ABSTRACT
OBJECTIVE: Increasingly, epidemiological studies are employing computerized and highly standardized interviews, such as the Composite International Diagnostic Interview (CIDI-Auto), to assess the prevalence of psychiatric illness. Recent studies conducted in specialist units have reported poor agreement between experienced clinicians' and CIDI-Auto diagnoses. In this study we investigated the concordance rate between clinicians and the CIDI-Auto for the diagnosis of six anxiety disorders and two mood disorders, whereby the CIDI-Auto was treated as the 'gold standard'. METHOD: Subjects were 262 patients who were assessed by a clinical psychologist or psychiatrist and completed the CIDI-Auto at a tertiary referral unit for anxiety and mood disorders. Agreement between the clinicians' diagnoses and the diagnoses generated by the CIDI-Auto according to both DSM-IV and ICD-10 codes, were examined by kappa statistics. Sensitivity and specificity values were also calculated. RESULTS: Agreement between clinicians and the CIDI-Auto (DSM-IV) ranged from poor for social phobia and posttraumatic stress disorder (kappa < 0.30) to moderate for obsessive- compulsive disorder (OCD; kappa = 0.52). Agreement between clinicians and the CIDI-Auto (ICD-10) ranged from poor for major depressive episode (kappa = 0.25) to moderate for OCD (kappa = 0.57). With the CIDI diagnosis treated as the gold standard, clinicians' diagnoses showed low sensitivity (kappa < 0.70) for all the disorders except for OCD (for ICD-10), but high specificity (kappa > 0.70) for all the disorders. CONCLUSION: Poor agreements between experienced clinicians and the CIDI-Auto were reported for anxiety and mood disorders in the current study. A major implication is that if diagnosis alone directed treatment, then patients could receive different treatments, depending on whether the computer, or a clinician, made the diagnosis.
Subject(s)
Anxiety Disorders/diagnosis , Interview, Psychological , Mood Disorders/diagnosis , Psychiatric Status Rating Scales , Adult , Decision Making , Female , Humans , Male , Sensitivity and SpecificityABSTRACT
OBJECTIVES: This paper reviews the use of clinical indicators in a consultation-liaison (C-L) service over a 12-month period at the Royal Melbourne Hospital, Melbourne, Australia. METHOD: Clinical indicators and C-L data were collected during the 1999 calendar year. A review of the process was conducted during and after completion of the 12-month period. RESULTS: The system was found to be practical and useful. The use of clinical indicators led to the identification of problems and stimulated effective interventions. The use of the clinical indicators was associated with improvement in communication between C-L staff, parent units and practitioners providing follow-up. CONCLUSIONS: The implementation of a database and clinical indicators was a useful addition to the C-L service. The use of clinical indicators was effective in improving clinical performance. These benefits need to be balanced against increased administrative burden.
Subject(s)
Health Status Indicators , Referral and Consultation , Communication , Electronic Data Processing , Follow-Up Studies , Humans , Patient Care TeamSubject(s)
Depressive Disorder/drug therapy , Fluoxetine/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Self-Injurious Behavior/chemically induced , Suicide Prevention , Australia , Depressive Disorder/psychology , Fluoxetine/administration & dosage , Humans , Risk Factors , Self-Injurious Behavior/psychology , Selective Serotonin Reuptake Inhibitors/administration & dosage , Suicide/psychologyABSTRACT
A case of senile dementia of Lewy body type is presented. The clinical and neuropathological characteristics of the illness are discussed in the context of recent advances in the understanding of this condition.
