STRUCTURED CLINICAL INTERVIEW FOR DSM-IV (SCID)

This is a diagnostic interview designed for use by mental health professionals. It assesses thirty-three of the more commonly occurring psychiatric disorders described in the fourth edition of the Diagnostic and statistical manual (DSM-IV) of the American Psychiatric Association (1994). Among these are Mood disorders (including Major depressive disorder), psychotic disorders (including Schizophrenia), Anxiety disorders (including Panic disorder) and the substance-use disorders. The SCID is a semi-structured interview that allows the experienced clinician to tailor questions to fit the patient's understanding; to ask additional questions that clarify ambiguities; to challenge inconsistencies; and to make clinical judgments about the seriousness of symptoms. The main uses of the SCID are for diagnostic evaluation, research, and the training of mental-health professionals.

The SCID is modeled on the standard clinical interview practiced by many mental-health professionals. It begins with an overview section that includes questions about basic demographic information (e.g., age, marital status), educational history, and work history, followed by questions about the chief complaint, past episodes of psychiatric disturbance, treatment history, and current functioning. The remainder of the interview is organized into the following sections: mood episodes, psychotic symptoms, differential diagnosis of psychotic disorders, differential diagnosis of mood disorders, substance-use disorders, anxiety disorders, somatoform disorders, eating disorders, and adjustment disorder. A separate interview, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) is available for the assessment of personality disorders.

The SCID comes in two basic versions: the research version (known as the SCID-I) and the clinician version (SCID-CV). The research version contains the full complement of disorders, subtypes and specifiers that are of interest to researchers. It is provided by the Biometrics Research Department at Columbia University as an unbound packet of pages so that the investigator has the ability to leave out pages covering disorders or subtypes that are not relevant to a particular study. The bound clinician version (published by American Psychiatric Press) includes only those disorders and specifiers that are the most clinically relevant. Training materials and computerized versions are also available. Additional detailed information about the SCID (including differences between the research and clinician versions, ordering information, training materials, references) is available on the SCID web site (www.scid4.org).

The substance use disorders covered in the SCID are dependence and abuse for seven classes of substances: alcohol, sedative-hypnotics-anxiolytics, Cannabis (marijuana), Stimulants, Opioids, Cocaine, and Hallucinogens/PCP. For each substance, the interviewer determines whether the symptoms of dependence or abuse have ever been present during the subject's lifetime; whether they have been present during the last month; and age when the first symptoms appeared. If dependence is current, the interviewer rates the current severity as mild, moderate, or severe. If dependence is in partial or full remission, the appropriate DSM-IV remission specifier is noted (e.g., early partial remission, sustained full remission, etc.). Because alcohol use is so much more common the other substance use, the assessment for alcohol dependence and abuse is conducted first, followed by an assessment of dependence or abuse on the remaining categories of substances.

The ALCOHOL (ethanol) section of the SCID begins with some overview questions about the subject's drinking history (e.g., "has there ever been a period when you had five or more drinks on one occasion?" "has anyone ever objected to your drinking?"). The subject's answers to these initial questions allow the interviewer to sequence the assessment questions to match the subject's drinking history as follows: If a history of dependence seems likely (e.g., the subject reports a history of detoxification from alcohol or attendence at AA), the interviewer begins with the assessment of the individual DSM-IV dependence criteria. (If criteria are met for dependence, the assessment of abuse is skipped since a DSM-IV diagnosis of dependence pre-empts a diagnosis of abuse; if criteria are not met for dependence, then the interviewer continues with the assessment of abuse). If the history is not suggestive of dependence but is indicative of excessive drinking or problematic use, the interviewer commences with the individual DSM-IV criteria for abuse. (If the criteria are met for abuse, the interviewer must then continue the assessment to see if the problematic drinking is sufficiently severe to qualify for dependence). Only if there have never been any episodes of excessive drinking and there is no evidence of alcohol-related problems can the interviewer skip the alcohol section and move on to the assessment of other substances.

The drug section of the SCID is similarly structured to tailor the sequence of questions to the subject's drug-taking history. If, for any class of substance, the subject reports having used the substance on at least 10 occasions in any one month period, the interviewer starts with the assessment for dependence. If the subject reports using a substance at least twice, but less than 10 times in any month, the assessment focuses on abuse. (As with the assessment for alcohol, if criteria are met for abuse, the interviewer follows up with the assessment for dependence). For prescribed medications, the interviewer checks for dependence if the subject reports taking having been "hooked" on the medication or reports often taking more of it than prescribed.

(See also: Addiction: Concepts and Definitions ; Complications: Mental Disorders ; Disease Concept of Alcoholism and Drug Abuse ; Epidemiology of Drug Abuse ; International Classification of Diseases )

BIBLIOGRAPHY

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders-4th edition. Washington, DC: Author.

Fennig S, Naisberg-Fennig S, Craig TJ, et al. (1996). Comparison of clinical and research diagnoses of substance use disorders in a first-admission psychotic sample. Am J Addiction 5 40-48.

First MB, et al. (1997). Structured clinical interview for DSM-IV—clinical version (SCID-CV) (User's Guide and Interview). Washington, D.C.: American Psychiatric Press, Inc.

Kranzler HR, Kadden RM, Babor TF, et al. (1996) Validity of the SCID in substance abuse patients. Addiction 91, 859-868.

Spitzer, R. L., et al. (1992). The structured clinical interview for DSM-III-R (SCID). I. History, rationale and description. Archives of General Psychiatry, 49, 624-629.

Thomas F. Babor

Revised by Michael B. First