Annotated Guide to the February 2001 SCID Revision
The following is a guide to the February 2001 SCID revision. Although it may look like a major revision (with a new typeface and even a new name "SCID-I: Structured Clinical Interview for DSM-IV-TR Axis I Disorders,") this revision is only slightly more extensive than previous SCID revisions. We have changed the name of the SCID to reflect the publication of the DSM-IV Text Revision (DSM-IV-TR) in July 2000. The DSM-IV-TR was an empirically-based revision and update of the DSM-IV text sections so, by and large, there were no changes in the diagnostic criteria. However, two changes in the DSM-IV-TR do call for changes in the SCID, both in Module E:
Please note that, as with previous SCID revisions, we have maintained the same item field numbers (i.e., the unique number printed using a small typeface on the right side of each rating) so that data analysis programs that use these data field identifiers will continue to work. New data fields were inserted between existing data fields by using additional letters. For example, the addition of a Chronology section for Schizophrenia required that we add 8 new data fields between items C13 and C14; thus, C13a, C13b,..., C13h were inserted. Similarly, when data fields were deleted, the prior numbering was retained (i.e., there are gaps in the numbering where fields were omitted).
Here is a page-by-page summary of the major changes:
A.2, A.13 (Current and Past MDE, Mood Episodes Module), J.10 (Lifetime MDE, Optional Module): The order of the questions for Major Depressive Episode criterion A(3) has been changed so that the question about appetite change comes before the question about weight loss or weight gain.
A.8-A.9 (Melancholic Features, Mood Episodes Module): Each item in Melancholic Features now has a corresponding SCID question—no longer do we just refer the interviewer back to the corresponding items in the Major Depressive Episode. In addition, a skip instruction to "MANIC EPISODE, A.18" is added after the diagnosis of Melancholic Features is made.
Although the skip instruction on the top of page A.10 instructs the interviewer to skip to A.18 if a diagnosis of Melancholic Features has been made, some interviewers missed this instruction. Thus, we have moved this skip instruction to right below the box for Melancholic Features on page A.9.
A.10 (Atypical Features, Mood Episodes Module): As above, each item in Atypical Features now has a corresponding SCID question.
C.1-C.25 (Psychotic Disorders Module): Page numbers within this module have all changed to reflect the addition of a separate chronology section for Schizophrenia on pages C.8-C.10.
C.8-C.10 (Schizophrenia, Psychotic Disorders Module): The Chronology section has been split into two parts. Schizophrenia now has its own Chronology section on pages C.8-C.10. The other psychotic disorders covered in this module have a separate Chronology section, starting on page C.24.
D.1 (Bipolar I Disorder, Mood Disorders Module): The skip instruction at the top now indicates that Module D can be skipped if all mood symptoms are accounted for by a diagnosis of Schizoaffective Disorder made in Module C. Furthermore, the "mixed" subtype in the bottom box now includes the DSM-IV definition of a mixed episode for clarification.
D.5 (Other Bipolar Disorders, Mood Disorders Module), Scoresheet page ii: A new subtype (i.e., type #4) for "Other Bipolar Disorder" has been added to allow the interviewer to specify that Bipolar Disorder NOS has been diagnosed due to the presence of sub-threshold Manic Episodes that do not meet criteria for Hypomanic Episodes, i.e., episodes with a duration of less than one week (thus not meeting the criteria for a Manic Episode) that cause significant impairment in social or occupational functioning (thus not meeting criteria for a Hypomanic Episode).
E.2, E.4-E.5, E.12-E.16, E.23-E24 (Substance Use Disorders Module): The time period for the Abuse and Dependence questions has been changed to focus on the period in which the subject reported using the most, or the period in which the substance use caused the most problems (which is known from the screening sections on pages E.1 and E.10-E.11). The wording of the questions has been changed from lifetime ("have you ever") to focus on the identified time period ("did you").
E.9 (Alcohol Dependence, Substance Use Disorders Module): The "With Agonist Therapy" option has been eliminated for Alcohol Dependence (i.e., benzodiazepines are not considered agonist therapy for Alcohol Dependence).
E.16 (Substance Dependence, Substance Use Disorders Module): In previous versions of the SCID, a note appeared here stating that the criterion for substance withdrawal may not apply to Cannabis and Hallucinogens/PCP. This note has been deleted based on information added to the DSM-IV-TR text indicating the possibility of withdrawal symptoms for these three classes of drug, especially for cannabis.
E.18 (Substance Dependence, Substance Use Disorders Module): Two data fields were inadvertently assigned to each rating on this page—one set of data field codes have been eliminated (but a gap is maintained to preserve the match up of data fields between SCID versions). Furthermore, below the ratings of "1," an instruction has been inserted to permit the diagnosis of Polysubstance Dependence "if the number of different dependence symptoms (taken from at least three different drug classes) and occurring during the same 12-month period adds up to at least three." This is in accordance with the clarification made in the DSM-IV text revision (see discussion above).
E.19-E.21 (Substance Dependence, Substance Use Disorders Module): The Chronology section for Substance Dependence inadvertently left out ratings for the age at onset. Furthermore, the layout of the ratings was confusing because the ratings for "With Physiological Dependence" and "Without Physiological Dependence" were embedded in the middle of the rating for criteria being met in the past month. The entire Chronology section has been reorganized as follows: The section starts with Age At Onset for each drug class in which the lifetime criteria have been met for Dependence. Next are the ratings indicating if criteria have been met in the past month. Following this, the Chronology section is divided based on the ratings made for the current month as follows. For those drug classes coded "3" (i.e., criteria met in past month), ratings are made on page E.20 indicating current type ("With Physiological Dependence" or "Without Physiological Dependence") and current severity (Mild, Moderate, Severe). For those drug classes coded "1" (i.e., lifetime criteria met but not in past month), ratings are made on page E.21 indicating type of remission (Early Full, Early Partial, Sustained Full, Sustained Partial, On Agonist Therapy, In A Controlled Environment).
E.21 (Substance Dependence, Substance Use Disorders Module): The subtype "On Agonist Therapy" has been eliminated from all drug classes except Opioids, Polysubstance, and Other (see discussion above).
E.25 (Substance Abuse, Substance Use Disorders Module): The Chronology section for Substance Abuse inadvertently left out ratings for the age at onset—these have been added for each drug class.
Alternative to Pages E.10-E.25 for Substance Dependence/Substance Abuse: The non-alcohol substance dependence and abuse section is perhaps the most complex part of the SCID because it allows for the simultaneous rating of dependence and abuse for 10 different classes of substances. While this level of information is important for studies focusing on substance use problems, many studies are only interested in determining whether dependence or abuse has been met for ANY substance. For this reason, we are including an "alternate version" of the Non-alcohol Substance Dependence and Abuse section. In this version, the interviewer decides (after the screening section) which single drug class and time period to focus on (presumably the period of heaviest use or most severe drug-related problems). In cases of multiple drug use, the interviewer first selects the drug most likely to meet criteria for dependence or abuse. If criteria are not met for the chosen drug, the interviewer then has the option of considering other drugs and other time periods until either criteria are met or else the interviewer is satisfied that there is no dependence or abuse for any drug used.