the specific nature and content of the intervention, the research methodology, clinical focus, technological configuration, and the modality of the intervention. Results: The published scientific literature on TMH reveals strong and consistent evidence of the feasibility of this modality of care and its acceptance by its intended users, as well as uniform indication of improvement in symptomology and quality of life among patients across a broad range of demographic and diagnostic groups. Similarly, positive trends are shown in terms of cost savings. Conclusion: There is substantial empirical evidence for supporting the use of telemedicine interventions in patients with mental disorders.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140291/1/tmj.2015.0206.pd

Usability and Reliability of Autism Diagnostic Observation Schedule (ADOS) Module 4 Remote Administration

Autism Spectrum Disorder (ASD) is characterized by impairments in social interaction, impairments in communication, and restricted repetitive and stereotyped patterns of behavior, interests, and activities. The Autism Diagnostic Observation Schedule (ADOS) Module 4 is a semi-structured diagnostic assessment tool designed for verbally fluent adolescents and adults with possible ASD. Due to a lack of available clinical expertise, it can be difficult for adults to receive an accurate ASD diagnostic assessment, especially those residing in rural areas. An ADOS teleassessment system was developed using the Versatile and Integrated System for Telerehabilitation (VISYTER). VISYTER consists of computer stations at the client site and clinician site, and a web portal server for managing and coordinating all elements of the assessment process. Clinician usability and fidelity to standard, face-to-face administration, was assessed. After improvements to the system were made, a study was conducted to determine the reliability of the ADOS module 4 administrations delivered remotely. Twenty-three adults with an ASD diagnosis participated in a within-subject crossover design study in which both a remote and face-to-face ADOS were administered. Weighted kappa was calculated for all 31 ADOS items. There was substantial agreement on 11 items and almost perfect or perfect agreement on 10 items. Intraclass correlations (ICCs) were calculated for algorithm subtotals. ICCs were greater than .75 for three out of four subtotals. There was substantial agreement on ADOS classification (i.e., diagnosis) between assessments delivered face-to-face versus assessments delivered remotely, Po=83%; ĸ =.772, ICC=.92. Non-agreement may have been due to outside factors or practice effect despite a washout period. Finally, usability and satisfaction of the remote assessment system was evaluated from the participants’ perspectives. Participant satisfaction with the remote ADOS delivery system was high. The results of these studies demonstrate that an ASD assessment designed to be delivered face-to-face can be reliably administered remotely using an integrated web-based system

Mobile devices for the remote acquisition of physiological and behavioral biomarkers in psychiatric clinical research

Psychiatric disorders are linked to a variety of biological, psychological, and contextual causes and consequences. Laboratory studies have elucidated the importance of several key physiological and behavioral biomarkers in the study of psychiatric disorders, but much less is known about the role of these biomarkers in naturalistic settings. These gaps are largely driven by methodological barriers to assessing biomarker data rapidly, reliably, and frequently outside the clinic or laboratory. Mobile health (mHealth) tools offer new opportunities to study relevant biomarkers in concert with other types of data (e.g., self-reports, global positioning system data). This review provides an overview on the state of this emerging field and describes examples from the literature where mHealth tools have been used to measure a wide array of biomarkers in the context of psychiatric functioning (e.g., psychological stress, anxiety, autism, substance use). We also outline advantages and special considerations for incorporating mHealth tools for remote biomarker measurement into studies of psychiatric illness and treatment and identify several specific opportunities for expanding this promising methodology. Integrating mHealth tools into this area may dramatically improve psychiatric science and facilitate highly personalized clinical care of psychiatric disorders

When new technology is an answer for old problems: the use of videoconferencing in cognitive aging assessment

People living with cognitive impairment and dementia require regular screening of their symptomatology and needs. Brief cognitive screening is crucial for assessing these conditions. Such screening can give health professionals a snapshot of the patient’s cognitive abilities and help in their monitoring and adaptation. An appropriate administration of brief cognitive screening using telemedicine technology, such as videoconference, can improve access to care and treatment planning. Moreover, the burden that rural and underserved communities often suffer because of limited access to specialty mental health services is also of concern. Herein, in this review, we describe the existing and relevant research regarding the administration of neuropsychological instruments via videoconferencing, and suggest methodological improvements for further studies. To date, only a handful of scientific studies have been published documenting the feasibility and acceptability of videoconferencing among older people and health professionals. Varying in their assessment tools, the studies demonstrate the reliability of cognitive testing and clinical diagnosis of dementia via videoconferencing, as noted by the associations between results of several cognitive tests using it as compared to face-to-face interviews. Further research is required to replicate findings and bring new solutions for their adaptation to a wide range of individuals, health professionals, areas of practice and settings.info:eu-repo/semantics/publishedVersio