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Josef Parnas - One of the best experts on this subject based on the ideXlab platform.
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The Psychiatric Interview: validity, structure, and subjectivity
European Archives of Psychiatry and Clinical Neuroscience, 2013Co-Authors: Julie Nordgaard, Louis A. Sass, Josef ParnasAbstract:There is a glaring gap in the Psychiatric literature concerning the nature of Psychiatric symptoms and signs, and a corresponding lack of epistemological discussion of psycho-diagnostic Interviewing. Contemporary clinical neuroscience heavily relies on the use of fully structured Interviews that are historically rooted in logical positivism and behaviorism. These theoretical approaches marked decisively the so-called “operational revolution in psychiatry” leading to the creation of DSM-III. This paper attempts to examine the theoretical assumptions that underlie the use of a fully structured Psychiatric Interview. We address the ontological status of pathological experience, the notions of symptom, sign, prototype and Gestalt, and the necessary second-person processes which are involved in converting the patient’s experience (originally lived in the first-person perspective) into an “objective” (third person), actionable format, used for classification, treatment, and research. Our central thesis is that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects. We claim that in order to perform faithful distinctions in this particular domain, we need a more adequate approach, that is, an approach that is guided by phenomenologically informed considerations. Our theoretical discussion draws upon clinical examples derived from structured and semi-structured Interviews. We conclude that fully structured Interview is neither theoretically adequate nor practically valid in obtaining psycho-diagnostic information. Failure to address these basic issues may have contributed to the current state of malaise in the study of psychopathology.
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assessing the diagnostic validity of a structured Psychiatric Interview in a first admission hospital sample
World Psychiatry, 2012Co-Authors: Julie Nordgaard, Rasmus Revsbech, Ditte Saebye, Josef ParnasAbstract:The use of structured Psychiatric Interviews performed by non-clinicians is frequent for research purposes and is becoming increasingly common in clini-cal practice. The validity of such Interviews has rarely been evaluated empirically. In this study of a sample of 100 diagnostically heterogeneous, first-admitted 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, were compared with a consensus lifetime best diagnostic estimate (DSM-IV) by two experienced research clinicians, based on multiple sources of information, which included videotaped comprehensive semi-structured narrative Interviews. The overall kappa agreement was 0.18. The sensitivity and specificity for the diagnosis of schizophrenia by SCID were 19% and 100%, respectively. It is concluded that structured Interviews performed by non-clinicians are not recommendable for clinical work and should only be used in research with certain precautions. 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.
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a semi structured phenomenologically oriented Psychiatric Interview descriptive congruence in assessing anomalous subjective experience and mental status
Clinical Neuropsychiatry, 2012Co-Authors: Clinical Neuropsychiatry, Julie Norgaard, Josef ParnasAbstract:Objective: The contemporary methodology in obtaining psychopathological information relies almost exclusively on the use of structured questionnaires and Interview schedules. These Interviews yield high interrater reliability and reduce cost. The assessments of anomalous self-experience and of mental status (disorders of experience and expression) are often considered as “soft”, “subjective” and hence unreliable. In spite of the advantages of the structured Interviews, concerns have been raised about the epistemological coherence and the validity of the structured Interviews. To examine the interrater congruens between experienced clinicians with a semi structured, phenomenologically oriented psychopathological Interview assessing anomalous self-experience and mental status. Method: Seventeen inpatients were Interviewed by one of the raters, with both raters were present. The Interview comprised of a thorough psychosocial history and the EASE–scale. Results: The interater-congruens for the total EASE-scale showed nearly perfect agreement with kappa=0.94. The interrater-reliablility for the MSE assessment showed substantial to complete agreement with kappa above 0.81, except for four items: “Withdrawn/shy” (kappa=0.77), “Suspicious, guarded and hostile” (kappa=0.77), “Raport insecure and anxious” (kappa=0.76), “Restless” (kappa=0.64). Conclusions: High interrater-congruens can be achieved for the assessment of anomalous self-experience and mental status in the context of conversational, phenomenological-oriented semi-structured Interview. Limitations: The major limitation of the study is a relatively small sample size, conditioned by the time-consuming nature of the individual Interviews. Second, we should have included a measurement of reliability in a less experiencedrecently EASE-introduced rater, since it is that kind of researchers that are typically enrolled for the empirical data collections.
Geoffrey C. Dunbar - One of the best experts on this subject based on the ideXlab platform.
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The Mini-International NeuroPsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic Psychiatric Interview for DSM-IV and ICD-10
Journal of Clinical Psychiatry, 1998Co-Authors: David V. Sheehan, K. Harnett Sheehan, Juris Janavs, Emmanuelle Weiller, Thierry Hergueta, Roxy Baker, P Amorim, Yves Lecrubier, Geoffrey C. DunbarAbstract:The Mini-International NeuroPsychiatric Interview (M.I.N.I.) is a short structured diagnostic Interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 Psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured Psychiatric Interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of Interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this Interview.
Rajesh Sagar - One of the best experts on this subject based on the ideXlab platform.
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study of dsm iv axis i Psychiatric disorders in patients with refractory complex partial seizures using a short structured clinical Interview
Epilepsy & Behavior, 2010Co-Authors: Soaham Desai, Garima Shukla, Vinay Goyal, Sumit Singh, M V Padma, Manjari Tripathi, Achal K Srivastava, Mamta Bhushan Singh, K Shivakumar, Rajesh SagarAbstract:Abstract Psychiatric disorders are a source of significant comorbidity in patients with refractory epilepsy, yet are often underrecognized. We assessed the prevalence of DSM-IV Axis I Psychiatric disorders using a short structured clinical Interview (Mini-International Psychiatric Interview [MINI]) in patients with medically refractory complex partial seizures. Consecutive patients with refractory epilepsy being evaluated with video/EEG monitoring and imaging for seizure focus localization and lateralization underwent MINI evaluation to assess for the presence of Psychiatric disorders. Among 117 patients (74 male, 43 female) studied, 57 (48.7%) had at least one Psychiatric disorder; 19 (16.2%) had depression, 10 (8.5%) dysthymia, 27 (23.0%) anxiety disorder, and 11(9.4%) other disorders. Most clinical features and epilepsy-related variables had no significant association with Psychiatric disorder on logistic regression analysis. Almost half of the patients with refractory focal seizures have a coexistent Psychiatric disorder, and its presence or absence cannot be predicted by their clinical profiles. All patients should be assessed and treated for Psychiatric comorbidity to improve overall quality of life.
Glyn Lewis - One of the best experts on this subject based on the ideXlab platform.
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investigating the effect of demographic and socioeconomic variables on misclassification by the srq 20 compared with a Psychiatric Interview
Social Psychiatry and Psychiatric Epidemiology, 2005Co-Authors: Ana Bernarda Ludermir, Glyn LewisAbstract:Previous research among primary care attenders in Latin America has noted that females and those with less education may over-report Psychiatric complaints on the SRQ-20, compared with responses to a standardized Psychiatric Interview administered by a clinician. In this paper, the association between demographic and socioeconomic variables and misclassification by the SRQ-20 were investigated and the size of misclassification estimated in a population-based survey. A cross-sectional survey of a random sample of private households included 683 adults aged 15 years and over living in Olinda, Recife Metropolitan Region, Pernambuco, Brazil. The SRQ-20 results were compared with an Interview administered by a psychiatrist. The effect of demographic and socioeconomic variables on misclassification by the SRQ-20 was assessed by calculating the odds ratio (OR) for being a case on the SRQ-20 after adjustment for being a case on the Psychiatric Interview. Logistic regression was used to investigate the size of misclassification, adjusting the association between common mental disorders, defined by the SRQ-20,and different variables for the Psychiatric Interview results. In the univariate analysis, females, the elderly, the less educated, manual workers, housewives and migrants did tend to over-report complaints in the absence of symptoms. However, the apparent influence of age, education, occupation and migration on misclassification by the SRQ-20 was markedly reduced and became statistically non-significant after adjustment for sex and for the other variables in the table. In contrast, the gender effect was not altered after adjustment. Our results suggest that misclassification on the SRQ-20 was mostly related to being female, though this did not entirely explain the increased prevalence of CMD in women in the sample. Further research is needed to understand why different ways of measuring CMD can lead to different results.
Julie Nordgaard - One of the best experts on this subject based on the ideXlab platform.
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The Psychiatric Interview: validity, structure, and subjectivity
European Archives of Psychiatry and Clinical Neuroscience, 2013Co-Authors: Julie Nordgaard, Louis A. Sass, Josef ParnasAbstract:There is a glaring gap in the Psychiatric literature concerning the nature of Psychiatric symptoms and signs, and a corresponding lack of epistemological discussion of psycho-diagnostic Interviewing. Contemporary clinical neuroscience heavily relies on the use of fully structured Interviews that are historically rooted in logical positivism and behaviorism. These theoretical approaches marked decisively the so-called “operational revolution in psychiatry” leading to the creation of DSM-III. This paper attempts to examine the theoretical assumptions that underlie the use of a fully structured Psychiatric Interview. We address the ontological status of pathological experience, the notions of symptom, sign, prototype and Gestalt, and the necessary second-person processes which are involved in converting the patient’s experience (originally lived in the first-person perspective) into an “objective” (third person), actionable format, used for classification, treatment, and research. Our central thesis is that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects. We claim that in order to perform faithful distinctions in this particular domain, we need a more adequate approach, that is, an approach that is guided by phenomenologically informed considerations. Our theoretical discussion draws upon clinical examples derived from structured and semi-structured Interviews. We conclude that fully structured Interview is neither theoretically adequate nor practically valid in obtaining psycho-diagnostic information. Failure to address these basic issues may have contributed to the current state of malaise in the study of psychopathology.
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assessing the diagnostic validity of a structured Psychiatric Interview in a first admission hospital sample
World Psychiatry, 2012Co-Authors: Julie Nordgaard, Rasmus Revsbech, Ditte Saebye, Josef ParnasAbstract:The use of structured Psychiatric Interviews performed by non-clinicians is frequent for research purposes and is becoming increasingly common in clini-cal practice. The validity of such Interviews has rarely been evaluated empirically. In this study of a sample of 100 diagnostically heterogeneous, first-admitted 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, were compared with a consensus lifetime best diagnostic estimate (DSM-IV) by two experienced research clinicians, based on multiple sources of information, which included videotaped comprehensive semi-structured narrative Interviews. The overall kappa agreement was 0.18. The sensitivity and specificity for the diagnosis of schizophrenia by SCID were 19% and 100%, respectively. It is concluded that structured Interviews performed by non-clinicians are not recommendable for clinical work and should only be used in research with certain precautions. 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.
