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Psychiatry Res. 2001 Dec 31;105(3):255-64.

Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews.

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  • 1Department of Psychiatry, School of Medical Sciences, University of California, Los Angeles, 2406 Astral Drive, Los Angeles, CA 90046, USA.


This study compared structured vs. unstructured interviews for making psychiatric diagnoses. Three clinicians independently diagnosed 56 inpatient-subjects, each using a different method: (1) the unstructured Traditional Diagnostic Assessment (TDA), the standard method of clinical practice; (2) the Structured Clinical Interview for DSM-Clinical Version (SCID-CV), a widely used structured method; and (3) the Computer Assisted Diagnostic Interview (CADI), a structured computer-based method. Once finished, the three clinicians developed a Consensus diagnosis, using Spitzer's LEAD Standard (L=Longitudinal evaluation of symptomatology, E=Evaluation by expert consensus, AD=All Data from multiple sources). Diagnoses were assigned to one of 10 groups (cognitive impairment, general medical condition-induced, alcohol-induced, drug-induced, mania, depression, schizophrenia, schizoaffective, psychosis NOS, and anxiety). Diagnostic accuracy for each method, measured against Consensus, was as follows: TDA-agreement=53.8%, kappa=0.4325 ('fair'); SCID-CV-agreement=85.7%, kappa=0.8189 ('excellent'); CADI -agreement=85.7%, kappa=0.8147 ('excellent'). All three methods reached acceptable levels of diagnostic accuracy. Structured methods (SCID-CV, CADI) were significantly better than the unstructured TDA.

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