Research report

Assessing the diagnostic validity of a

structured
psychiatric interview in a first-admission
hospital sample
JULIE NORDGAARD, RASMUS REVSBECH, DITTE SBYE, JOSEF
PARNAS
World Psychiatry 2012;11:181-185

Abstract
structured
psychiatric
interviews

performed
by nonclinicians

The validity of such

interviews has rarely
been evaluated
empirically.

research
purposes

Abstract
In this study of a sample of 100 diagnostically Heterogeneous; firstadmitted inpatients
the results of an assessment with the
Structured Clinical Interview for DSM-IV
(SCID)yielding a DSM-IV diagnosis and
performed by a trained non-clinician

a consensus lifetime best

diagnostic estimate (DSM-IV) by
two experienced research
clinicians

based on multiple sources of information

The sensitivity and specificity for the diagnosis of schizophrenia by SCID were
19% and 100%, respectively

The overall
kappa
agreement
was 0.18

Abstract
It is concluded that structured
interviews performed by nonclinicians are not
recommendable for clinical
work and should only be used
in research with certain
precautions.

keywords

Structure
d
interview

It is suggested that a revival

of systematic theoretical and
practical training in
psychopathology is an
obvious way forward in order
to improve the validity and
therapeutic utility of
psychiatric diagnosis.

diagnosis

schizophreni
a spectrum

Psychopathology

Sample

Sampl
The study was
e
carried out at the
Psychiatric Center
Hvidovre,
a department of the
University of
Copenhagen

All consecutive first admissions,

18 months,
from june 2009

Sixteen patients declined to

participate in the study
Inclusion Criteria :
- patients had to be considered
capable of tolerating
lengthy interviews
- to provide informed
consent.

Exlution Criteria:
- comprised primary or clinically
dominating alcohol/substance
abuse,
- history of brain injury,
- mental retardation,
- organic brain disorder, and
- age >65 years.

The final sample : 34 men and 66

women, a mean age
of 27.7 years ( 18-65 yo),
representing 82% of the
patients initially invited to
participate.

Six patients had to be excluded

after enrolment

The cross-tabulation of SCID and

CLBE diagnoses

Intervie
ws

Statistic
s

RESULT
S

The corresponding kappa between SSCI and

CLBE was 0.92.

The kappa of the overall diagnostic

concordance between these two approaches
was 0.18.

Using the CLBE as gold

standard, the sensitivity and
specificity of the SCID for
schizophrenia alone were
19% and 100%, respectively.

The kappa agreement between the SCID

and the CLBE with the sample dichotomized
into the schizophrenia spectrum
(schizophrenia, other psychosis, schizotypal
disorder) vs. not-spectrum (all other
diagnoses combined) was 0.31.

RESULT

DISCUSSIO
N

DISCUSSION
A limitation of this study is that the patient
selection tended
to eliminate flamboyant psychotic cases,
making the sample
diagnostically more difficult

DISCUSSION

The overall agreement between

the SCID-derived and CLBE DSMIV diagnoses was very low

(kappa 0.18).

DISCUSSION
SCID

tended to diagnose more

patients with major depression
and fewer with schizophrenia
and schizotypal disorder.

Monosyllabic response to a question of the structured interview

was often short of crucial psychopathological information

DISCUSSION

Lack of
diagnostic
realibility

Incompatible
with
psychiatriys
scientific
aspirations

Revoluti
on in
psychiat
ry

DISCUSSION
SCID

I
in order to :
Circumvent the
complexities of human
sebjectivity, discourse
and communication

Aspires to :
achieving a quasi
experimental
stimulus-response purity
of the behavioristic
paradigm

how to elicit, explore

and convert the
patients
experience(firstperson perspective)
into a third-person
data format,used for
the diagnostic
allocation, is
unaddressed

SCID
Yes/ No
questio
n

yes is confirmatory
of the diagnostic criterion being
asked about. That
confidence reflects another implicit
belief, namely that the
symptoms have their mode of
existence as ready-made, well
defined
and well-articulated mental objects
in the patients
consciousness,

DISCUSSION
CLINICIA
N

Granted the liberty for contextually

appropriate in-depth conversation with
the patient

no strikingly
evident
improvement in the
reliability
and the validity of
clinicians
diagnoses

a general decline in
psychopathological
competence

consequence
of the
operational
revolution

DISCUSSION

DISCUSSION
CONCLUSIO
N
a poor diagnostic performance of a
structured psychiatric interview
conducted
by a for-the-purpose trained nonclinician