Clinical judgement and the standardized interview in psychiatry

There has been little discussion of the advantages and disadvantages of allowing a psychiatrist to make clinical judgements about the presence or absence of symptoms in administering currently used standardized psychiatric interviews. This paper reports an examination of the value of clinical judgements in defining cases of minor psychiatric disorder, by studying existing data in which the Clinical Interview Schedule (CIS) was used. This comparison can be made because the first section of the CIS is largely self-report while interviewers are also instructed to use clinical judgement in the second section to decide on ratings. The results indicate that in the context of identifying minor psychiatric disorder the ratings requiring clinical judgement add little information to those based on self-report, may be less reliable and may lead to the biased assessment of anxiety and depression.