CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 12DIAGNOSTIC INTERVIEWINGABRAHAM RUDNICKDAVID ROESchizophrenia, which is considered the most severe psychiatric disorder, is characterizedby many impairments, such as psychosis and apathy, cognitive deficits and comorbidsymptoms, as well as disrupted functioning and behavioral problems. Diagnostic interviewingis the “gold standard” for establishing a psychiatric diagnosis. In this chapter, wereview diagnostic interviewing strategies for what are currently considered to be the characteristicsymptoms of schizophrenia, recognizing that diagnostic criteria may change (asthey have in the past).Current classifications—hence, diagnostic criteria—of schizophrenia are based primarilyon the work of Kraepelin, who focused on the deteriorating course of the illness(which he termed dementia praecox), and Bleuler, who emphasized the core symptoms ofthe disorder as difficulties in thinking consistently and concisely (loose associations); restrictionin range of emotional expression, and emotional expression that is incongruentwith the content of speech or thought (flat and inappropriate affect, respectively); loss ofgoal-directed behavior (ambivalence); and retreat into an inner world (autism). The twocurrent major classification systems in psychiatry, the Diagnostic and Statistical Manualof Mental Disorders (DSM; American Psychiatric Association, 2000) and the InternationalClassification of Diseases (ICD; World Health Organization, 1992) both specifythat the diagnosis of schizophrenia is based on the presence of characteristic symptoms,the absence of others, and psychosocial difficulties that persist over a significant period oftime. Symptoms must be present in the absence of general medical or so-called “organic”conditions (e.g., substance abuse, neurological disorders such as Huntington’s disease,and more) that could lead to a similar clinical presentation.The characteristic symptoms of schizophrenia are divided into positive and negativesymptoms, although cognitive impairments and perhaps some comorbid symptoms maybe core deficits of schizophrenia as well (American Psychiatric Association, 2000).Positive symptoms refer to the presence of perceptual experiences, thoughts, and behaviorsthat are ordinarily absent in individuals without a psychiatric illness. The typical117