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You are here : Health.am > Health Centers > Mental Health - DepressionSchizophrenia • • Schizophrenia Diagnosis

Schizophrenia - Interviewing strategies

Schizophrenia • • Schizophrenia DiagnosisMay 13, 2009

The current most widely accepted approach for diagnostic interviewing in psychiatric assessment is the use of structured interviews. The main advantage of structured interviews is that they provide a standardized approach for gathering information, which increases the (interrater)  reliability of the assessment.  Another advantage is that they provide guidelines for determining whether a specific symptom exists or not. On the downside, to benefit fully from the advantages of structured interviews, a fair amount of training, as well as ongoing fidelity evaluation, is required. A comprehensive assessment interview should commence with evaluation of basic characteristics of the disorder, followed by frequently associated features and common comorbid diagnoses. In the following section we focus on interviewing strategies for assessing characteristic symptoms of schizophrenia, recognizing that various assessment instruments can support a given interviewing strategy.

A wide range of assessment instruments, divided primarily into self-report and interview-based instruments, have been developed to evaluate the existence and severity of psychiatric symptoms.  The Structured Clinical Interview for DSM-IV (SCID;  First, Spitzer, Gibbon, & Williams, 1995) is the most widely used diagnostic assessment instrument in the United States for research studies with persons who have psychiatric disabilities. Psychiatric rating scales based on semistructured interviews have also been developed to provide a useful, reliable measure of the wide range of psychiatric symptoms commonly present in people with psychiatric disorders. These scales typically contain from 1–50 or so specifically defined items, each rated on a 5- to 7-point severity scale.

Some interview-based scales have been developed to measure the full range of psychiatric symptoms, such as the Brief Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962) and the Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Fiszbein, 1987), whereas other interview-based scales have been designed to tap specific dimensions, such as the Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1982). The same classification holds true for self-report scales.

Interview-based psychiatric rating scales typically assess a combination of symptoms elicited through direct questioning and symptoms or signs observed in the course of the interview, as well as symptoms elicited by collateral history taking (from caregivers and clinical documentation). For example, in the BPRS, depression is rated by asking questions such as “What has your mood been lately?” and “Have you been feeling down?”.

Ratings of mannerisms and posturing, on the other hand, are based on the behavioral observations of the interviewer. Psychiatric symptom scores can either be added up for an overall index of symptom severity, or summarized in subscale scores corresponding to symptom dimensions,  such as negative,  positive,  and comorbid (affective and other) symptoms.

Abraham Rundisk David Roe

KEY POINTS

  • Schizophrenia is a severe and complex psychiatric disorder; characteristic - positive and negative - symptoms, as well as other impairments, commonly accompany the disorder.
  • Diagnostic interviewing for schizophrenia is facilitated by structured assessment tools.
  • There are various challenges in diagnostic interviewing of people with schizophrenia, for which guidelines can be helpful.
  • Many of the guidelines for diagnostic interviews of people with schizophrenia address clinical communication skills.
  • Differential diagnosis should be given special attention in diagnostic interviews of people with schizophrenia.
REFERENCES
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
  • Andreasen, N. C. (1982). Negative symptoms in schizophrenia: Definition and reliability. Archives of General Psychiatry, 39, 784 - 788.
  • Curson, D. A., Patel, M., Liddle, P. F., & Barnes, T. R. E. (1988). Psychiatric morbidity of a long-stay hospital population with chronic schizophrenia and implications for future community care. British Medical Journal, 297, 819 - 822.
  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders - Patient Edition (SCID-I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.
  • Kay, S. R., Opler, L. A., & Fiszbein, A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261 - 276.
  • Kranzler, H. R., Kadden, R. M., Burleson, J. A., Babor, T. F., Apter, A., & Rounsaville, B. J. (1995). Validity of psychiatric diagnoses in patients with substance use disorders: Is the interview more important than the interviewer? Comprehensive Psychiatry, 36, 278 - 288.
  • Overall, G., & Gorham, D. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799 - 812.
  • Roe, D., & Davidson, L. (2005). Self and narrative in schizophrenia: Time to author a new story. Journal of Medical Humanities, 31, 89 - 94.
  • Roe, D., & Kravetz, S. (2003). Different ways of being aware of and acknowledging a psychiatric disability: A multifunctional narrative approach to insight into mental disorder. Journal of Nervous and Mental Disease, 191, 417 - 424.
  • Roe, D., Lereya, J., & Fennig, S. (2001). Comparing patients and staff member's attitudes: Does patient's competence to disagree mean they are not competent? Journal of Nervous and Mental Disease, 189, 307 - 310.
  • Rudnick, A. (1997). On the notion of psychosis: The DSM-IV in perspective. Psychopathology, 30, 298 - 302.
  • Schuckit, M. A. (1989). Drug and alcohol abuse: A clinical guide to diagnosis and treatment, third edition. New York: Plenum Press.
  • Switzer, G. E., Dew, M. A., Thompson, K., Goycoolea, J. M., Derricott, T., & Mullins, S. D. (1999). Posttraumatic stress disorder and service utilization among urban mental health center clients. Journal of Traumatic Stress, 12, 25 - 39.
  • World Health Organization. (1992). International classification of diseases (ICD-10) (10th ed.). Geneva: Author.

Provided by ArmMed Media

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