Diagnostic Interview Schedule (DIS)

DIAGNOSTIC INTERVIEW SCHEDULE (DIS)

Developed in the late 1970s for use in large-scale studies of the prevalence of mental disorders in the U.S. population (Regier et al., 1984), the Diagnostic Interview Schedule (DIS) is a highly structured psychiatric interview that carefully specifies the questions that the interviewer must ask to make a Diagnosis. Another version is the DISC, or Diagnostic Interview Schedule for Children. Unlike the DIS, this version allows the re-ordering of questions or sections. Because the DIS requires a minimum of clinical judgment, it can be administered by nonprofessional or nonclinician interviewers who have received a week of intensive training. In addition to alcohol and other substance-use disorders, the DIS provides diagnostic information about Depression, Schizophrenia, and Anxiety disorders; eating disorders; Anti-Social Personality; and a variety of other psychiatric conditions. The DIS has been the subject of a number of validation studies showing that nonclinician interviewers diagnose patients as accurately as trained clinicians using criteria from DSM-III (Diagnostic and Statistical Manual of Mental Disorders, third edition). With the American Psychiatric Association's publication of the revised versions of DSM, major changes were made to the DIS as well.

In June 2000 a study of 349 individuals who were given the DIS was published, then examined by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). The DIS missed many cases of major depressive disorders (as determined by SCAN), but there was correlation in the symptom groups. The researchers concluded that DIS may be too conservative with risk factors.

The DIS was first used in The Epidemiologic Catchment Area (ECA) study, which was a survey of mental disorders in the United States. This survey's results led to worldwide testing, which in turn led to comparative analyses among the nations.

The DIS also has been widely used in research on substance-use disorders (Helzer & Canino, 1992), in part because it can be administered by nonclinician interviewers in population surveys. Interviewers read questions aloud to the subject exactly as they are written in the interview booklet. No deviation from the written format is allowed, except to repeat questions that may have been misunderstood. A set of standard probes is used to determine whether a given symptom was caused by the effects of physical illness. The interviewer also asks for the age of onset and the recency of most symptoms.

A series of thirty questions constitutes the Alcohol Dependence/abuse section of the DIS. The section begins with questions about alcohol consumption and intoxication (e.g., "Have you ever gone on binges or benders where you kept drinking for a couple of days or more without sobering up?"). Additional questions are asked to diagnose the symptoms of dependence (e.g., "Did you ever get tolerant to alcohol, that is, you needed to drink a lot more in order to get an effect, or found that you could no longer get high on the amount you used to drink?"). A third type of question pertains to the symptoms of alcohol abuse (e.g., "Have you ever had trouble driving because of drinking—like having an Accident or being arrested for drunk driving?").

The drug dependence section of the DIS (version III-B) consists of twenty-four questions that conform to the DSM-III-R criteria for drug use disorders. This section begins by asking if the patient has used any of the following types of drugs "to get high or for other mental effects": Marijuana, Stimulants (e.g., Amphetamines), Sedatives (e.g., Barbiturates), prescribed drugs (e.g., Tranquilizers), Cocaine, Heroin, other Opiates, Psychedelics, PCP, Inhalants, and other drugs not previously specified. If the person has used any of these substances more than five times, additional questions are asked to evaluate the mode of ingestion for each drug (e.g., by mouth, smoking, snorting, or injecting).

The remaining questions ask about DSM-III-R symptoms of dependence and abuse. For example, patients are asked if they have had difficulty abstaining from drugs ("Have you ever tried to cut down on any of these drugs but found you couldn't?"); experienced Withdrawal symptoms ("Has stopping or cutting down on any of these drugs made you sick?"); or experienced other physical complications ("Did you have any health problems like an accidental Overdose, a persistent cough, a seizure [fit], an infection, a cut, sprain, burn, or other injury as a result of taking any of these drugs?"). The DIS can be scored manually or by computer to obtain specific drug and alcohol diagnoses in DSM-III-R.

In 1994, the American Psychiatric Association released the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). This version is applicable to both children and adults, which has made it an integral part of school and child psychology, especially when dealing with attention deficit hyperactivity disorder (ADHD). The DSM-IV functions as a way of organizing and recognizing cognitive and personality disorders, as well as addictive and disruptive behaviors. The DSM-IV was also used in the late 1990s (in conjunction with part of the DIS) to help determine substance abuse treatment needs for prisoners and to screen veterans for post-traumatic stress disorder (PTSD).

(See also: Addiction: Concepts and Definitions ; Diagnosis of Drug Abuse ; Disease Concept of Alcoholism and Drug Abuse )

BIBLIOGRAPHY

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders-3rd edition-revised. Washington, DC: Author.

Bell, C. C., et al. (1999). DSM-IV (Evaluation). JAMA, The Journal of the American Medical Association, 282, 387.

Breslau, N., et al. (1999). Short screening scale for DSM-IV posttraumatic stress disorder. American Journal of Psychiatry, 156, 908.

Eaton, W. W., et al. (2000). A Comparison of Self-Report and Clinical Diagnostic Interviews for Depression: Diagnostic Interview Schedule and Schedules for Clinical Assessment in Neuropsychiatry in the Baltimore Epidemiologic Catchment Area Follow-Up. Archives of General Psychiatry, 57, 217.

Edelbrock, C., et al. (1999). Interviewing as Communication: An Alternative Way of Administering the Diagnostic Interview Schedule for Children. Journal of Abnormal Child Psychiatry, 27, 447.

Helzer, J. E., & Canino, G.J. (Eds.). (1992). Alcoholism in North America, Europe, and Asia. New York: Oxford University Press.

Jensen, P. S., & Edelbrock, C. (1999). Subject and Interview Characteristics Affecting Reliability of the Diagnostic Interview Schedule for Children. Journal of Abnormal Child Psychiatry, 27, 413.

Leuzzi, R. A., & Spandorfer, J. (2000). Some individuals never outgrow ADHD, says DSM-IV. Internal Medicine, 21, 44.

Lo, C. C., & Stephens, R. C. (2000). Drugs and Prisoners: Treatment Needs on Entering Prison. American Journal of Drug and Alcohol Abuse, 26, 229.

Nigg, J. T. (1999). The ADHD Response-Inhibition Deficit as Measured by the Stop Task: Replication with DSM-IV Combined Type, Extension, and Qualification. Journal of Abnormal Child Psychology, 27, 393.

Regier, D. A., et al. (1984). The NIMH Epidemiologic Catchment Area (ECA) program: Historical context, major objectives and study population characteristics. Archives of General Psychiatry, 41, 934-941.

Robins, L., et al. (1989). NIMH diagnostic interview schedule, version III, revised (DIS-III-R). St. Louis: Washington University.

Robins, L.N., et al. (1982). Validity of the diagnostic interview schedule. version II: DSM-III diagnoses. Psychological Medicine, 12, 855-870.

Thomas F. Babor

Revised by Rebecca Marlow-Ferguson