Concurrent diagnostic validity of a structured psychiatric interview

In order to estimate the concurrent validity of a structured psychiatric interview, we compared interview diagnoses obtained for 101 psychiatric inpatients to those recorded in the same patients' hospital charts. For most diagnoses considered, concordance was found to be high. For those in which concordance was low, we examined the reasons for the diagnostic discrepancy. Diagnostic errors that were judged to have occurred on the basis of the structural interview often seemed to have resulted from a lack of longitudinal clinical observation. However, more errors were judged to have occurred in the hospital charts, apparently because of physician oversight. We conclude that the concurrent validity of this structured interview is high and that such examinations might be useful not only for research but also for the routine initial evaluation of psychiatric patients.     

Diagnosing depression in the medically ill: validity of a lay-administered structured diagnostic interview

Understanding the validity of structured psychiatric diagnostic interviews in medically ill patients will advance the ability to conduct research into the treatment and management of these disorders in general medical settings. We compared the University of Michigan version of the CIDI Fulop et al., 1987 (Composite International Diagnostic Interview) for major depression to a clinical gold standard, derived through Spitzers Longitudinal, Expert, All Data Fulop et al., 1987 (LEAD) criteria based on the SCID-III-R. A convenience sample of medical inpatients was administered the SCID-III-R and the CIDI for major depression in random order. A physician panel reviewed the SCID interview and other pertinent data and determined whether patients had a lifetime or current Fulop et al., 1987 (past month) diagnosis of major depression. The CIDI was scored with and without hierarchical exclusions for mania, hypomania, substance use, or medical illness. When the UM-CIDI was scored for a lifetime diagnosis of major depression without hierarchical exclusions, agreement above chance Fulop et al., 1987 (κ) was very good Fulop et al., 1987 (κ=0.67) between the CIDI and the physician panel and good Fulop et al., 1987 (κ=0.46) when the UM-CIDI was scored with exclusions. Agreement above chance for diagnosis of a recent disorder was better for UM-CIDI scoring with exclusions Fulop et al., 1987 (κ=0.51) compared to scoring without exclusions Fulop et al., 1987 (κ=0.43). Predictive value-positive was excellent in both scoring versions for a lifetime diagnosis Fulop et al., 1987 (82%) and good to very good for current depression Fulop et al., 1987 (46% and 62%). In all cases predictive value-negative was very good to excellent (77–93%). Discordant cases were almost uniformly due to difficulties in attribution of symptoms to medical illnesses. We conclude that the CIDI can perform acceptably as a research instrument to diagnose major depression in medically ill patients, potentially supplemented by clinician review of cases identified by the CIDI with current disorder.     

Acceptance of a structured diagnostic interview in children,parents, and interviewers

The objective of this study was to investigate the satisfaction and acceptance of a structured diagnostic interview in clinical practice and in a research setting. Using the Structured Diagnostic Interview for Mental Disorders in Children and Adolescents (Kinder‐DIPS), 28 certified interviewers conducted 202 interviews (115 with parents, 87 with children). After each interview, children, parents, and interviewers completed a questionnaire assessing the overall satisfaction (0 = not at all satisfied to 100 = totally satisfied) and acceptance (0 = completely disagree to 3 = completely agree) with the interview. Satisfaction ratings were highly positive, all means >82. The mean of the overall acceptance for children was 2.43 (standard deviation [SD] = 0.41), 2.54 (SD = 0.33) of the parents, 2.30 (SD = 0.43) of the children's interviewers, and 2.46 (SD = 0.32) of the parents' interviewers. Using separate univariate regression models, significant predictors for higher satisfaction and acceptance with the interview are higher children's Global Assessment of Functioning, fewer number of children's diagnoses, shorter duration of the interview, a research setting, female sex of the interviewer, and older age of the interviewer. Results indicate that structured diagnostic interviews are highly accepted by children, parents, and interviewers. Importantly, this is true for different treatment settings.     

Preliminary studies of the structured diagnostic interview for personality disorders: SCID II

The aim of the study was to compare control subjects and consultant patients with the SCID II (interview and questionnaire), then to compare clinical diagnosis with the SCID II (interview and questionnaire). The preliminary study was carried out to assess the feasibility of the procedure. This appraisal was conducted with a group of patients (n = 26) and a control group (n = 16). Only the patients were diagnosed according to DSM IV criteria. The patients and the control group completed the Mini-Mult and the SCID II (questionnaire and interview). The two groups were matched on sex, age and educational level. The two groups were discriminated on all Mini-Mult scales but one: the internalization index. The results showed that the SCID questionnaire and the SCID interview differentiate the two groups. The SCID questionnaire showed high sensitivity in the group of patients. It is a more efficient instrument to screen control subjects except one personality disorder (obsessive-compulsive). The diagnostic agreement between the clinical diagnosis and the structured interview was poor. However our results are comparable to the other studies.     

Differences between multiple personality disorder and other diagnostic groups on structured interview

The Dissociative Disorders Interview Schedule was administered to 20 subjects with multiple personality disorder, 20 with schizophrenia, 20 with panic disorder, and 20 with eating disorders. The findings showed that multiple personality can be differentiated from the other groups on variables such as history of physical abuse, sexual abuse, substance abuse, sleepwalking, childhood imaginary playmates, secondary features of multiple personality and extrasensory and supernatural experiences. Those with multiple personality also differ from the other groups on DSM-III criteria for multiple personality, psychogenic amnesia, and psychogenic fugue. The groups did not differ on the number of subjects who had had a major depressive episode.     

Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview.

OBJECTIVE AND METHOD: Diagnosis and treatment of the dissociative disorders may be delayed for many years because of difficulties in detecting patients at high risk for dissociative disorders. This study investigates the utility of the Dissociative Experiences Scale (DES), a self-report instrument for dissociative experiences, in detecting patients at high risk for dissociative disorders. The clinician-administered Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D) was used as the diagnostic standard, and 36 outpatients with mixed diagnoses and nine normal subjects were evaluated for the presence and absence of a dissociative disorder. DES scores were then compared. RESULTS: Results indicate that a DES cutoff score of 15-20 yields good to excellent sensitivity and specificity as a screening instrument. However, for higher cutoff points the sensitivity can be much lower. CONCLUSIONS: Thus, although the DES can be used to identify some high-risk patients, they should be further evaluated with such diagnostic instruments as the SCID-D or by in-depth clinical follow-up.     

Comparison of dissociative identity disorder with other diagnostic groups using a structured interview in Turkey

Twenty patients with dissociative identity disorder (DID), 20 with schizophrenic disorder, 20 with panic disorder, and 20 with complex partial epilepsy were evaluated with the Dissociative Disorders Interview Schedule (DDIS) and the Dissociative Experiences Scale (DES). Subjects with dissociative identity disorder were more frequently diagnosed as having somatization disorder, past or concurrent major depressive episode, borderline personality disorder, depersonalization disorder, and dissociative amnesia than other groups. They reported Schneiderian symptoms and extrasensory perceptions more frequently. In their anamnesis suicide attempts, trance states, sleepwalking, and childhood traumas were more frequent than those in comparison groups. The secondary features of dissociative identity disorder and the DES score differentiated these patients from comparison groups significantly. DID has a set of clinical features different from that of schizophrenic disorder, panic disorder and complex partial epilepsy. The differences are similar to those yielded previously in studies from North America.     

Diagnosis of depression by primary care physicians versus a structured diagnostic interview. Understanding discordance

In this paper, false-negative and false-positive cases of depressive illness are examined, differentiating levels of disagreement between a primary care physician's diagnosis and a standardized research diagnosis. Two stratified random samples of primary care patients in Seattle, USA (N = 373) and Groningen, The Netherlands (N = 340) were examined with the Composite International Diagnostic Interview-Primary Health Care Version (CIDI-PHC). Physician's severity ratings and diagnosis of psychological disorder were obtained. Three levels of disagreement between physician and CIDI diagnosis were distinguished: 1) complete disagreement about the presence of psychiatric symptoms (true false-negative and true false-positive patients); 2) disagreement over severity of recognized psychological illness (underestimated or overestimated); and 3) disagreement over the specific psychiatric diagnosis among those given a diagnosis (misdiagnosed or given another CIDI diagnosis). All three levels of disagreement were common. Only 27% of the false-negative cases were due to complete disagreement (true false-negatives), and 55% of the false-positives were due to complete disagreement (true false-positives). The true false-negative patients were younger, more often employed, rated their own health more favorably, visited their doctor for a somatic complaint and made fewer visits than the underestimated, misdiagnosed, and concordant positive patients. Complete disagreement in depressive diagnoses between the primary care physician and research interview is not as frequent as indicated by an undifferentiated false-negative/ false-positive analysis. Differentiating levels of disagreement does more justice to diagnostic practice in primary care and provides guidance on how to improve the diagnostic accuracy of primary care physicians.     

The polydiagnostic interview: a structured interview for the polydiagnostic classification of psychiatric patients

A structured interview (PODI) for the polydiagnostic evaluation of affective and schizophrenic disorders is presented. The interview includes elements of the Structured Clinical Interview for DSM-III (SCID) and of the Present State Examination (PSE). The central idea of this interview is to break down complex criteria into their elements, to assess a wide area of such elements, and to recombine them by a computer program according to different algorithms that are included in a greater number of operational diagnoses. Reliability data will be presented which show sufficiently high kappa and Yule coefficients for a selected set of diagnostic criteria for depressive, manic and psychotic disorders. The applicability of the PODI was established in about 180 interviews.     

Post-traumatic vertigo in children: a diagnostic approach

The relatively high incidence of persistent post-traumatic headache and vertigo in children and adolescents presents a diagnostic and therapeutic challenge. It is often difficult to differentiate between functional complaints generated by psychological trauma or compensation-seeking and symptoms reflecting an organic etiology. The clinical and laboratory findings of 22 patients with post-traumatic headaches and vertigo were delineated into five major diagnostic categories: labyrinthine concussion, whiplash syndrome, basilar artery migraine, vertiginous seizures, and a non-specific post-traumatic dizziness. Patients with post-traumatic hearing loss were excluded from this study because they represent a group with different diagnostic problems and more recognizable organic pathology. Each patient had a complete neurologic evaluation including specific clinical vestibular tests (i.e., stepping test, reinforced Romberg, past-pointing evaluation, and positional tests using the Nylen-Hallpike maneuver. Laboratory studies included skull x-ray, computed tomography, electroencephalography, electronystagmography, and audiologic assessment. Symptoms, signs, and tests were evaluated in each category of post-traumatic vertigo to help establish the diagnosis and initiate treatment.     

A structured diagnostic interview for hypochondriasis. A proposed criterion standard.

We developed a structured diagnostic interview for DSM-III-R hypochondriasis (SDIH) that is the first such clinician-administered instrument. The SDIH was administered to 88 general medical outpatients who scored above a predetermined cutoff on a hypochondriacal symptom questionnaire, and to 100 comparison patients randomly chosen from among those below the cutoff. Using the joint assessment method, interrater agreement on the DSM-III-R diagnostic criteria was 88% to 97% and agreement on the diagnosis was 96%. Concurrent validity was suggested by a significant correlation between the interview and the primary care physicians' ratings of hypochondriasis. A measure of external validity was demonstrated in that several clinical characteristics thought to be ancillary features of hypochondriasis were significantly more prevalent in interview-positive patients than in interview-negative patients. Finally, the SDIH appeared to have discriminant validity in that patients diagnosed as hypochondriacal had several other clinical features that distinguished them from the patients who scored above the cutoff on hypochondriacal symptomatology, but failed to be diagnosed as hypochondriacal with the SDIH.     

偏头痛性眩晕与基底型偏头痛(附9例临床分析)

目的分析9例偏头痛伴眩晕/头晕患者的临床及实验室检查结果,探讨头痛与眩晕/头晕的关系,以利正确诊治。方法作者医院收治的偏头痛伴眩晕/头晕患者9例,对所有患者均详细收集病史,并进行神经系统查体以及前庭功能、听力检查和头颅CT/MRI等实验室检查,以除外中枢性和耳源性眩晕。结果 9例偏头痛伴眩晕/头晕患者中,基底型偏头痛2例,无先兆偏头痛3例,偏头痛性眩晕(migrainous vertigo,MV)6例(其中2例为无先兆偏头痛发作数年后和50岁后转变为MV)。本组6例MV患者中,眩晕/头晕在头痛发作前数秒钟～1h内发生3例,在头痛发作后发生1例,与头痛同时发生1例,另1例偏头痛患者其头痛与眩晕从未同时发作过,为偏头痛等位征。结论 MV是不同于基底型偏头痛的头痛伴眩晕综合征,二者易与梅尼埃病、良性复发性位置性眩晕、后循环缺血(posterior circulation ischemia,PCI)等周围性和中枢性眩晕混淆或并存,临床应注意鉴别。     

Use of a structured diagnostic interview to identify bipolar disorder in adolescent inpatients: frequency and manifestations of the disorder

The authors interviewed 17 adolescent inpatients and their mothers with the Schedule for Affective Disorders and Schizophrenia for School-Aged Children and Adolescents, Epidemiological Version (K-SADS-E), a semistructured interview that generates RDC and DSM-III diagnoses for major affective disorders and nonaffective psychoses and DSM-III diagnoses for dysthymic, cyclothymic, and other selected disorders. Five of the patients (29%) satisfied DSM-III criteria for bipolar disorder or atypical bipolar (bipolar II) disorder, although these diagnoses had not been identified in the hospital charts. These data support previous findings that bipolar disorder occurs moderately frequently in adolescent inpatients, although it is often unrecognized. Moreover, the disorder can be readily identified with structured diagnostic methods.     

Scaling structured interview data: a comparison of two methods

OBJECTIVE: Although structured interviews are currently considered essential assessment strategies for conducting research, the data they generate are typically not used for purposes beyond making categorical determinations about diagnoses. Because of the need for dimensional scales to be used in conjunction with categorical data, two dimensional scales constructed from structured interviews are presented and examined. One scale, Behavior, Anxiety, Mood, and Other (BAMO), provides an overall score by summing the percentage of symptoms endorsed for each of 20 behavior, anxiety, mood, and other disorders found in the Diagnostic Interview for Children and Adolescents-Revised (DICA-R, DSM-III-R version). Another scale, DICA-SUM, is constructed by summing all endorsed symptoms on the interview. In this study the psychometric and pragmatic characteristics of BAMO and DICA-SUM are compared. METHOD: Data were obtained from 570 children (331 bereaved, 110 depressed, 129 community) aged 5 to 18 years (mean +/- SD = 11.3 +/- 3.2) who were interviewed as part of an ongoing longitudinal childhood bereavement study from 1987 to 1996. RESULTS: Discriminant and convergent validity with other child psychopathology measures are comparable for BAMO and DICA-SUM. However, BAMO more clearly conveys information regarding the approximate number of diagnoses endorsed. CONCLUSION: This study identified two methods of creating dimensional scales from structured interviews. Use of such dimensional scales might allow for improved comparison of results across studies.     

Post-traumatic stress disorder assessment with a structured interview: reliability and concordance with a standardized clinical interview

Epidemiologic studies of post-traumatic stress disorder (PTSD) have used the PTSD module of the NIMH Diagnostic Interview (DIS) in its various editions and modifications. Although the diagnoses of numerous disorders made by the DIS or the WHO – Composite International Diagnostic Interview (CIDI), which is modelled on the DIS, have been compared to clinical diagnoses, little is known about the performance of these instruments in diagnosing PTSD. In this study, we examine the test–retest reliability of a modified version of the PTSD section of the DIS-IV and the CIDI 2.1 and compare it with an independently conducted clinical interview in the 1996 Detroit Area Survey of Trauma, an epidemio-logical study of a representative sample of 2181 persons. A blind readministration of the structured interview was conducted by a lay interviewer 12–18 months after the initial interview, on 32 respondents classified as PTSD cases in the initial interview and on 23 non-cases who reported exposure to trauma. The clinical reappraisal was conducted blindly by two psychiatric social workers, using the Clinician Administered PTSD Scale for DSM-IV (CAPS-DX). The data were weighted to adjust for the oversampling of cases and the differential probabilities of selection of traumatic events across respondents with different numbers of events. The test–retest consistency of the structured interview was a kappa of 0.62 and an odds ratio of 42.5. The comparison of the structured interview with the clinical reappraisal showed agreement in 81% of the assessed sample. Positive predicted value was 0.75, negative predictive value was 0.97, and the odds ratio was 94.8 (all weighted values). Discrepant cases were mostly ‘false positives’ and, of these, the majority were subthreshold cases missing only one symptom in the CAPS-DX. Copyright © 1998 Whurr Publishers Ltd.     

The diagnostic interview schedule: Its development,evolution, and use

Conclusion The DIS has been a response to the new opportunities for highly-reliable, large-scale psychiatric diagnostic surveys that arose with the development of well-define diagnostic criteria and fully described algorithms for combining them. Because it has made use of the power of computers to store and combine many bits of data for a given individual, it offers approaches to diagnosis that are flexible enough to serve the current needs of a broad variety of kinds of investigations and, we hope, to meet future needs as algorithms change.     

Diagnostic accuracy of a structured interview for nocturnal frontal lobe epilepsy (SINFLE): a proposal for developing diagnostic criteria

Objectives

To measure the accuracy of anamnestic features collected during clinical history for the diagnosis of nocturnal frontal lobe epilepsy (NFLE).

Methods

A case-control diagnostic study. Participants included a case group of people with ascertained target disease (NFLE group) and a control group of people with sleep disorders potentially confounding for NFLS (NOT-NFLE group), defined by means of a consensus procedure among experts (panel diagnosis as reference standard). Two major clinical patterns defining the semeiology of the epileptic event (i.e. dystonic, DP, and/or hyperkinetic pattern, HP), and 13 additional minor features were identified, formulated as questions, and telephonically administered to NFLE and NOT-NFLE groups by a trained doctor blinded to the final diagnosis. The diagnostic accuracy of each characteristic was tested against the reference standard.

Results

Out of 262 selected subjects, 101 were recruited; 42 were NFLE and 59 NOT-NFLE. A positive history of DP or HP had a sensitivity of 59.5% and a specificity of 91.5%, irrespective of the other minor anamnestic features. The anamnestic model improved, with a sensitivity of 59.5% and specificity of 96.6%, if at least one of the following four minor anamnestic features was added: (a) duration less than two minutes, (b) unstructured vocalization during the episode, (c) experience of an aura preceding the motor attack, and (d) a history of tonic-clonic seizures during sleep.

Conclusions

The present study disclosed two major anamnestic patterns and four minor features that we called SINFLE, with unsatisfactory sensitivity but high specificity. These patterns could be the basis for developing future NFLE diagnostic criteria and to quantify the diagnostic accuracy of elements usually collected in the clinical history.