Psychiatry - July 2008 - (Page 26)

Reliability of Diagnoses In my opinion, psychiatrists do not use structured interviews in actual clinical settings, whether inpatient or outpatient. Since starting my psychiatric residency in 1990, I have not seen a single psychiatrist use structured interviews in routine clinical practice. In September, 2007, I presented at the annual meeting of the Association for Academic Psychiatry in Boston to an audience of psychiatrists, and posed the question: Do any of you use structured interviews in your actual work with patients? Not a single hand was raised. I opine that psychiatrists do not use structured interviews for three main reasons. First, structured interviews were designed as research tools to be used in research settings and not designed for psychiatrists to use in actual clinical settings. Second, structured interviews are too timeconsuming to be considered an efficient use of time during routine patient visits. Whether a psychiatrist works in a private facility or a university setting, if he or she is not efficient and productive, someone (whether a financial officer or the Chairman of the department) will be on the psychiatrist’s back telling him or her that the level of productivity is not compatible with the salary! It is sad but very true. Finally, the rules of structured interviews make it very difficult for the psychiatrist to establish a rapport with the patient. I had the luxury of two funded grants that allowed my research team and myself at West Virginia University to use two structured interviews: Structured Clinical Interview for DSMIV Axis I Disorders (SCID-I) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN).2–5 By virtue of the funds, we had the time to interview more than 100 patients using the SCID and the SCAN. Each interview took an average of two hours, and the process of selecting the patients was very difficult. Even with 26 DO PSYCHIATRISTS USE STRUCTURED INTERVIEWS IN REAL CLINICAL SETTINGS? by Ahmed Aboraya, MD, DrPh enjoyed reading Dr. Pies’s article1 “How Objective Are Psychiatric Diagnoses? (Guess Again)” published in the October issue of Psychiatry 2007 and I agree with the article’s conclusion. Dr. Kelwala’s letter to the editor1 regarding Dr. Pies’s article criticized structured interviews because they have a narrow range of alternatives and do not explore the “deep layers of the 26 Psychiatry 2008 [ J U L Y ] I mind.” As the discussion on the use of structured interviews got heated, I could not help asking the question: Do psychiatrists actually use structured interviews in real clinical settings? In this column, I will answer this question based on my personal experience, and then I will pose the question to the readers of Psychiatry 2008, with an opportunity to respond.

Table of Contents Feed for the Digital Edition of Psychiatry - July 2008

Psychiatry - July 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Reliability of Diagnoses: Do Psychiatrists Use Structured Interviews In Real Clinical Settings? Trend Watch: Use of Atypical Antipsychotics in the Elderly Review: The Struggle for Mental Healthcare in New Orleans-One Case at a Time Psychotherapy Rounds: Psychotherapeutic and Adjuntive Pharmacologic Approaches to Treating Posttraumatic Stress Disorder Original Research: Baseline Dissociation and Prospective Success in Special Forces Assessment and Selection Commentary: Performance-Enhancing Drugs: Where Should the Line Be Drawn and By Whom? Commentary: Psychiatric Diagnosis and the Pathlogist's View of Schizophrenia Journal Watch Classified Advertising Information for Authors

Psychiatry - July 2008

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