Research Paper Topics on Culture

FINANCIAL DISCLOSURES: Dr. Kotwicki is the Medical Director of Skyland Trail. He reports no other conflicts of interest. Dr. Harvey is a member of the National Advisory board of Skyland Trail and is compensated for this service.

FINANCIAL DISCLOSURES: Dr. Kotwicki is the Medical Director of Skyland Trail. He reports no other conflicts of interest. Dr. Harvey is a member of the National Advisory board of Skyland Trail and is compensated for this service.

KEY WORDS: Bipolar disorder, psychosis, structured diagnoses, validity ABSTRACT clinician diagnoses and those appears to be a reasonable trade-off Background. Psychiatric generated by structured interviews. between brevity and accuracy diagnoses are important for The same three interviewers through the use of the MINI treatment planning. There are a examined all patients in all three compared to the SCID, with number of current challenges in the phases of the study. substantial improvements in stability area of psychiatric diagnosis with Results. Admission and discharge of diagnoses compared to clinician important treatment implications. In diagnoses were available for 313 diagnoses. Clinical diagnoses were this study, we examined the cases. Diagnoses generated with the minimally overlapping with the differential usefulness of two semi- unstructured procedure were results of structured diagnoses, structured interviews of differing changed by discharge 74 percent of suggesting that structured length compared to clinical diagnoses the time, compared to four percent assessment, particularly early in the for generation of diagnoses that did for SCID diagnoses and 11 percent illness or in short term treatment not require modification over the for MINI diagnoses. Referring settings, may improve treatment course of treatment. clinician diagnoses were disconfirmed planning. Methods. We performed a three- in Years 2 and 3 in 56 percent of year, three-cohort study at an SCID cases and 44 percent of MINI INTRODUCTION outpatient psychiatric rehabilitation cases. The distinctions between The reliability of psychiatric facility, comparing the stability of unipolar and bipolar disorders were diagnoses has improved markedly admission diagnoses when generated particular points of disagreement, since the introduction of structured by unstructured procedures relying with similar rates of under and over- psychiatric interviews.1 These on referring clinician diagnosis, the diagnosis of bipolar disorder. The rate interviews were first developed in the SCID, and the MINI. We examined of confirmation of referring clinician late 1960s2 and were fine tuned3 up changes in diagnoses from admission diagnoses of schizoaffective disorder through the time of the introduction to discharge (averaging 13 weeks) was 10 percent with the SCID and 11 of the the Diagnostic and Statistical and, during the second two years, percent with the MINI. Manual of Mental Disorders, Third convergence between referring Discussion. In this setting, there Edition (DSM-III)4 in 1980. At the 14 Innovations in CLINICAL NEUROSCIENCE [VOLUME 10, NUMBER 5–6, MAY–JUNE 2013] same time, the use of these multiple, newly indicated treatments patients accurate diagnosis is structured interviews is still not and associated advertising. In important. This is particularly common in everyday clinical practice, addition, an increased appreciation of relevant to time-limited treatment. As with most use in research settings. It the fact that bipolar disorders can be interventions such as day treatment is not clear how much the application marked by brief episodes of or other rehabilitation therapies may of such interviews would impact the hypomania rather than full manic be approved by insurance payers for reliability and validity of diagnoses in episodes has increased the challenge delivery only for finite periods, clinical practice settings, but it seems in discrimination between bipolar and inaccurate targeting of treatment likely that there are certain unipolar mood disorders. We know interventions early on could lead to circumstances where the increase in that distinguishing unipolar therapeutic interventions being validity would be quite substantial. depression and bipolar illness has applied for relatively abbreviated and The importance of collection of valid socioeconomic and functional potentially inefficacious periods. assessment

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