Psychiatric Diagnosis and Classification - ResearchGate

More documents

Recommendations

Info

CLINICAL ASSESSMENT INSTRUMENTS IN PSYCHIATRY 209 one or the other of the official classifications of mental disorders. The usefulness of such instruments is closely linked to their reliability and validity. Inter-rater Reliability The reliability of clinical assessment instruments is usually studied using one of the two following methods: an observer scores the interview while the interviewer also scores it and the results are compared to determine the degree to which the two raters agree inter-rater reliability), or the interview is repeated at a later time, by the same or by a different interviewer test± retest reliability). Good to excellent inter-rater and test±retest reliability have been reported for most interviews described in this chapter. Validity The best way to establish the validity of a clinical diagnostic instrument would be to measure its validity against an external ``gold standard'' [101]. In the absence, up to now, of any such standard for any of the disorders that are assessed in psychiatry, psychiatric diagnoses achieved using clinical assessment instruments have been compared to diagnoses derived from: i) clinician's free-form assessment; ii) other clinical assessment instruments; iii) the Longitudinal, Expert, All Data LEAD) procedure; or iv) the consensus best-estimate diagnostic procedure. Comparison with Clinician's Free-form Assessment Agreement between diagnoses obtained with structured or semi-structured interviews and clinician's free-form assessment or diagnoses in medical records has generally been found to be low [102]. Such comparisons are, however, unsatisfactory for evaluating the validity of assessment instruments, since clinicians' diagnoses are unreliable themselves, as shown by lack of agreement between two clinicians assessing the same patient [103, 104]. Comparison between Assessment Instruments Evaluating the validity of one instrument by comparing it to another instrument requires that the validity of the second instrument has been
210 PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION established. Up to the present, there is, however, no such instrument, although well-established instruments, such as the SCID, have been used to evaluate the validity of new instruments. Comparisons with LEAD Longitudinal, Expert, All Data) Diagnoses The LEAD procedure was proposed by Spitzer in 1983 [101] for the assessment of the validity of diagnostic instruments. The LEAD procedure involves ``longitudinal'' evaluation, i.e. not limited to a single examination, made by ``experts'', i.e. by experienced clinicians, using ``all data'', i.e. not only data obtained during the interviews with the respondent, but also data provided from other sources, such as from family members or other significant others, hospital personnel, or case records. The LEAD procedure has been used in a number of studies to assess the validity of diagnostic instruments, e.g. the DIS [105], or the validity of personality disorder diagnoses [106]. In recent studies, data used in the procedure have themselves been obtained using semi-structured interviews. Comparisons with the Consensus Best-estimate Diagnostic Procedure The best-estimate diagnostic procedure has been proposed by Leckman et al. [107]. Comprehensive information obtained from different methods personal interview, family history from family informants, and medical records), including information obtained from clinical diagnostic interviews, is assessed by two or more experts to arrive independently and then by consensus at a criterion diagnosis. The procedure has been used in particular in the field of genetics [108]. CONCLUSIONS Clinical assessment instruments in psychiatry differ in the diagnostic systems that they cover, in the training and expertise needed to administer them, in their costsÐtime and moneyÐ, and in the data that they yield, from screening to comprehensive diagnosis. To guide the clinician or researcher in choosing the best instrument for a given purpose or a particular study, Robins [109] has described study-specific as well as universal criteria. Study-specific criteria include the extent to which disorders of interest are covered by the instrument e.g. with regard to subtypes, age of onset or course), appropriateness to the study sample e.g. clinical setting vs. general
Page 2 and 3:
Psychiatric Diagnosis and Classific
Page 4 and 5:
Page 6 and 7:
Page 8 and 9:
Page 10 and 11:
PREFACE xi world who are interested
Page 12 and 13:
2 PSYCHIATRIC DIAGNOSIS AND CLASSIF
Page 14 and 15:
Page 16 and 17:
Page 18 and 19:
Page 20 and 21:
10 PSYCHIATRIC DIAGNOSIS AND CLASSI
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Page 32 and 33:
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Page 56 and 57:
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
IMPLICATIONS OF COMORBIDITY 81 Fina
Page 92 and 93:
IMPLICATIONS OF COMORBIDITY 83 It a
Page 94 and 95:
IMPLICATIONS OF COMORBIDITY 85 leve
Page 96 and 97:
IMPLICATIONS OF COMORBIDITY 87 ledg
Page 98 and 99:
Table 4.2 Matrix of levels and subl
Page 100 and 101:
IMPLICATIONS OF COMORBIDITY 91 unde
Page 102 and 103:
IMPLICATIONS OF COMORBIDITY 93 Tabl
Page 104 and 105:
IMPLICATIONS OF COMORBIDITY 95 For
Page 106 and 107:
IMPLICATIONS OF COMORBIDITY 97 ``Ju
Page 108 and 109:
IMPLICATIONS OF COMORBIDITY 99 Tabl
Page 110 and 111:
IMPLICATIONS OF COMORBIDITY 101 It
Page 112 and 113:
IMPLICATIONS OF COMORBIDITY 103 stu
Page 114 and 115:
IMPLICATIONS OF COMORBIDITY 105 52.
Page 116 and 117:
108 PSYCHIATRIC DIAGNOSIS AND CLASS
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
THE ROLE OF PHENOMENOLOGY IN PSYCHI
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167: THE ROLE OF PHENOMENOLOGY IN PSYCHI
Page 168 and 169: THE ROLE OF PHENOMENOLOGY IN PSYCHI
Page 170 and 171: Psychiatric Diagnosis and Classific
Page 172 and 173: MULTIAXIAL DIAGNOSIS IN PSYCHIATRY
Page 186 and 187: CLINICAL ASSESSMENT INSTRUMENTS IN
Page 226 and 227: 220 PSYCHIATRIC DIAGNOSIS AND CLASS
Page 244 and 245: ___________________________________
Page 256 and 257: PSYCHIATRIC DIAGNOSIS IN DEVELOPING
Page 266 and 267:
PSYCHIATRIC DIAGNOSIS IN DEVELOPING
Page 268 and 269:
Page 270 and 271:
Page 272 and 273:
Page 274 and 275:
Page 276 and 277:
Page 278 and 279:
Page 280 and 281:
Page 282 and 283:
Page 284 and 285:
Page 286 and 287:
282 INDEX AsociacioÂn PsiquiaÂtri
Page 288 and 289:
284 INDEX consciousness in phenomen
Page 290 and 291:
286 INDEX eating disorders 80 Eatin
Page 292 and 293:
288 INDEX India contd) Unani/Arabic
Page 294 and 295:
290 INDEX obsessive-compulsive diso
Page 296 and 297:
292 INDEX St. Louis diagnostic crit
Page 298 and 299:
294 INDEX US Navy classification 49
show all

Psychiatric Diagnosis and Classification - ResearchGate

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?