Longitudinal, Expert, All Data Research Articles

The LEADING Guideline: Reporting Standards for Expert Panel, Best-Estimate Diagnosis, and Longitudinal Expert All Data (LEAD) Studies.

Accurate assessments of symptoms and illnesses are essential for health research and clinical practice but face many challenges. The absence of a single error-free measure is currently addressed by assessment methods involving experts reviewing several sources of information to achieve a more accurate or best-estimate assessment. Three bodies of work spanning medicine, psychiatry, and psychology propose similar assessment methods: The Expert Panel, the Best-Estimate Diagnosis, and the Longitudinal Expert All Data (LEAD) method. However, the quality of such best-estimate assessments is typically very difficult to evaluate due to poor reporting of the assessment methods and when they are reported, the reporting quality varies substantially. Here, we tackle this gap by developing reporting guidelines for such best-estimate assessment studies. The development of the reporting guidelines followed a four-stage approach: 1) drafting reporting standards accompanied by rationales and empirical evidence, which were further developed with a patient organization for depression, 2) incorporating expert feedback through a two-round Delphi procedure, 3) refining the guideline based on an expert consensus meeting, and 4) testing the guideline by i) having two researchers test it and ii) using it to examine the extent previously published studies report the standards. The last step also provides evidence for the need for the guideline: 10 to 63% (Mean = 33%) of the standards were not reported across thirty randomly selected studies. The LEADING guideline comprises 20 reporting standards related to four groups: The Longitudinal design (four standards); the Appropriate data (four standards); the Evaluation - experts, materials, and procedures (ten standards); and the Validity group (two standards). We hope that the LEADING guideline will be useful in assisting researchers in planning, conducting, reporting, and evaluating research aiming to achieve best-estimate assessments.

Validity and Reliability of the Scale to Report Emotional Stress Signs-Multiple Sclerosis (STRESS-MS) in Assessing Abuse and Neglect of Adults With Multiple Sclerosis.

Approximately 30% of people with multiple sclerosis (MS) require caregiving, with unknown prevalence of abuse and neglect. To explore these issues, we created the Scale to Report Emotional Stress Signs-Multiple Sclerosis (STRESS-MS). The objective was to develop, validate, and field-test a self-report questionnaire for screening people with MS for mistreatment. We developed the STRESS-MS questionnaire and administered it to 102 adults with advanced MS-related disability and 97 primary informal caregivers, correlating responses with direct observation of mistreatment, conducting an item analysis, and evaluating validity using a Longitudinal, Expert, All Data (LEAD) panel. Most STRESS-MS subscales correlated highly with criterion-standard LEAD panel evaluations of mistreatment, with strong concurrent and discriminant validity. Nearly 53% of participants with MS reported experiencing psychological abuse; 9.8%, financial exploitation; 6.9%, physical abuse; 4.9%, neglect; and 3.9%, sexual abuse. Protective factors for people with MS included social support and older age; risk factors included depression and aggressiveness. The greatest risk factor was an informal caregiver who spent 20 or more hours per week caring for the person with MS. The STRESS-MS questionnaire is reasonably reliable and valid for detecting caregiver mistreatment in adults with MS. Although most informal caregivers are not abusive, this study highlights an underrecognized need to detect and prevent abuse and neglect of people with MS.

Improving forensics: Characterizing injuries among community-dwelling physically abused older adults.

Physical elder abuse affects a substantial number of older adults, leaving victims at increased risk for negative health outcomes. Improved detection of abuse-related injuries may increase victim access to professional support, but providers report difficulties distinguishing between accidental and abuse-related injuries, due in part to victims' pre-existing health conditions and medication use. To describe the spectrum and characteristics of injuries among physically abused older adults and identify injury characteristics associated with abuse. Case-control study. Physically abused adult protective services clients were interviewed in their home; non-abused comparison group participants were interviewed in an outpatient geriatrics clinic. Sample included 156 community-dwelling adults aged 65 and older, including 57 physically abused and 99 non-abused individuals. Self-reported abuse history was confirmed through independent case assessment by a LEAD (Longitudinal, Expert All-Data) panel of clinicians with family violence expertise. Full-body assessments were conducted, documenting injury incidence, diagnosis, and location. We also collected sociodemographic characteristics, level of social support, functional ability, medical history, and medication use. Physically abused older adults were more likely to be injured upon assessment (79.0% vs 63.6%; p < 0.05) and have a greater number of injuries ( vs , p < 0.05). Injuries seen more often among abused individuals included: upper extremity ecchymoses (42.1% vs 26.3%; p < 0.05), abrasions (31.6% vs 11.1%; p < 0.01), and areas of tenderness (8.8% vs 0.0%; p < 0.01); and head/neck/maxillofacial ecchymoses (15.8% vs 2.0%; p < 0.01) and tenderness (15.8% vs 0.0%; p < 0.001). Lower extremity abrasions (12.3%) were common but unrelated to abuse status. While physical abuse does not always result in physical injury, victims more commonly display head/neck/maxillofacial ecchymoses or tenderness and upper extremity abrasions, ecchymoses, or tenderness. Detection of these injuries among older adults warrants further interview and examination.

Multicenter Validation of an Emergency Department–Based Screening Tool to Identify Elder Abuse

Emergency department (ED) visits provide an important opportunity for elder abuse identification. Our objective was to assess the accuracy of the ED Senior Abuse Identification (ED Senior AID) tool for the identification of elder abuse. We conducted a study of the ED Senior AID tool in 3 US EDs. Participants were English-speaking patients 65 years old and older who provided consent or for whom a legally authorized representative provided consent. Research nurses administered the screening tool, which includes a brief mental status assessment, questions about elder abuse, and a physical examination for patients who lack the ability to report abuse or for whom the presence or absence of abuse was uncertain. The reference standard was based on the majority opinion of a longitudinal, expert, all data (LEAD) panel following review and discussion of medical records, clinical social worker notes, and a structured social and behavioral evaluation. For the reference standard, LEAD panel members were blinded to the results of the screening tool. Of 916 enrolled patients, 33 (3.6%) screened positive for elder abuse. The LEAD panel reviewed 125 cases: all 33 with positive screen results and a 10% random sample of negative screen results. Of these, the panel identified 17 cases as positive for elder abuse, including 16 of the 33 cases that screened positive. The ED Senior AID tool had a sensitivity of 94.1% (95% confidence interval [CI] 71.3% to 99.9%) and specificity of 84.3% (95% CI 76.0% to 90.6%). This multicenter study found the ED Senior AID tool to have a high sensitivity and specificity as a screening tool for elder abuse, albeit with wide CIs.

Clinical validity and intrarater and test-retest reliability of the Structured Clinical Interview for DSM-5 - Clinician Version (SCID-5-CV).

The Structured Clinical Interview for the DSM is one of the most used diagnostic instruments in clinical research worldwide. The current Clinician Version of the instrument (SCID-5-CV) has not yet been assessed in respect to its psychometric qualities. We aimed to assess the clinical validity and different reliability indicators (interrater test-retest, joint interview, face-to-face vs telephone application) of the SCID-5-CV in a large sample of 180 non-prototypical and psychiatric patients based on interviews conducted by raters with different levels of clinical experience. The SCID-5-CV was administered face-to-face and by telephone by 12 psychiatrists/psychologists who took turns as raters and observers. Clinical diagnoses were established according to DSM-5 criteria and the longitudinal, expert, all data (LEAD) procedure. We calculated the percentage of agreement, diagnostic sensitivity and specificity, and the level of agreement (kappa) for diagnostic categories and specific diagnoses. The percentage of positive agreement between the interview and clinical diagnoses ranged between 73% and 97% and the diagnostic sensitivity/specificity were >0.70. In the joint interview, the levels of positive agreement were high (>75%) and kappa levels were >0.70 for most diagnoses. The values were less expressive, but still adequate, for interrater test-retest interviews. The SCID-5-CV presented excellent reliability and high specificity as assessed with different methods. The clinical validity of the instrument was also confirmed, which supports its use in daily clinical practice. We highlight the adequacy of the instrument to be used via telephone and the need for careful use by professionals with little experience in psychiatric clinical practice.

Diagnostic validity of the MINI-KID disorder classifications in specialized child and adolescent psychiatric outpatient clinics in Sweden

BackgroundMissing diagnostic information often results poor accuracy of the clinical diagnostic decision process. The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) is a short standardized diagnostic interview and covers a rather broad range of diagnoses applicable to children and adolescents. MINI-KID disorder classifications have shown test-retest reliability and validity comparable to other standardized diagnostic interviews and is claimed to be a useful tool for diagnostic screening in Child and Adolescent Psychiatric care. The concordance between the Swedish language version of the MINI-KID Interview and LEAD (Longitudinal, Expert, All Data) research diagnoses was studied in secondary child and adolescent psychiatric outpatient care.MethodsMINI-KID interviews were performed for 101 patients, boys n = 50, girls n = 51, aged 4 to 18 years. The duration of the interview was on average 46 min, the child/adolescent participating together with the parent(s) in most cases. The seven most prevalent diagnoses were included in the analyses.ResultsThe average overall percent agreement (OPA) between MINI-KID and LEAD was 79.5%, the average percent positive agreement (PPA) 35.4 and the average percent negative agreement (NPA) 92.7. OPA was highest for Obsessive-Compulsive Disorder (OCD) (0.89), Tic disorders (0.88) and Pervasive developmental disorders (0.81). There were similar results in diagnostic agreement comparing the two versions: the standard MINI-KID and MINI-KID for parents. The specific screening questions in MINI-KID resulted in additional preliminary diagnoses compared with the regular initial clinical assessment.ConclusionsOverall, there was an acceptable agreement between MINI-KID disorder classifications and research diagnoses according to LEAD. The standardized interview MINI-KID could be considered as a tool with the possibility to give valuable information in the diagnostic process in child and adolescent care which is similar to the setting in the present study.

Validation of the DSM–5 Alternative Model Personality Disorder Diagnoses in Turkey, Part 1: LEAD Validity and Reliability of the Personality Functioning Ratings

ABSTRACTThis study addresses longitudinal, expert, all data (LEAD) validity and reliability of the personality functioning ratings in Turkey, which are essential in assessing Criterion A for the entire DSM–5 alternative model for personality disorders (AMPD) diagnoses. A total of 120 consenting patients recruited at a university psychiatry clinic were rated by individual clinicians with respect to DSM–III–R and AMPD criteria. Subsequently, a LEAD panel consisting of 3 senior clinicians convened to reach a consensus personality disorder diagnosis for each participant. Blind personality functioning ratings of a subgroup of 20 participants by the same set of 4 clinicians were obtained for test–retest reliability investigation. Concordance between the LEAD and AMPD diagnoses was as good as that between the LEAD and DSM–III–R diagnoses (kappas = .68). The personality functioning scores correlated strongly (r > .50) with the sum of specific DSM–III–R diagnoses. Reliability estimates pertaining to the personality functioning scores and resultant AMPD Criterion A decisions were mostly in the good range. In conclusion, DSM–5 alternative model-oriented personality functioning ratings yield total or composite scores that are evidently valid and reliable tools to diagnose general personality disorder and to estimate its global severity.

Validity of the Brief Child and Family Phone Interview by comparison with Longitudinal Expert All Data diagnoses in outpatients.

Background:The Brief Child and Family Phone Interview (BCFPI) is a standardized intake and follow-up interview used in child and adolescent mental health services (CAMHS). Although it has shown good validity compared with other measures using parent reports, it has not yet been compared with diagnoses derived from a Longitudinal Expert All Data (LEAD) procedure, which includes information from separate diagnostic interviews with parent(s) and child. The aim was to compare the BCFPI evaluation in an outpatient child and adolescent psychiatry setting with an evaluation derived from a LEAD procedure.Methods:At four Swedish outpatient CAMHS, 267 patients were interviewed at intake with the BCFPI. Within six weeks, patients and parents were interviewed separately with the 2009 version of the semi-structured Kiddie Schedule for Affective Disorders and Schizophrenia for School-age Children, Present and Lifetime Version (K-SADS-PL) and parents completed the Child Behavior Checklist (CBCL). LEAD diagnoses were subsequently determined by two senior clinicians based on 1.2 years of clinical records including the K-SADS-PL and ensuing information from further assessments, psychological tests, information from teachers and other informants as well as treatment outcome. The Diagnostic and Statistical Manual of Mental Disorders subscales from the CBCL and the subscales from the BCFPI were compared with LEAD diagnoses. These measured symptoms of attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder.Results:The criterion validity for BCFPI versus LEAD diagnoses was fair for oppositional defiant disorder (area under curve, 0.73), generalized anxiety disorder (0.73) and major depressive disorder (0.78), good for attention-deficit hyperactivity disorder (0.81) and conduct disorder (0.83), and excellent for separation anxiety disorder (0.90). The screening properties of BCFPI and CBCL were similar.Conclusion:The BCFPI is a concise and valid tool, performed along with the larger and more established CBCL, in screening for major psychiatric disorders. It is well suited as an intake interview in CAMHS.

The Validity of the Screen for Child Anxiety Related Emotional Disorders Revised (SCARED-R) Scale and Sub-Scales in Swedish Youth

We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n = 239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children’s Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.

Predictive validity of the K-SADS-PL 2009 version in school-aged and adolescent outpatients

Background: The schedule for affective disorders and schizophrenia for school-age children (K-SADS) is one of the most commonly used standardized diagnostic interviews in child and adolescent psychiatry. Validity studies are scarce, and limited to concurrent validity with other measures and clinical diagnoses.Aims: To evaluate the K-SADS interview in an outpatient child and adolescent psychiatry (CAP) setting with a Longitudinal Expert All Data (LEAD) procedure.Methods: CAP residents performed a K-SADS-PL interview with the revised 2009 version containing the new PDD section on 239 clinically referred outpatients of 6–17 years old and their parent(s). A consensus LEAD diagnosis by two senior clinicians 1.2 (SD = 0.6) years later was based on clinical records including the K-SADS and subsequent information from further assessments, information from teachers and other informants, outcome of treatment, and at least three visits after the K-SADS.Results: Predictive validity for K-SADS vs LEAD diagnoses were good-to-excellent for broader categories of anxiety disorders (κ = 0.94), depressive (κ = 0.91), behavioural (κ = 0.91) and tic (κ = 0.81) disorders, good for ADHD (κ = 0.80), and good-to-moderate for autism spectrum disorders (κ = 0.62). Bipolar, psychotic, and eating disorders were too few to be analysed.Conclusion: The K-SADS diagnoses elicited from an interview with the child and one from parents on one occasion have an excellent validity for most major child psychiatric disorders. ADHD can be reliably diagnosed at one visit, but clinicians need to stay alert for possible undiagnosed ADHD. Diagnosing autism with K-SADS-PL 2009 version at one visit is not advisable.

Eating disorders in a large clinical sample of men and women with personality disorders

We assessed and compared the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) across six Axis II groups (borderline, obsessive-compulsive, avoidant, dependent, paranoid, and personality disorder NOS) and patients with major depressive disorder (MDD) without personality disorders (PD). The sample included 3,266 consecutive and first admissions to 16 different treatment units in the Norwegian Network of Psychotherapeutic Day Hospitals between 1993 and 2009. All patients were interviewed with the SCID-II for DSM-III-R (prior to 1996) or DSM-IV (from 1996) and the MINI for Axis I disorders in accordance with the LEAD (longitudinal, expert, all-data) standard. The prevalence of any ED in the PD sample was approximately 17% for women and 3% for men. A lower rate of ED (5%) was found for patients with MDD without PD. A significantly higher proportion of patients with borderline personality disorder were diagnosed with BN or EDNOS. The rate of AN was significantly elevated in female patients with obsessive-compulsive personality disorder. Men demonstrated significantly less diagnostic co-occurrence and no significant differential variation across PD groups or MDD. Data which included a psychiatric comparison group showed less co-occurrence and non-significant variation across PD groups for men, but demonstrated a meaningful and specific pattern of comorbidity between ED and PD for women. There was an elevated risk of ED among female patients with PD, most pronounced for borderline. An almost five-fold higher rate of AN was found among women with obsessive-compulsive PD.

Validity and limitations of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

OBJECTIVE: To study the concurrent validity of the Brazilian Composite International Diagnostic Interview 2.1 using as gold standard the clinical diagnoses based on the ICD-10 criteria and the Longitudinal, Expert, All Data (LEAD) procedure. METHOD: The sample was composed of 185 subjects selected at psychiatric hospitals, psychiatric outpatient units, the community, and primary care services. These individuals were intentionally selected according to 9 diagnostic groups. Instruments: Composite International Diagnostic Interview (CIDI-core) version 2.1 (paper-and-pencil) administered by 16 trained interviewers. Analysis: concurrent validity of diagnoses of the Composite International Diagnostic Interview 12-month. RESULTS: Values found for sensitivity and specificity in each diagnosis were: alcohol-related disorders (79.5%/97.2%); psychoactive substance-related disorders (77.3%/100%); schizophrenia and other psychotic disorders (28.6%/93.9%); manic episode and bipolar affective disorder (38.9%/96.4%); depressive disorder (82.5%/ 93.8%); phobic-anxiety disorder (80.6%/93.5%); obsessive-compulsive disorder (18.2%/98.9%); somatoform disorder (41.7%/90.8%); eating disorder (45.5%/100.0%). CONCLUSION: The Composite International Diagnostic Interview proved to be valid for diagnoses of alcohol-related disorders, psychoactive substance-related disorders, depressive disorder and phobic-anxiety disorder. The probable explanations for the poor performance for the other diagnoses were: necessity of some clinical judgement by the lay interviewer; difficulty to use the Probe Flow Chart; interviewees' difficulty of understanding; and lack of mechanisms to certify the veracity of the information.

Diagnostic Interview for Genetic Studies (DIGS): Inter-rater and test-retest reliability and validity in a Spanish population

Objective To test the reliability and validity of the DIGS in Spanish population. Methods Inter-rater and test-retest reliability of the Spanish version of DIGS was tested in 95 inpatients and outpatients. The resultant diagnoses were compared with diagnoses obtained by the LEAD (Longitudinal Expert All Data) procedure as “gold standard”. The kappa statistic was used to measure concordance between blind inter-raters and between the diagnoses obtained by LEAD procedure and through the DIGS. Results Overall kappa coefficient for inter-rater reliability was 0.956. The kappa value for individual diagnosis varied from major depression = 0.877 to schizophrenia = 1. Test-retest reliability was 0.926. Kappa for all individual target diagnoses ranged from 0.776 (major depression) to 1. Kappa between LEAD procedure and DIGS ranged from 0.704 (major depression) to 0.825 (bipolar I disorder). Conclusion Most of the DSM-IV major psychiatric disorders can be assessed with acceptable to excellent reliability with the Spanish version of the DIGS interview. The Spanish version of DIGS showed an acceptable to excellent concurrent validity. Giving the good reliability and validity of Spanish version of DIGS it should be considered to identify psychiatric phenotypes for genetics studies.

Validity and limitations of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

To study the concurrent validity of the Brazilian Composite International Diagnostic Interview 2.1 using as gold standard the clinical diagnoses based on the ICD-10 criteria and the Longitudinal, Expert, All Data (LEAD) procedure. The sample was composed of 185 subjects selected at psychiatric hospitals, psychiatric outpatient units, the community, and primary care services. These individuals were intentionally selected according to 9 diagnostic groups. Composite International Diagnostic Interview (CIDI-core) version 2.1 (paper-and-pencil) administered by 16 trained interviewers. concurrent validity of diagnoses of the Composite International Diagnostic Interview 12-month. Values found for sensitivity and specificity in each diagnosis were: alcohol-related disorders (79.5%/97.2%); psychoactive substance-related disorders (77.3%/100%); schizophrenia and other psychotic disorders (28.6%/93.9%); manic episode and bipolar affective disorder (38.9%/96.4%); depressive disorder (82.5%/ 93.8%); phobic-anxiety disorder (80.6%/93.5%); obsessive-compulsive disorder (18.2%/98.9%); somatoform disorder (41.7%/90.8%); eating disorder (45.5%/100.0%). The Composite International Diagnostic Interview proved to be valid for diagnoses of alcohol-related disorders, psychoactive substance-related disorders, depressive disorder and phobic-anxiety disorder. The probable explanations for the poor performance for the other diagnoses were: necessity of some clinical judgement by the lay interviewer; difficulty to use the Probe Flow Chart; interviewees' difficulty of understanding; and lack of mechanisms to certify the veracity of the information.

Neuroticism and Affective Instability: The Same or Different?

Objective: The purpose of this study was to examine the correlates and consequences of two constructs related to affective experience: neuroticism and affective instability. Method: One hundred thirty-two patients were assessed at intake for axis I and II symptoms, general personality traits, and specific impairments, including impairments in interpersonal functioning. The data included responses to structured and semistructured interviews, self-reports of interpersonal problems, and reports of interpersonal problems from significant others. Clinical ratings of axis I and II symptoms and of impairment were made by using the LEAD (i.e., longitudinal, expert, all data) consensus approach. Ninety-one of the 132 patients were reassessed at 12-month follow-up. Results: Neuroticism and affective instability manifested varied concurrent relations, with neuroticism being strongly related to an anxious, avoidant style and affective instability related to more externalizing personality styles. Prospectively, neuroticism predicted later symptoms, occupational impairment, and global dysfunction, whereas affective instability predicted romantic impairment. Conclusions: The findings suggest that neuroticism and affective instability—which are considered core aspects of personality pathology—are related but distinct constructs with unique correlates and different predictive abilities.

Neuroticism and Affective Instability: The Same or Different?

The purpose of this study was to examine the correlates and consequences of two constructs related to affective experience: neuroticism and affective instability. One hundred thirty-two patients were assessed at intake for axis I and II symptoms, general personality traits, and specific impairments, including impairments in interpersonal functioning. The data included responses to structured and semistructured interviews, self-reports of interpersonal problems, and reports of interpersonal problems from significant others. Clinical ratings of axis I and II symptoms and of impairment were made by using the LEAD (i.e., longitudinal, expert, all data) consensus approach. Ninety-one of the 132 patients were reassessed at 12-month follow-up. Neuroticism and affective instability manifested varied concurrent relations, with neuroticism being strongly related to an anxious, avoidant style and affective instability related to more externalizing personality styles. Prospectively, neuroticism predicted later symptoms, occupational impairment, and global dysfunction, whereas affective instability predicted romantic impairment. The findings suggest that neuroticism and affective instability--which are considered core aspects of personality pathology--are related but distinct constructs with unique correlates and different predictive abilities.

Diagnosing comorbid psychiatric disorders in substance abusers: validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV.

The authors' goal was to assess the validity of DSM-IV diagnoses obtained with the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and the Structured Clinical Interview for DSM-IV (SCID) compared with the longitudinal, expert, all data (LEAD) procedure in a group of substance abusers. A total of 105 substance abusers recruited at a drug abuse treatment center in Barcelona, Spain, were assessed. The PRISM and SCID were administered blindly by independent research interviewers. LEAD diagnoses were made by two senior psychiatrists who were blind to PRISM and SCID diagnoses. The kappa statistic was used to measure concordance between the LEAD procedure and the PRISM and SCID. Affective and anxiety disorders were diagnosed more frequently by the PRISM and SCID than by the LEAD procedure. Use of the PRISM resulted in more diagnoses of substance-induced depression, and use of the SCID resulted in more diagnoses of primary major depression than the LEAD procedure. Kappas between the LEAD procedure and the PRISM in current major depression, past substance-induced depression, and borderline personality disorder were better than those obtained between the LEAD procedure and the SCID. The concordance among the three methods for diagnoses of current dependence disorders was good or excellent for alcohol, anxiolytic, cocaine, and heroin dependence and fair for cannabis dependence. Abuse diagnoses showed poor concordance. Using the LEAD procedure as a "gold standard," the authors conclude that the Spanish version of the PRISM seems to be a better instrument than the Spanish version of the SCID for diagnosing major depression and borderline personality disorders in substance abusers.

Validity of the longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders

The longitudinal, expert, all data (LEAD) procedure has been employed as a criterion for the assessment of the procedural validity of diagnostic instruments. This study evaluated the procedure's concurrent, discriminant and predictive validity. Interview and questionnaire data obtained from 100 individuals in a substance abuse treatment program were used to assess current and lifetime substance use disorders and common comorbid disorders. An experienced, doctoral-level clinician formulated LEAD diagnoses for each patient, based on an initial interview, ongoing clinical contact and the results of the research assessment and all available clinical records. LEAD-derived substance use diagnoses showed good concurrent, discriminant and predictive validity. The validity of comorbid diagnoses obtained using the LEAD procedure was generally fair to good. Comparison with diagnoses based only on the clinician's unstructured initial interview showed that the availability of additional data enhanced diagnostic validity. Diagnoses derived by a research technician using the Structured Clinical Interview for DSM-III-R showed validity comparable to that of LEAD diagnoses. To enhance its diagnostic validity, applications of the LEAD standard should include a structured interview. Other variations in the application of the LEAD standard, including a longer evaluation period, may also enhance its performance as a diagnostic criterion measure.

Longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders.

The Longitudinal, Expert, All Data (LEAD) procedure has been proposed as a criterion for the assessment of the procedural validity of diagnostic instruments. The authors evaluated the procedure's test-retest reliability and whether it enhanced diagnosis based on a single interview. Data were collected using interviews and questionnaires to assess current and lifetime substance use disorders and common comorbid disorders in 100 patients recruited from a substance abuse treatment program. An initial diagnostic interview was conducted by a primary expert who, at the end of treatment, formulated LEAD diagnoses for each patient, based on the results of the research assessment and all available clinical records. Secondary experts used a similar procedure in a subsample of 40 patients to provide a measure of test-retest reliability. Overall reliability of LEAD diagnoses was good, though it varied from excellent for substance use disorders to poor for some comorbid psychiatric disorders. As a consequence of the LEAD procedure, the total number of substance use diagnoses increased significantly, with no effect on diagnostic reliability. Based on these findings, we conclude that, while the overall reliability of the LEAD procedure is comparable to other diagnostic methods, there was considerable variability among groups of diagnoses. The additional cost of the procedure would appear to be justified only when diagnostic sensitivity is at a premium and principally for the diagnosis of psychoactive substance use disorders. Before it is widely used as a diagnostic criterion measure, the utility of the LEAD procedure should be evaluated in a variety of patient samples and under varying circumstances.

Validity in the diagnosis of personality disorders: The use of the LEAD standard.

This study examined the reliability, stability, and clinical and predictive validity of Axis II diagnosis in 40 patients with major depression. Subjects were assessed with the Personality Disorder Examination (PDE) and the Personality Assessment Form (PAF). The clinical validity of these measures was determined by examining their agreement with consensual diagnoses formulated using the LEAD (Longitudinal, Expert, All Data) standard proposed by Spitzer (1983). Interrater reliability for categorical decisions was excellent with the PDE but only fair with the PAF; reliability improved on the PAF when assessed using continuous scores. Stability of diagnoses over a 6-month period was moderate with both the PDE and PAF. Concordance among the 3 methods was limited, with unanimous agreement on 20of 40cases(50%) at intake and!8of31 cases(58%) at follow up. Patients with personality disorders identified by the LEAD standard consensus (and to a lesser degree, by the PDE) had worse outcomes at the 6-month follow-up assessment.