Mental health articles

diagnostic criteria
Structured Clinical Interviews
There is no definitive diagnostic tool available for making any psychiatric diagnosis, but the clinical interview currently stands as the linchpin of a multiaxial, multimodal assessment protocol. With a goal of improving diagnostic validity and reliability, a number of structured and semistructured clinical interviews have been developed to assess psychological and psychiatric problems. The Structured Clinical Interview for DSM-IV was designed for use by trained clinicians to assess signs and symptoms of both Axis I and Axis II disorders. The interview is divided into modules that assess the presence of major categories of disorders and also assess specific diagnoses within each category. The format of the interview is such that the diagnostic criteria are presented concurrently with the stem questions to assess the presence of each DSM diagnostic criterion.
However, the stem questions are not intended to be used in the absence of further probing by the clinician. The original PTSD module of the SCID was developed for use in the National Vietnam Veterans Readjustment Study; consequently, considerable data have been collected regarding the reliability and the validity of the PTSD module in a veteran population. In the NVVRS, interrater reliability for the DSM-III version of the PTSD module was .933 (kappa coefficient). Additionally, the correspondence in PTSD diagnosis between the SCID and other measures of PTSD (e.g., Mississippi Scale for CombatRelated PTSD, the Keane et al. MMPI-PTSD subscale) was high. As the diagnostic criteria for PTSD (and other psychiatric disorders) have been revised, subsequent versions of the SCID have been revised to correspond to current nosological specifications. As researchers and clinicians have gained a better understanding of the complexities of PTSD and its co-occurrence with other psychiatric disorders, recognition of the importance of the capacity to assess comorbid disorders has been commensurate. Instruments such as the SCID that assess the full spectrum of Axis I and Axis II diagnoses offer a decided advantage in this regard. However, the same concerns about ensuring reliable and valid diagnosis apply to assessing these comorbid conditions. Fortunately, the SCID has been fairly rigorously tested across the diagnostic spectrum. For example, the SCID has been shown reliable when distinguishing major depressive disorder from generalized anxiety disorder. In child and adolescent assessment, the Diagnostic Interview for Children and Adolescents— Revised offers an approach similar to that of the SCID; that is, the instrument assesses several DSM-IV disorders, including PTSD. A four-point rating scale of symptom frequency is part of this assessment. Examination of the reliability of the PTSD module has indicated good interrater reliability; however, validity studies of the PTSD module of the DICAR revealed variable sensitivity and specificity. Several interviews have been designed that are narrower in focus; that is, they were developed for assessing PTSD exclusively. One notable example of this type of interview is the Clinician Administered PTSD Scale. The CAPS was designed to address the shortcomings of previously developed structured interviews for diagnosing PTSD.
The CAPS is a comprehensive interview that (1) uses behavioral referents for symptoms when feasible; (2) assesses all DSM-IV criteria, as well as a selected sample of relevant associated features; (3) provides separate intensity and frequency ratings of symptoms; (4) specifically establishes that the time frame for symptom occurrence is consistent with diagnostic criteria; and (5) determines both current and lifetime symptoms. Additionally, the CAPS provides ratings of global functioning and of the impact of PTSD symptoms on relevant areas of life functioning. Evaluations of reliability and validity indicate strong psychometric performance. Initial examinations of interrater reliability were quite good (at the symptom level, r ranges from .92 to .99, and there is perfect agreement at the diagnostic level), and subsequent examinations of test–retest reliability for PTSD were .89. Weathers, Blake et al. also found a coefficient alpha of .89, and compared to a SCID PTSD diagnosis, they obtained a sensitivity of .91, a specificity of .86, and a kappa of .77. Additionally, the CAPS has shown strong correlation with other psychometric measures of PTSD, including the Mississippi Scale and the PK Scale of the MMPI. Recent additions to the CAPS include changes to accommodate DSM-IV symptom revisions, as well as additional questions to assess trauma exposure in more detail. A version of the CAPS for use with children has also been developed—the CAPS-C. This instrument is based on DSM-IV diagnostic criteria but also includes the assessment of additional symptoms/features that have been documented in children.
Assessment of academic and social functioning are also included in the CAPSC. This relatively new instrument has not yet reached full psychometric maturity but shows promise, particularly given the full range of symptoms and functional variables that are assessed. There is some indication, however, that the length and the demand of completing the rating scales may be problematic for younger children. In this section, we have provided only a brief introduction to the types of clinical interviews and approaches now available for assessing PTSD, as well as examples of some of the more notable of these interviews. Other choices of clinical interviews that are currently available are delineated and reviewed more extensively in other sources.

Tags: diagnostic, disorder, PTSD, stress