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Journal ArticleDOI

The clinical interview and psychiatric diagnosis: have they a future in psychiatric practice?

Martin Roth1
01 Oct 1967-Comprehensive Psychiatry (W.B. Saunders)-Vol. 8, Iss: 5, pp 427-438
About: This article is published in Comprehensive Psychiatry.The article was published on 1967-10-01. It has received 11 citations till now. The article focuses on the topics: Mini-international neuropsychiatric interview & Psychiatric assessment.
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Journal ArticleDOI
TL;DR: A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.

76,181 citations

01 Jan 2002
TL;DR: The Mini-Mental State (MMS) as mentioned in this paper is a simplified version of the standard WAIS with eleven questions and requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Abstract: EXAMINATION of the mental state is essential in evaluating psychiatric patients.1 Many investigators have added quantitative assessment of cognitive performance to the standard examination, and have documented reliability and validity of the several “clinical tests of the sensorium”.2*3 The available batteries are lengthy. For example, WITHERS and HINTON’S test includes 33 questions and requires about 30 min to administer and score. The standard WAIS requires even more time. However, elderly patients, particularly those with delirium or dementia syndromes, cooperate well only for short periods.4 Therefore, we devised a simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely. It is “mini” because it concentrates only on the cognitive aspects of mental functions, and excludes questions concerning mood, abnormal mental experiences and the form of thinking. But within the cognitive realm it is thorough. We have documented the validity and reliability of the MMS when given to 206 patients with dementia syndromes, affective disorder, affective disorder with cognitive impairment “pseudodementia”5T6), mania, schizophrenia, personality disorders, and in 63 normal subjects.

70,887 citations

Journal ArticleDOI
TL;DR: It is argued that rating scales served professional ends during the 1960s and 1970s and helped old age psychiatrists establish jurisdiction over conditions such as dementia and present their field as a vital component of the welfare state.
Abstract: During the late 20th century numerical rating scales became central to the diagnosis of dementia and helped transform attitudes about its causes and prevalence. Concentrating largely on the development and use of the Blessed Dementia Scale, I argue that rating scales served professional ends during the 1960s and 1970s. They helped old age psychiatrists establish jurisdiction over conditions such as dementia and present their field as a vital component of the welfare state, where they argued that ‘reliable modes of diagnosis’ were vital to the allocation of resources. I show how these arguments appealed to politicians, funding bodies and patient groups, who agreed that dementia was a distinct disease and claimed research on its causes and prevention should be designated ‘top priority’. But I also show that worries about the replacement of clinical acumen with technical and depersonalized methods, which could conceivably be applied by anyone, led psychiatrists to stress that rating scales had their limits and could be used only by trained experts.

10 citations


Cites background from "The clinical interview and psychiat..."

  • ...Roth and other old age psychiatrists believed the adoption of rating scales would increase their authority by overcoming the fact that ‘psychiatrists may differ widely from one another in the diagnostic judgement they make in identical cases’ (Roth, 1967: 428)....

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  • ...…that we cannot account for the development and popularity of rating scales in Britain without appreciating how the promise of ‘more detailed and quantifiable information’ met the political desire for rationalization and efficiency in the welfare state (Roth, 1967: 428; Sturdy and Cooter, 1998)....

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  • ...…concerns that over-reliance on standardized and impersonal methods would replace the need for trained experts, which highlights an underlying tension in efforts to promote ‘greater rigour and discipline’ in psychiatry, as in medicine and science more generally (Roth, 1967: 427; Lawrence, 1985)....

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  • ...…of drug treatments, prompting the development of more thorough tained that rating scales never provided automatic diagnosis and stressed the importance of ‘clinical judgements’ in interpreting both the symptoms exhibited by patients and the numerical data that scales generated (Roth, 1967: 431)....

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Journal ArticleDOI
TL;DR: The present investigation will suggest some answers to the following questions about the value of a datum and how each piece of information or pattern of information, is actually utilized in the diagnostic decision.
Abstract: The psychiatric diagnosis is based on a diversity of information concerning human behaviour, and it may be difficult to formulate an operational definition for each datum. In his paper on problems of psychiatric interviewing and diagnosis, Roth (1967) has given an excellent survey of the present situation. In the last decade, there has been a growing interest in the diagnostic decision, and psychiatrists have, as a natural consequence, tried to deliminate the operational conditions for the description of the mental state. This description is a fundamental part of the psychiatric record, and it is based on information obtained in a reasonably clear situation the clinical examination. It has also proved possible to make a consensus of observation and usage (Silbermann (1971), Feighner et al. (1972) and Scharfetter ( 1971) ) . Many other forms of information from the record are necessary for the diagnostic decision (MeZZergBrd (1971) ), but it is difficult to evaluate how each piece of information or pattern of information, is actually utilized. The present investigation will suggest some answers to the following questions. How can the value of a datum be estimated? And will it be possible, as a result of this analysis, to discard information or demonstrate the need of supplementary data? And finally, will a change in the usual sequence of interviewing improve the procedure? If the diagnosis shall be verified, it is necessary to demonstrate a close relationship between the diagnostic concept and well-defi3ed factors of etiology and prognosis. Our paper does not pretend to offer any certainty of diagnosis, and our evaluation is based on a series of decisions made by us in the usual way, i. e., without explicit decision rules. In an investigation to come (MelZergBrd & Leroy (1973)), we will try to elucidate the problems of diagnostic certainty and therapeutic risk a little further.

9 citations


Cites background from "The clinical interview and psychiat..."

  • ...In his paper on problems of psychiatric interviewing and diagnosis, Roth (1967) has given an excellent survey of the present situation. In the last decade, there has been a growing interest in the diagnostic decision, and psychiatrists have, as a natural consequence, tried to deliminate the operational conditions for the description of the mental state. This description is a fundamental part of the psychiatric record, and it is based on information obtained in a reasonably clear situation - the clinical examination. It has also proved possible to make a consensus of observation and usage (Silbermann (1971), Feighner et al. (1972) and Scharfetter ( 1971) ) . Many other forms of information from the record are necessary for the diagnostic decision (MeZZergBrd (1971) ), but it is difficult to evaluate how...

    [...]

  • ...In his paper on problems of psychiatric interviewing and diagnosis, Roth (1967) has given an excellent survey of the present situation....

    [...]

  • ...In his paper on problems of psychiatric interviewing and diagnosis, Roth (1967) has given an excellent survey of the present situation. In the last decade, there has been a growing interest in the diagnostic decision, and psychiatrists have, as a natural consequence, tried to deliminate the operational conditions for the description of the mental state. This description is a fundamental part of the psychiatric record, and it is based on information obtained in a reasonably clear situation - the clinical examination. It has also proved possible to make a consensus of observation and usage (Silbermann (1971), Feighner et al....

    [...]

  • ...In his paper on problems of psychiatric interviewing and diagnosis, Roth (1967) has given an excellent survey of the present situation. In the last decade, there has been a growing interest in the diagnostic decision, and psychiatrists have, as a natural consequence, tried to deliminate the operational conditions for the description of the mental state. This description is a fundamental part of the psychiatric record, and it is based on information obtained in a reasonably clear situation - the clinical examination. It has also proved possible to make a consensus of observation and usage (Silbermann (1971), Feighner et al. (1972) and Scharfetter ( 1971) ) ....

    [...]

Journal ArticleDOI
TL;DR: The Brief Psychiatric Rating Scale with the six schizophrenia specific items from the Positive and Negative Syndrome Scale has been investigated and was found to capture the information that translates into the severity of schizophrenia.
Abstract: ObjectiveA restricted Brief Psychiatric Rating Scale (BPRS-6) with the six schizophrenia specific items from the Positive and Negative Syndrome Scale (PANSS) has been investigated. These six items from the PANSS have recently been found to have both clinical validity and ‘unidimensionality’ in measuring the severity of schizophrenic states. The primary objective of this study was to evaluate the clinical validity of the BPRS-6. The secondary objective was to evaluate the ‘unidimensionality’ of the BPRS-6 by an ‘item response theory’ model.MethodsThe BPRS-6 was scored independently by two psychiatrists and two psychologists while viewing six open-ended videotaped interviews in patients with a DSM-III diagnosis of schizophrenia. The interviews were conducted by Heinz E. Lehmann, an experienced psychiatrist. They were focused on the psychopathology that contributed most to the ‘severity’ of the patient’s clinical state.ResultsThe BPRS-6 with three positive symptoms (delusions, conceptual disorganisation, hallucinations) and three negative symptoms (blunted affect, emotional withdrawal, poverty of speech) was found to be clinically valid and captured the variables that contribute most to the severity of schizophrenia. The BPRS-6 was also found to have acceptable ‘unidimensionality’ (coefficient of homogeneity 0.45) and inter-rater reliability (inter-class-coefficient 0.81).ConclusionThe BPRS-6 was found to capture the information that translates into the severity of schizophrenia. It has also acceptable psychometric validity.

8 citations


Cites methods from "The clinical interview and psychiat..."

  • ...The interviews were open, non-structured interviews which complied with the rules of a clinimetrically valid interview as stipulated by Roth (17)....

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References
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Journal ArticleDOI
TL;DR: The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type, used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information.
Abstract: Types of Rating Scale The value of this one, and its limitations, can best be considered against its background, so it is useful to consider the limitations of the various rating scales extant. They can be classified into four groups, the first of which has been devised for use on normal subjects. Patients suffering from mental disorders score very highly on some of the variables and these high scores serve as a measure of their illness. Such scales can be very useful, but have two defects: many symptoms are not found in normal persons; and less obviously, but more important, there is a qualitative difference between symptoms of mental illness and normal variations of behaviour. The difference between the two is not a philosophical problem but a biological one. There is always a loss of function in illness, with impaired efficiency. Self-rating scales are popular because they are easy to administer. Aside from the notorious unreliability of self-assessment, such scales are of little use for semiliterate patients and are no use for seriously ill patients who are unable to deal with them. Many rating scales for behaviour have been devised for assessing the social adjustment of patients and their behaviour in the hospital ward. They are very useful for their purpose but give little or no information about symptoms. Finally, a number of scales have been devised specifically for rating symptoms of mental illness. They cover the whole range of symptoms, but such all-inclusiveness has its disadvantages. In the first place, it is extremely difficult to differentiate some symptoms, e.g., apathy, retardation, stupor. These three look alike, but they are quite different and appear in different settings. Other symptoms are difficult to define, except in terms of their settings, e.g., mild agitation and derealization. A more serious difficulty lies in the fallacy of naming. For example, the term "delusions" covers schizophrenic, depressive, hypochrondriacal, and paranoid delusions. They are all quite different and should be clearly distinguished. Another difficulty may be summarized by saying that the weights given to symptoms should not be linear. Thus, in schizophrenia, the amount of anxiety is of no importance, whereas in anxiety states it is fundamental. Again, a schizophrenic patient who has delusions is not necessarily worse than one who has not, but a depressive patient who has, is much worse. Finally, although rating scales are not used for making a diagnosis, they should have some relation to it. Thus the schizophrenic patients should have a high score on schizophrenia and comparatively small scores on other syndromes. In practice, this does not occur. The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type. It is used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information. The interviewer may, and should, use all information available to help him with his interview and in making the final assessment. The scale has undergone a number of changes since it was first tried out, and although there is room for further improvement, it will be found efficient and simple in use. It has been found to be of great practical value in assessing results of treatment.

29,488 citations

Journal ArticleDOI
TL;DR: A description of the construction of the test and the normative data that have been accumulated in connection with it are presented as of possible interest to other researchers.
Abstract: Since the Taylor Manifest Anxiety Scale has proven to be such a useful device in the selection of subjects for experimental purposes, a description of the construction of the test and the normative data that have been accumulated in connection with it are presented as of possible interest to other i

3,143 citations

Journal ArticleDOI
TL;DR: Examination of differences in pattern of outcome between specific groups provides strong confirmation for hypotheses suggesting that affective psychosis, late paraphrenia and acute confusion were each entities largely independent of the two main causes of progressive dementia in old age: senile and arteriosclerotic psychosis.
Abstract: 1. The case records of 450 patients were studied and classified into five previously defined diagnostic groups: Affective Psychosis, Senile Psychosis, Late Paraphrenia, Acute Confusion and Arteriosclerotic Psychosis. Affective Psychosis accounted for over half the cases in the total material. Follow up studies showed that at six months and two years after admission each of the five disorders is characterized by a distinctive pattern of outcome as described by the proportion of patients dead, in hospital and out of hospital. 2. Examination of differences in pattern of outcome between specific groups provides strong confirmation for hypotheses suggesting that affective psychosis, late paraphrenia and acute confusion were each entities largely independent of the two main causes of progressive dementia in old age: senile and arteriosclerotic psychosis. The relevant differences between the groups were largely independent of differences in age distribution. 3. There is some evidence to suggest that the findings may have a bearing upon the problems of old age mental disorder faced by hospitals in other parts of this country. 4. The overlap between the senile-arteriosclerotic group on the one hand and the affective paraphrenic group on the other was relatively small. But if all kinds of affective disturbance are reckoned, their incidence in arteriosclerotic psychosis is greater than is likely to be accountable in terms of fortuitous coincidence. 5. Problems for further study are discussed. Investigations into the differences between and within the groups might lead to the identification of factors of practical or aetiological significance.

611 citations

Book
01 Jan 1934

496 citations

Journal ArticleDOI
TL;DR: A structured "present state" interview has been developed and tested and introduces a degree of standardization and precision which suggests that more of the diagnostic process might be brought under control with obvious benefit to clinical practice and research.
Abstract: A structured "present state" interview has been developed and tested. As used by five trained interviewers the provisional categorizations made are reliable and so are most of the clinical scores. The advantage of the procedure is that it is based on clinical practice and experience, but introduces a degree of standardization and precision which suggests that more of the diagnostic process might be brought under control with obvious benefit to clinical practice and research.

344 citations