Psychiatric Diagnosis and Classification - ResearchGate

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CLINICAL ASSESSMENT INSTRUMENTS IN PSYCHIATRY 197 Table 8.7 Example of a question from the Diagnostic Interview Schedule DIS) From SECTION DÐGeneralized Anxiety Disorder D5. During the 6 months or more when you had No Yes worries like that on your mind, were you also . . . a. feeling restless or keyed up or on edge a lot of 1 5 the time b. Were you easily tired 1 5 c. Did you have a lot of trouble keeping your mind 1 5 on what you were doing d. Would your mind go blank so you lost track of 1 5 what you had been thinking about e. Did you feel particularly irritable 1 5 f. Were your muscles tense, sore, or aching 1 5 Its questions can be asked and coded by trained lay interviewers, according to clearly stated rules [63] see Table 8.7). The interview has subsequently been adapted to DSM-III-R and DSM-IV. The current version DIS 4.0 focuses on DSM-IV diagnoses only and integrates many ideas that emerged in the course of field experience of the DIS and the Composite International Diagnostic Interview CIDI), which was originally based on the DIS and uses the same strategies [64]. Both interviews have a lot in common: they have a modular diagnostic structure with fully structured questions many with identical wording); they use reference cards to assist the interviewer and a probe flow chart to rule out symptoms without clinical significance or which are not fully explained by physical causes. A disorder is defined current if present the last two weeks, the last month, the last six months, the last year or at any time in the last year. Each diagnosis is based on the presence of a minimum number of criteria and diagnostic labels in the left-hand margin show how each question serves the scoring algorithms. Severity may be assessed by the number of criteria met, the number of different diagnoses present, the total number of symptoms, the length of the period the subject has had these symptoms, as well as by the degree of functional impairment. The interview also asks for onset and recency for each syndrome and whether the subject sought professional help see Table 8.8, p. 199). A personal computer PC) program has been developed for data entry, cleaning and scoring. It provides diagnosis, and indicates the age of onset and recency of the syndromes [65]. Support material includes mock interviews, a suggested training schedule, question-by-question specifications, a history of the interview, homework assignments and a videotape. The DIS has been proved to work well as a screening instrument and provides acceptable classifications for epidemiological purposes [66, 67].
198 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION The instrument has been used in epidemiological studies throughout the world [68]. The present version 4.0 makes the DIS also attractive as a diagnostic instrument for clinical settings. The instrument is available through the Washington University in St. Louis, Missouri http://epi.wustl. edu/dis/dishome.htm). The Composite International Diagnostic Interview CIDI) The CIDI [69] is a comprehensive, fully structured diagnostic instrument for the assessment of mental disorders according to the definitions and criteria of ICD-10 and DSM-IV. It was developed as a joint project between the WHO and the former United States Alcohol, Drug Abuse and Mental Health Administration ADAMHA). It has been translated into some 25 languages and thereby is the most widely used structured interview in the world, regularly revised and improved by an international advisory committee. The CIDI has been designed for use in a variety of cultures and settings. It is primarily intended for use in epidemiological and cross-cultural studies, but can also be used for clinical and research purposes. The interview is modular and covers presently somatoform disorders, anxiety disorders, depressive disorders, mania, schizophrenia, eating disorders, cognitive impairment, and substance use disorders. Version 1.0 was released in December 1990, version 1.1 in May 1993, and version 2.1 in January 1997 [70]. The current version 2.1 is available in a lifetime and a 12-month form and has 15 sections: a) Demographics; b) Nicotine use disorder; c) Somatoform and dissociative disorders; d) Phobic and other anxiety disorders; e) Depressive disorders and dysthymic disorder; f) Manic and bipolar affective disorder; g) Schizophrenia and other psychotic disorder; h) Eating disorders; j) Alcohol use disorders; k) Obsessive-compulsive disorder and post-traumatic stress disorder; l) Substance-related disorders; m) Dementia, amnesic and other cognitive disorders; o) Comments by the respondent; p) Interviewer observations; x) Interviewer ratings. The highly structured CIDI questions are fully spelled out and positive responses are followed by specific probes, which aim at determining the psychiatric significance and clinical relevance of a reported symptom see Table 8.8). Negative responses will often lead to skips within the interview. If a particular diagnosis is suspected to be present, questions about the onset and the recency of a particular cluster of symptoms will be asked. The duration and the frequency of a particular set of symptoms are also evaluated. The CIDI is designed to be completed in a single session and lasts approximately 75 minutes. Even though the interview is quite complex in
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PREFACE xi world who are interested
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10 PSYCHIATRIC DIAGNOSIS AND CLASSI
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IMPLICATIONS OF COMORBIDITY 81 Fina
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IMPLICATIONS OF COMORBIDITY 85 leve
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Table 4.2 Matrix of levels and subl
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IMPLICATIONS OF COMORBIDITY 91 unde
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IMPLICATIONS OF COMORBIDITY 93 Tabl
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108 PSYCHIATRIC DIAGNOSIS AND CLASS
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THE ROLE OF PHENOMENOLOGY IN PSYCHI
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282 INDEX AsociacioÂn PsiquiaÂtri
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286 INDEX eating disorders 80 Eatin
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288 INDEX India contd) Unani/Arabic
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294 INDEX US Navy classification 49
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