Structured Clinical Interview for DSM-IV

The Structured Clinical Interview for DSM-IV (SCID) disorders is a semistructured standardized diagnostic interview commonly used for clinical and research applications. (DSM-IV is the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition.) Several versions of the SCID are available, including standard face-to-face interview, computerized interviewer-entered data, and computerized patient-entered self-report. The SCID was developed at the New York Psychiatric Institute Biometrics Research Lab in a comprehensive effort to standardize DSM-IV diagnostic interviewing procedures including uniform phrasing of interview questions. Standardized interview procedures were greatly needed to enhance interrater DSM diagnostic reliability, particularly when interviewers differed significantly in education, training, and clinical experience.

When DSM-IV Axis I disorders are under consideration, the SCID-I interview is appropriate. The SCID-I interview is comprised of sequential modules that assess for mood disorders, psychotic symptoms, psychotic disorders, substance use disorders, anxiety, and other Axis I disorders commonly found in adults. Each module begins with screening questions. When negative responses are provided for all the screening questions, the interviewer is directed to the next module by means of a branching system. When some positive responses are provided for the screening questions, the interviewer is directed to a more comprehensive review of symptoms for that module. The SCID-II should be used when Axis II personality disorders are under consideration. Again, sequential modules are used to examine each of the DSM-IV Axis II personality disorders. The SCID-II can also be used for detecting the DSM residual category (personality disorder not otherwise specified) and some unofficial diagnostic categories (depressive personality disorder). A SCID-I or SCID-II interview typically ranges from 45 to 90 minutes, depending on the complexity of patient report, including long-standing psychiatric history.

The SCID-I and SCID-II are available in research and clinician versions. The research versions closely [Page 977]follow DSM-IV criteria including detailed questions to ascertain presence of DSM-IV subtype specifiers. The research versions can be highly useful when documenting multiple DSM subtype specifiers, as may be encountered when interviewing a person with a complicated history of depressive or manic episodes. Although the research versions are preferred when comprehensive diagnostic information is needed to meet research protocol criteria for participant inclusion and exclusion, these versions tend to be time consuming when one is interviewing patients with intricate psychiatric histories. Rest breaks may be offered if a patient appears to be fatigued by a lengthy interview. The test developers offer a one-sided master copy of the research version and will permit modifications if the full diagnostic interview is not needed for the intended research purposes. A one-time fee with photocopying privileges is available for research funded by nonprofit organizations. A per-use fee is required when research is funded by for-profit organizations (contact Biometrics Research, 212-543-5524). Clinician versions of the SCID are streamlined to cover major DSM disorders often seen in adult clinical populations and are available from American Psychiatric Press (appi.org). Computer-assisted versions and a variety of training resources are available from Multi-Health Systems (mhs.com). On-site training and a 20-hour video training series are available from Biometrics Research. The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) Revised, developed separately by Marlene Steinberg, focuses specifically on dissociation, including modules for posttraumatic dissociative symptoms and acute stress disorder (see mhs.com).

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