Psychiatric Diagnosis and Classification - ResearchGate

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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
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PREFACE xi world who are interested
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2 PSYCHIATRIC DIAGNOSIS AND CLASSIF
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10 PSYCHIATRIC DIAGNOSIS AND CLASSI
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IMPLICATIONS OF COMORBIDITY 81 Fina
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Table 4.2 Matrix of levels and subl
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IMPLICATIONS OF COMORBIDITY 93 Tabl
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THE ROLE OF PHENOMENOLOGY IN PSYCHI
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282 INDEX AsociacioÂn PsiquiaÂtri
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284 INDEX consciousness in phenomen
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286 INDEX eating disorders 80 Eatin
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288 INDEX India contd) Unani/Arabic
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290 INDEX obsessive-compulsive diso
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292 INDEX St. Louis diagnostic crit
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294 INDEX US Navy classification 49
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