IPDE - Extranet Systems - World Health Organization

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53 Experiences with IPDE The investigators considered three solutions: (1) to administer the interview in two sessions; (2) to create separate modules for the ICD-10 and DSM-III-R PDs; and (3) to screen cases with a questionnaire with a low rate of false-negatives, thereby eliminating interviews with subjects unlikely to have a PD diagnosis. Another question raised by some respondents concerned the duration of the behaviour used to define PD. ICD-10 and DSM-111-R do not specify the exact duration of the abnormal behavioural patterns constituting PDs, but both classifications use the term 'long-term'. ICD-10 states that the abnormal behaviour 'is stable and of long duration, having its onset in late childhood or adolescence,' while DSM-III-R says that it is 'characteristic of the persons's recent (past year) and long-term functioning (generally since adolescence or early adulthood).' There is some discrepancy then between ICD-10 and DSM-III-R regarding the onset of the maladaptive behaviour. The IPDE solved these problems by requiring that the behaviour associated with almost all the diagnostic criteria be present for at least five years, and at least one of the criteria be evident before age 25, in order to diagnose that disorder. Concern was also expressed that a patient might have a disorder like depression that gives a distorted image of what heishe is usually like. A patient may also be unaware of some traits or unwilling to acknowledge them. The influence of depression is a well known problem in the evaluation of PD by self-report. A previous study with the PDE showed little influence of anxiety or depression on the categorical or dimensional assessment of PD.S It may be reasonable to conclude the same for IPDE if experienced clinicians carefully question the patients and use their clinical judgement. Severely depressed patients, however, might have difficulties in remembering their habitual state due to the effect of depression. An alternative solution is to postpone the PD examination until the patient is euthymic m to interview a relative. Lack of awareness or lying about unfavourable or less socially acceptable behaviour is a general problem in diagnosing mental disorders, and is not peculiar to stmcture.d interviews. Although the questions flow naturally, they presume that the subject is attentive, of normal intelligence, and motivated. What are specific points with regard to applicability of IPDE in your culture? Before the study several interviewers were concerned that the IPDE might reflect North American attitudes and social and cultural norms
54 A. A. Dahl and A. Andreoli which may not be valid elsewhere. This criticism was not widespread, and ultimately the IPDE proved relevant across cultural and social settings. Some investigators noted some problems of applicability. A few mentioned, e.g., that questions concerning reckless driving, and physical abuse of family members were problematic in their culture. Some high school education was probability necessary for an adequate understanding of the IPDE questions. And in some counvies the high rate of longterm unemployment made the questions related to work experience less meaningful. The following quotes illustrate experiences with the IPDE in different cultures: The pattern of occurrence of personality disorders is largely unexplored in the Indian context, and the IPDE may usher in empirical investigation into this area. Overall I am finding few problems of applicability of the IPDE to our culture of interest. Our subjects an mostly American urbanites who reside near the birthplace of the DSM-III-R itself. Therefore, one might expect that our subjects would share values and perspectives similar to those exemplified by the IPDE. This seems to be the case. Respondents who were not psychologically-minded had great difficulty with borderline questions about identity. Although patients suffering from mental subnormality were excluded, those respondents whose intelligence appeared to be at the lower end of normal had considerable difficulty with these concepts. In contrast, subjects from middle-class backgrounds pedormed much more satisfactorily. In French culture, people often answer not with specific examples, but more in tenns of: 'I feel this way.' It is my impression that the IPDE asks for a kind of psychological-mindedness or self-reflection which is often not found in Holland. I also think that the place of leisure activities and social relations compared to work is somewhat different in our culture, which could lead to an overdiagnosis of obsessive-compulsive personality disorder. If there is need to shorten the interview, please indicate the sections that can be omitted. All centres reported that the IPDE took a long time to administer, and the instrument can be shortened if only one of the two diagnostic systems is used. If only certain PDs need to be evaluated, it can also be shortened, but all PDs have to be examined to get complete differential diagnostic coverage. Several centres reported that they had not found any cases of DSM-III-R sadistic PD. and that the questions for that diagnosis could be omitted. It should be noted that in DSM-IV, sadistic, self-defeating, and
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Until recently, the standardization
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Assessment and diagnosis of persona
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Contents Contributors Preface Annan
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Contributors Dr Antonio Andreoli Ho
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Preface One of the major goals of t
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... 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 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 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 100 and 101: 89 Discussion and Conclusions emoti
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
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103 Appendix Table A12 Personality
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Table A13 (con?) Criterion B7 B8 1
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107 Appendix Table A13 (cont) Frequ
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109 Appendix Table A14 (cont.) Freq
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Acknowledgements 113 Manual History
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Manual History of the IPDE One of t
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116 Manual Struchlre of the IPDE Th
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118 Manual that is likely to enhanc
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120 Manual data. If examiners have
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122 Manual Scoring conventions Much
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124 Manual Recording the scores Req
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126 Manual Q. What do you do when s
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128 Manual section, if there are qu
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ICD-10 criteria and corresponding I
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132 ICD-10 criteria and correspondi
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134 IPDE ICD-10 module screening qu
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136 Screening questionnaire 47 1 lo
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I 138 IPDE ICD-10 module* interview
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140 Interview schedule 2. 0 1 2 7 0
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142 Inte~iew schedule 4. O 1 2 I N
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144 Interview schedule 6. O l Z ? 0
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146 Interview schedule 8. 0 1 2 1 0
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148 Interview schedule .10. 0 1 2 ?
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150 Interview schedule 12. 0 1 2 7
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152 lnte~iew schedule 14. 0 1 2 ? 0
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154 Interview schedule 16. 0 1 2 ?
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156 interview schedule 18. 0 1 2 ?
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158 Interview schedule 20. O 1 2 N
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164 Interview schedule *26. 0 1 2 ?
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166 lntewiew schedule 28. 0 1 2 ? 0
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170 lnte~iew schedule 32. O 1 2 7 N
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174 lntewiew schedule 36. 0 1 2 ? 0
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176 lnterv~ew schedule 38. 0 1 2 ?
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184 lnte~iew schedule 46. 0 1 2 7 0
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~ 186 Interview schedule 48. 0 1 2
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194 Interview schedule 56. 0 1 2 1
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196 Interview schedule VI. IMPULSE
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200 Interview schedule Have you eve
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202 Interview schedule 1 63. 0 1 2
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204 Intewiew schedule Rate the foll
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206 IPDE ICD-10 module handscoring
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+ 39+44=4, 208 Handscoring algorith
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210 Handscoring algorithms and summ
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IPDE ICD-10 module summary scoreshe
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224 Index paranoid 108 schizoid 108
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226 Index Personalily Assessment Sc
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