PubMed Health⌕ Search

Biomedical subjects

L N Robins

Publications and source records attributed to L N Robins.

At least 19 recordsLinked to original sources
PubMed1992

A comparison of two computer-administered versions of the NIMH Diagnostic Interview Schedule.

This study compared three versions of the NIMH Diagnostic Interview Schedule (DIS): "traditional" interviewer-administered DIS; computer-administered DIS (subject interacting alone with computer); computer-prompted DIS (interviewer using computer program as a guide). Kappas for 20 diagnoses ranged from .15 to .94, and averages for the three method pairs ranged from .57 to .64, which are comparable to other DIS reliability studies. Agreement between pairs of methods were comparable. Subjects' attitudes toward the computer interview were positive. While they felt they could better describe their feelings and ideas to a human, they found the computer contact less embarrassing. Overall, subjects had no preference for one method over another. Measures of social desirability and deviant response biases were correlated with diagnostic results. Reading ability did not affect subject's ability to respond to the DIS, although subjects with lower reading levels preferred the computer interview more.

Adult↗
PubMed1992

Comparison of Composite International Diagnostic Interview and clinical DSM-III-R criteria checklist diagnoses.

This article describes a comparison of Composite International Diagnostic Interview (CIDI) diagnostic results and results based on clinicians' observation of CIDI assessments. Psychiatrists scored a DSM-III-R criteria checklist either while observing or after administering 20 CIDI interviews. Overall diagnostic concordance between the checklist and CIDI diagnoses was found to be good (kappa = 0.78). Good diagnostic agreement was also found for 3 groups of DSM-III-R disorders: depressive disorders (kappa = 0.84), psychoactive substance use disorders (kappa = 0.83) and anxiety phobic disorders (kappa = 0.76). These results are consistent with the results from a similar comparison between the CIDI and checklist results for ICD-10 diagnoses.

Anxiety Disorders↗
PubMed1992

Clinical observation of assessment using the Composite International Diagnostic Interview (CIDI). An analysis of the CIDI Field Trials--Wave II at the St Louis site.

Two clinicians scored the ICD-10 Research Criteria Checklist either while observing or after administering CIDI interviews to a sample of 20 subjects. Overall diagnostic concordance between clinical and CIDI assessments was found to be good (overall kappa = 0.77). Assessment of the specific diagnoses could be done only for the three most commonly represented in the studied sample: anxiety/phobic disorders (kappa = 0.73), depressive disorders (kappa = 0.78), and psychoactive substance use disorders (kappa = 0.83). While the lack of independence of the two assessments and the small, non-randomly selected sample might have exaggerated the concordance, this study shows that the CIDI provides all the data needed to score diagnoses in the ICD-10 nomenclature, as indicated by the small number of questions clinicians needed to ask following completion of the CIDI.

Adult↗
PubMed1991

Retrospective postmortem dementia assessment. Validation of a new clinical interview to assist neuropathologic study.

Neuropathologic studies of dementia and normal aging suffer from a lack of individuals examined for the presence and severity of dementia before death. To increase clinical information in such cases, a retrospective collateral interview was developed. Thirty-nine individuals were studied; 27 had autopsies. In all cases, the autopsy confirmed the Retrospective Collateral Dementia Interview (RCDI) diagnosis of the presence or absence of dementia; the RCDI had a sensitivity of 88% and a specificity of 80% for specifically detecting probable Alzheimer's disease. Agreement between the RCDI and premortem diagnosis was 96%; between RCDI and medical records, 100%. Agreement between RCDI staging of dementia severity and the last assessment of the living subject was 70%; between the RCDI and a brief staging at death, 86%. This validation confirms the value of postmortem interviews with close informants to assess dementia presence and severity.

Aged↗
PubMed1991

Performance of two forms of a computer psychiatric screening interview: version I of the DISSI.

This study reports on the performance of two forms of version I of the Diagnostic Interview Schedule (DIS) computer screening interview, using the traditional interviewer-administered DIS (T-DIS) as the standard. The screening interview was either self-administered (called the S-DISSI) with the subject keying in responses, or interviewer-administered (I-DISSI), with the interviewer keying in the subject's responses. Sensitivity and specificity for both forms were ample (excluding antisocial personality), ranging from 60% to 100% for sensitivity and 54% to 95% for specificity. Concordances with the T-DIS were similar for both forms of the screening interview, ranging from .10 to .87 and compared favorably to those reported by other investigators. The I-DISSI took on average 30 min less than either the T-DIS and S-DISSI. Since the performances of both versions were equivalent, the decision to use either may be based on available resources and characteristics of the study population.

Adult↗
PubMed1991

Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project.

Children with conduct disorder have long been known to be at high risk for developing externalizing disorders, alcohol and drug abuse, and antisocial personality. Relationships of conduct disorder to other adult psychiatric disorders, on the other hand, have not been definitively shown. Taking advantage of the large community sample (N = 19,482) interviewed in the NIMH Epidemiologic Catchment Area Program, the authors examined the effects of childhood conduct problems on ten DSM-III psychiatric disorders: somatization, phobia, panic, obsessive-compulsive, depression, mania, alcohol use disorder, drug use disorder, schizophrenia and antisocial personality. Each of the ten adult disorders showed an increase in prevalence with an increasing number of conduct problems, although effects were stronger for externalizing disorders. The predictive power of conduct problems was similar for males and females. The effect of conduct problems on nonexternalizing disorders was found to be largely mediated through externalizing disorders, particularly for men but direct effects also occurred for both sexes. These findings raise questions about the conventional view of psychiatric disorders as divisible into externalizing and internalizing disorders. They also suggest that the increasing rates of conduct problems in younger cohorts may be responsible in part for the rising rates of other disorders. Thus, prevention of and early intervention with conduct disorder may hold promise for reducing rates of a broad range of disorders.

Adolescent↗
PubMed1991

Conduct disorder.

Explore the source record for details and available documents.

Antisocial Personality Disorder↗
PubMed1991

Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-10 and DSM-III-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

Cross-Cultural Comparison↗
PubMed1991

The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA Field Trial.

The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-III-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD-10 and DSM-III-R regarding substance abuse and dependence disorders.

Alcoholism↗
PubMed1990

Cognitive impairment and length of hospital stay in older persons.

We looked at performance on the Folstein Mini-Mental State Exam (MMSE) as a predictor of hospitalization and length of stay in the coming year in community-dwelling older persons from the National Institute of Mental Health Epidemiologic Catchment Area program. They had been assessed with the MMSE at the outset and were re-evaluated with the MMSE and a Health Services Questionnaire 1 year later. Subjects were more likely to be hospitalized in the subsequent year if they were older than 75 years or if they scored poorly on the MMSE. Severe cognitive impairment increased the risk more than mild impairment. Multivariate analyses that controlled for demographic variables demonstrate that MMSE performance is a significant predictor of any subsequent hospitalization (medical or psychiatric) among whites and among those at both high and low educational levels. This effect was not explained solely by the increased rate of psychiatric hospitalizations. We also determined that a decline in MMSE score over 1 year was associated with an increased risk of hospitalization, more hospital days, longer average length of stay, and a prolonged (greater than 20 days) hospital stay. We conclude that both initial poor performance on the MMSE and deterioration increase the risk of hospital use and lead to more extended hospital stays. However, even with poor MMSE performance, most older persons remain out of the hospital and most of those hospitalized do not have prolonged stays; thus, MMSE score alone is insufficient as a predictor of impending hospitalization. Further studies are needed to add other measures of risk for hospitalization and prolonged hospital stays.

Age Factors↗
PubMed1989

Diagnostic grammar and assessment: translating criteria into questions.

There has been concern about whether standardized psychiatric interviews make valid diagnoses. Agreements between the Diagnostic Interview Schedule (DIS), as an example of a standardized interview, with independent assessments by a clinician are reasonably high in most studies, but the clinical assessment is itself of uncertain validity. Using predictive ability is an alternative way of judging validity. Data are presented to show that the DIS is almost as good at prediction as a clinician's assessment, but here too there are problems. Because prediction is probabilistic (i.e. the same disorder can have multiple outcomes, and different disorders can share outcomes), it is not possible to say how good prediction has to be to demonstrate perfect validity. Across varied methods of validity assessment, some disorders are regularly found more validly diagnosed than others, suggesting that part of the source of invalidity lies in the diagnostic grammar of the systems whose criteria standardized interviews evaluate. Sources of invalidity inherent in the content and structure of a variety of diagnoses in DSM-III and its heir, DSM-III-R, are reviewed and illustrated, in part with results from the Epidemiological Catchment Area study. The relationship between diagnostic criteria and standardized interviews is symbiotic. While attempts to adhere closely to existing diagnostic criteria contribute to the diagnostic accuracy of standardized interviews, the exercise of translating official diagnostic criteria into standardized questions highlights problems in the system's diagnostic grammar, enabling standardized interviews to contribute to improvements in diagnostic nosology.

Humans↗
PubMed1989

The reliability of the CIDI-SAM: a comprehensive substance abuse interview.

The CIDI-SAM is a fully-structured interview that ascertains DSM-III, DSM-III-R, Feighner, RDC and ICD-10 diagnoses for alcohol, tobacco and nine classes of psychoactive drugs. It was designed at the request of the WHO/ADAMHA Task Force on Psychiatric Assessment instruments to expand the substance abuse sections of the CIDI. Using a test-retest design, the diagnostic and item reliabilities of this instrument were tested in a sample of 39 patients in substance abuse treatment at three St. Louis treatment facilities. Kappa values and their 95% confidence intervals, and Yule's Y values are reported. The average kappa for DSM-III substance disorders was 0.84, for DSM-III-R it was 0.82. We report, on the average, excellent kappa values for individual alcohol and drug symptoms. We also ascertained from the respondent's themselves the reasons why answers to specific questions might have been discordant. The findings from this unique 'discrepancy interview' are reported.

Adult↗
PubMed1989

History-taking in the elderly with and without cognitive impairment. How useful is it?

To assess the usefulness of interviewing older adults with cognitive impairment, we analyzed data from the NIMH Epidemiologic Catchment Area Study. People aged 65 and older with cognitive impairment were twice as likely as age-matched unimpaired elders to report sufficient symptoms of psychiatric disorders to qualify for a current diagnosis (16% vs 7%), and were also more likely to qualify for a lifetime diagnosis (25% vs 15%). We considered whether this excess could be due to random responses by the impaired, but found the rank order of their symptoms very similar to that of the unimpaired. Although dementia is thought to affect recent more than remote memory, the impaired were no less likely than the unimpaired to report disorders of recent onset. We also compared the cognitively impaired and unimpaired with respect to their reliability as assessed by reinterview one year later and found no significant difference. We conclude that there is no reason to believe that the excess of disorders in the mildly impaired is an artifact caused by their poorer performance as respondents. Interviewing the elderly person with cognitive impairment is a useful way of discovering concurrent disorders that may be treatable.

Aged↗
PubMed1989

Comprehensive health care for high-risk adolescents: an evaluation study.

This study was designed to evaluate the effectiveness of a large scale program to improve health care for high-risk adolescents. Seven clinics, funded to provide comprehensive primary care to adolescents, were compared to three non-funded clinics. The majority of the 2,788 adolescent patients sampled in these clinics were female (78 percent) and Black (71 percent). Each patient was initially interviewed at the time of a clinic visit and reinterviewed 12 months later; their medical records were systematically reviewed. As expected, the funded clinics detected and treated a wider range of medical and behavioral problems than the comparison clinics, a finding that was based on the self-reports of patients and confirmed by documentation in the medical records. However, improvements in life-style and in specific medical outcomes were not observed. To build on the limited success of this program, efforts are needed to encourage more males to receive care and to develop more specific interventions for patients in this age group.

Adolescent↗