Unstructured Clinical Interview Research Articles

Validation of the Brazilian Portuguese version of the Stanford cataplexy questionnaire

IntroductionCataplexy is a sudden and involuntary episode of loss of muscle tone during wakefulness. Cataplexy cannot be easily recognized when clinical features are atypical or when the physician is unfamiliar with its characteristics. The unstructured clinical interview is the only standard diagnostic method, but the use of a targeted questionnaire can help in the diagnosis of cataplexy. MethodsThe Stanford cataplexy questionnaire is a self-administered 51-question questionnaire. This validation consisted of an initial translation and back-translation of the questionnaire from English into Brazilian Portuguese, followed by a pilot study with 10 participants for the cultural adaptation of the scale. Results155 consecutive patients aged 18–85 completed the questionnaire. The Brazilian version of the Stanford cataplexy questionnaire showed similar results to the original version with good metric properties (area under the curve), high internal consistency (Cronbach's alpha equal to 0.87), good reliability and reproducibility. ConclusionsThe Brazilian Portuguese version of the Stanford Cataplexy questionnaire presented good accuracy satisfactory psychometric properties in identifying cataplexy.

Improving diagnostic accuracy: Comparison of nomograms and classification tree analyses for predicting the diagnosis of oppositional defiant disorder.

Unstructured clinical interviews are inaccurate tools for diagnostic decision-making. While structured diagnostic evaluations improve reliability, they are infrequently used in clinical practice. Empirical approaches are a hallmark of evidenced-based assessment and may reduce burdens of structured interviews. We explore two approaches to empirical prediction of diagnosis, the naïve nomogram, and classification tree analysis (CTA). To illustrate the clinical utility of each approach, we compared their use in a sample of 6-year-olds (N = 619) to predict structured-interview diagnoses of oppositional defiant disorder (ODD). Findings indicate the accuracy of both approaches in predicting the absence of a disorder and improved detection of ODD using CTA for subgroups of children. Both empirical prediction techniques have applicability to diagnostic decision-making in psychiatry and pediatrics. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

57.3 Implementing Self-Rating Scales in an Adolescent Unit

Although psychiatry recognizes the benefits of measurement-based practice (MBP), unstructured clinical evaluations are routine inpatient practice. A meta-analysis demonstrated that unstructured clinical interviews yield different diagnoses than structured interviews. Research demonstrates that unstructured clinical interviews yield fewer diagnoses, commonly miss comorbid diagnoses, and have weak clinician interrater reliability. Further, there is a paucity of treatment outcome research within inpatient psychiatry due to the lack of MBP.

«Золотой стандарт» в сравнении с лечением на основании собственного клинического опыта («Treatment as usual»): диагностическая практика в системе ювенальной юстиции

<p>Mental health concerns are highly prevalent in the juvenile justice system (JJS). Assessment practices vary significantly across probation departments, often relying on past medical history or unstructured clinical interviews. Numerous structured and semi-structured assessment tools exist, some of which have previously been used within JJS samples. The current research compared mental health diagnosis prevalence and distribution as assigned by the current practice in a probation department versus utilizing the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) in a sample of youth involved with the JJS. Results suggested the K-SADS identified a higher variety of mental health concerns with higher precision (e.g., all diagnoses were specified rather than unspecified). However, the standard assessment practice identified a higher prevalence of ADHD diagnoses, as well as “Other Conditions That May Be a Focus of Clinical Attention.” Limitations and future directions are discussed.</p>

Should the demonstration of improved patient outcome be necessary to overhaul diagnostic approaches?: Comment on Bach and Tracy (2022).

I will argue in this commentary that it is premature to change the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition approach toward diagnosing personality disorders to the alternative model for personality disorders (AMPD) because such a change in determining personality pathology will be disruptive, and such a disruption is warranted only when it can be demonstrated that patient outcomes are better. I briefly review studies comparing unstructured clinical evaluations with semistructured interviews for symptom disorders, and these studies have found that there is a high rate of missed diagnoses and misdiagnosis by usual clinical assessment. Although on common sense grounds it seems reasonable to assume that greater diagnostic precision will improve outcome, semistructured interviews are not recommended as the standard of care because no studies of adults have yet demonstrated that patient outcomes are better when semistructured interviews are used instead of unstructured clinical interviews. This logic equally applies to overhauling a diagnostic system. In fact, upon considering an approach toward subtyping patients based on outcome in treatment, it is unlikely that a study randomly assigning patients to competing diagnostic or assessment approaches would demonstrate superiority of one method over the other. Finally, I raise concerns about reliance on self-report scales to assess personality and note an absence of studies comparing self-report and interviewer assessments of the AMPD that computed or discussed the positive predictive value of self-report measures of the AMPD system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Genogram of excitatory stimuli from S-ONapp application in Premature Ejaculation. Case Study

Objective: The aim of this case study is to change the cognitive-behavioral and sex-therapy mechanisms to reduce sexual distress, relieve anxiety and shift the focus to solving the problem of premature ejaculation of a 35-year-old patient, reaching the stage of changing the sexual focus with the sensory one, by diversifying the excitatory stimuli so that his pleasure and satisfaction help him maintain a normal functioning of his sexual and mental life. Methods: In the therapeutic intervention we applied CBT intervention techniques in cognitive behavioral therapy thus analyzing cognitions, behaviors, and emotions. 1. Standard testing, 2. Sexual testing, 3. Treatment plan. The standard clinical psychological testing used anamnesis and clinical observation, structured, semi-structured and unstructured clinical interviews (Delcea C. 2021) as well as clinical evaluation scales The Generalized Anxiety Disorder 7 (GAD 7), The Patient Health Questionnaire (PHQ- 9) Depression Scale, Beck's Depression Inventory (BDI II), Trauma Symptom Checklist (TSC-40), Symptom Checklist 90-R, Attachment Style Identification Questionnaire (Diana Poole Heller). For sexual testing we used the PESI-Premature Ejaculation Severity Index questionnaire, sexual interviews (Delcea C., 2021). Methodology used in sex therapy intervention: 1. To understand the stimuli of excitement, pleasure, and relaxation, we used the Genogram of excitatory stimuli (Delcea C., 2019) to focus other stimuli on the favorite erogenous zone of the present model of arousal. 2. We used the CBE model (Cognition, Behavior, Emotion) in the cognitive restructuring of dysfunctional cognitions as well as the relational model for identifying and establishing the couple relationship and relational cooperation as well as intimacy and communication. 3. We decreased sexual distress involving decreased performance anxiety as well as relaxation techniques, anticipatory steps technique, distributive thinking technique, management technique, sexual anxiety (fear of performance), disturbance management, relationship management (Standardized intervention model SON, Delcea C ., 2019) as well as progressive desensitization, awareness of critical points and self-help by taking responsibility for the problem, gaining control over ejaculation and understanding the situation of premature ejaculation, improving communication, overcoming the barrier of privacy, accepting one's feelings about dysfunction, growth in one's own sexual performance as well as resolving interpersonal conflicts that maintain dysfunction. 4. Methods of Psychoeducation: The human sexual response, the anatomy and physiology of the male and female body as well as the analysis of the genitals, the change of the cognitive system regarding everything in a positive and playful note of the situation. Results: In the PHQ-9 test score = 10, the subject has no clinical depression. In the GAD-7 test, the score = 8 shows that the subject has a slight anxiety, which correlates with the interview data regarding his performance anxiety. In the TSC 40 test score = 10, the subject does not present clinical symptoms of trauma. In the BDI test - 2 score = 12, it shows the presence of a slight mood disorder without symptoms of clinical depression. The SC 90-R test does not show any mental disorders present on Axis I - II. From the test we notice that Marian has a slight anxiety related to his sexual problem of premature ejaculation, thus finding out that the anxiety causes him a slight fear of sexual performance. He had unrealistic expectations of him as a man considering that a normal sexual act lasts 30 minutes, having no control over his ejaculation, his sexual scenarios and fantasies being unimaginative, he is seeing sexuality as a performance not as an exchange of emotions and feelings in the making of moments of affection. Conclusions: Following the applied methodology, the subject presented a positive evolution, acquiring information about his dysfunction and the human sexual response.

The relationship between the duration and rate of drug use and explicit/ implicit memory bias among opium and stimulant addicts

Introduction: Today, drug abuse as a multifaceted phenomenon has become one of the main problems in societies and has taken different forms. Aim: The present study aims to examine the relationship between the duration and the rate of drug use and explicit/ implicit memory bias among opium and stimulant addicts. Method: The study design was a casual-comparative study. The statistical population included all opium and stimulant addicts in Takab city in 2018, that 30 opium addicts and 30 stimulant (methamphetamine) addicts were selected by available sampling and were homogenized in terms of some demographic variables. The research instruments included a computerized explicit memory, a computerized word base completion test, an unstructured clinical interview, and a demographic information questionnaire. Statistical data were analyzed by descriptive statistics, Pearson correlation coefficient, t -test and SPSS-17 software. Results: The results showed that there is a relationship between the drug use duration and explicit/ implicit memory bias in opium (r=+0.68) and stimulant addicts (r=+0.79) and also between rate of drug use and explicit/ implicit memory bias in opium (r=+0.73) and stimulant addicts (r=+0.81, P<0.05). In other words, with an increase in the duration and rate of drug use, the opium and stimulant addicts showed signs of higher explicit/ implicit memory bias even though stimulant addicts showed greater memory bias than the opium addicts (P<0.05). Conclusion: Emphasis on cognitive processes including memory bias among drug addicts, is one of the solutions to consider in prevention and clinical treatment interventions.

Psychological and Legal Aspects of Dangerous Sex Offenders: A Review of the Literature

The purpose of this article is to review legislation on ‘dangerous sex offenders’ critically. Most modern legislation determines an individual to be ‘dangerous’ if he or she is at unacceptably high risk of committing further sexual violence. While the decision is judicial in practice, clinical testimony is utilised to inform courts’ decision-making. Dangerousness may be a normative (legal) construct, but it is reliant on clinical assessment. Offenders are not at risk only due to historical factors; the possibility of committing sexual violence in the future is likely affected by temporal factors such as response to therapy, substance misuse, and proximity to victims. It is not clear that mental illness would place an offender at risk, although certain personality disorders are considered to be risk factors. In reporting actual risk, clinicians need to consider a range of variables, and not exclusively use actuarial measures or unstructured clinical interviews.

The Synergistic Effects Of Exercise In Combination With Other Antidepressant Therapies.

PURPOSE: Major depressive disorder (MDD) is a global public-health concern. Current anti-depressant treatments are far from satisfactory leaving half of patients undertreated. Research has found exercise alone to be an effective treatment for people suffering with mild to moderate depression however its mechanism of action remains unclear. There is also a lack of research investigating the effects of exercise in combination with other conventional antidepressant therapies in people suffering with severe depression such as MDD. The aim of this study is twofold: first, to investigate the effects of an eight week exercise program in combination with antidepressant medication and intensive group therapy in improving depressive symptoms, anxiety and sleep quality; secondly, to identify changes in brain derived neurotrophic factor (BDNF) which is known to be reduced in people suffering with MDD. METHODS: Sixteen sedentary participants were recruited from the Lakeridge Mental Health Day Treatment (LMHDT) program in Oshawa, Ontario, Canada. All participants had a clinical diagnosis of MDD based on DSM-IV criteria and an unstructured clinical interview conducted by hospital psychiatrists. Participants were assigned either to an eight week, supervised, moderate intensity exercise program plus LMHDT group or the LMHDT only group. Depression scores were determined using the Beck Depression Inventory (BDI), sleep quality by the Pittsburgh Sleep Quality Index (PSQI) and plasma BDNF was quantified by ELISA. All variables were measured at baseline and again at eight weeks. RESULTS: Following the eight weeks of combination treatment the exercise group showed a greater decrease in depression scores, F (1,14)=10.18, p=0.007, d=2.04, a greater improvement in sleep quality, F (1,14)=4.81, p=0.046, d=1.28 and a greater increase in plasma BDNF concentration, F(1,14)=12.47, p=0.003, d = 1.99 compared to the non-exercise group. The exercise group also had a greater decrease in anxiety scores although there was no significant difference between the two groups, F (1,14)=0.25, p=0.623, d=.33. CONCLUSIONS: This project has the potential to provide a tool to improve exercise prescription and to guide development of combined treatment approaches in order to optimize treatment outcomes for people suffering with MDD.

Clinical practice guidelines for Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a common psychiatric illness with lifetime prevalence of 1-3% [1]. It is the fourth-most common psychiatric illness and a leading cause of disability. OCD is associated with significant impairment in functioning, quality of life and disability. If untreated, OCD is a chronic illness with a waxing and waning of symptoms. A recent meta-analysis of long-term naturalistic prospective studies demonstrated that nearly a half of patients experience remission with much higher rates of remission in Indian patients compared to those in the west [2]. Early diagnosis and appropriate treatment may improve outcomes. Despite OCD being a common mental illness, most seek treatment after several years of suffering. Those who suffer from OCD tend to be secretive about their symptoms and suffer from shame and embarrassment. Less than a third of OCD sufferers receive appropriate pharmacotherapy and even less receive evidence-based psychotherapy. Symptoms The hallmarks of OCD are presence of obsessions and compulsions. Obsessions are repetitive, unwanted, intrusive thoughts, images or urges that are mostly ego-dystonic and cause severe distress or anxiety. Compulsions (or rituals) are repetitive behaviours or mental acts that are performed in response to an obsession to reduce anxiety/distress or prevent a dreaded consequence. Obsessions and compulsions are time consuming, distressing and are often resisted unsuccessfully. Clinical manifestations of OCD are remarkably similar across cultures and geographic locations. Common obsessions and compulsions and symptom dimensions identified through factor-analytical studies are shown in Table 1. Table 1 Common symptoms of OCD

A Review of 20 Years of Research on Overdiagnosis and Underdiagnosis in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project

The Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project represents an integration of research methodology into a community-based outpatient practice affiliated with an academic medical centre. The MIDAS project is the largest clinical epidemiological study using semi-structured interviews to assess a wide range of psychiatric disorders in a general clinical outpatient practice. In an early report from the MIDAS project, we found that across diagnostic categories clinicians using unstandardized, unstructured clinical interviews underrecognized diagnostic comorbidity, compared with the results of semi-structured interviews. Moreover, we found that the patients often wanted treatment for symptoms of disorders that were diagnosed as comorbid, rather than principal, conditions. This highlighted the importance, from the patient's perspective, of conducting thorough diagnostic interviews to diagnose disorders that are not related to the patient's chief complaint because patients often desire treatment for these additional diagnoses. While several of the initial papers from the MIDAS project identified problems with the detection of comorbid disorders in clinical practice, regarding the diagnosis of bipolar disorder we observed the emergence of an opposite phenomenon-clinician overdiagnosis. The results from the MIDAS project, along with other studies of diagnosis in routine clinical practice, have brought to the forefront the problem with diagnosis in routine clinical practice. An important question is what do these findings suggest about the community standard of care in making psychiatric diagnoses, and whether and how the standard of care should be changed? The implications are discussed.

Using self‐ and informant reports in the assessment of personality pathology in clinical settings—An easy and effective 1–2 combination.

Samuel's (2015) review convincingly demonstrates that the use of unstructured clinical interviews to arrive at diagnoses of personality disorders is problematic at best. For a variety of reasons, clinicians are unlikely to begin using semi-structured interviews to arrive at more reliable and valid diagnoses. Given this, we suggest clinicians more routinely use self- and informant reports of personality pathology. We review evidence suggesting that extant concerns about the ability and willingness of the self and others to provide such reports are overstated. Further, we briefly review evidence supporting the validity and utility of such reports.

Association of Metacognitive Beliefs, Obsessive Beliefs and Symptom Severity With Quality of Life in Obsessive–Compulsive Patients

The aim of this study was to evaluate the association of obsessive beliefs, obsessive–compulsive disorder severity and metacognitive beliefs to the quality of life in patients with obsessive–compulsive disorder (OCD). Sixty one adults with a principal diagnosis of OCD were recruited for the study. Participants were assessed by trained clinicians using an unstructured clinical interview, the Obsessive Beliefs Questionnaire, the Yale–Brown Obsessive–Compulsive Scale, the Metacognitive Beliefs Questionnaire and the WHO Quality of Life Questionnaire. Data were analyzed using Pearson's of correlation coefficients and multiple regression analyses. Findings indicate that obsessive beliefs, severity total OCD and metacognitive beliefs were associated with total quality of life scores. Regression analysis revealed that while OCD total severity explained 40.1% of the variance in total quality of life, obsessive beliefs (perfectionism/certainty domain) and metacognitions (cognitive self-consciousness and negative beliefs about thoughts in general) explained an additional 13.7%, 7.7% and 5.4% of the variance in QoL. Findings indicate that the metacognitive beliefs associated with OCD symptom severity are different from that associated with quality of life. The implications are that metacognitive therapy aimed at symptom reduction may not necessarily result in improved QoL in OCD patients.

Therapeutic Risk Management of the Suicidal Patient

This column is the second in a series presenting a model for therapeutic risk management of the suicidal patient. As discussed in the first part of the series, the model involves several elements including augmenting clinical risk assessment with structured instruments, stratifying risk in terms of both severity and temporality, and developing and documenting a safety plan. This column explores in more detail how to augment clinical risk assessment with structured instruments. Unstructured clinical interviews have the potential to miss important aspects of suicide risk assessment. By augmenting the free-form clinical interview with structured instruments that demonstrate reliability and validity, a more nuanced and multifaceted approach to suicide risk assessment is achieved. Incorporating structured instruments into practice also serves a medicolegal function, since these instruments may become a living part of the medical record, establishing baseline levels of suicidal thoughts and behaviors and facilitating future clinical determinations regarding safety needs. We describe several instruments used in a multidisciplinary suicide consultation service, each of which has demonstrated relevance to suicide risk assessment and screening, ease of administration, and strong psychometric properties. In addition, we emphasize the importance of viewing suicide risk assessment as an ongoing process rather than as a singular event. Finally, we discuss special considerations in the evolving practice of risk assessment.

Determinants of health-related quality of life in morbid obese candidates to gastric banding.

To analyse determinants of self reported health-related quality of life (HR-QoL) in morbid obese patients candidates to laparoscopic adjustable gastric banding (LAGB). Determinants of HR-QoL were investigated in 383 morbid obese patients (82 M and 301 F) with BMI≥40 kg/m² (BMI≥35 kg/m² if complicated obesity) and age 18-60 years. HR-QoL was determined with the SF-36 questionnaire. Determinants of the two summary measures of SF-36 (physical component and mental component) were analysed by stepwise multiple linear regression analysis with age, BMI, physical comorbidites, mental comorbidites and eating behaviour disorders as independent variables. Physical comorbities (diabetes, hypertension, hypertriglyceridemia, low HDL, sleep apnea and osteoarthritis) were coded as present or absent on the basis of simple diagnostic clinical criteria; mental comorbidities (depression) and eating behaviour disorders (binge eating, sweet eating and nibbling) on the basis of an unstructured clinical interview. Mean age was 38.8±10.2 years and mean BMI was 41.5±5.4 kg/m². Scores in the eight SF-36 subscales were lower in women than in men and lower than in the general Italian population. However, 18.4-43.5% of the participants had HR-QoL levels above the normative values, depending on the scale. In both genders, low scores in the mental component of the SF-36 were associated to the presence of depression and eating behaviour disorders and not to physical comorbidities or BMI levels. Low physical self-perceived well being was associated to high BMI levels in men and to depression, hypertension and hypertriglyceridemia in women. HR-QoL was poor in morbid obese candidates to LAGB, particularly in women, and was negatively affected more by mental comorbidites and eating behaviour disorders than by physical comorbidities or BMI levels.

Energetic and Cell Membrane Metabolic Products in Patients with Primary Insomnia: A 31-Phosphorus Magnetic Resonance Spectroscopy Study at 4 Tesla

Primary insomnia (PI) is a sleep disorder characterized by difficulty with sleep initiation, maintenance, and/or the experience of nonrestorative sleep combined with a subsequent impairment of daytime functioning. The hyperarousal hypothesis has emerged as the leading candidate to explain insomnia symptoms in the absence of specific mental, physical, or substance-related causes. We hypothesized that the cellular energetic metabolites, including beta nucleoside triphosphate, which in magnetic resonance spectroscopy approximates adenosine triphosphate (ATP), and phosphocreatine (PCr), would show changes in PI reflecting increased energy demand. Matched-groups, cross-sectional study performed at two university-based hospitals. Sixteen medication-free individuals (eight males, eight females; mean ± standard deviation (SD) age = 37.2 ± 8.4 y) with PI and 16 good sleepers (nine males, seven females; mean ± SD age = 37.6 ± 4.7 y). Diagnosis was established for all individuals by unstructured clinical interview, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID), sleep diary, and actigraphy. Polysomnography was collected in individuals with PI. Phosphorous magnetic resonance spectroscopy (31P MRS) data were collected on all individuals at 4 Tesla. We assessed cell membrane (anabolic precursors and catabolic metabolites) and bioenergetic (ATP, phosphocreatine) metabolites in gray matter and white matter to determine their relationship to the presence and severity of PI. Individuals with PI showed lower phosphocreatine in gray matter and an unexpected decrease of phosphocholine, a precursor of the cell membrane compound phosphatidylcholine, in white matter. In addition, there was a trend toward a negative association between polysomnographically determined wake after sleep onset and gray matter beta-nucleoside triphosphate and white matter phosphocholine in the primary insomnia group. These results support the hyperarousal hypothesis in PI based on lower phosphocreatine in gray matter in the PI group.

Comorbidity of attention-deficit/hyperactivity disorder and bipolar disorder in North Indian clinic children and adolescents

ObjectiveThis study examined comorbidity between attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BPD) in children attending child and adolescent psychiatry (CAP) services in a Medical University in North India. MethodsChildren attending CAP services, old or new, were assessed using unstructured clinical interview, kiddie-Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version (K-SADS-PL), Mental State Examination (MSE) for ADHD, Child Mania Rating Scale (CMRS) Parent Version and Children's Global Assessment Scale (C-GAS). Information was collected from both children and parents. All children were clinically evaluated, and prospectively followed up. The diagnosis was made by consensus. Subjects with DSM-IV-TR diagnosis of ADHD, BPD, and ADHD+BPD were compared with each other. Research criteria for broad phenotype BPD were applied in ADHD subjects without DSM-IV-TR diagnosis of BPD. Results45 subjects had ADHD; 21, BPD and; 7 had lifetime DSM-IV-TR diagnosis of ADHD+BPD. 13.5% of ADHD subjects had comorbid BPD and 25% of BPD subjects had comorbid ADHD. ADHD-CT was the most common subtype of ADHD. Nearly two third of BPD subjects had their first mood episode before 13 years of age. ADHD+BPD subjects were more likely to be mentally retarded and have longer duration of mood episode compared to BPD subjects. Three subjects with DSM-IV-TR diagnosis of ADHD without BPD were additionally diagnosed with broad phenotype of BPD. ConclusionsVariable comorbidity rates of ADHD+BPD in different studies are most likely due to differences in study setting, study sample, conceptualization of BPD and assessment methods.

Quality of life in obsessive-compulsive disorder: The role of mediating variables

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

Présentation de l’Entretien Semi-structuré Multiregistres

Whereas instruments are available to diagnose various psychiatric disorders and to rate their severity, there is a lack of instruments to assess the phenomenology of these disorders, i.e., a set of mental phenomena that compose subjective experience. Our objective is to present a new type of psychopathological interview, aimed to study the phenomenology of mental activity. In developing the Assess_Mind, we tried to integrate within one single instrument the qualities of unstructured clinical interviews, such as openness to unexpected information, and the qualities of structured interviews, such as adequate psychometric properties. The basic principle of the Assess_Mind is to explore various “registers” of mental activity: affects, fears, desires, memories, and associations of ideas. This exploration is based on open, but standardized, questions. A rigorously defined algorithm for interviewing indicates which question is to be asked, dependent on the responses of the patient and on the chronological progression of the interview. After the interview is completed, a rating module comprising specific scales allows to assess clinical information that has been collected. We expect that the Assess_Mind will contribute to help clinicians to perform initial assessments of patients and to follow the course of their clinical state.

How do eating disorder specialist clinicians apply DSM-IV diagnostic criteria in routine clinical practice? Implications for enhancing clinical utility in DSM-5

The clinical utility of the DSM-IV eating disorder (ED) diagnostic criteria among practicing clinicians has not been formally evaluated, despite the considerable diagnostic challenges these disorders present. This study evaluated inter-rater reliability between research and clinical diagnoses, identified discrepantly rated diagnostic criteria, and evaluated ED subtype use in a naturalistic treatment setting. Seventy-six adolescent and young adult female patients consecutively admitted to a residential ED program were evaluated independently by clinicians (unstructured clinical interview) and research assessors (Structured Clinical Interview for DSM-IV). Clinicians and research assessors conferred concordant ED diagnoses in 80.3% of cases ( κ = 0.70), thus highlighting the clinical utility of the extant DSM-IV diagnostic scheme in this specialty ED treatment setting. All but two discordant cases included a diagnosis of ED not otherwise specified (EDNOS). Clinicians applied ED subtypes in just 20.4% of eligible cases, and were significantly more likely to apply subtypes to major depressive disorder. Although clinical and research interviews yielded substantial reliability, EDNOS had the lowest reliability among the ED diagnoses. Moreover, infrequent subtype application on this specialty unit raises questions about the clinical utility of DSM-IV anorexia nervosa and bulimia nervosa subtypes, even in the context of clinically useful overarching categories.