The use of videoconferencing with patients with psychosis: a review of the literature.

Videoconferencing has become an increasingly viable tool in psychiatry, with a growing body of literature on its use with a range of patient populations. A number of factors make it particularly well suited for patients with psychosis. For example, patients living in remote or underserved areas can be seen by a specialist without need for travel. However, the hallmark symptoms of psychotic disorders might lead one to question the feasibility of videoconferencing with these patients. For example, does videoconferencing exacerbate delusions, such as paranoia or delusions of reference? Are acutely psychotic patients willing to be interviewed remotely by videoconferencing? To address these and other issues, we conducted an extensive review of Medline, PsychINFO, and the Telemedicine Information Exchange databases for literature on videoconferencing and psychosis. Findings generally indicated that assessment and treatment via videoconferencing is equivalent to in person and is tolerated and well accepted. There is little evidence that patients with psychosis have difficulty with videoconferencing or experience any exacerbation of symptoms; in fact, there is some evidence to suggest that the distance afforded can be a positive factor. The results of two large clinical trials support the reliability and effectiveness of centralized remote assessment of patients with schizophrenia.

Face-to-face versus remote administration of the Montgomery-Asberg Depression Rating Scale using videoconference and telephone.

Although the use of telemedicine in psychiatry has a long history in providing clinical care to patients, its use in clinical trials research has not yet been commonly employed. Telemedicine allows for the remote assessment of study patients, which could be done by a centralized, highly calibrated, and impartial cohort of raters independent of the study site. This study examined the comparability of remote administration of the Montgomery-Asberg Depression Rating Scale (MADRS) by videoconference and by telephone to traditional face-to-face administration. Two parallel studies were conducted: one compared face-to-face with videoconference administration (N=35), and the other compared face-to-face with telephone administration (N=35). In each study, depressed patients were interviewed independently twice: once in the traditional face-to-face manner, and the second time by either videoconference or teleconference. A counterbalanced order was used. The mean MADRS score for interviews conducted remotely by videoconference was not significantly different from the mean MADRS scores conducted by face-to-face administration (mean difference=0.51 points), P=.388, intraclass correlation (ICC)=.94, P<0001. Similarly, the mean MADRS score for interviews conducted by telephone was not significantly different from the mean MADRS score conducted by face-to-face administration (mean difference=0.74 points), P=.270, ICC=.93, P<0001. Results of the study support the comparability of remote administration of the MADRS, by both telephone and videoconference, to face-to-face administration. Comparability of the administration mode allows for remote assessment of patients in both research and clinical applications.

Attentional fixation in panic disorder.

According to Beck's (1988) clinical observations, patients with panic disorder describe a fixation on their distressing physical and psychological symptoms and an inability to access corrective information during panic attacks. The present study sought to evaluate empirically the notion that attentional fixation is characteristic of these patients. A subset of panic patients participating in 3 cognitive therapy clinical trials completed the Attentional Fixation Questionnaire (AFQ) at intake, during treatment and at termination. The AFQ had adequate internal consistency at all time intervals, and it correlated positively with measures of depression, anxiety and distorted cognitive content. At termination, the AFQ total score and nearly all single items decreased significantly, and patients who continued to meet diagnostic criteria for panic disorder scored higher on most items than patients who no longer met diagnostic criteria for panic disorder. These preliminary data suggest that attentional fixation is an important dimension of cognition relevant to panic disorder.

Dysfunctional beliefs in panic disorder: The Panic Belief Inventory.

The Panic Belief Inventory (PBI) was developed to assess beliefs that increase the likelihood of catastrophic reactions to physical and emotional experiences in panic disorder. In the first stage of scale development, 197 panic disorder patients completed the PBI and standard self-report inventories of psychiatric symptomatology. An exploratory factor analysis yielded a 4-factor solution from which a 35-item instrument with 4 scales was constructed. The shortened measure and its scales had good internal consistency and convergent validity and moderate discriminant validity. Subsequently, 22 panic disorder patients who received cognitive therapy completed the PBI and other self-report inventories of dysfunctional cognitions at intake, 4 weeks, 8 weeks, termination, and several follow-up intervals. Results indicated that the PBI decreased significantly across treatment, with the largest decline occurring between intake and 4 weeks into treatment. The PBI correlated more strongly with dysfunctional cognitions associated with anxiety than dysfunctional cognitions associated with depression. These results provide preliminary evidence that the PBI has adequate psychometric characteristics, is useful to assess change in dysfunctional beliefs during treatment, and has the potential to advance cognitive theories of panic.

History of family suicide behaviors and negative problem solving in multiple suicide attempters.

This study examined the relationship between family history of suicide, negative problem solving orientation and suicide attempt status (multiple suicide attempters versus single suicide attempters). Suicide attempters with a family history of suicide were more likely to have multiple suicide attempts when compared to suicide attempters who did not have a family history of suicide. This relationship was consistent with a model in which the relationship between family history and suicide attempt status is mediated by negative problem solving. Results of this study are discussed as they pertain to the theory and treatment of suicide attempters.