title: Applicability of telemedicine for assessing patients with schizophrenia: acceptance and reliability.
abstract: BACKGROUND
  Telemedicine holds promise for providing expert psychiatric consultation to underserved populations, but has not been quantitatively studied in schizophrenia or any other major mental disorder. This study was conducted to assess the reliability and acceptance of video-conferencing equipment in the assessment of patients with schizophrenia.
  
  
  METHODS
  We assessed reliability of the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS) under three conditions: (1) in person, (2) by videoconferencing at low (128 kilobits per second [kbs]) bandwidth, (3) by videoconferencing at high (384 kbs) bandwidth. All 45 patients met DSM-IV criteria for schizophrenia. All patients and the two interviewers rated various aspects of the study interviews against previous live psychiatric interviews.
  
  
  RESULTS
  Total scores on both the BPRS and SAPS were assessed equally reliably by the three media. Total score on the SANS was less reliably assessed at the low bandwidth, as were several specific negative symptoms of schizophrenia that depend heavily on nonverbal cues. Video interviews were well accepted by patients in both groups, although patients in the high bandwidth group were more likely to prefer the video interview to a live interview.
  
  
  CONCLUSIONS
  Global severity of schizophrenia and overall severity of positive symptoms were reliably assessed by videoconferencing technology. Higher bandwidth resulted in more reliable assessment of negative symptoms and was preferred over low bandwidth, although patients' and raters' acceptance of video was good in both conditions. Videoconsultation appears to be a reliable method of assessing schizophrenic patients in remote locations who have limited access to expert consultation.
authors.affiliation: Consolidated Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Zarate
authors.forename: L
authors.initials: L
authors.lastname: Weinstock
authors.forename: P
authors.initials: P
authors.lastname: Cukor
authors.forename: C
authors.initials: C
authors.lastname: Morabito
authors.forename: L
authors.initials: L
authors.lastname: Leahy
authors.forename: C
authors.initials: C
authors.lastname: Burns
authors.forename: L
authors.initials: L
authors.lastname: Baer
mesh_terms: D000328:Adult; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011570:Psychiatry / Q000592:standards; D019114:Remote Consultation / Q000295:instrumentation / Q000592:standards; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index; D013690:Television / Q000295:instrumentation / Q000592:standards