IPDE - Extranet Systems - World Health Organization

More documents

Recommendations

Info

89 Discussion and Conclusions emotionally unstable, ICD-10 requires four of seven criteria for a diagnosis; and except for antisocial, DSM-III-R requires four or five from a list that varies from seven to nine criteria. Although there are fewer differences between ICD-10 and DSM-IV, many still remain. A more detailed comparison of ICD-10, DSM-III-R, and DSM-lV is beyond the scope of this chapter. However, mention should be made of the extent to which ICD-10 and DSM-III-R tended to produce similar results in the present study. Within the limitations imposed by the sample sizes of the individual disorders, no statistically significant (pc.05) differences were observed in the base rates with which the corresponding specific PDs were diagnosed in the overall sample of 716 patients. There was a trend, albeit statistically not significant, for DSM-III-R to identify more cases of antisocial, paranoid, and histrionic behaviour and for ICD-I0 to diagnose more cases of anxioudavoidant behaviour. Both systems provide a residual category for cases judged to have a PD that does not meet the requirements for any of the specific types. There is no method of identifying these patients without invoking some arbitrary standard. The IPDE assigns a residual diagnosis to anyone who does not meet the requirements for a specific disorder, but nevertheless accumulates 10 or more criteria €mm the various disorders. There are more opportunities to obtain the diagnosis in DSM-III-R than in ICD-10 because the former has l l0 criteria and the latter only 56. It is not surprising, then, that approximately twice as many patients received a nonspecific diagnosis of PD in DSM-III-R as in ICD-I0 (12.8% vs 6.8%). This, of course, does not address the question of whether the two classification systems actually identified the same patients as having a particular disorder. That can be determined by the kappa statistic, particularly for those disorders with a prevalence of at least 5%. There are only two of them; the kappas are 0.66 (borderline) and 0.52 (anxiouslavoidant), evidence of moderate but far €mm perfect agreement. With the distribution of cases in the sample of 716 patients, these kappas were associated with 92% agreement regarding the diagnosis of borderline and 89% for anxioudavoidant. The kappa values for the remaining disorders should be viewed as relatively unstable because of the base rate problem. They range from 0.32 (dissocial) to 0.61 (anankastidobsessive-compulsive), with a median of 0.52. The DSM-III-R and ICD-10 comparisons should not be a f f d by the less-than-perfect interrater reliability of the IPDE since the same examiner conducted the interview and rated the information on which the ICD-l0 and DSM-111-R diagnoses for a padcular patient were based.
90 A. W. Loranger The substantial disagreement regarding the dissocial and antisocial diagnoses is not entirely unexpected considering the different approaches the two classification systems have taken regarding the disorder. The DSM-111-R emphasized lawbreaking and criminal acts, while ICD-10 is more concerned with generic concepts such as lack of empathy, inability to profit from experience, and inability to maintain enduring relationships. It is also possible to judge the overall agreement between DSM-111-R and ICD-l0 for the eight disorders they share in common. This can be done by calculating an overall weighted kappa based on all of these disorders, regardless of whether they meet the criterion of a S 8 base rate. That kappa is .S4, an indication of only moderate agreement. There appears to be sufficient disagreement regarding the cases of personality disorders identified by ICD-I0 and DSM-111-R to justify the prior decision of the WHOIADAMHA (US Alcohol, Drug Abuse and Mental Health Administration) steering committee to develop an instrument that would accommodate both classification systems. The two, however, provide roughly similar interrater agreement and temporal stability when assessed by the IPDE. Conclusions The IPDE was administered by 58 psychiatrists and clinical psychol* gists to 716 patients in 11 counhies in North America, Europe, Africa, and Asia. The interview demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. Experienced clinicians also found the instrument user friendly, c~lNt'dly relevant, and clinically meaningful. By providing a standard method of diagnosis and case identification, the IPDE should stimulate international PD research, and facilitate comparisons of the results of such worldwide investigations. References I Williams, J.B.W., Gibbon, M,, First, M.B., Spitzer. R.L., Danes, M., Bonus, l., Howes, M.J., Kane, 1.. Pope, H.G., Jr. Rounsaville, B. & Winchen, H.-U. The Structured Clinical interview for DSM-111-R (SCID), E Multisite test-retest reliability. Archives of Geneml Psychinfry, 1992: 49: 63M. 2 Stangl, D., Pfohl, B., Zimmerman, M,, Bowers. W. & Corenthal, C. A structured
Page 2 and 3:
Until recently, the standardization
Page 4 and 5:
Assessment and diagnosis of persona
Page 6 and 7:
Contents Contributors Preface Annan
Page 8 and 9:
Contributors Dr Antonio Andreoli Ho
Page 10 and 11:
Preface One of the major goals of t
Page 12 and 13:
... Xlll Acknowledgements The IPDE
Page 14 and 15:
Problems in the field of personalit
Page 16 and 17:
5 Problems in the field of PD perso
Page 18 and 19:
7 Problems in the field of PD In DS
Page 20 and 21:
9 Problems in the field of PD cultu
Page 22 and 23:
11 Review of diagnostic instruments
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
19 Epidemiology of DSM-Ill PDs in c
Page 32 and 33:
Table l. Prevalence rates of specif
Page 35 and 36:
24 1. H. Reich and G. de Girolamo (
Page 37 and 38:
26 .- 5 2 0 W C .- 0 P g F ? g e Q
Page 39 and 40:
28 J. H. Reich and G. de Girolarno
Page 41 and 42:
Table 3. Prevalence rates ofpersona
Page 44 and 45:
Pfohl etal.. l986 (67) Pilgrim & Ma
Page 46 and 47:
35 Epidemiology of DSM-Ill PDs were
Page 48 and 49:
37 Epidemiology of DSM-Ill PDs migh
Page 50 and 51: 39 Epidemiology of DSM-Ill PDs 23 R
Page 52 and 53: 4 1 Epidemiology of DSM-Ill PDs 55
Page 54 and 55: 43 International personality disord
Page 56 and 57: I 45 IPDE iner what he is actually
Page 58 and 59: 47 IPDE Sample of IPDE item The que
Page 60 and 61: 49 IPDE dimensional scores are not
Page 62 and 63: 1 9 IPDE considerable training and
Page 64 and 65: 53 Experiences with IPDE The invest
Page 66 and 67: 55 Experiences with IPDE passive ag
Page 68 and 69: 57 Field Trial
Page 70 and 71: 59 Sampling, inte~iewers, interview
Page 72 and 73: Description of centres participatin
Page 74 and 75: 63 Centres participating in IPDE fi
Page 82 and 83: P- P Table 1. Sample sizes and IPDE
Page 84 and 85: 73 Results Table 3. ICD-I0 Disorder
Page 86 and 87: 75 Results Table 5. Frequency of CO
Page 88 and 89: 77 Results Table 8. Interrater reli
Page 90 and 91: Discussion and conclusions Armand W
Page 92 and 93: 8 1 Discussion and Conclusions stab
Page 94 and 95: 83 Discussion and Conclusions Repet
Page 96 and 97: Discussion and Conclusions of princ
Page 98 and 99: 87 Discussion and Conclusions Frequ
Page 102 and 103: 9 1 Discussion and Conclusions inte
Page 104 and 105: 93 Appendix Table A2 Persomlity dis
Page 106 and 107: 95 Appendix Table A4 Personality di
Page 108 and 109: 97 Appendix Table A6 Personaliry di
Page 110 and 111: 99 Appendix Table SA Personaliry di
Page 112 and 113: Table A10 Personality disorder diag
Page 114 and 115: 103 Appendix Table A12 Personality
Page 116 and 117: Table A13 (con?) Criterion B7 B8 1
Page 118 and 119: 107 Appendix Table A13 (cont) Frequ
Page 120 and 121: 109 Appendix Table A14 (cont.) Freq
Page 122 and 123: Acknowledgements 113 Manual History
Page 124 and 125: Manual History of the IPDE One of t
Page 126 and 127: 116 Manual Struchlre of the IPDE Th
Page 128 and 129: 118 Manual that is likely to enhanc
Page 130 and 131: 120 Manual data. If examiners have
Page 132 and 133: 122 Manual Scoring conventions Much
Page 134 and 135: 124 Manual Recording the scores Req
Page 136 and 137: 126 Manual Q. What do you do when s
Page 138 and 139: 128 Manual section, if there are qu
Page 140 and 141: ICD-10 criteria and corresponding I
Page 142 and 143: 132 ICD-10 criteria and correspondi
Page 144 and 145: 134 IPDE ICD-10 module screening qu
Page 146 and 147: 136 Screening questionnaire 47 1 lo
Page 148 and 149: I 138 IPDE ICD-10 module* interview
Page 150 and 151:
140 Interview schedule 2. 0 1 2 7 0
Page 152 and 153:
142 Inte~iew schedule 4. O 1 2 I N
Page 154 and 155:
144 Interview schedule 6. O l Z ? 0
Page 156 and 157:
146 Interview schedule 8. 0 1 2 1 0
Page 158 and 159:
148 Interview schedule .10. 0 1 2 ?
Page 160 and 161:
150 Interview schedule 12. 0 1 2 7
Page 162 and 163:
152 lnte~iew schedule 14. 0 1 2 ? 0
Page 164 and 165:
154 Interview schedule 16. 0 1 2 ?
Page 166 and 167:
156 interview schedule 18. 0 1 2 ?
Page 168 and 169:
158 Interview schedule 20. O 1 2 N
Page 170 and 171:
Page 172 and 173:
Page 174 and 175:
164 Interview schedule *26. 0 1 2 ?
Page 176 and 177:
166 lntewiew schedule 28. 0 1 2 ? 0
Page 178 and 179:
Page 180 and 181:
170 lnte~iew schedule 32. O 1 2 7 N
Page 182 and 183:
Page 184 and 185:
174 lntewiew schedule 36. 0 1 2 ? 0
Page 186 and 187:
176 lnterv~ew schedule 38. 0 1 2 ?
Page 188 and 189:
Page 190 and 191:
Page 192 and 193:
Page 194 and 195:
184 lnte~iew schedule 46. 0 1 2 7 0
Page 196 and 197:
~ 186 Interview schedule 48. 0 1 2
Page 198 and 199:
Page 200 and 201:
Page 202 and 203:
Page 204 and 205:
194 Interview schedule 56. 0 1 2 1
Page 206 and 207:
196 Interview schedule VI. IMPULSE
Page 208 and 209:
Page 210 and 211:
200 Interview schedule Have you eve
Page 212 and 213:
202 Interview schedule 1 63. 0 1 2
Page 214 and 215:
204 Intewiew schedule Rate the foll
Page 216 and 217:
206 IPDE ICD-10 module handscoring
Page 218 and 219:
+ 39+44=4, 208 Handscoring algorith
Page 220 and 221:
210 Handscoring algorithms and summ
Page 222 and 223:
Page 224 and 225:
Page 226 and 227:
Page 228 and 229:
Page 230 and 231:
Page 232 and 233:
IPDE ICD-10 module summary scoreshe
Page 234 and 235:
224 Index paranoid 108 schizoid 108
Page 236 and 237:
226 Index Personalily Assessment Sc
show all

IPDE - Extranet Systems - World Health Organization

Create successful ePaper yourself

Delete template?

Save as template?