ADIS, CAPS, & Clinical Significance

8/13/2019 ADIS, CAPS, & Clinical Significance

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ADIS, CAPS, and Clinical Significance


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DSM-IV-TR Diagnosis & formulation

Diagnoses founded in behavioral descriptors

Behavioral descriptors = behavioral excessesor deficits

Through description of problem, it can be understood

Through understanding, the problem can begin to be

predictedto occur under certain circumstancesandconditions (its lawful)

Prediction lends itself to theoretical control, through thecontrol of conditionsthat predict the problem behavior

Therefore, diagnosis is the foundation for formulationand treatment

Interviewingdescription or formulation of problempredictionintervention or control over problem


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Open/closed-ended questions: Is the writing on the wall?

Unstructured interviewingvalidly obtains info.

What is obtained?

However, is it reliable? reliability vs. validity

Structured interviewing hasbeen established as both

reliable and valid. What about therapeuticrelationship effects?

Research re: Structure-driventherapists


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Structured interviewing: Friend or foe?

Managed care:Limitingtreatment to reduce costs (i.e.,

pencil-pushing/actuarialphenomenon).

Accountability: Practicingwithin supported boundaries(e.g., empirically evaluated,supported, and evidence-based).

Research-needs:Screeningresearch subjects in / out.

This stated / realized: Feelingsabout diagnosis? ( + / - )


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Semi - & structured - interviewing: Benefits

to the beginning interviewer & therapist

With experience structure Provides guidelines for what to

do/say next Improved reliability provides

variance due to chance

Improved hits provide increased

rates correct conceptualization,in turn leading to correct

treatment


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decisions, decisions so many decisions, so

little time what to do oh, what to do?!?!?!?


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ADISIV: Anxiety Disorders

Interview Schedule for DSM-IV

Developed because psychosocial

treatments for anxiety disorders

have become highly specific

SCID lacked depth and detail

Again, systematic/detailed

questioning necessary for a

reliable differential diagnosis

ADIS provides accurate

diagnosis & functional analysis

of problems/symptoms


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Bennies of the ADIS

Asks some dichotomous questions (yes/no answers)

Asks dimensional questions, which are important fordiagnostic clarity, comparativeness, and as an outcome

prognostic indicator Depth of detail assists clinical judgment more than others;

nonetheless, all require not only familiarity with therespective instruments, but also of the DSM-IV since theirdecision-tree line of questions are based upon DSMdescriptors and templates of disorders

ADIS carries added advantage to researchers, especiallyfor anxiety disorders


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ADIS structure & form

Utilizes a semi-structured format, allowing for both a

structured format for accuracy and reliability, but also for

clarification

Incorporates introduction section and summary sections

Provide standard questions, which in the ADIS are bold

Starts with dichotomous questions, and then funnels down

to specific dimensional questions


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ADIS structure

All modules start with the INITIAL INQUIRY questions,

which are typically dichotomous in nature; This allows the

interviewer to decide whether to proceed into the module

At the end of the interview, the Hamilton scales (anxiety

and depression) are administered

Hamiltons are followed by a summary section, where the

patient is asked what the primary issue is they want help

with, as well as whether they feel like there was anything

the interviewer missed and/or didnt ask about


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Clinical significance and reliable change

Question: How do you gauge change? Better Q: What constitutes change?


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How to measure change in psychotherapy

Change used to be artifact of clinical opinion Tx thought or felt pt was better/worse

Reliability non-existent & meaningless validity

No meaningful (statistical) legitimacy

Stronger change indicators demanded by MHC

Pure statistical change not useful either What does 25% or 35% (responder) change mean?

Without a sense of whether it matters, it is useless

More usable ways to monitor change needed

How compare with non-clinicals (normals)?


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What is normal versus not?

Human functioning located

on rangeof instrument of

interest

Typically, hi score worse andlow score better

Monitor score behavior over

treatment and follow-up data

points

Determine how patient

compares to average joes


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Teaching statistics to non-researchers

Labcouch gap

Chasm unacceptable

Average tx is stats

aversive Math anxiety rampant

Simple formulas better

Illustrations critical Use tx own cases


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Clinical decision-making and change indexes

Three easily definable/quantifiable C targets1. Cross clinical threshold C dont stop until

a. Once passed C: Ok to begin to fade

2. Within 1 std dev alright to begin termination/stop

a. Introduce relapse prevention & generalization trainingb. Discuss importance of maintenance & mentor programs

3. At non-clinical (normal) mean, stop

a. Offer booster sessions ( 3 in 6-12 months)

4. Below normal ---just bennie

Reliable change: Dont consider fading, or

discussions of termination until RCI 1.96


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PTSD: Tracking progress for CS and RCI

Clinicals PTCI 1

C PTCI 1


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A scienceof clinical psychology

Since 1600s the cornerstone of testability hasserved as foundation of scientific practice

With increasing specialization/sophistication,

people understand less and less about many

techniques and underlying concepts

Opposition to ESTs not on basis of evidence but by

denial of efficacy of rational inquiryor insistence

upon equal epistemic merit of alternatives

Flight from- and rejection of- reason = danger


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Is psychological science an oxymoron?

Subversion of reason and knowledge is leavingclinical psychology without a formal guiding,

scientific compass/foundation

Snake oil gains acceptability & credibility

Derogation of science is old, and people are

aligning away from logic, reason, and truth

Humanism gains, science loses

Under light of reason, superstition can be burnedaway to reveal a truly rational society

In such rational truth, charlatanism cannot hide


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Beliefs, myths, and behaviors

Inactive / less active ingredients detract from optimalprogress / outcome because detracts time afforded

more active / effective pieces

Worst case, become equivalent of safety bhrs

Faith: A belief not supported by logical proof or

material evidence

Equivalent to superstition, myth, and outright lies

Act in non-scientific/anti-scientific ways Subordinates truth-seeking to subjective preference,

inclination, expediency, or opportunistic consideration


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Dodo-Bird Verdict (1936)

All treatments are effective,

and equally so

Everyonehas won, and allmust have prizes

Should actively ingredient

treatments be held as

equivalents of everything fromless active to sham treatments?


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When a true genius appears in the world, you

may know him by this sign, that the duncesare all in confederacy against him

Jonathan Swift


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Conclusions

Without understanding theissues that bring your patientto see you, you mightmisapply treatment.

Learn how to systematicallyand critically think about your

patients.

Dont be a Prof. Gallagher

Pendant

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ADIS, CAPS, & Clinical Significance

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