pic_scid1 pic_scid1 pic_scid1 pic_scid2 pic_scid2 pic_scid2

November 2002 Revision

The major changes in this revision is that the entire SCID is now printed using MS-Word, allowing for a much more esthetically pleasing look. In order to save paper and take advantage of more flexible page layouts, we have altered the page layouts so that in some modules of the SCID, the page numbers have been altered as compared to previous editions of the SCID.

The only change in content for the November 2002 revision was an addition of a note below the first item on page D.4. The note reads "CODE "3" IF MANIC EPISODE IS SUPERIMPOSED ON PSYCHOTIC DISORDER." This note clarifies the flow through the D module and corrects a potential error in cases in which a manic episode is superimposed on Schizophrenia. Consider a case of a patient with a chronic psychotic disturbance who also has manic episodes during the course of the illness. If the manic episodes overlap with the psychotic symptoms and are a significant part of the total disturbance, the diagnosis in Module C is Schizoaffective Disorder (and the instruction at the beginning of D.1 instructing the user to skip Module D if mood episodes are accounted for by a diagnosis of Schizoaffective Disorder would prevent entry into the D module). However, if the manic episodes are only brief relative to the total duration of the disturbance, two diagnoses are given: Schizophrenia and Bipolar Disorder NOS. Thus, a pass through module D is necessary to diagnose the Bipolar Disorder NOS. Entering the D module, the user skips to D.2 (because of the third criterion on D.1) and then skips again to D.4 (because of the 4th criterion on D.2). The wording of the first criterion on the top of D.4 is potentially confusing when it comes to mood symptoms that occur as part of a psychotic disorder. This criterion is the gateway for Bipolar Disorder NOS and the intention was NOT to independently diagnose stray mild mood symptoms that occur during a psychotic disorder as Bipolar Disorder NOS—instead, such symptoms are considered associated features of the psychotic disorder and are thus not diagnosed separately. In the case of a full manic episode occurring during a psychotic disorder, a diagnosis of Bipolar Disorder NOS is justified. Thus, we have added a note to indicate that if the mood symptoms constitute a full manic episode, you should continue (thus, "3" should be coded). If the mood symptoms are not part of a manic episode, "1" should be coded.

November 2001 Revision

Two changes (affecting three pages) have been made as part of the November 2001 revision of the SCID for DSM-IV-TR (February 2001).

Issue #1: There is an error in Module C regarding the way Major Depressive Episodes that do not include criterion A(1) "depressed mood," (i.e., the episodes are characterized by loss of interest in the absence of depressed mood) are handled.

Background: Psychotic symptoms that occur during Major Depressive Episodes generally result in a differential diagnosis of the following disorders: Major Depressive Disorder With Psychotic Features, Schizophrenia with Depressive Disorder NOS (so-called "Postpsychotic depression of Schizophrenia"), and Schizoaffective Disorder. This differentiation is only meaningful, however, if the depressive episode actually includes depressed mood as its anchor symptom. If the depressive episode is defined only as loss of interest or pleasure accompanied by 4 (or more) additional symptoms, then the depressive episode becomes indistinguishable from the prodromal and residual phases of Schizophrenia. Thus, there is a requirement in the criteria for both Schizoaffective Disorder and in the appendix category Postpsychotic depressive disorder of Schizophrenia that the Major Depressive Episode include criterion A(1) depressed mood.

Specifics:

Page C.1: Consider following scenario: Imagine a patient who has a chronic negative symptom picture that meets the criteria for a Major Depressive Episode with loss of interest in activities, agitation, poor concentration, low energy, and poor sleep (5 criteria of MDE without depressed mood). Superimposed on that are episodes of acute psychosis. If we follow the instructions on page C.1 for that patient, we would skip out of module C and go directly to module D (and ultimately rate it as a Major Depressive Episode with psychotic features) because it is true that the psychotic symptoms occur ONLY during Major Depressive Episodes (i.e., during the one chronic MDE characterized above). Clearly a more appropriate way to diagnose this case is as chronic Schizophrenia with some acute psychotic exacerbations. The problem is that the type of Major Depressive Episode is not qualified on page C.1. The fix is therefore to modify the note to clarify that in situations in which the depressive episodes are only characterized by loss of interest, a rating of "3" should be made, leading the user to continue on page C.2.

Page C.13: The A criterion includes a note clarifying that the Major Depressive Episode must include criterion A(1) depressed mood. The problem here is the skip instruction. Currently, the user is instructed to skip to page C.23 (Psychotic Disorder NOS). This skip is in fact appropriate if the reason that criterion A is not met is because there is no overlap between the mood episodes and symptoms that meet criterion A of Schizophrenia. However, if criterion A is not met because the Major Depressive Episodes in question do not include criterion A(1) depressed mood, the user is supposed to continue with the evaluation of Schizophrenia (Remember that we got to page C.13 in the first place via a skip from page C.3). Thus, if criterion A on C.13 is not true, then the user should continue on page C.4. The fix is that we have modified the skip instruction under the "1" rating to provide both choices.

Issue #2: (with changes to pages F.20 and F.21): Some subjects with Obsessive-Compulsive Disorder may be reluctant to reveal their obsessions and/or compulsions to the interviewer because of embarrassment about their content. Thus, their answer to the screening questions, which appear relatively early in the interview, may be false negatives. In order to reduce this possibility, the interviewer is encouraged to reconsider skipping out of the OCD section by virtue of "NO" answers to the two OCD screening questions (i.e., questions 8 and 9) and ask them again on pages F.20 and F.21. The fix therefore is an addition of a "note" to the screening skip instructions on the top of pages F.20 and F.21, alerting the user to this issue.