CLINICAL HANDBOOK OF SCHIZOPHRENIA

12. Diagnostic Interviewing 119psychiatric symptoms. The Structured Clinical Interview for DSM-IV (SCID; First,Spitzer, Gibbon, & Williams, 1995) is the most widely used diagnostic assessment instrumentin the United States for research studies with persons who have psychiatric disabilities.Psychiatric rating scales based on semistructured interviews have also been developedto provide a useful, reliable measure of the wide range of psychiatric symptomscommonly present in people with psychiatric disorders. These scales typically containfrom 1–50 or so specifically defined items, each rated on a 5- to 7-point severity scale.Some interview-based scales have been developed to measure the full range of psychiatricsymptoms, such as the Brief Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962)and the Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Fiszbein, 1987),whereas other interview-based scales have been designed to tap specific dimensions, suchas the Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1982). Thesame classification holds true for self-report scales.Interview-based psychiatric rating scales typically assess a combination of symptomselicited through direct questioning and symptoms or signs observed in the course of theinterview, as well as symptoms elicited by collateral history taking (from caregivers andclinical documentation). For example, in the BPRS, depression is rated by asking questionssuch as “What has your mood been lately?” and “Have you been feeling down?”.Ratings of mannerisms and posturing, on the other hand, are based on the behavioral observationsof the interviewer. Psychiatric symptom scores can either be added up for anoverall index of symptom severity, or summarized in subscale scores corresponding tosymptom dimensions, such as negative, positive, and comorbid (affective and other)symptoms.INTERVIEWING GUIDELINESPsychiatric diagnosis involves use of generic clinical assessment skills, such as combiningopen-ended and close-ended questions, as well as specialized skills needed to addresschallenges associated with psychiatric impairments. In this section we discuss guidelinesfor interviewing people with schizophrenia, focusing on particular challenges to interviewing,and highlighting clinical communication skills in particular.Guideline 1: Preinterview “Baggage”Some challenges to interviewing may begin even before the interviewee has actually attendedthe interview or met the interviewers. These may be related to the interviewees’feelings, expectations, and concerns generated perhaps by past experience. For instance,even before coming to the interview, the interviewee may feel threatened, expect to beharshly judged and criticized, and be concerned about the possible consequences of theinterview. Such preinterview feelings may manifest themselves in a range of differentways. For example, an interviewee who is feeling threatened may be very guarded or maybe aggressive as a response to his or her perceived threat. Similarly, an interviewee whoexpects to be harshly judged may be hesitant and reluctant to interact or even hostile andantagonistic toward the interviewer. Finally, an interviewee who is concerned with theconsequences of the interview might be busy trying to guess how he or she might “best”respond to questions asked by the interviewer, which would seriously threaten the validityof the information elicited.Because the effectiveness and quality of all interviews depend on rapport, a startingpoint for the interviewer meeting an interviewee with features described earlier would be