The Present State Examination

The Present State Examination (PSE)(62> is a semistructured procedure, based upon an interview schedule containing items that are rated as the interview proceeds. The content of the PSE has always been more or less comprehensive and it contains a number of symptoms, such as worry, muscular tension, restlessness, etc., that are not associated with particular diagnoses. These symptoms are included because they are often clinically obvious and also important to the patient (see comments below on 'bottom-up' and 'top-down' organization of interview schedules).

The ratings made by the interviewer do not depend entirely upon the immediate reply of the subject, but represent the interviewer's clinical judgement as to whether or not the subject has the symptoms as described in the glossary of definitions learned during the interview training. Questions are provided for all the symptoms and items and are used whenever possible in the order provided, but the order may be varied if the interviewer thinks fit. The interviewer is also encouraged to ask any other questions that seem relevant to determine the timing, frequency, and severity of the symptoms, as in an ordinary clinical interview. In other words, the interviewer aims to conduct a clinical interview that has been structured as much as possible so as to allow symptoms to be rated with high inter-rater reliability, but without seeming to be unpleasantly rigid to either the subject or the interviewer. Much practice and training are required before these aims can be achieved, but there is no doubt that it is possible.

The PSE was not developed with any particular diagnostic classification in mind. It was intended from the start simply to be a means of arriving at a comprehensive and defined set of symptoms described in a reliable manner, with the user being left to decide whether and how to condense the symptoms into groups and what to do with the results. This is sometimes referred to as a 'bottom-up' style of instrument organization. Versions 7 and 8 of the PSE were first used on a large scale in two studies that involved international collaboration and comparisons, namely the United States-United Kingdom Diagnostic Project between London and New York, (6,64> and the International Pilot Study of Schizophrenia co-ordinated by the WHO, Geneva. (65) Since then its content has been revised and extended as versions 9 and 10, but the techniques of interviewing and rating remain the same. PSE-10 is one of the main components of Schedules for Clinical Assessment in Neuropsychiatry.

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