Use of a Structured Clinical Interview to Eliminate Unspecified Psychiatric Diagnoses
Date of Award
Doctor of Nursing (ND)
Hector R. Morales, DNP, APRN, PMH/CS-BC
Background: A definitive psychiatric diagnosis can provide significant direction to patient treatment strategies and will facilitate the identification of potential risks and qualification for supportive resources. Psychiatric research programs that were initiated in the 1950s led to the classification framework known as the Diagnostic and Statistical Manual (DSM) of Mental Disorders. These guidelines provide physicians with the information that they need for the appropriate diagnosis of major psychiatric conditions. While the DSM has had a large impact on the practice of psychiatry, there are still no biological markers of these diseases. This has led to the development of diverse assessment methods that can lead to inconsistent diagnoses.
Methods: A ten-day reflective assessment was completed prior to the selection of the Quality Improvement (QI) topic. Three PICOT (patient, intervention, comparison, outcome, and time) questions were developed following this assessment to identify gaps in current practice methods. A literature review was then conducted. Current research guidelines that support the implementation of a structured clinical interview as part of the diagnostic process were identified. The Plan-Do-Study-Act method was used to establish a plan for implementation and achieving goals. Initial evaluations and documented diagnoses provided to patients who were evaluated during an earlier six-week period were reviewed for comparison purposes.
Intervention: The Structured Clinical Interview for DSM-5, Clinician Version (SCID-5-CV) is the standard method used to diagnose psychiatric disorders. Patients between the ages of 18 and 65 years who were seeking an initial evaluation during the six-week study period were assessed using the SCID-5-CV.
Results: Nine patients met the initial eligibility criteria; two patients were ultimately excluded. Ages ranged from 18 to 60 years old and included five females, two males. Data collected from the seven evaluations using the SCID-5-CV were reviewed, analyzed, and documented.
Conclusion: Implementation of the SCID-5-CV into clinical practice improved diagnostic accuracy and reduced the frequency of unspecified psychiatric diagnoses. Despite the time barriers associated with its administration, the use of the SCID-5-CV provides clinicians with the assurance that all DSM-5 criteria for each diagnosis are met. Benefits to the patients, including more effective treatment responses and qualification for supportive resources were also recognized.
Mimbela, Gabriela, "Use of a Structured Clinical Interview to Eliminate Unspecified Psychiatric Diagnoses" (2022). Cohort X. 11.