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As functional imaging becomes more common in clinical practice, differences between neuropsychological performance and neuroimaging may diminish. The use of functional imaging already is advancing our knowledge of brain-behavior relationships.

BI BLlOCRAPHY
1. Bigler ED: Frontal lobe damage and neuropsychological assessment. Arch Clin Neuropsychol3:279-297, 1988, 2. Bigler ED, Ye0 RA, Turkheimer E (eds): Neuropsychological Function and Brain Imaging. New York, Plenum Press, 1989. 3. Grant I, Adams KM (eds): Neuropsychological Assessment of Neuropsychiatric Disorders. New York, Oxford Press, 1996. 4. Heinrichs RW, Zakzanis KK: Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology 12:426-445, 1998. 5. Hill CD, Stoudemire A, Morris R, Matino-Saltzman D, Markwalter HR: Similarities and differences in memory deficits in patients with primary dementia and depression-related cognitive dysfunction. J Neuropsychiatry Clin Neurosci 5:277-282, 1993. 6 . Lezak MD: Neuropsychological Assessment, 3rd ed. New York, Oxford University Press, 1995. 7. Newman PJ, Sweet JJ: Depressive disorders. In Puente AE, McCaffrey RJ (eds): Handbook of Neuropsychological Assessment: A Biopsychosocial Perspective. New York, Plenum Press, 1992. 8. Orsillo SM, McCaffrey RJ: Anxiety disorders. In Puente AE, McCaffrey R J (eds): Handbook of Neuropsychological Assessment: A Biopsychosocial Perspective. New York, Plenum Press, 1992. 9. Reitan RM, Wolfson D: The Halstead-Reitan Neuropsychological Battery: Theory and Interpretation, 2nd ed. Tucson, AZ, Neuropsychology Press, 1993. 10. Sweet JJ, Newman P, Bell B: Significance of depression in clinical neuropsychological assessment. Clin Psycho1 Rev 12:2145, 1992. 11. Walker E, Lucas M, Lewine R: Schizophrenic disorders. In Puente AE, McCaffrey RI (eds): Handbook of Neuropsychological Assessment: A Biopsychosocial Perspective. New York, Plenum Press, 1992.

7. SELF-REPORT QUESTIONNAIRES
Garry Welch, Ph.D.
1. What are the potential uses of self-reportingpsychiatric and personality tests? There are many potential clinical and research uses, although interpretation of scores and profiles often requires a high level of expertise. These tests are helpful in: History taking and formulating clinical hypotheses Screening and diagnosis of clinical problems and mental disorders Determining appropriate referral to specialty services Monitoring change and response to treatment interventions Conducting research into factors associated with the disorders Auditing and assessing clinical services

2. What is reliability?
Reliability is whether the measure provides repeatable or reproducible test scores that accurately reflect the patients true status and contain little influence from unimportant extraneous factors. For example, if a test is supposed to detect current anxiety state, it is reliable if it mostly measures current anxiety and does not take into account other factors-such as the individuals recall of the answers given the last time the test was administered-and does not include unclear questions or poorly worded instructions.

3. What is the role of reliability in psychiatric and personality tests? Reliability of measurement is important because it sets an upper limit on the validity, or clinical usefulness, that the measure will likely have when applied to various individuals and in various

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settings. Unreliable measures cannot be highly valid, and results obtained from them may cloud the true meaning of test scores, thereby undermining clinical decision-making.

4. How do I determine if a test is reliable?

Reliability indices used to describe psychiatric and personality questionnaires range in value from 0 (no reliability) to 1 (perfect reliability) and are of two types: (1) the test-retest index, which indicates how stable the test scores are over a short period, with individuals assumed not to have changed much on the topic of interest, and (2) the internal reliability index, which shows whether the questions are all highly intercorrelated and are therefore likely to be measuring the same thing. Test-retest reliability typically is measured by the correlation coefficient or (preferably) the intraclass correlation coefficient. Test-retest reliability coefficients can be difficult to interpret if they are not high (i.e., around 0.8). Lower reliability values may indicate that the test is unreliable, or that the individuals tested have changed in status over the period of testing. Test-retest coefficients obtained for known fluctuating variables (e.g., depressed mood or anxious mood) are expected to be lower than those for a relatively stable personality trait, such as extroversion, which may demonstrate test-retest reliability of around 0.9. Internal reliability indices are easier to interpret than test-retest and typically involve the use of Cronbachs alpha index. Results should range from 0.7 to 0.8 if the test is to be used to compare groups of people, but the upper range should be higher (preferably around 0.9) if the test is to be used to classify individuals. Ideally, both test-retest and internal reliability information should be available for a test. Reliability information obtained from different settings may vary. For example, data gathered in a heterogeneous general population study may not directly apply to a highly selected hospital-based patient population. Typically, reliability coefficients will be somewhat lower in the latter case for technical reasons related to the narrower range of scores obtained.

5. What is validity? Validity is whether a test adequately measures what it is supposed to measure, to allow specific conclusions to be drawn. There are several types of validity: content, predictive, convergent, and discriminant.

6. What is the role of validity in psychiatric and personality tests? Although reliability analyses can establish that a test is measuring something in a reproducible fashion, validity analyses can help establish exactly what is being measured. Validity analyses can determine whether the test can satisfactorily perform an important clinical task, such as early screening for problems, making a diagnosis, monitoring response to treatment, and directing research into the causes of particular disorders. Validity studies usually involve (1) calculating correlations between the test and other related measures or individual attributes, and (2) looking at the size of difference in mean scores for selected study groups.
7. How do I determine if a test is valid? The fundamental question in considering the validity of a test is Do the test scores have biologic or clinical meaning for the specific task I have in mind and for the particular individuals? One of the difficulties in assessing validity in psychiatry and psychology is that there often is no absolute standard against which to judge the validity of a test. Although this creates headaches for clinicians and researchers in many branches of medicine, it is a particular problem in mental health, where psychosocial phenomena that can be neither readily observed nor easily described are of interest. Ideally, the validity of psychiatric and personality tests is determined by weighing the evidence from a variety of validity studies that show that the test measures what it was designed to measure.

Self-Report Questionnaires
Checklist for Reliability and Validity Issues Related to Questionnaires Reliability Test retest reliabiliqAre temporal reliability coefficients around 0.8 over 2-day to 2-week periods? Are values lower for fluctuating variables like mood and higher (approximately 0.9) for stable variables such as personality traits? Internal reliabiligAre Cronbach alpha values around 0.7-0.8 for group comparisons or about 0.9 for individual screening or classification uses? Validity Content Is the breadth of the conceptual domain adequately covered? Is critical content covered? Predictive Does the test predict future behavior? Convergent Does the test correlate well with existing similar measures? Are similar findings obtained from different sources, e.g., from subject, clinician, or spouse? Discriminant Do the scores of selected groups differ in their mean as predicted? Are low correlations found with theoretically unrelated variables, or are negative correlations found where these are theoretically expected? For a screening test, does it have 100% sensitivity and high positive-predictivepower? Does a measure of treatment response have good responsiveness (see Question 12)? Construct This term represents a judgment, based on an accumulation of related validity studies performed over time, that the test measures its intended topic.

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8. What is content validity? It is essentially a subjective judgment, based usually on expert consensus and/or a review of the literature, that the breadth of the conceptual domain the test is aiming to measure is adequately covered or that the most clinically significant areas of the domain (i.e., critical content) are well covered. Generally, when a new psychiatric or personality test appears in the literature it has some practical or theoretical advantage over the older ones. For example, a new test may be briefer and quicker to administer, have better worded questions, or have new questions that reflect recent changes in theory or clinical practice. Or it may be a companion measure to be used as a screening device, replacing a longer questionnaire or clinical interview in special situations in which the use of the latter is impractical (e.g., community surveys). 9. What is predictive validity? This term indicates interest in predicting some important behavior at a point in the future. For example, scores of a screening test of depressive symptoms might be expected to correlate highly with later suicidal behavior or later antidepressant drug use.

10. What does convergent validity show?

It verifies that the test correlates highly with measures to which it is thought to be theoretically related. For example, one measure of depression would be expected to have high correlations with other measures of depression. Another approach may be to establish that test scores obtained from different sources are at least moderately correlated, e.g., those from patient, therapist, and family members.

11. What does the term discriminant validity establish? That the test is not correlated with measures to which it is theoretically unrelated, e.g., that depressed scores are not correlated with those measuring intelligence. Also, that test scores are

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significantly different for groups theoretically expected to differ, e.g., depressed patients should score higher than either normal controls or successfully treated patients on a measure of depression that is under scrutiny. 12. Define responsiveness. The term describes the ability of a test to detect true change in patient clinical status over time (usually in the context of treatment). For example, scores for a depression test should be lower on retesting of a depressed patient group that has received a drug treatment or psychotherapy of known efficacy. Deyo et al. provide a good discussion of responsiveness and examples of suitable indices.

13. Which indices are most useful in diagnosis and screening? Diagnostic and screening discriminant validity allows screening and classification of illness. The most useful validity indices for this purpose are positive predictive power (PPV), which indicates the proportion of high scorers (using a given cut-off score) on a test who were found to be clinically ill by clinical interview, and sensitivity, which indicates the proportion of truly ill individuals who scored high on the test. Typically they are expressed as percentages. For a good screening measure, ideally there should be 100% sensitivity at the recommended cut-off score, to ensure no potential true cases are missed, and as high a PPV as possible to minimize the number of false positives (high scorers who are in fact not ill) interviewed. Psychiatric and personality measures rarely are used alone to determine diagnosis, but are used commonly in screening and as an adjunct to the diagnostic interview.

14. Explain construct validity.

This umbrella or summary term involves judging how well a given test fulfills its aim in measuring an underlying concept. Construct validity is programmatic and requires the gradual accumulation of evidence through a wide range of appropriate validity studies that measure different aspects of the tests validity. It may include information from all of the types of validity plus data from factor analytic studies. These statistical studies examine the pattern of correlations among scores for individual questions in a test to determine whether groups of conceptually similar terms intercorrelate highly.

15. Will following the reliability and validity checklist (see Question 7) ensure that I use selfreport questionnaires successfully? Remember, no measure is reliable and valid for all purposes, and red flags should be raised if a test is uncritically described as reliable and valid in a clinical or research article you have read. Available information on the potential usefulness of a given test should be considered in light of your specific purpose, the characteristics of the patients or subjects to be tested, and the setting they are to be drawn from. Again, many psychiatric and personality tests require a high level of training and clinical expertise, and interpretation and appropriate professional help should be sought if necessary.
16. What is a valid questionnaire to measure depression? The Beck Depression Inventory (BDI) is the most widely used and validated self-report questionnaire for measuring the symptoms of depression. It has 21 questions and is straightforward to administer and score. Information on its reliability and clinical usefulness (and normative data) is available for many different medical, psychiatric, and general population samples to aid the interpretation of an individual or group BDI score.
17. What are the potential clinical uses of the BDI? The BDI is used mostly to monitor change in the severity of depressive symptoms over time in individuals receiving treatment for depression or taking part in research studies of depression. It is not recommended as a diagnostic tool, although cut-off scores for nondepressed (< lo), mildly depressed (10-14), moderately depressed (15-22), and severely depressed (23 +) categories have been recommended by the original authors based on validity studies. Among medically ill patient groups,

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physical symptoms common to depression become problematic when interpreting BDI scores. In patients with renal failure, for example, a cut-off of 15 best discriminates clinically depressed patients from the nondepressed, although only 40% of individuals scoring above 15 will, in fact, be clinically depressed on subsequent full psychiatric interview. Common confounding somatic symptoms in renal failure include fatigue, anorexia, and sleep and bowel dysfunction that result from problems such as elevated blood urea nitrogen levels, acidemia, electrolyte imbalances, and problems with calcium metabolism.

18. Is there a valid questionnaireto measure anxiety? The State Trait Anxiety Inventory is the most widely used and well validated self-report measure of the symptoms of anxiety. It has 20 questions that measure state (i.e., situation-specific) anxiety and 20 that measure trait (i.e, resulting from enduring personality style) anxiety. The test is simple to administer and score and takes only 10 minutes to complete. The state scale has been widely used in the assessment of current anxiety in general population, psychiatric, and medical settings, As expected, both scales have good internal reliability, and the state scale has lower reported test-retest reliability (0.16-0.62) than the trait scale (0.65-0.82). The state scale correlates well with other similar anxiety measures and is a responsive measure of treatment outcome in clinical trials involving psychotropic drugs, medical procedures, and psychotherapy. Evaluation of potentially confounding somatic State Trait Anxiety Inventory items has yet to be carried out in suitable medical settings. 19. What are the practical uses of the normative data provided for psychiatric and personality tests? Normative data can be very useful in interpreting individual or group scores because they provide yardsticks against which the clinical or other significance can be judged. They typically are presented as mean test scores plus standard deviations (SD; the variability of the scores) for selected groups and are to be found in test manuals and research papers. Norms may be available for a wide range of groups, and the test user must select the most appropriate. Medically or psychiatrically ill groups, general populations groups, or groups based on specific demographic factors (such as age or sex) typically are provided. To compare the score of an individual with others, it often is useful to transform individual scores to standard or Z scores recalculated in SD units. Individuals scoring at the group mean are then converted to a score of 0, and those scoring above or below one SD from the mean are converted to a score of 1 and -1, respectively. This is handy because 68% of people are expected to always fall within one SD of the mean. For example, if an individual scores 76 on a test and the comparison group has a mean score of 65 and an SD of 8, the individuals new Z score will be 1.4 (i.e., his or her score is 1.4 SDs above the group mean). Z scores often are converted to T scores, so that all values are positive, because some people prefer not to work with negative numbers. With T scores, the group mean and SD are reset to some other, more convenient value, although the relative value of any individuals score is unchanged. For example, in intelligence testing, T-score means and SDs commonly are reset from 0 and 1 to 100 and 15, respectively, and in personality testing they are reset to 50 and 10. 20. How is human personality broadly conceptualizedand measured today? Although this is a complex area with a long history of debate among competing schools of thought, a broad general acceptance now exists that the Five-Factor Model of personality provides the most comprehensive description. The model suggests that personality can be best described in general terms by five concepts (with aspect of personality involved in parentheses): agreeability (attitudinal) neuroticism (emotional) conscientiousness (motivational) extroversion (interpersonal) openness to experience (experiential)
9

21. Elaborate on the Five-Factor Model. This model is a major advance in the field of personality assessment, helping to integrate widely varying and historically conflicting schools of thought (e.g., behaviorism, humanism, social

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learning, cognitive-developmental, and psychoanalysis). It also provides a conceptual basis for organizing the wide array of currently available personality tests. The Five-Factor Model is important because it promises to provide a broad conceptual framework for the several hundred specific personality factors described to date, and empirical support exists for its cross-cultural generalizability. Critics of the Five-Factor Model note that some important concepts (such as impulsivity) are not included and that it is essentially atheoretical and descriptive, rather than explanatory. Typical usage has entailed close association with the revised NEO Personality Inventory in general population studies. However, wide application is occurring in psychiatry, to provide a broad dimensional assessment of a personality and to complement the familiar casehon-case categorical or diagnostic approach typically used for personality disorders. The Five-Factor Model also has application in behavioral medicine and industrial psychology.

22. What are some more specific measures of personality? A wide range of specific personality measures are available to assess more finely grained concepts of personality than those measured in the Five-Factor Model. The more common of these include: the Eysenck Personality Questionnaire, the 16PF, the California Personality Inventory, and the Minnesota Multiphasic Personality Inventory. Such measures help generate useful clinical hypotheses, but generally are not good diagnostic tools for psychiatric problems. Commonly, patient profiles are generated from test scores and the overall profile pattern is interpreted, rather than individual subscale scores examined. For example, many clinically useful profiles have been suggested using the Minnesota Multiphasic Personality Inventory subscales, and literally thousands of studies have been carried out with this test and its applications. Another measure, the Personality Research Form, is a valuable research tool, and its 22 dimensions fit the Five-Factor Model. 23. What are good questionnaires to use in evaluating eating disorders? Two measures of the symptoms of anorexia nervosa and bulimia nervosa are available to screen for clinical and subclinical eating disorders, to describe fully if eating disorder symptoms are present, and to detect changes in symptom status over time. They also are widely used in research to improve understanding of the nature and treatment of eating disorders. The two recommended measures are the Eating Disorder Inventory-2 (EDI-2) and the Bulimia Test-Revised (BULIT-Revised). These are not diagnostic measures, but principally are useful adjuncts to clinical assessments and decision making.
24. Describe the EDI-2. The EDI-2s 91 questions assess a wide range of behaviors, feelings, and symptoms found in eating disorders. It has three core clinical subscales related to eating and weight and shape concerns, and eight more that provide information on general problems often present with eating disorders. The Drive for Thinness, Bulimia, and Body Dissatisfaction subscales are the most important clinically. The Drive for Thinness subscale has been applied with a cut-off score of 14 to identify any potential eating disturbance. The scores for all 1 1 subscales are presented as individual patient profiles and the overall pattern compared with normative profiles provided in the EDI-2 manual. The EDI-2 subscales are: Core clinical subscales 1. Drive for thinness-xcessive fear of weight gain, preoccupation with weight and dieting 2. Bulimia-frequent bouts of uncontrollable eating binges and thoughts about binges 3. Body dissatisfaction-about body size and shape General subscales 1. Ineffectiveness-feelings of insecurity, worthlessness, and inadequacy 2. Perfectionism-high expectations for personal performance and achievement 3. Interpersonal distrust-feelings of alienation, avoidance of close relationships 4. Luck of interoceptive awareness-inability to identify accurately ones own emotional states and bodily sensations related to eating and hunger

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5. Maturity f e a r s d e s i r e to retreat or regress to the relative safety and security of childhood

6. Asceticism-belief in the virtue of self-discipline, control of bodily urges, and self-denial 7. Lack o f impulse regulation-a tendency toward impulsivity, self-destructive behavior, and recklessness 8. Social insecurity-perceptions of self-doubts and insecurity in social relationships

25. How is the EDI-2 used?

Typically a patient profile is compared with those given for available norms to clarify the nature and severity of the problems. The EDI-2 can be most helpful in providing information to understand the patient, planning treatment, and assessing progress.

26. What is the function of the BULIT-Revised?

The BULIT-Revised was designed to screen for bulimia nervosa (BN) and to monitor changes in related bulimic symptom severity over time. It is composed of 28 core questions, plus 8 others used for descriptive purposes but not scored. The BULIT-Revised test includes questions on the nature and frequency of binge eating, loss of control during binges, use of purging behaviors, and dissatisfaction with bodily shape. The internal reliability of the BULIT-Revised is high and has been found to correlate well with related measures. As a community screening measure, Welch and colleagues showed that a cut-off score of 98 is optimal among young women (i.e, clinically important cases will not be missed). However, many false-positive cases will be included (about 30%) because of technical problems related to the low base rate of BN among females in community samples (approximately 2-3% prevalence). This problem also occurs in screening for anorexia nervosa. Nevertheless, both the EDI-2 and BULIT-Revised can reduce the subsequent interviewing workload in community studies. Also, in the clinical setting, individual BULIT-Revised questions and the total score can help in assessment and in monitoring response to treatment.

27. What tests are good options for measuring general psychiatric distress or probable psychiatric caseness by questionnaire?
Two useful tools are the General Health Questionnaire, which is designed for research use in community and nonpsychiatric settings, and the Symptom Check List-90, designed for use in psychiatric and medical populations.

28. Describe the General Health Questionnaire. The General Health Questionnaire comes in short, intermediate, and long versions; the intermediate 30-question version is probably the most commonly employed. Its principal use is in identifying probable nonpsychotic psychiatric illness.The General Health Questionnaire is simple to administer and score, although long-standing patient problems may be missed, because the test asks how the patient feels relative to usual. The test manual recommends two additional questions that can be added to adjust for this problem (use of psychiatric drugs and history of nervous problems). The General Health Questionnaire has been found to correlate highly with similar screening measures, and the 30-question version has an overall sensitivity of 74% and a specificity of 82%. Patients with physical health problems may score higher because of the presence of somatic anxiety symptoms.
29. Describe the Symptom Checklist-90 (SCL-90). The SCL-90 assesses nonpsychotic psychiatric symptoms in nine different symptom areas: somatization, obsessive-compulsion, paranoid ideation, psychoticism, phobic anxiety, depression, anxiety, interpersonal sensitivity, and hostility. It offers a global score related to the intensity of perceived psychological distress and the number of psychological symptoms (Global Severity Index). The nine subscales generally have good internal and test-retest reliability, and the Global Severity Index has been found to correlate well with similar measures and have good responsiveness to detect

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changes in psychological distress. A standardized (T-score) cut-off score of 63 has been suggested for the Global Severity Index to detect probable psychiatric illness. Note that norms for the General Health Questionnaire and the SCL-90 are available for a range of medical, psychiatric, and general population groups.

30. Are computer programs available to help score and interpret some of the psychological tests mentioned here? Yes. This is a burgeoning field with many new programs coming onto the market each year. Stoloff and Couch provide a recent listing of useful, currently available computer programs to help score and interpret commonly used tests. The measures covered include the BDI, the Spielberger State-Trait Anxiety Inventory, the 16PF, the Minnesota Personality Inventory, the California Personality Inventory, and the Personality Research Form.
31. The phrase quality of life pops up everywhere. What is it? Health-related quality of life is a complex, patient-centered, and dynamic description of the changes in patient functioning and well being over time that are related to the patients illness, treatment, and complications. A general consensus now exists that, in its fullest sense, quality of life encompasses four distinct areas that cover the patients total experience of illness: (1) physical health and symptoms, (2) functional status and activities of daily living, (3) mental well-being (including existential and spiritual aspects of living), and (4) social health, i.e., social role functioning and social support (including the patients relationship to the medical team and hospital environment). 32. What measures can be used to assess health-related quality of life? Quality-of-life measures can be used to compare individual patient profiles with those of a similar patient group or to compare quality of life across different patient groups. These measures commonly are termed generic and include the SF-36, the Sickness Impact Profile, and the Nottingham Health Profile. Another measure of quality of life is the disease-specific. This type is tailored to the specific issues of a given illness and provides greater sensitivity to detect subtle changes in quality of life than more generic measures. Selection of the appropriate generic or specific measure depends on the research goal or clinical issue. Note, however, that the SIP and NHP are better suited for severely ill patients. Patient-focused self-reporting is the preferred mode of assessment of the subjective aspects of quality of life such as psychological and social functioning, not only because self-reporting measures are inexpensive and easy to administer, but also because they provide the most important information: the patients perspective. Some potential applications of quality-of-life measurement include: Screening and monitoring for psychosocial problems in individual patient care Population surveys of perceived health problems for medical audit Outcome measures for use in health services or evaluation research Outcome measures in clinical trials Costlutility analyses
BIBLIOGRAPHY
1. Bowling A: Measuring health: A Review of Quality of Life Measurement Scales. Philadelphia, Open University Press, 1991. 2. Costa PT, McCrae RR: Revised NEO Personality Inventory and the NEO Five-Factor Model. Odessa, FL, Psychological Assessment Resources, 1992. 3. Deyo R, Kiehr P, Patrick DL: Reproducibility and responsiveness of health status measures: Statistics and strategies for evaluation. Controlled Clinical Trials 12:142s-I58s, 1991. 4. Garner DM: Eating Disorder Inventory-2 Professional Manual. Odessa, FL, Psychological Assessment Resources, 1991. 5. Patrick D, Deyo R:Generic and disease-specific measures in assessing health status and quality of life. Med Care 27:S217-S232, 1989. 6 . Proceedings of the International Conference on the Measurement of Quality of Life as an Outcome in Clinical Trials. Controlled Clinical Trials 12:243~-256s,1991.

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7. Stoloff M, Couch J: Computer Use in Psychology: A Directory of Software, 3rd ed. Washington, DC, American Psychological Association, 1992. 8. Streiner D, Norman GR: Health Measurement Scales: A Practical Guide to Their Development and Use. Oxford, Oxford University Press, 1989. 9. Thelen M, Farmer J, Wonderlich S, Smith M: A revision of the bulimia test-the BULIT-R. Psychological Assessment 3:119-124, 1987. 10. Thompson C: The Instruments of Psychiatric Research. Chichester, 1989. 11. Welch GW, Thompson L, Hall A: The BULIT-R: Its reliability and clinical validity as a screening tool for DSM-I11 R bulimia nervosa in a female tertiary education population. Int J Eating Dis 14:95-105, 1993. 12. McCrae RR, Costa PT, Pedroso de Lima M: Age differences in personality across the adult life span: Parallels in five cultures. Develop Psycho1 35(2):466477, 1999.

8. STANDARDIZED PSYCHIATRIC INTERVIEWS

Jacqueline A. S a ~ s o nPh.D ,

1. When should I use a standardized interview? Standardized interviews are necessary when collecting data for research and for comparing your own patients with those reported in the psychiatric literature. They also are valuable as a systematic means of evaluating patients that is less subject to bias or incomplete assessment. In clinical practice, its easy to spend a lot of time discussing the problems volunteered by the patient, but fail to ask about other problems that are less apparent but no less important. Patients are particularly reticent when they feel symptoms are embarrassing or socially unacceptable. Alcohol or drug abuse, sexual compulsions, or symptoms related to trauma often are missed because clinicians dont probe. Standardized interviews enhance understanding of specific syndromes and pinpoint the questions most useful in eliciting psychiatric information. In this way, they are valuable training devices. 2. How is a standardized interview different from a clinical interview? In a standardized interview, there are specific guidelines that define the areas of questioning to be covered and the kind of information to be elicited from a patient. The interviewer is expected to cover all the areas included in the guidelines and to ask for a sufficient amount of detail to complete ratings in each area. The format of the interview is also specified to insure that the interview is conducted in a comparable fashion by all clinicians both within and across institutions.
3. What is the difference between a fully structured and a semi-structuredinterview format? A fully structured interview specifies the wording of questions and the order in which questions are asked. The format is defined and must not be altered by the interviewer in any way. In a semistructured interview, the wording of questions and ordering are specified but may be modified by the interviewer to suit the needs of a particular patient, as long as all areas are covered in the interview. Fully structured interviews provide a high degree of consistency from one interview to another, and have been used extensively in epidemiologic studies that involve many raters. Semi-structured interviews are less standardized but allow for clarifications and probes that can improve the validity of responses from atypical or severely impaired patients.

4. What kinds of standardized interviews are available? The two most common types are interviews to assess the psychiatric diagnosis (diagnostic interviews) and interviews to assess the severity of certain types of symptoms at a specific point in time (cross-sectionalsymptom severity rating scales).