The microcomputerized Diagnostic Interview Schedule: clinical use in an out-patient setting

Abstract

While the validity of the Diagnostic Interview Schedule (DIS) is still controversial, enough data exists to support a trial in a clinical setting. A new microcomputerized version presents the diagnostic profile of the patient within minutes after the interview and reduces the possibility of errors in data collection and transcription, thus making the interview appropriate and available for widespread use. The present study examines the use of this instrument in a psychiatric out-patient department. Forty-one referrals to a psychiatric out-patient department were assessed by each of two methods: the standard problem-oriented non-structured clinical interview (NSI) and the microcomputerized DIS. The mean time taken for the DIS was 111.6 minutes, and patient acceptance of the microcomputerized format was high. The DIS provided a mean of 5.5 diagnoses per person compared to 2.56 for the NSI, but 31.7% of the patients had no clinically significant current DIS diagnosis. Approximately one-half the patients were assigned a diagnosis by the NSI which was beyond the 38 DSM-III diagnoses covered by the DIS. A comparison of the diagnostic results of both interviews reveals large differences in the group, and very little agreement in individual patients. The proportion of patients assigned diagnoses of substance abuse, affective disorder, psychosexual disorder, and personality disorders by each interview were quite different. Many of the patients diagnosed as having primarily Personality Disorder by the NSI were found to have an affective disorder by the DIS. The reasons for these differences and the resulting implications are discussed. This study supports the use of the microcomputerized DIS as a clinically useful adjunct to the diagnostic process.