BRIEF COMMUNICATIONS
Screening Psychiatric Patients for Axis II Disorders* DAVID NUSSBAUM, Ph.D. I AND RiCHARD ROGERS, Ph.D. 2
This study examined the usefulness of the SCID-PQ on a sample of 82 inpatients as a screening measure for Axis II disorders. The SCID-PQ proved effective (i.e., resulted in a very low false negatives and moderate false positives) in screening for seven of the II DSM-III-R personality disorders. Of the four remaining disorders, minor modifications were suggested which resulted in improved classification rates for dependent and schizoid personality disorders.
achieving satisfactory reliability for Axis II disorders (range
= 0.56 to 0.64) (10).
Spitzer and Williams (11), in an. effort to improve the diagnostic reliability, operationalized the DSM-III-R criteria using a structured interview, the Structured Clinical Interview for DSM-III-R (SCID-R). Earlier efforts with standardized interviews have demonstrated the value of the interviews in achieving satisfactory to excellent interrater reliability (12,13). One major component of the SCID-R is devoted to the diagnoses of Axis II disorders (14). This diagnostic approach appears promising for classifying the full range of personality disorders (15). In order to ease the substantial burden placed on clinicians by multiaxial diagnoses, Spitzer and Williams (16) also devised a self-administered questionnaire, the SCID Personality Questionnaire (SCID-PQ), which parallels the SCID-II-R. If effective, the SCID-PQ would greatly facilitate the diagnosis of personality disorders by screening psychiatric patients for co-existing Axis II disorders. Until now however, there have been no reported studies evaluating the effectiveness of the SCID-PQ as a screening device (17). This study investigated the usefulness of the SCID-PQ as a screening measure for Axis II disorders with inpatients. Our goal was to study the personality disorders which are amenable to cost-effective screening using the SCID-PQ. In addition, we investigated alternative cut-off scores for the SCID to improve classification rates for the four diagnoses for which the SCID-PQ was less effective.
T
he emergence of multiaxial diagnoses in the DSM-III and the DSM-III-R is largely an acknowledgement of the importance of personality disorders in the effective treatment of psychiatric patients. As observed by Frances (I), recent investigations have underscored the way in which the combination of Axis I and Axis II disorders shapes both the patient's clinical presentation and treatment response. The rather formidable task facing clinicians is how to screen psychiatric patients effectively for each of the 11 Axis II disorders. The diagnosis of personality disorders reflects their rich and divergent origins in psychoanalytical and personological theory which, in turn, have strongly influenced the successive changes in diagnostic nosology (unpublished manuscript, 1988). Problems which naturally arise from such a theorydriven endeavour are I. overlapping and sometimes indistinct boundaries between specific personality disorders (1-3); 2. emphasis on categorical rather than dimensional diagnosis (3,4) which may lead to a bewildering array of symptom variations for a single diagnosis (5); and 3. conceptual difficulties in establishing the inter-relationships among the disorders that substantially contribute to problems in establishing reliable inclusion/exclusion criteria (6-9). It is not surprising that clinicians have had great difficulties
Method
A sample of 82 inpatients was recruited from METFORS, a forensic assessment unit at the Clarke Institute of Psychiatry. METFORS is comprised of the outpatient Brief Assessment Unit (BAU), where patients referred by the courts are screened by interview and chart review (if available) for their competence to stand trial and returned to the correctional facility the same day; and a 23 bed inpatient unit for those patients whose fitness for trial is unclear. Evaluations of criminal responsibility, and occasionally, examinations of potential for violence are also conducted at METFORS. Inpatients typically stay on the unit for a period of two weeks. We therefore had a diverse clinical sample of patients referred by the courts; not a sample preselected on the basis of diagnosis or treatment modality. The 82 subjects we studied were consecutively admitted patients who were able to provide informed consent and were willing to participate in the research project. The participants completed an informed con-
*Manuscript received June 1991, revised December 1991. Jpsychologist-in-Charge and Coordinator of Research, METFORS/Clarke Institute of Psychiatry; Lecturer, Department of Psychiatry, University of Toronto, Toronto, Ontario. 2 Associate Professor, Department of Psychology, University of North Texas, Denton, Texas; formerly, Senior Psychologist and Coordinator of Research, METFORS/Clarke Institute of Psychiatry; Associate Professor of Psychiatry and Psychology, University of Toronto, Toronto, Ontario. Address reprint requests to: Dr. D. Nussbaum, METFORS/Clarke Institute of Psychiatry, 1001 Queen Street West, Toronto, Ontario M6J IH4
Can. J. Psychiatry Vol. 37, November 1992
658
November, 1992
659
SCREENING PSYCHIATRIC PATIENTS FOR AXIS-II DISORDERS
sent form in conformity with ethical approval of the project by the University of Toronto, Office of Research Administration. All subjects completed the SCID-PQ which was followed, after a minimum of a week interval, by the SCID-II-R interview. The interviews were conducted by two staff psychologists and a psychology intern, all of whom were experienced in administering the SCID. As an estimate of interrater reliability, ten SCID-II-R joint interviews were conducted on a separate sample of inpatients. The level of interrater agreement was very high for all II personality disorders (concordance rate of 95.5% and a kappa of 0.97). We were therefore confident in the reliability of SCID-II-R diagnoses. In the study itself, all standard instructions were followed with one significant variation - since the interviewers were blind to the SCID-PQ results and the level of agreement on each variable was relevant, all the SCID-R questions were administered to every subject. Results Usefulness of the SCID-PQ for each personality disorder was calculated for sensitivity, specificity, true positives and false negatives. The level of diagnostic agreement was assessed using kappa coefficients (18). Table I summarizes the effectiveness of SCID-PQ as a screening measure for Axis II disorders with inpatients, and data on decision results for each Axis II disorder. The accuracy of a screening measure is evaluated primarily in terms of the true positives and false negatives obtained using the measure. Clinicians are most interested in avoiding undetected diagnoses (i.e., false negatives) through the screening process. Of secondary interest is the rate of false positives obtained, since this reflects on the efficiency of the screening measure (i.e. a high false positive rate would sug-
gest that the screen is time-consuming and therefore not particularly useful). The SCID-PQ was successful with all but two personality disorders (schizoid and dependent personality disorders) in producing few low false negatives. Of the two, schizoid personality disorders were not sufficiently represented in the clinical sample (n = 5). In addition, high false positive rates (~ 60%) were found for paranoid and antisocial personality disorders. Based on these findings, we reexamined the cut-off scores of the SCID-PQ for four diagnoses: dependent, schizoid, paranoid, and antisocial personality disorders. By using only three criteria (rather than four) the criteria on the SCID-PQ, the true rate of positives for dependent personality disorder improved dramatically from 70.0% to 100.0%, with only a slight increase in false positives from 30.6% to 39.0%. Although few patients in the study had schizoid personality disorders, a similar decrease from four to three criteria markedly improved the true positive rate (100.0%). Standard implementation of this reduction would, of course, require further investigation. Attempts to improve the efficiency of the SCID-PQ (i.e., to result in fewer false positives) for paranoid and antisocial personality disorders were not successful. When the criteria were increased by even one, the true positive rate fell to an unacceptably low level. Discussion The SCID-PQ performed remarkably well as a screening measure for the SCID-II-R. The kappa coefficients were relatively modest, although this is less of a concern for screening measures where moderate false positive rates are expected (i.e., as a screen, it is most important to have a very low false negative rate which is usually achieved at the expense of false positives). With additional studies, the SCID-
Table I Effectiveness of the SCID-PQ in the Screening of Axis II Disorders in an Inpatient Sample Axis II Diagnosis Avoidant
Sensitivity 95.0%
Specificity 61.2%
Dependent
70.0%
69.4%
True Positives (%) 19 (23.2) 7 (8.5)
False Positives (%) 24 (29.3)
True Negatives (%) 38 (46.3)
False Negatives (%) I (1.2)
Kappa 0.41
22 (26.8)
50 (61.0)
3 (3.7)
0.23 0.49
Obsessive-compulsive
95.8%
65.5%
23 (28.0)
20 (24.4)
38 (46.3)
I (1.2)
Passive-aggressive
87.5%
65.2%
14 (14.1)
23 (28.0)
43 (52.4)
2 (2.4)
0.36
100.0%
52.2%
13 (15.9)
33 (40.2)
36 (43.9)
0(0.0)
0.26
1(1.2)
0.31
Self-defeating Paranoid
96.6%
39.6%
28 (34.2)
32 (39.0)
21 (25.6)
Schizotypal
90.9%
66.7%
20 (24.4)
20 (24.4)
40 (48.8)
2 (2.4)
0.46
Schizoid
60.0%
83.1%
3 (3.7)
13 (15.9)
64 (78.0)
2 (2.4)
0.25
Histrionic
88.8%
53.1%
16 (19.5)
30 (36.6)
34 (41.5)
2 (2.4)
0.26
Narcissistic
92.3%
59.4%
12 (14.6)
28 (34.2)
41 (50.0)
I (1.2)
0.36
Borderline
91.7%
56.9%
22 (26.8)
25 (30.5)
33 (40.2)
2 (2.4)
0.38
Antisocial
94.1%
38.5%
16 (19.5)
40 (48.8)
25 (30.5)
I (1.2)
0.28-
"This Kappa was calculated between development questionnaire data and developmental interview data as there are no adult antisocial items on the questionnaire.
660
Vol. 37, No.9
CANADIAN JOURNAL OF PSYCHIATRY
PQ may prove useful in clinical practice in reducing the onerous task of multiaxial diagnoses. The SCID-PQ was constructed on a rational basis to make it easier for clinicians. As such, its ease of use is achieved by unidirectional scoring ("yes" responses are invariably endorsements of psychopathology), clustering of symptoms by diagnosis, and a rigidly parallel structure to the SCID-II-R interview. Based on the results of this study, we suggested a minor modification in cut-off scores to the accuracy (true positives) for dependent personality disorder and that a similar change be envisioned for schizoid personality disorders. However, fundamental changes in the structure of the SCIDPQ, based on an empirical rather than a rational model, would be even more promising. For example, alternating SCID-PQ questions from different diagnostic clusterings may augment the overall rate of classification. Directionality of endorsements and non endorsements should be varied within each diagnostic question cluster, to avoid effects of yea- or naysaying response sets. Indeed, with scales to correct for response bias (for example, defensiveness, malingering, and irrelevant responding) (19), it is quite possible that a revised SCID-PQ might supplant SCID-II-R interviews with the majority of patients and free clinicians to devote their diagnostic skills to a narrow band of problematic cases. Acknowledgements The study was supported by a grant from the Clarke Institute of Psychiatry Research Fund. The authors would like to thank Dr. Mike Hall of the Institute for Social Research, York University, and Mr. Daniel Bloom of Computer Services, York University, for their assistance with data analysis. We would also like to acknowledge the assistance of Dr. Elizabeth Lynett for her help in conducting the interviews.
References 1. Frances W. Introduction to personality disorders. In: Michels R, Cavenar JO, Cooper AM, et ai, eds. Psychiatry. Philadelphia PA: J.B. Lippincott, 1988. 2. Frances AJ. The DSM-II1 personality disorders section: a commentary. Am J Psychiatry 1980; 137: 1050-1054. 3. Widiger TA, Kelso K. Psychodiagnosis of Axis II. Clin Psychol Rev 1983; 3: 491-510. 4. Frances AJ. Categorical and dimensional systems of personality diagnosis: a comparison. Compr Psychiatry 1982; 23: 516-527.
5. Stone MH. Borderline personality disorder. In: Michels R, Cavenar JO, Cooper AM, et ai, eds. Psychiatry. Philadelphia PA: J.B. Lippincott, 1988. 6. Millon T. Disorders of personality: DSM-II1: Axis II. New York: John Wiley & Sons, 1981. 7. Plutchik R, Conte HR. Quantitative assessment of personality disorders. In: Michels R, Cavenar JO, Cooper AM, et ai, eds. Psychiatry. Philadelphia PA: J.B. Lippincott, 1988. 8. Conte HR, Plutchik R. A circumplex model for interpersonal traits. J Pers Soc Psychol 1981; 40: 701-711. 9. Kass F, Skodol AE, Charles E, et al. Scaled ratings of DSM-II1 personality disorders. Am J Psychiatry 1985; 142: 627-630. 10. Spitzer RL, Forman JBw. Initial interrater diagnostic reliability. Am J Psychiatry 1979; 136: 818-820. II. Spitzer RL, Wiiliams JBW, Gibbons M. Structured clinical interview for DSM-II1-R. New York: Biometrics Research, 1987. 12. Robins, LN, Helzer JE, Croughan J, et al. National Institute of Mental Health diagnostic interview schedule. 'Arch Gen Psychiatry 1981; 38: 381-389. 13. Endicott J, Spitzer RL. A diagnostic interview: the schedule of affective disorders and schizophrenia. Arch Gen Psychiatry 1978; 35: 837-844. 14. Spitzer RL, Williams JB. Structured clinical interview for DSM-II1 personality disorders (SCID-II). New York: New York State Psychiatric Institute, 1985. 15. Reich JH. Instruments measuring DSM-II1 and DSM-II1-R personality disorders. J Pers Dis 1987; I: 220-240. 16. Spitzer RL, Williams JBW, Gibbons M. scm Personality Questionnaire. New York: Biometrics Research, 1987. 17. Standage K. Structured interviews and the diagnosis of personality disorders. Can J Psychiatry 1989; 34(9): 906-912. 18. Cohen J. A coefficient of agreement for nominal scales. Ed Psycho I Meas 1960; 163: 37-47. 19. Rogers R. Clinical assessment of malingering and deception. New York: The Guilford Press, 1988.
Resume Les auteurs ont evalue l' utilite du SCID-PQ pour deceler les troubles de type Axis II chez 82 malades hospitalises. Le SCID-PQ se revele efficace (a savoir ires petit nombre de reactions faussement negatives et nombre modere de reactions faussement positives) pour sept des onze troubles de la personnalite du DSM-III-R. Pour les quatre autres troubles, on suggere des modifications mineures qui assureront une meilleure classification des troubles de personnalite dependante et de personnalite schizoide.
Screening Psychiatric Patients for Axis II Disorders* DAVID NUSSBAUM, Ph.D. I AND RiCHARD ROGERS, Ph.D. 2
This study examined the usefulness of the SCID-PQ on a sample of 82 inpatients as a screening measure for Axis II disorders. The SCID-PQ proved effective (i.e., resulted in a very low false negatives and moderate false positives) in screening for seven of the II DSM-III-R personality disorders. Of the four remaining disorders, minor modifications were suggested which resulted in improved classification rates for dependent and schizoid personality disorders.
achieving satisfactory reliability for Axis II disorders (range
= 0.56 to 0.64) (10).
Spitzer and Williams (11), in an. effort to improve the diagnostic reliability, operationalized the DSM-III-R criteria using a structured interview, the Structured Clinical Interview for DSM-III-R (SCID-R). Earlier efforts with standardized interviews have demonstrated the value of the interviews in achieving satisfactory to excellent interrater reliability (12,13). One major component of the SCID-R is devoted to the diagnoses of Axis II disorders (14). This diagnostic approach appears promising for classifying the full range of personality disorders (15). In order to ease the substantial burden placed on clinicians by multiaxial diagnoses, Spitzer and Williams (16) also devised a self-administered questionnaire, the SCID Personality Questionnaire (SCID-PQ), which parallels the SCID-II-R. If effective, the SCID-PQ would greatly facilitate the diagnosis of personality disorders by screening psychiatric patients for co-existing Axis II disorders. Until now however, there have been no reported studies evaluating the effectiveness of the SCID-PQ as a screening device (17). This study investigated the usefulness of the SCID-PQ as a screening measure for Axis II disorders with inpatients. Our goal was to study the personality disorders which are amenable to cost-effective screening using the SCID-PQ. In addition, we investigated alternative cut-off scores for the SCID to improve classification rates for the four diagnoses for which the SCID-PQ was less effective.
T
he emergence of multiaxial diagnoses in the DSM-III and the DSM-III-R is largely an acknowledgement of the importance of personality disorders in the effective treatment of psychiatric patients. As observed by Frances (I), recent investigations have underscored the way in which the combination of Axis I and Axis II disorders shapes both the patient's clinical presentation and treatment response. The rather formidable task facing clinicians is how to screen psychiatric patients effectively for each of the 11 Axis II disorders. The diagnosis of personality disorders reflects their rich and divergent origins in psychoanalytical and personological theory which, in turn, have strongly influenced the successive changes in diagnostic nosology (unpublished manuscript, 1988). Problems which naturally arise from such a theorydriven endeavour are I. overlapping and sometimes indistinct boundaries between specific personality disorders (1-3); 2. emphasis on categorical rather than dimensional diagnosis (3,4) which may lead to a bewildering array of symptom variations for a single diagnosis (5); and 3. conceptual difficulties in establishing the inter-relationships among the disorders that substantially contribute to problems in establishing reliable inclusion/exclusion criteria (6-9). It is not surprising that clinicians have had great difficulties
Method
A sample of 82 inpatients was recruited from METFORS, a forensic assessment unit at the Clarke Institute of Psychiatry. METFORS is comprised of the outpatient Brief Assessment Unit (BAU), where patients referred by the courts are screened by interview and chart review (if available) for their competence to stand trial and returned to the correctional facility the same day; and a 23 bed inpatient unit for those patients whose fitness for trial is unclear. Evaluations of criminal responsibility, and occasionally, examinations of potential for violence are also conducted at METFORS. Inpatients typically stay on the unit for a period of two weeks. We therefore had a diverse clinical sample of patients referred by the courts; not a sample preselected on the basis of diagnosis or treatment modality. The 82 subjects we studied were consecutively admitted patients who were able to provide informed consent and were willing to participate in the research project. The participants completed an informed con-
*Manuscript received June 1991, revised December 1991. Jpsychologist-in-Charge and Coordinator of Research, METFORS/Clarke Institute of Psychiatry; Lecturer, Department of Psychiatry, University of Toronto, Toronto, Ontario. 2 Associate Professor, Department of Psychology, University of North Texas, Denton, Texas; formerly, Senior Psychologist and Coordinator of Research, METFORS/Clarke Institute of Psychiatry; Associate Professor of Psychiatry and Psychology, University of Toronto, Toronto, Ontario. Address reprint requests to: Dr. D. Nussbaum, METFORS/Clarke Institute of Psychiatry, 1001 Queen Street West, Toronto, Ontario M6J IH4
Can. J. Psychiatry Vol. 37, November 1992
658
November, 1992
659
SCREENING PSYCHIATRIC PATIENTS FOR AXIS-II DISORDERS
sent form in conformity with ethical approval of the project by the University of Toronto, Office of Research Administration. All subjects completed the SCID-PQ which was followed, after a minimum of a week interval, by the SCID-II-R interview. The interviews were conducted by two staff psychologists and a psychology intern, all of whom were experienced in administering the SCID. As an estimate of interrater reliability, ten SCID-II-R joint interviews were conducted on a separate sample of inpatients. The level of interrater agreement was very high for all II personality disorders (concordance rate of 95.5% and a kappa of 0.97). We were therefore confident in the reliability of SCID-II-R diagnoses. In the study itself, all standard instructions were followed with one significant variation - since the interviewers were blind to the SCID-PQ results and the level of agreement on each variable was relevant, all the SCID-R questions were administered to every subject. Results Usefulness of the SCID-PQ for each personality disorder was calculated for sensitivity, specificity, true positives and false negatives. The level of diagnostic agreement was assessed using kappa coefficients (18). Table I summarizes the effectiveness of SCID-PQ as a screening measure for Axis II disorders with inpatients, and data on decision results for each Axis II disorder. The accuracy of a screening measure is evaluated primarily in terms of the true positives and false negatives obtained using the measure. Clinicians are most interested in avoiding undetected diagnoses (i.e., false negatives) through the screening process. Of secondary interest is the rate of false positives obtained, since this reflects on the efficiency of the screening measure (i.e. a high false positive rate would sug-
gest that the screen is time-consuming and therefore not particularly useful). The SCID-PQ was successful with all but two personality disorders (schizoid and dependent personality disorders) in producing few low false negatives. Of the two, schizoid personality disorders were not sufficiently represented in the clinical sample (n = 5). In addition, high false positive rates (~ 60%) were found for paranoid and antisocial personality disorders. Based on these findings, we reexamined the cut-off scores of the SCID-PQ for four diagnoses: dependent, schizoid, paranoid, and antisocial personality disorders. By using only three criteria (rather than four) the criteria on the SCID-PQ, the true rate of positives for dependent personality disorder improved dramatically from 70.0% to 100.0%, with only a slight increase in false positives from 30.6% to 39.0%. Although few patients in the study had schizoid personality disorders, a similar decrease from four to three criteria markedly improved the true positive rate (100.0%). Standard implementation of this reduction would, of course, require further investigation. Attempts to improve the efficiency of the SCID-PQ (i.e., to result in fewer false positives) for paranoid and antisocial personality disorders were not successful. When the criteria were increased by even one, the true positive rate fell to an unacceptably low level. Discussion The SCID-PQ performed remarkably well as a screening measure for the SCID-II-R. The kappa coefficients were relatively modest, although this is less of a concern for screening measures where moderate false positive rates are expected (i.e., as a screen, it is most important to have a very low false negative rate which is usually achieved at the expense of false positives). With additional studies, the SCID-
Table I Effectiveness of the SCID-PQ in the Screening of Axis II Disorders in an Inpatient Sample Axis II Diagnosis Avoidant
Sensitivity 95.0%
Specificity 61.2%
Dependent
70.0%
69.4%
True Positives (%) 19 (23.2) 7 (8.5)
False Positives (%) 24 (29.3)
True Negatives (%) 38 (46.3)
False Negatives (%) I (1.2)
Kappa 0.41
22 (26.8)
50 (61.0)
3 (3.7)
0.23 0.49
Obsessive-compulsive
95.8%
65.5%
23 (28.0)
20 (24.4)
38 (46.3)
I (1.2)
Passive-aggressive
87.5%
65.2%
14 (14.1)
23 (28.0)
43 (52.4)
2 (2.4)
0.36
100.0%
52.2%
13 (15.9)
33 (40.2)
36 (43.9)
0(0.0)
0.26
1(1.2)
0.31
Self-defeating Paranoid
96.6%
39.6%
28 (34.2)
32 (39.0)
21 (25.6)
Schizotypal
90.9%
66.7%
20 (24.4)
20 (24.4)
40 (48.8)
2 (2.4)
0.46
Schizoid
60.0%
83.1%
3 (3.7)
13 (15.9)
64 (78.0)
2 (2.4)
0.25
Histrionic
88.8%
53.1%
16 (19.5)
30 (36.6)
34 (41.5)
2 (2.4)
0.26
Narcissistic
92.3%
59.4%
12 (14.6)
28 (34.2)
41 (50.0)
I (1.2)
0.36
Borderline
91.7%
56.9%
22 (26.8)
25 (30.5)
33 (40.2)
2 (2.4)
0.38
Antisocial
94.1%
38.5%
16 (19.5)
40 (48.8)
25 (30.5)
I (1.2)
0.28-
"This Kappa was calculated between development questionnaire data and developmental interview data as there are no adult antisocial items on the questionnaire.
660
Vol. 37, No.9
CANADIAN JOURNAL OF PSYCHIATRY
PQ may prove useful in clinical practice in reducing the onerous task of multiaxial diagnoses. The SCID-PQ was constructed on a rational basis to make it easier for clinicians. As such, its ease of use is achieved by unidirectional scoring ("yes" responses are invariably endorsements of psychopathology), clustering of symptoms by diagnosis, and a rigidly parallel structure to the SCID-II-R interview. Based on the results of this study, we suggested a minor modification in cut-off scores to the accuracy (true positives) for dependent personality disorder and that a similar change be envisioned for schizoid personality disorders. However, fundamental changes in the structure of the SCIDPQ, based on an empirical rather than a rational model, would be even more promising. For example, alternating SCID-PQ questions from different diagnostic clusterings may augment the overall rate of classification. Directionality of endorsements and non endorsements should be varied within each diagnostic question cluster, to avoid effects of yea- or naysaying response sets. Indeed, with scales to correct for response bias (for example, defensiveness, malingering, and irrelevant responding) (19), it is quite possible that a revised SCID-PQ might supplant SCID-II-R interviews with the majority of patients and free clinicians to devote their diagnostic skills to a narrow band of problematic cases. Acknowledgements The study was supported by a grant from the Clarke Institute of Psychiatry Research Fund. The authors would like to thank Dr. Mike Hall of the Institute for Social Research, York University, and Mr. Daniel Bloom of Computer Services, York University, for their assistance with data analysis. We would also like to acknowledge the assistance of Dr. Elizabeth Lynett for her help in conducting the interviews.
References 1. Frances W. Introduction to personality disorders. In: Michels R, Cavenar JO, Cooper AM, et ai, eds. Psychiatry. Philadelphia PA: J.B. Lippincott, 1988. 2. Frances AJ. The DSM-II1 personality disorders section: a commentary. Am J Psychiatry 1980; 137: 1050-1054. 3. Widiger TA, Kelso K. Psychodiagnosis of Axis II. Clin Psychol Rev 1983; 3: 491-510. 4. Frances AJ. Categorical and dimensional systems of personality diagnosis: a comparison. Compr Psychiatry 1982; 23: 516-527.
5. Stone MH. Borderline personality disorder. In: Michels R, Cavenar JO, Cooper AM, et ai, eds. Psychiatry. Philadelphia PA: J.B. Lippincott, 1988. 6. Millon T. Disorders of personality: DSM-II1: Axis II. New York: John Wiley & Sons, 1981. 7. Plutchik R, Conte HR. Quantitative assessment of personality disorders. In: Michels R, Cavenar JO, Cooper AM, et ai, eds. Psychiatry. Philadelphia PA: J.B. Lippincott, 1988. 8. Conte HR, Plutchik R. A circumplex model for interpersonal traits. J Pers Soc Psychol 1981; 40: 701-711. 9. Kass F, Skodol AE, Charles E, et al. Scaled ratings of DSM-II1 personality disorders. Am J Psychiatry 1985; 142: 627-630. 10. Spitzer RL, Forman JBw. Initial interrater diagnostic reliability. Am J Psychiatry 1979; 136: 818-820. II. Spitzer RL, Wiiliams JBW, Gibbons M. Structured clinical interview for DSM-II1-R. New York: Biometrics Research, 1987. 12. Robins, LN, Helzer JE, Croughan J, et al. National Institute of Mental Health diagnostic interview schedule. 'Arch Gen Psychiatry 1981; 38: 381-389. 13. Endicott J, Spitzer RL. A diagnostic interview: the schedule of affective disorders and schizophrenia. Arch Gen Psychiatry 1978; 35: 837-844. 14. Spitzer RL, Williams JB. Structured clinical interview for DSM-II1 personality disorders (SCID-II). New York: New York State Psychiatric Institute, 1985. 15. Reich JH. Instruments measuring DSM-II1 and DSM-II1-R personality disorders. J Pers Dis 1987; I: 220-240. 16. Spitzer RL, Williams JBW, Gibbons M. scm Personality Questionnaire. New York: Biometrics Research, 1987. 17. Standage K. Structured interviews and the diagnosis of personality disorders. Can J Psychiatry 1989; 34(9): 906-912. 18. Cohen J. A coefficient of agreement for nominal scales. Ed Psycho I Meas 1960; 163: 37-47. 19. Rogers R. Clinical assessment of malingering and deception. New York: The Guilford Press, 1988.
Resume Les auteurs ont evalue l' utilite du SCID-PQ pour deceler les troubles de type Axis II chez 82 malades hospitalises. Le SCID-PQ se revele efficace (a savoir ires petit nombre de reactions faussement negatives et nombre modere de reactions faussement positives) pour sept des onze troubles de la personnalite du DSM-III-R. Pour les quatre autres troubles, on suggere des modifications mineures qui assureront une meilleure classification des troubles de personnalite dependante et de personnalite schizoide.
