Sensitivity of psychiatric diagnosis based on the best estimate procedure.
OBJECTIVE
A "best estimate" diagnosis is one made by expert clinicians on the basis of diagnostic information from direct interview conducted by another clinician plus information from medical records and from reports of family members. The authors address the question of whether the best estimate procedure can enhance the classification of psychiatric diagnoses of subjects who are interviewed directly.


METHODS
Four hundred seventy-five subjects were interviewed directly: 201 opiate-addicted probands who sought treatment from a university-based clinic and 274 of their spouses and/or first-degree relatives. Subjects were interviewed by trained clinical assessors using the Schedule for Affective Disorders and Schizophrenia and classified according to Research Diagnostic Criteria. Two psychologists independently diagnosed the same subjects by applying the best estimate procedure. Lifetime rates of major and minor depressive disorder, antisocial personality, alcoholism, and drug abuse were calculated. The rates of diagnoses made on the basis of direct interviews alone were compared with the rates of diagnoses made according to the best estimate procedure.


RESULTS
Higher rates of diagnoses of all four disorders were made when the best estimate procedure was applied than when direct interview alone was used; the best estimate procedure also resulted in a minimal rate of false positives.


CONCLUSIONS
The higher rate of diagnoses based on the best estimate procedure may represent an enhancement in the accuracy of psychiatric diagnoses or an increase in erroneous diagnoses. The authors consider the second possibility less likely.
Kosten
T A
TA
Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. 06519.
Rounsaville
B J
BJ
D000328:Adult; D000437:Alcoholism / Q000145:classification / Q000175:diagnosis; D000987:Antisocial Personality Disorder / Q000145:classification / Q000175:diagnosis; D003627:Data Interpretation, Statistical; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis; D005189:False Positive Reactions; D005190:Family; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000145:classification / Q000175:diagnosis*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000145:classification / Q000175:diagnosis