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Bipolar disorder (BD) is frequently underdiagnosed and due to poor screening, the average time between onset of symptoms and diagnosis is more than 7-years (Mantere et al., 2004). Improper diagnosis has serious consequences in intervention (Ghaemi et al., 2001), and previous assessment instruments are now considered insufficient to detect intervention changes, and to provide a more functional and integrated view of BD.
Our study aims to develop a new DSM-5 based Clinical Interview for Bipolar Disorder (CIBD), providing criteria to diagnose BD, but also the individual’s perceptions dealing with BD symptoms. This interview follows the same structure of CIPD (Martins et al., 2015), which has shown acceptability by the participants and experts.
CIBD was developed by a multidisciplinary team considering the DSM-5 criteria for Bipolar Disorders. There was a thorough research regarding assessment and evaluation of BD, and several suggestions from an international task force of specialist working with BD patients were considered, when writing the questions for the interview. A detailed description of CIBD development is presented. The authors of the interview have extended experience in the management and assessment of BD patients, and CIBD is now being assessed by a wider non-related panel, regarding pertinence and clarity.
Preliminary assessment and qualitative feedback from participants that were interviewed is shown, with an overall positive feedback.
CIBD assesses both the diagnosis/presence of mood episodes (hypo/mania, and depressive) and symptoms’ psychosocial correlates. CIBD detects subtle changes caused by intervention adding a much needed recovery focused perspective.
I very much admire Stephan Heckers’ framing of ‘four forms of scientific reductionism in psychiatry’ and their relation to the autonomy of the patient. Stephan seems to be using ‘reductionism’ in a legitimate, but perhaps non-standard way. ‘Reduction’ in his sense has to do with loss of information. There is, first, the ‘clinical encounter’ in which the patient’s lived experience is translated into the third-person account given by the therapist. Then there is classification, identification of a biological problem, and causal implications. Each of these steps misses out something about the ‘lived experience’ of the patient. I find the discussion somewhat tantalizing, and suggest the real reason for acknowledging autonomy may be the need for a ‘Jaspersian engagement’ with the patient, which identifies the one-off idiosyncracies of the patient’s mental life, rather than merely those aspects that fall under generalizations.
Clinical interviewing is a flexible method for gathering assessment information and initiating psychotherapy. Clinical interviews can be used to establish therapeutic relationships, provide role inductions for psychotherapy, gather assessment information, develop case formulations/treatment plans, and for implementing therapeutic interventions. When used for assessment or intake purposes, clinical interviews focus on specific content, such as psychodiagnosis, mental status, and suicide risk. Although central to psychodiagnostic assessment, interview reliability and validity can be adversely affected by noncredible client responding (e.g., the over- or underreporting of symptoms). To address noncredible client responding, clinicians need to (1) be aware of the potential for inaccurate reporting, (2) adopt a “scientific mindedness” approach, (3) manage their countertransference, (4) use specific questioning or interpersonal strategies, and (5) triangulate data by using information from multiple sources. Undoubtedly, technology and other forces may change how future clinicians conduct clinical interviews; however, it is likely that clinical interviews will remain foundational to psychological assessment and treatment.
Neuropsychological assessment is an important component of the comprehensive neurodiagnostic evaluation of many patients with suspected or known brain dysfunction. Neuropsychological evaluations are covered by most major insurance carriers using the American Medical Association's Current Procedural Terminology (CPT) codes for the procedures. A clinical interview with the patient, focusing upon the presenting complaint and history of potential central nervous system (CNS) risk factors or other demographic and background characteristics, might contribute to symptoms or impact current test performance. The neuropsychological evaluation typically begins with a review of the referral question and available medical records. Neuropsychological tests vary in terms of their available normative comparison groups, although some represent large databases comprised of representative samples of the general population. Neuropsychological reports vary widely depending upon the practitioner, his or her background and current setting, the nature and extent of the evaluation, and the referral base of the neuropsychologist's practice.
This chapter presents an overview of the mental status examination, its core elements, and its most commonly used methods. The mental status examination focuses on cognitive, emotional, behavioral, and related sensorimotor functions and their disturbances - i.e., neuropsychiatric symptoms, signs, and syndromes. Through observation, interview, and testing, the mental status examination identifies the symptoms and signs of structural and/or functional disturbances of the brain. Neuropsychiatric symptoms and signs are sometimes categorized as positive or negative. Atypical clinical presentations sometimes are neurological condition-specific variants of typical neuropsychiatric syndromes. The observational components of the mental status examination are undertaken at the first moment of any form of contact with a patient and continue throughout the entire clinical encounter. Observation continues throughout the clinical interview, during which the examiner attends to the patient's appearance, behavior, statements, manner of communicating, and interpersonal interactions with examiner.
The chapter highlights the idea that many individuals exposed to significant trauma do not develop acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) and describes subgroups that may be at greater risk for these conditions in the aftermath of disaster. It reviews neurobiological mechanisms in normal and pathological traumatic stress responses. Traumatic experience results in both immediate and long-term endocrine changes that affect metabolism and neurophysiology. Some evidence exists to support the effectiveness of psychotherapeutic approaches immediately after trauma in preventing the development of ASD or PTSD. Cognitive-behavioral therapy (CBT) attempts to correct cognitive distortions and reduce the frequency and symptomatology associated with traumatic memories. Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line medication treatment for PTSD. The clinical interview remains the gold standard for the assessment of ASD or PTSD for several reasons. Future research should help to identify individual and group-specific risk factors or vulnerabilities.
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