IPDE - Extranet Systems - World Health Organization

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Discussion and conclusions Armand W. manger This investigation represents the first attempt to assess personality disorders (PDs) worldwide with contemporary methods of diagnosis. The semistructured inmiew (International Personality Disorder Examination-IPDE), developed within the World Health Organization (WHO) program on diagnosis and classification, was designed to assess PDs within the framework and guidelines of two distinct but overlapping classification systems. DSM-111-R, which was intended for use in the US, is primarily the product of American psychiatric opinion, while ICD-10, which is meant for worldwide use, reflects the views and needs of the international psychiahic community. lnterrater Agreement To provide a valid diagnosis an inseument must first demonstrate a reasonable degree of interrater reliability. An international test of reliability such as the present one involves patients fmm a wide variety of national and cultural settings, who speak many different languages. The examiners also consist of a large number of psychiatrists and clinical psychole gists Wained at many different facilities amund the world. Therefore, this was an unusually exacting test of reliability to which no other interview for PDs has ever been subjected. The results, nevertheless, compare quite favourably with published reports on semistructured interviews that are used to diagnose the psychoses, mood, anxiety. and substance use disorders. Such comparisons, of c ow, must be viewed as rough approximations. There are obvious differences in the heterogeneity of the patient samples. the base rates of the individual disorders. as weU as variations in the methods used to measure reliability. Furthermore, many of these studies have been conducted within one facility only, and rarely have they been undertaken outside the nation in which the interview was developed. With these caveats in mind, we compared the results of the present study with those of the SCID Axis I field trial.' That study involved 390
80 A. W. Loranger patients at four locations in the US and one in Germany. The median kappa values for those individual disorders with a base rate of at least 5% were 0.64 for current diagnoses and 0.68 for lifetime diagnoses. In the present field trial, the median kappa values for the individual PDs (diagnosis definite) with base rates of at least five per cent were 0.70 in DSMm-R and 0.72 in ICD-10. The overall weighted kappa values in the SCID study were 0.61 for current diagnoses and 0.68 for lifetime diagnoses. In the present study, the overall weighted kappa values for the definite diagnoses of the specific PDs were 0.57 in DSM-III-R and 0.65 in ICD-10. The median kappa values for an JPDE diagnosis that was definite or probable were 0.73 for DSM-III-R and 0.77 for ICD-10. The corresponding weighted kappa values for a diagnosis that was definite or probable were 0.65 for DSM-111-R and 0.72 for ICD-10. The SCID study did not identify probable cases. The SCID study involved a test-retest design in which the interview was administered by different examiners at least one day but no more than two weeks apart. This is likely to result in lower reliabilities tban when an examiner and observer rate the same interview, as in the present study. A similar test-retest design was not employed in the present study. because one of its objectives was to determine temporal stability over an extended period. There are practical and methodological constraints associated with the too frequent repetition of a lengthy interview. The IPDE also fared well compared with other criteria-based interviews for PDs that have been developed in recent However, reports of large-scale reliability studies conducted outside of the facilities where these other interviews were developed are rare or non-existent. The other interviews also differ from the IPDE in several ways. They do not provide coverage of ICD-10; they are not available in so many languages; and they do not have a detailed, item-by-item scoring manual. Temporal stability The term 'personality' refers to an individual's usual or characteristic rather than transient or situational behaviour. Therefore, a PD instrument should not only demonstrate interrater reliability, but it should also have temporal stability. Before imputing a particular criterion to a subject, the IPDE requires a minimal duration of five years, including some mdestation during the current year (past 12 months). Since the patients in the study were examined after an average interval of six months, temporal
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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
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Problems in the field of personalit
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5 Problems in the field of PD perso
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7 Problems in the field of PD In DS
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9 Problems in the field of PD cultu
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11 Review of diagnostic instruments
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19 Epidemiology of DSM-Ill PDs in c
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Table l. Prevalence rates of specif
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24 1. H. Reich and G. de Girolamo (
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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 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
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
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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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IPDE - Extranet Systems - World Health Organization

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