Concordance of DSM-IV Axis I and II diagnoses by personal and informant's interview

The validity and reliability of using psychological autopsies to diagnose a psychiatric disorder is a critical issue. Therefore, interrater and test-retest reliability of the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders and the usefulness of these instruments for the psychological autopsy method were investigated. Diagnoses by informant's interview were compared with diagnoses generated by a personal interview of 35 persons. Interrater reliability and test-retest reliability were assessed in 33 and 29 persons, respectively. Chi-square analysis, kappa and intraclass correlation coefficients, and Kendall's tau were used to determine agreement of diagnoses. Kappa coefficients were above 0.84 for substance-related disorders, mood disorders, and anxiety and adjustment disorders, and above 0.65 for Axis II disorders for interrater and test-retest reliability. Agreement by personal and relative's interview generated kappa coefficients above 0.79 for most Axis I and above 0.65 for most personality disorder diagnoses; Kendall's tau for dimensional individual personality disorder scores ranged from 0.22 to 0.72. Despite of a small number of psychiatric disorders in the selected population, the present results provide support for the validity of most diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV Axis I and Personality Disorders. This instrument can be recommended as a tool for the psychological autopsy procedure in post-mortem research.     

心理解剖研究中SCID诊断准确性的影响因素

目的探讨心理解剖临床定式访谈(SCID)诊断准确性的影响因素。方法研究对象为大连市第七人民医院的就诊的209例患者和大连地区的144名社区人群。由经过统一培训的,并获得NIMH访谈员资格认证的研究人员对研究对象和信息人分别进行SCID访谈。结果①心理解剖SCID诊断的一致性较好:kappa值从抑郁障碍的0.696到精神分裂症的0.930;灵敏度从焦虑障碍的55.10%到精神分裂症的88.57%;特异度从抑郁障碍的95.70%到酒精使用障碍的100%。②不同类别的信息人心理解剖SCID诊断的一致率差异有统计学意义(P0.05),其中一级亲属心理解剖SCID诊断一致率最高(P0.05)。农村信息人心理解剖SCID诊断一致率高于城市,与患者同住高于不与患者同住,差异有统计学意义(P0.05)。信息人学历越高,心理解剖SCID诊断一致率越高,差异有统计学意义(P0.05)。结论心理解剖SCID诊断具有较好的灵敏度和特异度,与患者本人SCID诊断一致性良好。心理解剖SCID诊断精神疾病时尽可能选取一级亲属(父母或配偶)以及高学历者为信息提供者。     

Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study

The baseline interrater reliability, test-retest reliability, follow-up interrater reliability, and follow-up longitudinal reliability of axis I and axis II diagnoses were assessed using the Structured Clinical Interview for DSM-III-R Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-III-R Personality Disorders (DIPD-R). Excellent kappas (>.75) were found in each of these reliability substudies for the majority of axis II disorders diagnosed five times or more. Dimensional reliability figures for axis II diagnoses were generally somewhat higher than those for their categorical counterparts; most intraclass correlation coefficients (ICCs) were in the excellent range. Excellent kappas were also found in each of these four reliability substudies for over half of the axis I disorders diagnosed five times or more. Taken together, the results of this study suggest that the reliability of axis II disorders is both good to excellent and practically equivalent to that found for most axis I disorders. The results of this study also suggest that high levels of reliability, once achieved, can be maintained over time for both axis I and II disorders.     

Other psychiatric disorders among bulimic patients

Clinical experience suggests that bulimia nervosa is a disorder often accompanied by additional psychiatric symptoms. Based on unstructured clinical interviews, 21 additional Axis I and six Axis II diagnoses were assigned to a sample of 30 bulimic women. The Structured Clinic Interview for DSM-III-Patient Version (SCID-P) generated 47 additional Axis I and 78 Axis II diagnoses. There was little agreement across measures in the assessment of mood disturbance. These results not only suggest a greater degree of pathology in bulimic women, but also raise important questions regarding the measurement and conceptualization of DSM-III-R Axis II disorders.     

Clinical assessment of Axis I psychiatric morbidity in chronic epilepsy: a multicenter investigation

This study characterizes the rate of current Axis I DSM-IV disorders using a brief standardized psychiatric interview procedure, the Mini International Neuropsychiatric Interview (v5.0) (MINI), and determined the validity of MINI diagnoses of current depressive episodes to the research standard (Structured Clinical Interview for DSM-IV Disorders [SCID]). One hundred seventy-four patients with chronic epilepsy from five tertiary medical centers were interviewed using the MINI and the mood disorders module of the SCID. Current Axis I disorders were evident in one-half the sample (49%), with prevalent anxiety (30.4%) and mood (21.8%) disorders. Major depressive episode was the most common individual diagnosis (17.2%). Concordance was high between the MINI and SCID for diagnoses of current depression, especially for major depression. Of those with current major depression, less than one-half were treated with antidepressant medications. Current Axis I DSM-IV diagnoses can be effectively and accurately identified in clinical settings using shorter standardized psychiatric interview techniques. Issues regarding recognition and treatment of psychiatric morbidity in epilepsy are discussed.     

Validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands

This study examined the validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands. This is the first large-scale study that examined the validity of the family history method for diagnosing DSM-III-R personality disorders. The best estimate DSM-III-R diagnoses of 264 first-degree relatives of 117 adult-onset schizophrenia probands based on direct structured diagnostic interviews, family history interview, and medical records were compared to Family History Research Diagnostic Criteria (FH-RDC) diagnoses based on the NIMH Relative Psychiatric History Interview and to family history Structured Clinical Interview for DSM-III-R: Personality Disorders (SCID-II) diagnoses based on the SCID-II adapted to a third person format. Diagnoses of relatives were made blind to proband diagnostic status. The median sensitivity for schizophrenia and the related psychoses was 29% (range 0-50%), the median specificity 99% (range 98-100%), and the median positive predictive value (PPV) 67% (range 20-80%). The median sensitivity for the personality diagnoses was 25% (range 14-71%), the median specificity 100% (range 99-100%), and the median PPV 100% (range 67-100%). The family history method has low sensitivity but has excellent specificity and PPV for schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders. The kappa coefficient for the family history method was moderately good for the psychoses (0.598) and for paranoid and schizotypal personality disorder (0.576). Using the family history method, the validity of making schizophrenia-related personality disorder diagnoses was comparable to that of making psychotic disorder diagnoses.     

Quality of life in patients with chronic idiopathic urticaria: the impact of Axis I and Axis II psychiatric disorders

OBJECTIVE: Chronic idiopathic urticaria (CIU) associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently present in patients with CIU. This study examined the impact of Axis I and Axis II psychiatric disorders on the QoL of patients with CIU. METHOD: The study sample consisted of 100 subjects including CIU patients with only Axis I psychiatric diagnoses (n=25), CIU patients with only Axis II diagnoses (n=25), CIU patients with both Axis I and Axis II diagnoses (n=25), CIU patients without any Axis I and Axis II diagnosis (n=25), and healthy control subjects with respect to urticaria and psychiatric disorders (n=25). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-1) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) was used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief (WHOWOL-BREF). RESULTS: There were significant differences among the groups with respect to all WHOQOL-BREF subscale scores. The QoL levels were similar among CIU patients with only Axis I psychiatric diagnoses, CIU patients with only Axis II diagnoses and CIU patients with both Axis I and Axis II diagnoses, and between CIU patients without any Axis I and Axis II diagnosis, and healthy control subjects. When compared with those of CIU patients without any Axis I and Axis II diagnosis, CIU patients without concurrent psychiatric diagnoses had significantly lower scores in most domains of the QoL scale. CONCLUSIONS: Axis I and Axis II psychiatric disorders seem to be considerable factors influencing the QoL in CIU patients.     

An assessment of structured diagnostic interviews for adult anxiety disorders

Structured diagnostic interviews have been developed to aid reliable diagnosis of psychiatric disorders. Five of the available interviews are reviewed with respect to adult anxiety disorders: the Anxiety Disorders Interview Schedule-Revised (ADIS-R), the Composite International Diagnostic Interview (CIDI), the Schedule for Affective Disorders and Schizophrenia (SADS), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and the Structured Clinical Interview for DSM-III-R (SCID). Each of these assessment instruments is compared concerning their relative merits, psychometric properties, and usefulness to practicing clinicians and researchers. It is concluded that structured interviews increase diagnostic reliability. Since reliability is a prerequisite for validity, structured diagnostic interviews represent a necessary addition to research clinical assessment.     

The Structured Clinical Interview for DSM-III-R Dissociative Disorders: preliminary report on a new diagnostic instrument

The authors describe the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D), which investigates five groups of dissociative symptoms (amnesia, depersonalization, derealization, identity confusion, and identity alteration) and systematically rates both the severity of individual symptoms and the evaluation of overall diagnosis of dissociative disorder. Preliminary findings from a study of 48 subjects with and without psychiatric diagnoses indicate good to excellent reliability and discriminant validity for the SCID-D as a diagnostic instrument for the five dissociative disorders and as a tool for the evaluation of dissociative symptoms encountered within nondissociative syndromes.     

Axis I and Axis II diagnoses in patients with chronic idiopathic urticaria

OBJECTIVE: This study presents the current prevalence of Axis I and Axis II psychiatric diagnoses and factors associated with the existence of Axis I psychiatric disorders in patients with chronic idiopathic urticaria (CIU). METHOD: The study sample was composed of 89 patients with CIU and 64 control subjects. Axis I and Axis II psychiatric disorders were ascertained by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, respectively. RESULTS: Of patients with CIU, 44 (49.4%) had at least one Axis I diagnosis, and 40 (44.9%) had at least one personality disorder. The most common Axis I disorder was obsessive-compulsive disorder (25.8%), and the most common Axis II disorder was obsessive-compulsive (30.3%) personality disorder in patients with CIU. Obsessive-compulsive disorder, major depression, obsessive-compulsive and avoidant personality disorders were more prevalent in patient group compared to control group. Obsessive-compulsive and avoidant personality disorders were related to the existence of Axis I disorders in patients with CIU. CONCLUSION: Psychiatric morbidity seems to be a frequent healthy problem in patients with CIU.     

Prevalence of personality disorders in patients with major depression and dysthymia.

The authors administered the Structured Clinical Interview for DSM-III-R Axis I (SCID-P) and Axis II (SCID-II) Disorders to 197 patients with major depression, 63 patients with dysthymia, and 32 patients with both major depression and dysthymia ("double depression"). Fifty percent of major depressive patients, 52% of dysthymic patients, and 69% of patients with double depression were diagnosed as having at least one personality disorder. Patients with a personality disorder had higher scores on the Beck Anxiety and Depression Inventories. The most commonly diagnosed personality disorders were from the anxious/fearful cluster, most notably avoidant and dependent personality disorders.     

DSM—IV临床定式访谈（SCID）在心理解剖诊断中的应用

目的本研究主要评估SCID在心理解剖中进行精神疾病诊断时的可靠性、灵敏度和特异度问题。方法对精神疾病住院患者进行SCID访谈（为患者SCID诊断）,对患者亲属进行SCID访谈（为心理解剖SCID诊断）。计算两种SCID诊断的重测信度,评分者信度以及心理解剖SCID诊断的灵敏度和特异度。结果患者SCID诊断,除焦虑障碍外,临床常见精神障碍的重测信度及评分者信度都高于0．75;心理解剖SCID诊断的酒精相关障碍、精神病性障碍、双相障碍、抑郁障碍及焦虑障碍的重测信度及评分者信度都大于0．75;在所有轴Ⅰ的疾病中,除酒精滥用和恶劣心境外,心理解剖SCID诊断与患者SCID诊断一致性系数均大于0．6。心理解剖SCID诊断的特异度都大于88％,但敏感度都低于特异度。结论研究表明SCID诊断具有较高的重测信度和评分者信度。心理解剖SCID诊断具有较好的灵敏度和特异度,与患者SCID诊断的一致性良好。     

High interrater reliability for the Structured Clinical Interview for DSM-III-R Axis I (SCID-I)

The interrater reliability of the Structured Clinical Interview for DSM-III-R (SCID) was studied. Fifty-four audiotaped SCID interviews were rated independently by 3 raters. The highest interrater agreements were observed for schizophrenia (0.94), major depressive disorder (0.93), dysthymia (0.88), generalized anxiety disorder (0.95), panic disorder (0.88), alcohol use disorder (0.96) and other psychoactive substance use disorder (0.85). The remaining diagnoses of mood and anxiety disorders obtained acceptable interrater agreement (0.70-0.80), with an exception for obsessive-compulsive disorder (0.40). The poorest agreement was obtained for somatoform disorders ( -0.03). Lack of hierarchy in DSM-III-R allows for multiple Axis I diagnoses. Interrater reliability for multiple diagnoses was tested. Agreement was generally good for combinations of 2 diagnoses, and poorer when 3 diagnoses were combined. Our findings confirm that SCID yields highly reliable diagnoses. SCID is recommended for research on mental disorders.     

Sadistic personality disorder and comorbid mental illness in adolescent psychiatric inpatients

Sadistic personality disorder (SPD) is a controversial diagnosis proposed in the DSM-III-R, but not included in the DSM-IV. Few studies have focused on this disorder in adolescents. This article describes the results of a study that sought to determine the presence of sadistic personality characteristics in psychiatrically hospitalized adolescents and of comorbid Axis I or personality disorder patterns in those youth with SPD or SPD traits. Fifty-six adolescents were assessed for sadistic and other personality disorders with the Structured Interview for DSM-III-R Personality Disorders-Revised (SIDP-R). Axis I disorders were assessed using the Diagnostic Interview for Children and Adolescents, Adolescent Version (DICA-R-A) and portions of the Schedule for Affective Disorders and Schizophrenia for School Age Children, Epidemiologic (K-SADS-E). The youth were divided into those with SPD and SPD traits, the Sadistic Group (n = 18), and the Nonsadistic Group (n = 38). A significant proportion of the adolescents in this study met full DSM criteria for SPD (14%). The Sadistic Group (32%) had significantly more Axis I and personality pathology than did the Nonsadistic Group. However, all but one in the Sadistic Group met criteria for other personality disorders, confounding the interpretation of these findings and consistent with adult literature studies. Subjects with sadistic personality characteristics were identified in this adolescent inpatient sample, and they had more extensive Axis I and II psychopathology than the comparison group. The validity of this disorder in younger populations requires further study. Future studies should also explore the impact that the mandatory use of the pleasure/gratification criterion has on the validity of the SPD diagnosis and whether the requisite presence of this criterion decreases the overlap currently noted between SPD and other Axis II diagnoses.     

The factor structure of the DSM-III-R personality disorders: an evaluation of competing models

Confirmatory factor analysis was used to test a series of competing models to determine the best way to characterize the factor structure of the DSM-III-R personality disorder scores. Data were collected from 301 clients with a primary diagnosis of anxiety disorder. The Structured Clinical Interview for DSM-III-R (SCID) was used to determine Axis I and Axis II diagnoses, and adequate to good reliability was obtained for the number of criteria met for a given personality disorder. Several factor models were tested, including a single-factor model, a three-factor model based on the DSM grouping of odd, dramatic, and anxious personality disorders, and a four-factor model based on normal personality theories. Only the DSM three-factor model received strong and unequivocal support.     

Study II: concurrent validity of the DSM-III-R Children's Interview for Psychiatric Syndromes (ChIPS)

OBJECTIVE: To test the concurrent validity of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) (DSM-III-R) revised Children's Interview for Psychiatric Syndromes (ChIPS). METHOD: In this study, the DSM-III-R revised ChIPS, the DSM-III-R revised Diagnostic Interview for Children and Adolescents (DICA-R-C), and clinicians' diagnoses were compared in 71 inpatients and outpatients 6 to 13 years of age using a standard kappa coefficient or a rare kappa coefficient and percentage agreement. RESULTS: High levels of agreement were found between the two interviews on all 14 syndromes analyzed (p < 0.05). ChIPS and DICA also had high levels of agreement with clinicians' diagnoses. When DSM-III-R revised ChIPS and DICA-R-C results were discrepant, ChIPS results were somewhat more likely than DICA-R-C results (48 % versus 38%) to agree with the clinician's diagnoses. CONCLUSION: ChIPS appears to be a valid assessment for screening children in inpatient and outpatient mental health facilities. It has the added benefit of being brief, with average administration time of 46 minutes for an inpatient sample and 36 minutes for an outpatient sample.     

Axis I and II comorbidity in agoraphobia: prediction of psychotherapy outcome in a clinical setting

The impact of concurrent Axis I and Axis II disorder diagnoses on the efficacy of psychotherapy in a clinical setting for panic disorder with agoraphobia was studied in a sample of 51 agoraphobic outpatients. Diagnoses were based on the Structured Clinical Interview for DSM-III-R. The effects of secondary major depression, dysthymia, generalized anxiety disorder, and avoidant personality disorder were examined via multiple regression analyses. Major depression was associated with less improvement on phobic behavior at 6-month follow-up, whereas dysthymia and avoidant personality disorder predicted less reduction in the frequency of panic attacks at posttest and follow-up, respectively. There was little evidence that generalized anxiety was associated with poorer outcome in this sample. Limitations to the internal validity of the study include uncontrolled use of medication and naturalistic treatment during the follow-up period.     

A comparison of two interviews for DSM-III-R personality disorders

The study examined agreement between personality disorder diagnoses obtained using two structured interviews and the effect of depression on the diagnoses obtained. Twenty subjects were interviewed while depressed, using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorder; both interviews are designed to yield DSM-III-R personality disorder diagnoses. Eighteen subjects were reinterviewed later, 17 after recovery. Diagnostic agreement between the two instruments for any disorder was fair (kappa = 0.38). Kappas for the personality disorder clusters ranged from 0.08 to 0.83. Kappas for individual personality disorders ranged from 0.18 for paranoid disorder to 0.62 for borderline disorder. While the depressive state did not consistently affect categorical diagnoses, dimensional scores tended to be higher when patients were depressed. A dimensional profile, in which scores on each disorder are generated for subjects, may be more reliable than categorical diagnoses derived from the same instrument.     

Validity of the Personality Diagnostic Questionnaire--revised: comparison with two structured interviews

The authors gave the self-report Personality Diagnostic Questionnaire--Revised (PDQ-R) to 87 applicants for inpatient treatment of severe personality psychopathology and, blind to these results, diagnosed personality disorders in the applicants by using the Personality Disorder Examination and the Structured Clinical Interview for DSM-III-R Personality Disorders. The PDQ-R was not a substitute for a structured interview assessment of axis II disorders because many of its diagnoses were false positives. Its high sensitivity and moderate specificity for most of the axis II disorders suggest, however, that it is an efficient instrument for screening patients with DSM-III-R personality disorders.     

Co-occurrence of Axis I and Axis II disorders in female and male patients with panic disorder with agoraphobia

Objective

The aim of this study is to compare female and male patients with panic disorder with agoraphobia (PDA) for the co-occurring Axis I and Axis II (personality) disorders, to better understand sex differences in PDA.

Methods

The Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders, Clinician Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders were administered to 157 consecutive outpatients (112 females and 45 males) with principal diagnosis of PDA, who sought treatment at the 2 anxiety disorders clinics. Women and men with PDA were then compared with regard to the type and frequency of the co-occurring Axis I and Axis II disorders.

Results

Women with PDA had a statistically greater tendency to receive co-occurring Axis I diagnoses and a greater number of Axis I diagnoses than men. Such a difference was not found for personality disorders. However, no sex difference was found for the mean number of co-occurring Axis I and Axis II diagnoses per patient. There were significantly more women with at least one co-occurring anxiety disorder. Women had a significantly higher frequency of specific phobia, whereas men were diagnosed with hypochondriasis and past alcohol abuse or dependence significantly more often. With regard to Axis II disorders, the only significant sex difference pertained to the higher frequency of dependent personality disorder among women.

Conclusions

The results of this study suggest that there are more similarities than differences between sexes in the co-occurring Axis I and Axis II disorders. Still, the relatively specific relationships between PDA and excessive alcohol use in men and between PDA and dependent personality traits and personality disorder in women seem important and have implications for clinical practice and treatment.