Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliabilityof diagnostic module.

BACKGROUND & OBJECTIVES: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. METHODS: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. RESULTS: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. INTERPRETATION & CONCLUSIONS: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.

Carbamazepine-induced erythema multiforme major in an epileptic patient with bipolar affective disorder.

Carbamazepine (CBZ) is frequently used for epilepsy and various psychiatric illnesses. It is known for its dermatological side effects which may range from mild rash to life-threatening reactions as Stevens Johnson syndrome or toxic epidermal necrolysis. We hereby report a rare case of 17-year-old woman suffering from generalized tonic clonic epilepsy with comorbid bipolar affective disorder, who was initially treated with sodium valproate with partial improvement. After 19 days of addition of CBZ to the therapy, the patient developed erythema multiforme major with >60% skin involvement and oral, conjunctival, intestinal, and vaginal mucosal involvement.

Anabolic androgenic steroids in delayed diagnosis of tuberculosis.

This is the first case report depicting masking of symptoms of intestinal tuberculosis by anabolic androgenic steroids (AAS) causing delay in diagnosis which lead to a major surgery. Negative tuberculosis skin test (TST) probably due to immunomodulating effects of AAS also contributed to the delay. Patient also had early dependence on AAS and rapid growth of scrotal sebaceous cysts, findings of which have not yet been reported.