Use of video conferencing for psychiatric and forensic evaluations.
Use of video conferencing for psychiatric and forensic evaluations.
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使用视频会议进行精神病学和法医评估。
DOI：
10.1176/ps.2006.57.5.713
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Blank,MichaelB
中科院分区：
文献类型：
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作者：
Lexcen,FrancesJ;Hawk,GaryL;Herrick,Steve;Blank,MichaelB
方法这项研究是在1997年至1998年间进行的，共有72名住院患者，他们来自弗吉尼亚州彼得堡中央州立医院最高安全级别的法医单位。大多数参与者在因精神错乱而被判无罪后被拘留。其余参与者在审前被拘留。所有参与者都有DSM-IV轴I诊断，患有严重的精神疾病。许多人还被诊断为AXIS II。这项研究获得了弗吉尼亚大学医学院机构审查委员会和彼得堡中央州立医院人类受试者委员会的批准。与设计或数据收集无关的个人获得同意。参与者从他们的食堂账户收到了10美元的付款。完成的同意书与数据协议分开保存，并留在医院以保护参与者的匿名。使用两种标准化的仪器。BPRS-A被用来作为精神病理学存在和严重程度的可靠和有效的估计，通过Likert量表上的7分症状评级来衡量(1)。MacCAT-CA已与审前成年被告的大样本标准化，用于评估受审能力(9)。MacCAT-CA由三个分量表组成：理解分量表评估被告对法庭程序和审判参与者角色的了解，推理分量表评估个人对事实信息与辩护相关性的认识，欣赏分量表评估被告对自己法律状况的感知是否受到思维障碍症状的不当影响。项目获得三个分数之一：0，没有学分；1，部分学分；或2，全额学分。本研究采用三种给药和观察条件。在每种情况下，由一人使用MacCAT-CA和BPRS-A。采访者和观察者都独立地对工具进行了评分。第一种情况(本地管理、远程观察)需要面对面的管理，通过视频会议进行观察。第二种情况(远程管理，本地观察)需要通过视频会议进行管理，并由面对面的评分员进行观察。第三种情况(地方管理、地方观察)需要亲自管理和观察。三人是有经验的大学附属临床心理学家，一人是临床心理学的高级研究生。所有人都接受了BPRS-A的临床评估和MacCAT-CA的法医评估方面的培训和经验。对评分员在条件内和跨条件下的管理和观察状态进行了平衡。传播地点是彼得堡中央州立医院的最高安全法医单位；夏洛茨维尔的法律、精神病学和公共政策研究所；以及夏洛茨维尔的弗吉尼亚大学东南农村精神健康研究中心。每个站点都建立了双向互动视频系统，由Intel ProShare台式视频会议系统、Intel Pentium计算机和128千比特每秒的传输速率组成。我们使用社会科学统计程序包11.0版计算了BPRS-A总分和MacCAT-CA分量表的ICCS的评分员间信度。可靠性高于。75表示重复性很好，大于。40岁及以下。75表示重复性好，小于。40例表示重复性差(10例)。
MethodsThe study was conducted between 1997 and 1998 with 72 inpatients from the maximum security forensic unit of Central State Hospital in Petersburg, Virginia. Most participants were detained after being found not guilty by reason of insanity. The remaining participants were detained pretrial. All participants had DSM-IV axis I diagnoses of severe mental illnesses. Many also had axis II diagnoses. Approval for the study was obtained from the institutional review board of the University of Virginia Medical School and from the human subjects committee of Central State Hospital in Petersburg. An individual not associated with the design or data collection obtained consent. Participants received a $10 payment to their canteen accounts. Completed consent forms were kept separate from data protocols and remained at the hospital to preserve the participants’ anonymity. Two standardized instruments were administered. The BPRS-A was used as a reliable and valid estimate of the presence and severity of psychopathology as measured by a 7-point rating of symptoms on a Likert scale (1). The MacCAT-CA, which has been standardized with large samples of pretrial adult defendants, was used to assess competence to stand trial (9). The MacCAT-CA comprises three subscales: the understanding subscale assesses the defendant’s knowledge of courtroom procedures and roles of trial participants, the reasoning subscale assesses the individual’s recognition of the relevance of factual information for a defense, and the appreciation subscale assesses whether a defendant’s perceptions of his or her own legal situation are unduly influenced by symptoms of thought disorder. Items receive one of three scores: 0, no credit; 1, partial credit; or 2, full credit. Three administration and observation conditions were used for this study. In each condition, the MacCAT-CA and BPRS-A were administered by one person. Both the interviewer and observer scored the instruments independently. The first condition (local administration, remote observation) entailed in-person administration, with observation via video conferencing. The second condition (remote administration, local observation) entailed administration by video conferencing and observation by the in-person rater. The third condition (local administration, local observation) entailed in-person administration and observervation.Four researchers participated. Three were experienced, university-affiliated clinical psychologists, and one was a senior graduate student in clinical psychology. All were trained and experienced in performing clinical evaluations with the BPRS-A and forensic evaluations with the MacCAT-CA. Pairs of raters were counterbalanced for administration and observation status within and across conditions. The transmission sites were the maximum security forensic unit at Central State Hospital in Petersburg; the Institute for Law, Psychiatry, and Public Policy in Charlottesville; and the Southeastern Rural Mental Health Research Center at University of Virginia in Charlottesville. Each site had established a two-way interactive video system consisting of the Intel Proshare desktop video conferencing system, Intel Pentium computers, and a transmission rate of 128 kilobits per second. We calculated interrater reliabilities with ICCs for total scale scores of the BPRS-A and subscales of the MacCAT-CA with the Statistical Package for Social Sciences, version 11.0. Reliabilities greater than. 75 indicated excellent reproducibility, greater than. 40 and less than. 75 indicated good reproducibility, and less than. 40 indicated poor reproducibility (10).