Convergence between structured diagnostic interviews and clinical assessment on the diagnosis of pediatric-onset mania.

BACKGROUND: Uncertainties remain as to the utility of structured diagnostic methodology to aid in the diagnosis of manic symptomatology in youth. To this end, this study compared structured diagnostic interview based diagnoses of mania in children and adolescents with that of an expert clinician. METHODS: We separately and independently assessed 69 youths recruited for a study of mania in childhood, all but 2 of whom experienced mania, with a structured diagnostic interview administered by trained psychometricians and a clinical assessment by a board-certified child and adolescent psychiatrist (JW) who was blind to the structured interview results. RESULTS: Structured interviews and clinical evaluations converged in all but two cases (67 of 69 or 97% agreement). In one discrepant case, the structured interview diagnosed a full case of mania, but the clinical interview diagnosed cyclothymia/subthreshold mania; in the other discrepant case, the structured interview failed to diagnose mania, but the clinical interview did diagnose mania. CONCLUSIONS: In children referred for evaluation of suspected bipolar disorder, a structured interview diagnosis of mania is very likely to be corroborated by a clinical interview.     

Trauma narratives: recommendations for investigative interviewing

In the investigation of a criminal event, the police may encounter witnesses or victims experiencing symptoms of being traumatized (e.g. anxiety, intrusive thoughts or avoidance of trauma-related stimuli). This may pose a challenge in investigative interviews where police interviewers aim to obtain reliable and detailed accounts. Based on previous theory and research, this theoretical paper aims to outline recommendations for police interviewers for approaching traumatized adult witnesses to facilitate communication, attend to the well-being of the individual and reach investigative aims. First, factors considered important for preparing for the interview and building rapport are presented. Then, different aspects of how to facilitate the interviewee’s account will be described with an emphasis on how police interviewers can approach emotional reactions to maintain rapport.     

Comparison of Composite International Diagnostic Interview and clinical DSM-III-R criteria checklist diagnoses.

This article describes a comparison of Composite International Diagnostic Interview (CIDI) diagnostic results and results based on clinicians' observation of CIDI assessments. Psychiatrists scored a DSM-III-R criteria checklist either while observing or after administering 20 CIDI interviews. Overall diagnostic concordance between the checklist and CIDI diagnoses was found to be good (kappa = 0.78). Good diagnostic agreement was also found for 3 groups of DSM-III-R disorders: depressive disorders (kappa = 0.84), psychoactive substance use disorders (kappa = 0.83) and anxiety phobic disorders (kappa = 0.76). These results are consistent with the results from a similar comparison between the CIDI and checklist results for ICD-10 diagnoses.     

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.     

Validity of the Composite International Diagnostic Interview (CIDI) psychosis module in a psychiatric setting

This study aimed to test the procedural validity of the psychosis module of the Composite International Diagnostic Interview (CIDI) by comparing it with diagnostic checklists completed by experienced clinicians. Seventy-five subjects were interviewed using the interviewer-administered version of the CIDI. Their clinician(s) then completed diagnostic checklists for DSMIV and ICD10 diagnoses of schizophrenia. Agreement was measured at the diagnostic, criterion and subcriterion levels. The validity standard (diagnostic checklist) was shown to be reliable with interrater agreement between the clinicians for the diagnosis of schizophrenia being excellent (κ = 0.82 for DSMIV and κ = 0.71 for ICD10). The agreement between the CIDI and the clinician checklists varied with sensitivities for DSMIV subcriteria ranging from 0.18 (negative symptoms) to 0.93 (bizarre delusions) and specificities ranging from 0.38 (catatonia) to 0.95 (disorganised speech). A similar pattern was found for ICD10 subcriteria: sensitivity varied from 0.19 (neologisms) to 0.90 (persistent delusions) and specificity varied from 0.39 (catatonia) to 0.95 (negative symptoms). The poorest levels of agreement were found for symptoms requiring interviewer judgement. The CIDI showed good agreement with clinician checklist diagnoses when the criteria were based on questions asked of the subjects. When the interviewer was required to make judgement of behaviours, the agreement between the CIDI and the clinician checklists was lower, resulting in overall poor agreement between the CIDI and the clinician checklists. Suggestions for improving the validity of the psychosis module of the CIDI are made.     

Further developments of the ‘Present State Examination’ and CATEGO system

Summary Some further developments of the PSE and CATEGO system are reported. The shorter ninth revision of the PSE, together with its glossary of definitions of symptoms, has proved useful in skilled hands and certain sources of error in the eighth edition have been reduced. The Syndrome Check List and Aetiology Schedule have proved useful in decreasing the number of coding errors.Supported by a grant from Sonderforschungsbereich Psychiatrische Epidemiologie     

Diagnosis of dementia from the history and aetiology schedule

OBJECTIVE: To provide a computerised method of diagnosing organic brain syndrome from history data without the use of mental state data. METHODS: Interview dataset from participants in a community study of the incidence of dementia was used to form a training sample and validation sample. The algorithm was developed on the training sample and tested on the validation sample. RESULTS: Performance in the training and validation samples was very similar. The algorithm shows monotonically increasing probability of being diagnosed with dementia as a function of the proposed level of diagnostic confidence. At the proposed cut point it has sensitivity 94% and specificity 84% for detecting concurrent psychiatrist's diagnosis of dementia. CONCLUSIONS: The method provides a good agreement with psychiatrist's diagnosis, and the results in the validation sample show little shrinkage. The method will prove useful in studies where it has proved impossible to collect mental state information on all the study participants.     

A comparison of different diagnostic tools for childhood depression

A comparison was made of the agreement of 5 different diagnostic tools for childhood depression. The diagnostic tools used were: 1) a non-directive interview with projective testing; 2) a semi-structured psychiatric interview developed by Herjanic; 3) the child behaviour check list developed by Achenbach; 4) the Kovacs child depression inventory and 5) the DSM-III criteria diagnosis. In the diagnostic tools using classic psychiatric techniques of interview there was a fairly high diagnostic agreement for depression, while the non-interview techniques (questionnaires) were less reliable in diagnosing affective disorder. Depressive symptoms were found to play an important part in non-affective disorder psychopathology in children. The good correlation between the standard intake procedure and the research methods is encouraging in that it seems that clinicians can make the diagnosis of childhood affective disorder in their everyday clinical work.     

半结构性问询在儿童复发性头痛诊断中的运用

目的探讨半结构性问询在儿童复发性头痛诊断中的运用。方法对2007年10月至2010年10月门诊及病房诊治的90例复发性头痛病人进行半结构性问询、随访、全面的体格检查及神经系统检查并辅以必要的辅助检查。结果①90例复发性头痛患者中88例(97.8%)为原发性头痛,63例偏头痛,其中3例合并紧张性头痛,22例为可能的偏头痛,2例癔病性头痛;继发性头痛2例(2%),分别为颅内肿瘤1例、屈光不正1例;②疑诊为窦性头痛的复发性头痛患者经抗生素及中成药治疗鼻窦炎后头痛无缓解;③实验室检查中经颅多普勒超声检查显示的血管痉挛或扩张的部位与头痛部位无相关性,EEG检查多无明显异常。结论偏头痛是复发性头痛的常见原因;慢性鼻窦炎无急性发作不会导致窦性头痛。在复发性头痛诊断中应用结构性问询,并加强随访,既提高了诊断率,又避免了不必要的检查。     

Use of Lorazepam in drug-assisted interviews: two cases of dissociative amnesia

Drug-assisted interviews are useful for psychiatric diagnosis and treatment. However, amobarbital, a typical medication used for this purpose, is associated with elevated risk of respiratory depression. Benzodiazepines are good substitutes for amobarbital, with similar therapeutic effects and fewer complications. Although drug-assisted interviews are not widely used, they may be beneficial for selected patients who do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. We report two cases of dissociative amnesia that were treated using lorazepam-assisted interviews. The use of lorazepam in drug-assisted interviews is effective and safe for resolving dissociative amnesia.     

A comparative study of posttraumatic stress disorder assessment under standard conditions and in the field

Little is known about the performance of clinician‐administered structured diagnostic interviews when given under variable levels of examiner training and monitoring. We sought to explore this question. We examined the performance of a self‐report questionnaire and a structured clinical interview in the assessment of post‐traumatic stress disorder (PTSD) in two community samples of war veterans. One sample was interviewed under standard conditions (N = 372) and the other under unknown and less standardized conditions (N = 420), more closely approximating ‘field conditions’. Interview results were used to predict questionnaire‐based PTSD status. Kappas, sensitivities, specificities, and positive predictive powers were moderate and of similar magnitude in both samples. Our results suggest that even under uncertain (‘field’) conditions, clinician‐administered structured interviews can produce results comparable to those produced under more tightly controlled conditions. Copyright © 2006 John Wiley & Sons, Ltd.     

Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders

The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.     

Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule

The Taiwan Psychiatric Epidemiological Project, conducted from 1982 to 1986, used the multistage random sampling method with 5005, 3004 and 2995 subjects selected respectively from metropolitan Taipei (MT), 2 small towns (ST) and 6 rural villages (RV). The case identification tool was the Chinese modified Diagnostic Interview Schedule (DIS-CM). This study presents the lifetime and one-year prevalence of 27 and of 17 specific psychiatric disorders respectively. The lifetime prevalence of any disorder defined by the DIS-CM -- excluding tobacco dependence -- was 16.3%, 28.0% and 21.5% in the MT, ST and RV samples respectively. The differences in lifetime prevalence between the sexes and between the 3 sampling areas were significant for 15 and 8 disorders respectively. The ST sample seemed to have the most disorders, with the highest prevalence among 3 sampling areas. The mean ratio of one-year to lifetime prevalence was 0.67. The differences in prevalence rates between the 3 sampling areas and between the international studies are discussed from methodological, social and cultural points of view.     

Alcoholism by Chinese diagnostic interview schedule: a prevalence and validity study

A community survey in metropolitan Taipei (MT) and two small towns (ST) by using the Chinese modified diagnostic interview schedule (DIS-CM) revealed a significant difference in the prevalence of alcohol abuse (AA) defined by DSM-III between two study samples (MT 3.4%; ST 8.0%), but the prevalence of alcohol dependence (AD) was not different (MT 1.5%; ST 1.8%). These figures are significantly higher than that of an earlier Formosan study. Demographic data, psychiatric symptoms, medical complications and impairment of social functions were adopted as the variables to validate the nosological status of AA and AD. The results of this study substantiated that AA and AD identified by the DIS-CM were nosologically different from a non-alcoholic group. The possible reasons for an increasing prevalence of alcoholism in Taiwan Chinese were discussed. An etiological hypothesis was proposed for AA and AD on account of their differential prevalences.     

The interrater reliability of a Dutch version of the Structured Clinical Interview for DSM-III-R Personality Disorders.

This study presents data on the interrater reliability of a Dutch version of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Seventy outpatients were interviewed before the start of their treatment by one rater, while a second rater observed. Both raters were instructed to make independent ratings and the second rater was not allowed to participate in the discussion. On criterion level, interrater reliabilities appear to be very good, with a few exceptions (most reliabilities are higher than 0.75). However, all 5 observation criteria had poor interrater reliabilities. Agreement on personality disorder, on the whole, was excellent (overall kappa = 0.80). The possible reasons why relatively lower reliabilities are found with some criteria are discussed. Finally, problems encountered during the interviews are addressed and possible adjustments of the SCID-II are suggested.     

Towards selective and improved performance of the mental status examination

Performance of mental status examinations (MSE) is often useful but is not warranted for all new patients, except for training, research, special request, or policy. Reasons for doing MSE must be weighed against possible detrimental effects on patients or on patient-clinician relationships. Both sides are reviewed. Methods for ameliorating or preventing adverse effects are described. Validity of findings using MSE are frequently doubtful and examiners often misinterpret their significance. A decision tree is presented to help decide whether to use the MSE in particular instances.     

Level of agreement between DIS and UM-CIDI alcohol and marijuana use disorders: implications for research

By and large, recent epidemiological investigations of alcohol and drug use disorders are based on structured interviews, such as the Diagnostic Interview Schedule (DIS) and the Composite International Diagnostic Interview (CIDI), which are designed to be administered by trained lay interviewers. Little is known about the level of agreement between these instruments. To fill this gap, we compared responses from 971 young adults from an epidemiological sample, who were administered both the DIS and the University of Michigan CIDI (UM-CIDI) in the same interview session. Level of agreement was estimated for responses to individual items, and for DSM-IIIR abuse/dependence (A/D) diagnoses and symptoms for alcohol and marijuana. DIS/UM-CIDI agreement for drug use disorders in the year preceding the interview was moderate for each disorder (alcohol A/D, kappa = 0.58; marijuana A/D, kappa = 0.68), although one-year prevalences of alcohol and marijuana A/D were approximately 40% higher for the DIS compared to the UM-CIDI. Despite the discrepancies, levels of comorbidity with other psychiatric disorders and associations with risk factors were similar for the DIS and UM-CIDI. Copyright © 1999 Whurr Publishers Ltd.