DSM Assessment

[BSWdavid]

Anyone have any recommendations for a good DSM-IV assessment tool? I've worked with the SCID but find it to be a bit complicated and often more trouble than it is worth. As I am still in the process of learning, any recommendations would be most helpful.

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[Therapist4Chnge]

If I had time/flexibility
MMPI-2 or MCMI-3
PAI
Semi-structured clinical interview
A few screeners, dependent on what is suspected. I like them as a place to start for differentials (tease out somatic complaints, etc).

More realistically
A few screeners
Semi-structured clinical interview

I've conduct a semi-structured interview throughout other assessments so I can add/subtract things on the fly. I started doing it with my neuro assessments, since it complimented some of my limit testing I'd do in addition to my "basics". I prefer at least two appointments to look for inconsistencies.....though that is less realistic in many settings.

As for screeners.....it all depends on what is suspected. MMSE, Cognistat, or RBANS to look for any gross cognitive issues. BAI/BDI/GDS/BHS/PCL for mood issues. AUDIT or related for alcohol/substance abuse issues. I could go on and on, but I think it is more important to do a solid clinical interview and use objective measures for supporting data.

 

[erg923]

Anyone have any recommendations for a good DSM-IV assessment tool? I've worked with the SCID but find it to be a bit complicated and often more trouble than it is worth. As I am still in the process of learning, any recommendations would be most helpful.

If your looking for something that hold to DSM-IV criteria, might wanna check out the Mini International Neuropsychiatric Interview (MINI). I am not a big fan of the SCIDs overview or PTSD section, but if you are properly trainied in its conduction (which requires a very high-level understanding of what the disorder criteria truely mean and why they are there), Im not sure what is "complicated" about it....

 

[BSWdavid]

If your looking for something that hold to DSM-IV criteria, might wanna check out the Mini International Neuropsychiatric Interview (MINI). I am not a big fan of the SCIDs overview or PTSD section, but if you are properly trainied in its conduction (which requires a very high-level understanding of what the disorder criteria truely mean and why they are there), Im not sure what is "complicated" about it....

Well, I guess I have found the SCID to be a bit complicated in learning. I imagine once one has a good grasp on how to use it, it is fairly simple. I think the problem is most clinical settings that I have worked/interned in don't allow enough time to perform a proper diagnostic assessment.

 

[Ollie123]

The only complicated thing about the SCID (beyond the obvious issues regarding the nuances of diagnosis and when criteria actually apply) is the format of the thing. I'm convinced the copy editor was in the midst of a manic episode, high on meth, and probably not too good at their job even independent of the above during the time it was developed.

You're not going to find an easy path to diagnosis (at least not a valid one), because the reality is that it IS complicated. If you are looking for pure efficiency of administration, I'll second the use of the MINI. Administration time is about half that of the SCID, and is about as valid for most diagnoses. In fact, I'm trying to convince my lab to switch from the SCID to the MINI for future research. We have way too many studies going on for the SCID to be a practical option since participants have to be scheduled around the time of grad student and faculty availability, take an immense amount of time, etc. That said, I actually dislike how the validation research is done on these measures (i.e. I'm not convinced someone diagnosed on the SCID but not the MINI constitutes a "False Negative" since that assumes the SCID is correct). It could be better or it could be worse, I'm not sure the research tells us.

Either way the MINI is a bit easier to use and a bit shorter. You sacrifice a bit of depth and information in return. Its designed to be used by people with relatively minimal training (i.e. trained bachelor's level folks) as opposed to clinicians, so it is a bit more straightforward.

 

[Neuropsych2be]

The only complicated thing about the SCID (beyond the obvious issues regarding the nuances of diagnosis and when criteria actually apply) is the format of the thing. I'm convinced the copy editor was in the midst of a manic episode, high on meth, and probably not too good at their job even independent of the above during the time it was developed.

You're not going to find an easy path to diagnosis (at least not a valid one), because the reality is that it IS complicated. If you are looking for pure efficiency of administration, I'll second the use of the MINI. Administration time is about half that of the SCID, and is about as valid for most diagnoses. In fact, I'm trying to convince my lab to switch from the SCID to the MINI for future research. We have way too many studies going on for the SCID to be a practical option since participants have to be scheduled around the time of grad student and faculty availability, take an immense amount of time, etc. That said, I actually dislike how the validation research is done on these measures (i.e. I'm not convinced someone diagnosed on the SCID but not the MINI constitutes a "False Negative" since that assumes the SCID is correct). It could be better or it could be worse, I'm not sure the research tells us.

Either way the MINI is a bit easier to use and a bit shorter. You sacrifice a bit of depth and information in return. Its designed to be used by people with relatively minimal training (i.e. trained bachelor's level folks) as opposed to clinicians, so it is a bit more straightforward.

Let me second Ollie and the others on the MINI. Its shorter than the SCID and easier and quicker to administer. It is fast enough to administer that I can use it in conjunction with a longer semi-structured interview developed by Drew Westen, whose work I admire. In my opinion, a caveat should always be considered. With the DSM-IV, we are working with a diagnostic system developed by another profession, a profession that utilizes a different conceptual model, and the system itself does not have established validity and reliability. The DSM-IV gives us a common nomenclature, and that is immensely useful. However, it would be a mistake to look at the DSM-IV diagnostic labels as having significant intrinsic meaning because reliability and validity of these labels has not been established.

 

[BSWdavid]

The only complicated thing about the SCID (beyond the obvious issues regarding the nuances of diagnosis and when criteria actually apply) is the format of the thing. I'm convinced the copy editor was in the midst of a manic episode, high on meth, and probably not too good at their job even independent of the above during the time it was developed.

You're not going to find an easy path to diagnosis (at least not a valid one), because the reality is that it IS complicated. If you are looking for pure efficiency of administration, I'll second the use of the MINI. Administration time is about half that of the SCID, and is about as valid for most diagnoses. In fact, I'm trying to convince my lab to switch from the SCID to the MINI for future research. We have way too many studies going on for the SCID to be a practical option since participants have to be scheduled around the time of grad student and faculty availability, take an immense amount of time, etc. That said, I actually dislike how the validation research is done on these measures (i.e. I'm not convinced someone diagnosed on the SCID but not the MINI constitutes a "False Negative" since that assumes the SCID is correct). It could be better or it could be worse, I'm not sure the research tells us.

Either way the MINI is a bit easier to use and a bit shorter. You sacrifice a bit of depth and information in return. Its designed to be used by people with relatively minimal training (i.e. trained bachelor's level folks) as opposed to clinicians, so it is a bit more straightforward.

I agree that the format is what is so tricky. There are many different guides to be used, one has to flip to different pages, etc., and I feel that it complicates the assessment process. Even the directions can be difficult to interpret (I often find myself reading them several times trying to understand exactly what to do). Differential diagnosis is difficult enough and I think the SCID complicates the process.

I will have to look into the MINI. Time is always of the essence, but I am considerably concerned by misuse of diagnostic labels. I constantly observe haphazard diagnostic assessments, where clinicians are prematurely assigning labels without taking the time to really differentiate between diagnoses (i.e often assigning an MDD diagnosis when Bipolar should be considered). I am frequently informed that the lack of time makes it difficult to perform a thorough assessment, but in my opinion, whether or not we agree with DSM labels, it can be dangerous to assign diagnoses that are inaccurate. I am quite frustrated and would like to do all that I can to become savvy in differential diagnosis, while observing time constraints; however, I find the SCID's format to be frustrating and time consuming.

 

[BSWdavid]

Let me second Ollie and the others on the MINI. Its shorter than the SCID and easier and quicker to administer. It is fast enough to administer that I can use it in conjunction with a longer semi-structured interview developed by Drew Westen, whose work I admire. In my opinion, a caveat should always be considered. With the DSM-IV, we are working with a diagnostic system developed by another profession, a profession that utilizes a different conceptual model, and the system itself does not have established validity and reliability. The DSM-IV gives us a common nomenclature, and that is immensely useful. However, it would be a mistake to look at the DSM-IV diagnostic labels as having significant intrinsic meaning because reliability and validity of these labels has not been established.

Where can I obtain the MINI?

 

[erg923]

Contact Below:
http://health.usf.edu/medicine/psychiatry/Faculty/staff_sheehan.html

Keep in mind this was specifically developed for epidemiological studies and clinical trials research. I, personally would have little need for this clinically. If you are a good clinician you really should have no problem compiling your own effective unstructured interview format.

 

[BSWdavid]

Contact Below:
http://health.usf.edu/medicine/psychiatry/Faculty/staff_sheehan.html

Keep in mind this was specifically developed for epidemiological studies and clinical trials research. I, personally would have little need for this clinically. If you are a good clinician you really should have no problem compiling your own effective unstructured interview format.

I agree, however, I am a grad student and still learning how to do accurate assessments. For now, I think something structured would be helpful; once I have more experience under my belt, I hope that I can taper off from a structured format.

 

[PsychGraduate]

I agree, however, I am a grad student and still learning how to do accurate assessments. For now, I think something structured would be helpful; once I have more experience under my belt, I hope that I can taper off from a structured format.

getting yourself a good DSM-IV-TR guidebook, one that is the right fit for you to use to find or, in conjunction with, looking at various assessment tools. I personally liked working with the book: DSM-IV-TR In Action by Sophia Dziegielewski. Great book! But do find what works for you. As far as tools to use now, well, you gotta feel them out and get some practice... I would suggest pick one do a mock test run with it first and then go from there...

 

[OneAtATime]

I agree, however, I am a grad student and still learning how to do accurate assessments. For now, I think something structured would be helpful; once I have more experience under my belt, I hope that I can taper off from a structured format.

My suggestion would be to dive in unstructured and learn as you go. I don't know anything about your site and its expectations, but my practicum sites have allowed us to take 3-4 sessions to complete diagnosis, allowing us to ask questions in each session, research and get supervision between, and head back in with more questions to help us get more specific. I'm very grateful for the approach that my department takes (no structured assessments, including not being allowed to take intake paperwork into the session), because I've now developed an ability to run through the intake and diagnostic questions from memory - and fill the forms out later from memory, which allows me to watch the client answer intake questions. I think this helps develop rapport and I've also learned quite a bit from observing body language as people talk. It was a difficult process to learn (memory is not typically one of my strengths!), but I'm a stronger clinician for it.