Lithium Information Center. One model of a computer-based psychiatric information service.

The Lithium Information Center has been functioning as a specialized psychiatric information service for nearly ten years. Over the years, the center has disseminated information about the medical uses of lithium to psychiatrists and other physicians, to patients, to the family and friends of patients, and to a host of other individuals and organizations including pharmacists, lawyers, nurses, social workers, mental health centers, clinics, and support groups. To encourage the development of similar psychiatric information services, we outline the center's methods of acquiring, organizing, and disseminating lithium information.

Routine on-line psychiatric diagnosis by computer.

With the advent of effective psychiatric treatments, greater accuracy in psychiatric diagnosis has become a vital concern for psychiatric training, research, and patient care. The authors have adapted current computer diagnostic procedures in order to obtain highly accurate diagnosis while simplifying and shortening the process of information input and diagnostic output. Their program requires a minimum of the clinician's time and provides feedback during the diagnostic process when the clinician requires it. The authors believe that routine use of this computer diagnostic program will improve psychiatric training, research, and patient care.

Computer-administered cognitive-behavioral therapy for depression.

The authors evaluated a six-session interactive computer cognitive-behavioral treatment program given to volunteer patients who met Research Diagnostic Criteria (RDC) for major or minor depressive disorder. Patients were randomly assigned to computer-administered cognitive-behavioral treatment, to therapist-administered cognitive-behavioral treatment, or to a waiting-list control condition. After treatment and at 2-month follow-up, both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory, SCL-90-R depression and global scales, Hamilton Rating Scale for Depression, and Automatic Thoughts Questionnaire. The treatment groups did not differ from each other at either time.

A comparison of the Diagnostic Interview Schedule and clinical diagnosis.

The Diagnostic Interview Schedule (DIS) was administered to 220 psychiatric patients by lay interviewers. Kappas for agreement between DIS and chart diagnoses ranged from .39 to -.03 and averaged .14 for 13 diagnostic categories. Agreement was best for affective, obsessive-compulsive, and schizophrenic disorders and was poorest for phobias where patients overemphasized fears. The authors suggest that clinician evaluation of information collected by the DIS is important, especially in diagnosing individual cases.

Suicide risk prediction by computer interview: a prospective study.

A computer interview program that uses a subjective Bayesian probability model to assess suicide risk was evaluated. Predictions made by clinicians for 52 patients were compared with predictions made by the computer for the same patients. The computer was significantly (p = .001) better at predicting attempters, and clinicians were significantly (p = .01) better at predicting nonattempters. An analysis of receiver operating characteristic curves showed that the computer had better overall discrimination, but the difference was nonsignificant.

Lithium Information Center: The Lithium Library revisited.

The Lithium Information Center's experience over the past 7 years is discussed. The center is a computer-based reference service which specializes in dissemination of information about the medical uses of lithium. At the heart of the center is the Lithium Library, a bibliographic retrieval system containing references to the lithium literature. More than 5,000 requests for literature searches and patient information have been answered by Lithium Library staff members since 1977. The center has recently expanded its services, creating the Lithium Index and Lithium Consultation, computerized programs that provide immediate answers to specific questions about lithium. The center's services are directed to patient care, lithium research, and medical and patient education. Because of topical specialization and use of computers, the Lithium Information Center has been able to provide more immediate, comprehensive, relevant, integrated, and up-to-date information than other bibliographic services.

A comparison of two computer-administered versions of the NIMH Diagnostic Interview Schedule.

This study compared three versions of the NIMH Diagnostic Interview Schedule (DIS): "traditional" interviewer-administered DIS; computer-administered DIS (subject interacting alone with computer); computer-prompted DIS (interviewer using computer program as a guide). Kappas for 20 diagnoses ranged from .15 to .94, and averages for the three method pairs ranged from .57 to .64, which are comparable to other DIS reliability studies. Agreement between pairs of methods were comparable. Subjects' attitudes toward the computer interview were positive. While they felt they could better describe their feelings and ideas to a human, they found the computer contact less embarrassing. Overall, subjects had no preference for one method over another. Measures of social desirability and deviant response biases were correlated with diagnostic results. Reading ability did not affect subject's ability to respond to the DIS, although subjects with lower reading levels preferred the computer interview more.

Performance of two forms of a computer psychiatric screening interview: version I of the DISSI.

This study reports on the performance of two forms of version I of the Diagnostic Interview Schedule (DIS) computer screening interview, using the traditional interviewer-administered DIS (T-DIS) as the standard. The screening interview was either self-administered (called the S-DISSI) with the subject keying in responses, or interviewer-administered (I-DISSI), with the interviewer keying in the subject's responses. Sensitivity and specificity for both forms were ample (excluding antisocial personality), ranging from 60% to 100% for sensitivity and 54% to 95% for specificity. Concordances with the T-DIS were similar for both forms of the screening interview, ranging from .10 to .87 and compared favorably to those reported by other investigators. The I-DISSI took on average 30 min less than either the T-DIS and S-DISSI. Since the performances of both versions were equivalent, the decision to use either may be based on available resources and characteristics of the study population.

Clinical computer applications in mental health.

Direct patient-computer interviews were among the earliest applications of computing in medicine. Yet patient interviewing and other clinical applications have lagged behind fiscal, administrative, and research uses. Several reasons for delays in the development and implementation of clinical computing programs are discussed. Patient interviewing, clinician consultation, and other applications of clinical computing in mental health are reviewed, as well as changes that will facilitate their appropriate use.

Computer-administered therapy for depression.

We performed a randomized controlled study to evaluate computer-based cognitive behavioral therapy in 36 patients who met Research Diagnostic Criteria for major or minor depression. Patients were randomly assigned to the computer, to a therapist, or to a control group placed on a waiting list. As determined by three measures of depression (the Beck inventory, the Hamilton rating scale, and the Symptom Checklist-90-R), both treated groups had improved significantly more than the control group at the end of the treatment period and 2 months later. The treated groups did not differ from each other at either time.

Comparison of computer- and interviewer-administered versions of the Diagnostic Interview Schedule.

A group of 150 psychiatric patients were administered the Diagnostic Interview Schedule (DIS) on two occasions, once by a trained layperson and once using a computerized interview format in which the patient interacted directly with the computer. Agreement between the two methods on 15 diagnoses was relatively modest, as indicated by a mean kappa score of .51, but was similar to agreement rates reported in other studies of the DIS. The discrepancies may have been due to the high number of acutely ill inpatients studied, patients' reporting more symptoms in one of the interviews, and difficulty translating some of the DIS questions to the computer. Patients had positive feelings about both methods, but a significant majority liked the computer interview better and found it less embarrassing. The authors conclude that computerized administration of the DIS is as reliable as other methods but that exclusive reliance on the DIS for clinical diagnosis is inappropriate.