FINANCIAL DISCLOSURES: Dr. Kotwicki is the Medical Director of Skyland Trail. He reports no other conflicts of interest. Dr. Harvey is a member of
the National Advisory board of Skyland Trail and is compensated for this service.
KEY WORDS: Bipolar disorder, psychosis, structured diagnoses, validity
ABSTRACT clinician diagnoses and those appears to be a reasonable trade-off
Background. Psychiatric generated by structured interviews. between brevity and accuracy
diagnoses are important for The same three interviewers through the use of the MINI
treatment planning. There are a examined all patients in all three compared to the SCID, with
number of current challenges in the phases of the study. substantial improvements in stability
area of psychiatric diagnosis with Results. Admission and discharge of diagnoses compared to clinician
important treatment implications. In diagnoses were available for 313 diagnoses. Clinical diagnoses were
this study, we examined the cases. Diagnoses generated with the minimally overlapping with the
differential usefulness of two semi- unstructured procedure were results of structured diagnoses,
structured interviews of differing changed by discharge 74 percent of suggesting that structured
length compared to clinical diagnoses the time, compared to four percent assessment, particularly early in the
for generation of diagnoses that did for SCID diagnoses and 11 percent illness or in short term treatment
not require modification over the for MINI diagnoses. Referring settings, may improve treatment
course of treatment. clinician diagnoses were disconfirmed planning.
Methods. We performed a three- in Years 2 and 3 in 56 percent of
year, three-cohort study at an SCID cases and 44 percent of MINI INTRODUCTION
outpatient psychiatric rehabilitation cases. The distinctions between The reliability of psychiatric
facility, comparing the stability of unipolar and bipolar disorders were diagnoses has improved markedly
admission diagnoses when generated particular points of disagreement, since the introduction of structured
by unstructured procedures relying with similar rates of under and over- psychiatric interviews.1 These
on referring clinician diagnosis, the diagnosis of bipolar disorder. The rate interviews were first developed in the
SCID, and the MINI. We examined of confirmation of referring clinician late 1960s2 and were fine tuned3 up
changes in diagnoses from admission diagnoses of schizoaffective disorder through the time of the introduction
to discharge (averaging 13 weeks) was 10 percent with the SCID and 11 of the the Diagnostic and Statistical
and, during the second two years, percent with the MINI. Manual of Mental Disorders, Third
convergence between referring Discussion. In this setting, there Edition (DSM-III)4 in 1980. At the
14 Innovations in CLINICAL NEUROSCIENCE [VOLUME 10, NUMBER 5–6, MAY–JUNE 2013]
same time, the use of these multiple, newly indicated treatments patients accurate diagnosis is
structured interviews is still not and associated advertising. In important. This is particularly
common in everyday clinical practice, addition, an increased appreciation of relevant to time-limited treatment. As
with most use in research settings. It the fact that bipolar disorders can be interventions such as day treatment
is not clear how much the application marked by brief episodes of or other rehabilitation therapies may
of such interviews would impact the hypomania rather than full manic be approved by insurance payers for
reliability and validity of diagnoses in episodes has increased the challenge delivery only for finite periods,
clinical practice settings, but it seems in discrimination between bipolar and inaccurate targeting of treatment
likely that there are certain unipolar mood disorders. We know interventions early on could lead to
circumstances where the increase in that distinguishing unipolar therapeutic interventions being
validity would be quite substantial. depression and bipolar illness has applied for relatively abbreviated and
The importance of collection of valid socioeconomic and functional potentially inefficacious periods.
assessment data through structured implications.12 Correspondingly, Thus, early identification of the
assessment procedures is contemporary diagnostic trends may eventual diagnosis can lead to
compounded by the problems in self- also incorrectly shape referring enhanced ability to deliver
report seen in multiple psychiatric diagnoses when patients initially appropriate treatments for a larger
conditions;5–7 questionnaire or present for treatment.
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