A COMPARISON OF THE STRUCTURED CLINICAL INTERVIEW FOR DSM-III-R AND CLINICAL DIAGNOSES

The relationship between diagnoses generated by the Structured Clinica l Interview for DSM-III-R Personality Disorders (SCID) and by nonstruc tured psychiatric interviews was examined. The purposes were to evalua te which DSM-III-R diagnoses were most reliably chosen, and to compare diagnostic practices between two clinical sites. Diagnoses generated by researchers using the patient version of the SCID and by psychiatri c interviews were compared for 100 patients. The participants had been randomly assigned to one of two acute treatment sites within the same institution, as part of a larger study of an alternative to inpatient hospitalization. Overall reliability between the SCID and the clinici ans, as determined by weighted Kappa, was poor. There was considerable variability among the major diagnostic categories, with higher agreem ent for schizophrenia and bipolar disorder than for others. The agreem ent for schizoaffective disorder was extremely low. There were also si gnificant differences in the patterns of diagnoses between the two sit es. The patient version of the SCID appears to produce results that ar e very different from clinical practice, which, in turn, may be influe nced strongly by location.