The series of instruments developed by Spitzer and his colleagues at Biometrics of the New York State Psychiatric Institute have been of several different kinds and, in the early years at least, had a much more rigid structure than the PSE. Users of the Mental Status Schedule and the longer Psychiatric Status Schedule were instructed to follow the order of the questions as printed in the schedule, the only deviation from this being a repetition of the same questions if thought necessary by the interviewer. However, later instruments such as the Schedule for Affective Disorders and Schizophrenia (56) and, more recently, the Structured Clinical Interview for DSM-III and DSM-IV(61> allow more flexibility for the interviewer in both interview style and the choice of a little or a lot of training (despite its length, the Structured Clinical Interview for DSM is recommended for clinical use as well as for research). There has also been an increasing tendency for instruments from the New York group to be dedicated to a particular purpose. For instance, the content of the Schedule for Affective Disorders and Schizophrenia is keyed towards the study of relationships between schizophrenia and affective disorders, and the Structured Clinical Interview for DSM contains only those items that are necessary for identifying disorders present in the corresponding DSM. Like the Diagnostic Interview Schedule mentioned in the next section, the Schedule for Affective Disorders and Schizophrenia and the Structured Clinical Interview for DSM have a 'top-down' structure, meaning that their content is determined from the start by an already existing set of criteria or symptoms.
The instruments produced by these two centres in the 1960s and 1970s have been used widely in many countries, and their success led to the production of many similar instruments by other researchers. The adoption of the PSE for use by the WHO in a number of international collaborative studies also led to its being translated into more than 25 languages, with varying but never extensive degrees of adaptation to fit the different cultures and social settings involved.
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