Diagnostic instruments

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In clinical work, typological diagnosis is based on typical cases, without the need for special instruments. In operationalized diagnosis, however, criteria and algorithms are used and can be supported by the so-called 'instruments' for use by professionals or, with certain restrictions, layworkers. Professionals often work with semistandardized interviews, which means that they have to evaluate the psychopathological picture systematically. Interviews conducted by layworkers must be standardized with questions asked exactly as written and answers recorded exactly so as to preclude any variation in the interview. For this reason certain syndromes are quite difficult to diagnose using standardized interviews, especially the acute psychotic disorders in which many of the patients' answers cannot be taken literally. To facilitate the diagnosis of mental disorders WHO has developed several instruments which are suitable for diagnosis according to both ICD-10 and DSM.

Schedule for Assessment in Neuropsychiatry (SCAN)

The Present State Examination was developed further into SCAN, a structured interview for clinicians. (61> SCAN is a semistandardized interview containing a glossary with definitions of symptoms, an item group checklist, and a questionnaire on the previous history. The interviewer has to use his or her clinical judgement about psychopathology. The interview takes about 60 to 90 minutes.

Composite International Diagnostic Interview (CIDI)

CIDI was developed on the basis of the Diagnostic Interview Schedule (DIS), and has been translated into a number of languages.(62) After several days of training both professionals and lay interviewers can use CIDI. In this standardized interview the answers of the interviewee are decisive. The interview takes about an hour.

International Personality Disorder Examination (IPDE)

IPDE was developed to diagnose personality disorders. (63> It should be used by experienced clinicians. The ICD-10 International Symptom Checklists (ISCL)

ISCL enables the severity, cause, and duration of syndromes to be judged. (64,6.5,) The Symptom Checklist (SCL) can be used as a screening instrument, while more exact ICD-10 diagnoses can be formulated using 32 International Diagnoses Checklists (IDCL). Another checklist, the IDCL-P,(6.6) was developed especially for personality disorders in accordance with the clinical descriptions and diagnostic guidelines. A further checklist, the ICD-10 Merkmalsliste, containing 750 criteria in 14 groups, has been developed and validated in eight German-speaking centres.(67)

Additional instruments

SIDAM, a structured interview for dementia of the Alzheimer type, multi-infarct dementia, or vascular dementia, for diagnosis of dementias according to DSM or ICD-10 was published in 1996.(68) Diagnostic instruments are considered further in Chapteil...10.1.

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