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Background: There are no published reports of cross-cultural equivalence and interrater reliability at the level of individual symptom items assessed by a semi-structured clinical interview employing operationalised clinician ratings., Aims: To assess the cross-cultural clinical equivalence and reliability of a Chinese version of the World Health Organization Schedules for Clinical Assessment in Neuropsychiatry (SCAN)., Method: UK-US and Taiwanese groups of psychiatrists used Chinese and English transcripts of videotape interviews of Taiwanese patients to discuss cross-cultural issues and ratings of SCAN items. Item ratings were compared quantitatively individually and pooled by SCAN section., Results: Chinese equivalents were found for all SCAN items. No between-group differences were found for most individual items, but there were differences for some scaled items. Average agreement between the two groups was 69-100%., Conclusions: Cross-cultural implementation based on SCAN in Taiwan appears valid.

The diagnostic concordance of DSM-III-R, DSM-IV, and ICD-10 inhalant use disorders was assessed using the sample of lifetime inhalant users (n=76) participating in the DSM-IV Field Trial for Substance Use Disorders. Substantially smaller proportions of lifetime inhalant users met DSM-IV inhalant abuse or dependence criteria than met comparable DSM-III-R or ICD-10 criteria. DSM-III-R and ICD-10 performed similarly, although DSM-III-R tended to be more inclusive vis-à-vis diagnoses of inhalant dependence. Kappa coefficients indicated a moderate degree of concordance between the three nosologies for inhalant use disorder diagnosis rates. Inclusion of possible withdrawal symptomatology criteria (that are not normally included) in the DSM-IV and ICD-10 criteria sets for inhalant dependence exerted little effect on diagnosis rates.

The object of this study was to assess the prevalence and correlates of the DSM-IV diagnosis of hypochondriasis in a primary care setting. A large sample (N = 1456) of primary care users was given a structured interview to make diagnoses of mood, anxiety, and somatoform disorders and estimate levels of disability. The prevalence of hypochondriasis (DSM-IV) was about 3%. Patients with this disorder had higher levels of medically unexplained symptoms (abridged somatization) and were more impaired in their physical functioning than patients without the disorder. Of the various psychopathologies examined, major depressive syndromes were the most frequent among patients with hypochondriasis. Interestingly, unlike somatization disorder, hypochondriasis was not related to any demographic factor. Hypochondriasis is a relatively rare condition in primary care that is largely separable from somatization disorder but seems closely intertwined with the more severe depressive syndromes.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

This study was designed to examine the agreement of DSM-IV alcohol and drug use disorder diagnoses generated by three WHO/NIH diagnostic instruments, the AUDADIS-ADR, the CIDI, and the SCAN. This substudy, conducted in three countries, Greece, Luxembourg, and the United States, was part of the larger joint project on diagnosis and classification of mental disorders and alcohol and drug-related problems, which was initiated to evaluate the cross-cultural applicability of the instruments and the criteria. Overall, concordance among the three assessments was good for alcohol and opiate dependence, fair to good for cocaine and sedative dependence, and low for amphetamine dependence. Cannabis dependence concordance was significantly more discrepant than any other substance. Agreement on abuse was low for all substances examined. In addition, the concordance of DSM-IV criteria for each substance was examined. Finally, reasons for discrepancies in responses among assessments were examined, based on discrepancy interview protocol methodology. Further investigation will help to refine these instruments in order to provide a more thorough understanding of alcohol and drug abuse diagnoses.

The main question addressed by this paper is whether DSM-IV substance dependence diagnoses obtained from two different instruments (the semi-structured WHO Schedules for Clinical Assessment in Neuropsychiatry, SCAN and the highly structured WHO Composite International Diagnostic Interview--Substance Abuse Module, SAM) are as consistent as diagnoses obtained from a single instrument (SAM) administered twice. Such comparisons of results from the two different instruments provide some measure of validity of the lay-administered SAM and of the underlying diagnostic concepts. Chance-corrected concordance was estimated using the kappa coefficient for SAM/SCAN (test/validation) and SAM/SAM (test/retest) comparisons. Analyses of agreement between SAM and SCAN for DSM-IV dependence diagnoses indicated good agreement for alcohol and cocaine, and fair agreement for opiates and cannabis. SAM/SAM (test/retest) agreement was excellent for alcohol and opiate dependence, good for cocaine dependence, and fair for cannabis dependence. Agreement on individual dependence criteria was generally consistent with overall diagnostic agreement though more variable. Notable was the poor agreement for cannabis criteria in the SAM/SCAN protocol. This may indicate that the dependence syndrome is less applicable to cannabis, while the consistency of agreement for alcohol, opiate, and cocaine dependence criteria supports the validity of these dependence syndromes. Finally, these data indicate that both the clinical (SCAN) and non-clinical (SAM) interviews can be used effectively for a variety of substances and dependence diagnoses.

In substance abuse research many study protocols require the recall and report of behavior from the distant past that may affect reliability. This study addresses the stability of substance use reports over a 10-year follow-up period. We reinterviewed 223 ECA subjects who reported baseline drug use. Reports from baseline to follow-up were categorized as either incident cases, agreements, or discrepancies. Different patterns were found for each substance group. The authors found that cannabis, cocaine, sedatives, and opiates had high agreement rates ranging from 82-86% and amphetamines had the lowest (73%). Implications for future drug research are discussed.

Objective: To present data on the reliability of the narrowing of the drinking repertoire criterion in the ICD-10 substance use disorder nomenclature and possible justification for its exclusion from ICD-10. This criterion has been one of the hallmarks of the Edwards and Gross dependence concept., Method: The sample of 318 consisted of 175 substance users from St. Louis area substance abuse treatment programs and 143 substance users from the St. Louis Epidemiologic Catchment Area Project, a general population survey. Respondents were interviewed about their substance use with the CIDI-SAM and reinterviewed approximately 1 week later. "Narrowing of the drinking repertoire" was reported by 24%., Results: Overall, the agreement from interview 1 to interview 2 was fair to good (kappa = 0.5851). Men and drinkers in treatment were found to be more reliable reporters than women and drinkers recruited from the general population., Conclusions: The decision to drop the repertoire criterion seems justified, especially when non-clinical samples are interviewed. However, since our data found it highly associated with meeting criteria for a dependence disorder it is clinically valid. Additional research among varied populations is necessary to determine if the concept of narrowing is culture or gender specific and if its deletion affects rates of dependence.

New revisions of diagnostic categories have produced the most recent classification systems, namely DSM-IV and ICD-10. The diagnostic approaches exemplified by these two nomenclatures are very similar to one another and represent a return to descriptive psychiatry in which careful observation of symptoms, signs, and course of mental diseases become the diagnostic criteria themselves. In many ways, these newest classification schemata can be considered a return to phenomenological psychiatry perhaps best exemplified at the start of this century by Emil Kraepelin. Thus, recent developments in psychiatric diagnosis can be thought of as "neo-Kraepelinian". Because they represent a relatively radical change from psychodynamic approaches to evaluation and diagnosis, they can also be called "revolutionary." This paper traces the roots of current diagnostic systems and compares and contrasts these systems to the classification schema described by Kraepelin. Diagnostic criteria for schizophrenia are used as an example of how diagnostic conventions have changed dramatically over the past 50 years. Discussion of the implications of this neo-Kraepelinian revolution in psychiatric diagnosis is included.

The proposed DSM-IV criteria for substance use disorders have included, as an option, a subtyping for physiologic dependence, characterized by either tolerance or withdrawal. Even if this option is not chosen at this stage of system revision, this weighting scheme justifies wider surveillance of these symptoms, especially for the more newly described cocaine dependence disorder. Wider surveillance of withdrawal is possible with the CIDI Substance Abuse Module (SAM), a WHO/ADAMHA diagnostic interview which covers criteria of substance use disorders according to the DSM-III, III-R, ICD-10 and proposed DSM-IV systems. To aid in this effort, we used the SAM, which includes a master list of all symptoms (n = 16) in the DSM manuals related to withdrawal from any substance to assess withdrawal symptoms from all substances. In this study, we hypothesized that the persons who used opiates with cocaine might misattribute their symptoms to cocaine; thus, we compared the responses of persons who used cocaine and opiates (opiate users) with the responses of persons who used cocaine without opiates (non-opiate users). Data from two St. Louis studies were combined for these analyses, users not in treatment or newly enrolled to drug-free or methadone treatment from a NIDA demonstration project and users selected for the St. Louis DSM-IV Field Trial. Of the 196 persons included from the field trial, 80% reported lifetime cocaine use compared with 91% of the 412 persons from the demonstration project. The symptoms mentioned in the diagnostic manuals were among the most frequently endorsed by both cocaine use groups.(ABSTRACT TRUNCATED AT 250 WORDS)

With proposed criteria for DSM-IV substance dependence imminent, an evaluation of the impact of changes from DSM-III to DSM-III-R would be informative. Recent admissions to St. Louis drug treatment centers were interviewed with the DIS-III-R, which covers criteria from both systems. Kappa values for system agreement, diagnostic overlap and percent positive agreement are reported by substance. The DSM-III-R system cast a wider net for dependence than DSM-III for alcohol, tobacco and amphetamines. Neither system predominated for cannabis, opioids and barbiturates/sedatives/hypnotics. Reasons for differences and implications of findings are discussed.

BackgroundSomatisation is a common and frustrating clinical problem in primary care.MethodUsing structural diagnoses and functional measures, we examined the prevalence and associated features of somatisation disorder defined by three current nosologies and an abridged construct in subjects using primary care services.ResultsSomatisation disorder, diagnosed according to the standard criteria, was found to have a very low prevalence (range 0.06-0.5%), while more than one-fifth of the sample (22%) met the criteria for the abridged diagnosis. There was poor agreement between succeeding versions of the DSM system for identifying cases of somatisation disorder, each system ending up with rather disparate sets of individuals as well as variable levels of psychopathology and disability.ConclusionsAccording to these data, standard somatisation disorder diagnoses add little to the prediction of disability/psychopathology beyond the contributions of an abridged construct of somatisation.