Download PDF
Methods Inf Med 1995; 34(03): 232-243
DOI: 10.1055/s-0038-1634597
Original Article
Schattauer GmbH

A Psychiatric Diagnostic System Integrating Probabilistic and Categorical Reasoning

M. B. do Amaral
1   Division of Medical Informatics, Chiba University Hospital, Chiba, Japan
,
Y. Satomura
1   Division of Medical Informatics, Chiba University Hospital, Chiba, Japan
,
M. Honda
1   Division of Medical Informatics, Chiba University Hospital, Chiba, Japan
,
T. Sato
2   Department of Psychiatry, Chiba University Hospital, Chiba, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
16 February 2018 (online)

    Permissions and Reprints

Abstract:

We describe a diagnostic support system for clinical psychiatry and its evaluation results. The system has two inter-related components: a rule-based reasoning part associated with uncertainty, and a deterministic part, that uses heuristics to perform categorical reasoning. The system includes the 30 groups of psychiatric diagnoses which are classified under the categories 290 to 319 of the DSM-III-R and the ICD-9. There are, in fact, 1508 rules relating 208 clinical findings with 257 diagnoses. The reasoning strategy is based on selecting and differentiating diagnostic categories in a hierarchical classification tree. The system is intended to be used for education of medical students, and to help non-specialist clinicians, residents in psychiatry, or experts with few years of experience in decision making. We tested the diagnostic performance of the system using case reports extracted from a specialized journal. In 52.8% of the cases, the correct diagnosis was ranked as the first hypothesis using only the rule-based part. In combination with the deterministic strategy, the correct diagnosis could be made for 73.6% of the analyzed cases.

Keywords:

Artificial Intelligence - Psychiatry - DSM-III-R - Diagnostic Reasoning - Expert Systems
 

  • References

  • 1 Elstein AS, Loupe MJ, Edman JG. An experimental study of medical diagnostic thinking. J Structural Learning 1971; 2: 45-53.
    PubMedSearch in Google Scholar
  • 2 McGuire C, Solomon L. Clinical Simulation. New York: Appleton-Century-Crofts; 1971
    Search in Google Scholar
  • 3 Taylo TR. Clinical decision analysis. Meth Inform Med 1976; 15: 216-24.
    PubMedSearch in Google Scholar
  • 4 Elstein AS, Shulman LS, Sprafka SA. Medical Problem Solving: An Analysis of Clinical Reasoning. Cambridge MA: Harvard University Press; 1978
    Search in Google Scholar
  • 5 Kassirer JP, Gorry GA. Clinical problem solving: A behavioral analysis. Ann Intern Med 1978; 89: 245-55.
    CrossrefPubMedSearch in Google Scholar
  • 6 Weinstein MC, Fineberg HV. Clinical Decision Analysis. Philadelphia PA: Saunders; 1980
    Search in Google Scholar
  • 7 Van Bemmel JH. Decision support in medicine: comparative methodology and impact on the medical curriculum. In: Rienhoff O, Piccolo U, Schneider B. eds. Expert Systems and Decision Support in Medicine. Berlin: Springer-Verlag; 1988: 3-19.
    Search in Google Scholar
  • 8 Engelbrecht R. Status of and research need for expert systems in medicine. In: Rienhoff O, Piccolo U, Schneider B. eds. Expert Systems and Decision Support in Medicine. Berlin: Springer-Verlag; 1988: 361-6.
    Search in Google Scholar
  • 9 Van Bemmel JH, Gremy F, Zvarova J. eds. Medical Decision Making: Diagnostic Strategies and Expert Systems. Amsterdam: North-Holland; 1985
    Search in Google Scholar
  • 10 Kulikowski CA. Artificial Intelligence methods and systems for medical consultations. IEEE Trans Pattern Anal Machine Intell 1980; PAMI-2: 464-76.
    PubMedSearch in Google Scholar
  • 11 Heatfield HA, Wyatt J. Philosophies for the design and development of clinical support systems. Meth Inform Med 1993; 32: 1-9.
    PubMedSearch in Google Scholar
  • 12 Miller RA. Taking inventory of medical decision support software development. Meth Inform Med 1993; 32: 9-11.
    PubMedSearch in Google Scholar
  • 13 Musen MA. Architectures for architects. Meth Inform Med 1993; 32: 12-3.
    PubMedSearch in Google Scholar
  • 14 Van der Lei. Experience from computer-based patient records for computer-assisted decision making. Meth Inform Med 1993; 32: 14-5.
    PubMedSearch in Google Scholar
  • 15 Szolovits P, Pauker SG. A coherent philosophy for development or a straightjacket for research. Meth Inform Med 1993; 32: 16-7.
    PubMedSearch in Google Scholar
  • 16 Spiegelhalter DJ. Uncertainty in expert systems. In: Gale W. ed. Artificial Intelligence and Statistics. Reading MA: Addison-Wesley; 1985: 17-48.
    Search in Google Scholar
  • 17 Kanal LN, Lemmer JF. eds. Uncertainty in Artificial Intelligence. Amsterdam: North-Holland; 1986
    Search in Google Scholar
  • 18 Lindley DV. Scoring rules and the inevitability of probability. Internat Statist Rev 1985; 50: 1-26.
    PubMedSearch in Google Scholar
  • 19 Chandresekaran B. Uncertainty handling in expert systems: uniform vs. task-specific formulations. In: Kanal LN, Lemmer JF. eds. Uncertainty in Artificial Intelligence. Amsterdam: North-Holland; 1986: 35-47.
    Search in Google Scholar
  • 20 Cohen PR. Heuristic Reasoning about Uncertainty. Boston: Pitmans; 1985
    Search in Google Scholar
  • 21 Fox J. Knowledge, decision making and uncertainty. In: Gale W. ed. Artificial Intelligence and Statistics. Reading MA: Addison-Wesley; 1985: 55-77.
    Search in Google Scholar
  • 22 Bayes T. An essay towards solving a problem in the doctrine of chances. Philos Trans R Soc 1763; 53: 370-5.
    CrossrefPubMedSearch in Google Scholar
  • 23 Shortliffe EH, Buchanan BG. A model of inexact reasoning in medicine. Math Biosci 1979; 23: 421-7.
    PubMedSearch in Google Scholar
  • 24 Zadeh LA. Fuzzy sets. Inform Control 1965; 8: 338-53.
    CrossrefPubMedSearch in Google Scholar
  • 25 Shafer G. A mathematical Theory of Evidence. Princeton: Princeton University Press; 1976
    Search in Google Scholar
  • 26 McGraw K, Harbison-Briggs J. Knowledge Acquisition. New York: Prentice-Hall; 1989
    Search in Google Scholar
  • 27 Quinlan JR. Induction of decision trees. Machine Learning 1986; 1: 81-106.
    PubMedSearch in Google Scholar
  • 28 Musen MA. The inference engine of Oncocin. In: Research Notes in Artificial Intelligence. London: Pitman; 1989
    Search in Google Scholar
  • 29 Leao BF, Rocha AF. Proposed methodology for knowledge acquisition. Meth Inform Med 1990; 29: 30-40.
    PubMedSearch in Google Scholar
  • 30 American Association for Artificial Intelligence. Second Knowledge Acquisition for Knowledge-Based Systems Workshop. Alberta: Banff; 1987
    Search in Google Scholar
  • 31 Schwartz SR, Stinson C, Berlant J. Computers in psychiatry. MD Computing 1985; 2: 43-50.
    PubMedSearch in Google Scholar
  • 32 Greist JH, Klein MH, Erdman HP, Jefferson JW. Computers and psychiatric diagnosis. Psychiatric Ann 1983; 13: 785-92.
    PubMedSearch in Google Scholar
  • 33 Overall JE, Hollister LE. Computer procedures for psychiatric classification. JAMA 1964; 187: 583-8.
    PubMedSearch in Google Scholar
  • 34 Sletten IW, Altman H, Ulet GA. Routine diagnosis by computer. Am J Psychiatry 1971; 127: 1147-52.
    CrossrefPubMedSearch in Google Scholar
  • 35 Spitzer RL, Endicott J. DIAGNO: a computer program for psychiatric diagnosis utilizing the differential diagnosis procedure. Arch Gen Psychiatry 1968; 18: 746-56.
    CrossrefPubMedSearch in Google Scholar
  • 36 Spitzer RL. Endicott Can the computer assist clinicians in psychiatric diagnosis?. Am J Psychiatry 1974; 131: 523-30.
    CrossrefPubMedSearch in Google Scholar
  • 37 Greist JH, Klein MH, Erdman HP. Routine on-line psychiatric diagnosis by computer. Am J Psychiatry 1976; 133: 1405-8.
    CrossrefPubMedSearch in Google Scholar
  • 38 Mulsant B, Servan-Schreiber D. Knowledge engineering: a daily activity on a hospital ward. Comp Biomed Res 1984; 17: 71-91.
    CrossrefPubMedSearch in Google Scholar
  • 39 Mulsant B. A neural network as an approach to clinical diagnosis. MD Computing 1990; 7: 25-36.
    PubMedSearch in Google Scholar
  • 40 Plugge LA, Verhey FR, Jolles J. A desktop expert system for the diagnosis of dementia. An evaluation study. Int J Technol Asses Health Care 1990; 152: 585-7.
    PubMedSearch in Google Scholar
  • 41 Kolodner JL, Kolodner RM. Towards a computer model of psychiatric reasoning. In: Proceedings of the Sixth Annual Symposium on Computer Applications in Medical Care. Washington DC: IEEE Computer Society Press; 1982: 99-103.
    Search in Google Scholar
  • 42 Kolodner JL. Towards an understanding of the role of experience in the evolution from novice to expert. Int J Man-Machine Stud 1983; 19: 497-518.
    PubMedSearch in Google Scholar
  • 43 Smith WG. A model for psychiatric diagnosis. Arch Gen Psychiatry 1966; 14: 521-9.
    CrossrefPubMedSearch in Google Scholar
  • 44 Fleiss JL, Spitzer RL, Cohen J. Three computer diagnosis methods compared. Arch Gen Psychiatry 1972; 27: 643-9.
    CrossrefPubMedSearch in Google Scholar
  • 45 Amchin J. Psychiatric Diagnosis: a Biopsychosocial Approach. Washington DC: American Psychiatric Press; 1990
    Search in Google Scholar
  • 46 Diagnostic and Statistic Manual of Mental Disorders (Third Ed, Rev) (DSM-III-R). American Psychiatric Press; Washington DC: 1987
    Search in Google Scholar
  • 47 Swarts DM, Pfohl B. A learning aid for DSM-III: computerized prompting of diagnostic criteria. J Clin Psychiatry 1981; 42: 359-63.
    PubMedSearch in Google Scholar
  • 48 Do Amaral ME, Satomura Y, Honda M, Sato T. A design for decision making: construction and connection of knowledge bases for a diagnostic system in medicine. Med Inform 1993; 18: 307-20.
    PubMedSearch in Google Scholar
  • 49 Do Amaral ME, Honda M, Satomura Y. Analysis of the medical clinical reasoning: necessary structures for implementation of a diagnostic model. In: Proceeding of the Japanese Congress on Medical Electronics and Biomedical Engineering. 1993: 230.
    PubMedSearch in Google Scholar
  • 50 Wise BP, Henrion M. A framework to compare uncertain inference systems to probability. In: Kanal LN, Lemmer F. eds. Uncertainty in Artificial Intelligence. Amsterdam: North-Holland; 1986: 69-85.
    Search in Google Scholar
  • 51 Hughes C. The representation of uncertainty in expert systems. Med Inform 1989; 14: 269-79.
    PubMedSearch in Google Scholar
  • 52 Do Amaral ME, Satomura Y. Extraction and use of essential data sets from the DSM-III-R to test the rule-based strategy of a decision support system. In: Proceedings of the 13th Japanese Congress on Medical Informatics. 1993: 281-2.
    PubMedSearch in Google Scholar
  • 53 Spitzer RL, Williams JB, Gibbon M, First M. Structured Clinical Interview for DSM-III-R. Washington DC: American Psychiatric Press; 1983
    Search in Google Scholar
  • 54 Do Amaral MB, Satomura Y, Honda M, Sato T. Projecting a diagnostic system to accept medical narratives as consultations. In: Knowledge Bases and Expert Systems for Medical Consultations. Japanese Society of Medical Informatics; Tokyo: 1992: 128-41.
    Search in Google Scholar
  • 55 Adams JB. A probability model of medical reasoning and the MYCIN model. Math Biosci 1976; 32: 177-86.
    CrossrefPubMedSearch in Google Scholar
  • 56 Heckerman DE. Probabilistic interpretation for MYCIN’s certainty factors. In: Kanal L, Lemmer J. eds. Uncertainty in Artificial Intelligence. Amsterdam: North-Holland; 1986: 153-66.
    Search in Google Scholar
  • 57 Szolovits P, Pauker SG. Categorical and probabilistic reasoning in medical diagnosis. In: Clancey WJ, Shortlife EH. eds. Readings in Medical Artificial Intelligence. Reading MA: Addison-Wesley; 1984: 210-40.
    Search in Google Scholar
  • 58 Miller RA, Pople HE, Myers JD. INTERNIST-1, an experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med 1982; 307: 468-76.
    CrossrefPubMedSearch in Google Scholar
  • 59 Miller RA. Medical diagnostic decision support systems – Past, Present and Future. J Amer Med Inform Assoc 1994; 1: 8-27.
    CrossrefPubMedSearch in Google Scholar
  • 60 Berner ES. et al. Performance of four computer-based diagnostic systems. N Engl J Med 1994; 330: 1792-6.
    CrossrefPubMedSearch in Google Scholar