Drill Rebecca, Nakash Ora, DeFife Jared A, Westen Drew
*Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA; †School of Psychology, Interdisciplinary Center, IDC, Herzliya, Israel; ‡Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine; and §Departments of Psychology and Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA.
J Nerv Ment Dis. 2015 Jun;203(6):459-62. doi: 10.1097/NMD.0000000000000300.
Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and practice. This study compared adaptive functioning validity ratings from Structured Clinical Interviews (SCIDs, symptom-focused structured diagnostic interviews), and Clinical Diagnostic Interviews (CDIs, systematic diagnostic interviews modeling naturalistic clinical interactions focusing on relational narratives). Two hundred forty-five patients (interviewed by two independent interviewers) and their interviewers completed the Clinical Data Form which assesses adaptive functioning and clinical information. Both interviews converged strongly with patient-reports, with no significant differences in validity of the interviews in measuring global and specific domains of adaptive functioning variables. Findings suggest that CDIs provide adaptive functioning data comparable to SCIDs (often considered "gold standard" for assessment but difficult to use in practice) and have important implications for bridging the research-practice gap. By incorporating clinicians' everyday methods, CDIs yield information that is psychometrically sound for empirical investigation, diagnostically practical, and clinically meaningful and valid.
适应性功能是研究和实践中精神科诊断与评估的一个关键方面。本研究比较了结构化临床访谈(SCID,以症状为重点的结构化诊断访谈)和临床诊断访谈(CDI,模拟自然主义临床互动、聚焦关系叙事的系统性诊断访谈)对适应性功能的效度评定。245名患者(由两名独立访谈者进行访谈)及其访谈者完成了评估适应性功能和临床信息的临床数据表单。两种访谈与患者报告的结果高度一致,在测量适应性功能变量的总体和特定领域时,访谈的效度没有显著差异。研究结果表明,CDI提供的适应性功能数据与SCID相当(SCID通常被视为评估的“金标准”,但在实践中难以使用),这对于弥合研究与实践之间的差距具有重要意义。通过纳入临床医生的日常方法,CDI产生的信息在心理测量上对实证研究是可靠的,在诊断上是实用的,在临床上是有意义且有效的。