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Traditional assessments of mental disorders provide highly individualistic evaluations of the patients' presenting problems, recent stressors and salient symptoms. Such individualized assessments, while rich in detail, lack the necessary standardization for reliable diagnoses. As a result, traditional assessments are often marred by inaccuracies, most notably in missed diagnoses and misdiagnoses (Rogers, 2003). To improve diagnostic reliability, healthcare professionals should augment traditional evaluations with more standardized assessments that include structured interviews. Following a review of current diagnostic predicaments, the chapter examines the role of structured interviews in improving clinical practice.
The assessment of mental disorders within the primary care system has not kept pace with diagnostic advances. As a result, diagnoses are often a hit-or-miss proposition. Consider for the moment the comparatively straightforward diagnosis of major depression. Tiemens et al. (1999) found the majority of patients with major depression went undiagnosed and untreated by primary care physicians. This finding is very consistent. Lowe et al. (2004) found that 60% of cases with major depression were missed diagnoses in primary health care. Even when the diagnosis was broadened to include any depressive disorder, the accuracy did not improve (i.e. 59% missed diagnoses). Misdiagnosis of major depression was also common. When these physicians did diagnose major depression, they were inaccurate in 62% of the cases. These worrisome results extend beyond major depression to a range of Axis I disorders (see Christensen et al., 2003; Spitzer et al., 1994).
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