To Screen or Not to Screen: Conceptual Issues in Screening for Psychiatric Disorders in Psychiatric Patients with a Focus on the Performance of the Psychiatric Diagnostic Screening Questionnaire

Abstract

Recent research has raised concerns about the adequacy of psychiatric diagnostic evaluations conducted in routine clinical practice. Semi-structured diagnostic interviews have been considered the diagnostic gold standard. Judged against this standard, studies comparing unstructured clinical evaluations with semi-structured interviews have found that there is a high rate of missed diagnoses and misdiagnosis by the usual clinical methods. Whether this is clinically significant is uncertain because there are no studies that have examined whether the use of standardized research interviews improves clinical outcome. On common sense grounds, however, it seems reasonable that greater diagnostic precision will improve outcome. More complete and accurate diagnostic evaluations might impact upon patients’ satisfaction with the diagnostic assessment, alliance with the treating clinician, selection of medication, or recommendation for psychotherapy. Additionally, improved diagnostic practice might be a better predictor of course and outcome, another important function of diagnosis. In the meantime, until studies are conducted to determine whether standardized research-like evaluations improve outcome, or the prediction of outcome, clinicians might want to consider whether one of the recently developed broad-based self-administered diagnostic screening questionnaires could be a useful adjunct to their unstructured diagnostic interview. The results of recent work on one such measure, the Psychiatric Diagnostic Screening Questionnaire (PDSQ), are summarized.