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Lifetime psychotic symptoms assessed with the DIS.

The article by Pulver and Carpenter (1983) attempts to test the reliability of a structured instrument, the National Institute of Mental Health Diagnostic Interview Schedule (DIS), in eliciting lifetime psychotic symptoms. The symptoms were first detected approximately 11 years previously through the use of another structured instrument, the Present State Examination (PSE) (Wing, Cooper, and Sartorius 1974), as part of the World Health Organization's International Pilot Study of Schizophrenia (WHO-IPSS) at the Washington, D.C. study center. The authors report that the DIS failed to detect significant psychotic symptoms previously elicited by the PSE, and therefore conclude that the DIS/lay interviewer approach underestimates the lifetime occurrence of psychotic symptoms and diagnoses. Since the DIS is currently in use in large-scale epidemiological surveys in the U.S. (the Epidemiological Catchment Area Project), underreporting of psychotic symptoms could produce substantial error in detecting the true prevalence of disorders such as schizophrenia. Unfortunately, Pulver and Carpenter's research design leaves unaddressed important factors which could account for discrepancies between the PSE, the Psychiatric Assessment Interview (PAI) (Carpenter et al. 1976), and the DIS symptom reports. The most obvious of these, independent of differences between the DIS and the PSE/PAI, is the fact that the PSE/ PAI asks about current symptoms and the DIS asks if a symptom has ever occurred. False-negative information in the retrospective reporting of major psychiatric symptoms, even in repeated interviews with the same, familiar, research psychiatrist over time, has been reported by Barbara Fish (1982) regarding subjects followed since birth for almost 30 years and judged to be at risk for the development of schizophrenia: To the extent that subjects and their families turned to us in times of crisis, they told of their experiences with all the intensity of the initial impact. We found that in the later retrospective histories, these same events were often forgotten, blurred, or completely distorted to fit a more comfortable self-concept. Symptoms were often revealed at times of stress and then later forgotten or denied during calmer periods. We became aware of the considerable false negative information provided during the regular, standardized interviews. The unreliability of self reports of past experiences has also been demonstrated in regard to life changes (Uhlenhuth et al. 1977; Jenkins, Hurst, and Rose 1979), the use of prescription medication (Parry, Baiter, and Cisin 1970-71), and other health-related events such as hospitalizations, auto accidents, and episodes of illness. The general conclusion that …