B R I T I S H J O U R N A L O F P S YC H I AT RY ( 2 0 0 3 ) , 1 8 2 ( s u p p l .

4 5 ) , s 4 8 ^ s 4 9

IGDA.5: Supplementary assessment procedures ^ symptom or diagnostic checklists are useful

when large numbers of patients or com-
munity residents are to be examined for
psychopathological, neuropsychological possible mental or physical disorders, with
positive cases referred for more extensive
and physical aspects evaluation. Instruments that can be admi-
nistered by a primary care physician or a
IGDA WORKGROUP, WPA less-qualified health worker are useful
when a mental health clinician is not avail-
able. Rating scales for psychopathological
symptoms or syndromes identified with
Likert or visual analogue scales of fre-
5.1 including self-rated and observer-rated quency or severity are useful to ascertain
Supplementary assessment procedures may scales, screening tests and scales, symptom initial levels of symptom severity and to
be used to complement the psychiatric diag- and diagnostic checklists, semi-structured measure change over time.
nostic interview. These include procedures and fully structured diagnostic interviews,
for the comprehensive evaluation of the neuropsychological tests, and biological 5.7
mental and physical state of the patient tests and procedures.
The assessment of psychodynamic and
(psychosocial procedures are considered in cognitive–behavioural perspectives on
part 6 (IGDA Workgroup, WPA 2003, this 5.4 psychopathology should be considered,
suppl.)). Psychopathological assessment in- Choice of a supplementary assessment through systematic procedures, especially
struments, biological tests and procedures procedure should be based on a number when these assessments are contributory
and neuropsychological tests are among of criteria, including the specific purpose to a better understanding of the clinical
those used to enrich or refine data collected intended (e.g. syndrome identification, condition or to treatment planning.
in a clinical interview in order to arrive at symptom severity, clinical change over
the standardised multi-axial diagnostic time); pathological domain (e.g. depression, 5.8
formulation. dementia, personality functioning); charac- Neuropsychological assessment helps to as-
teristics of the patient to be tested (e.g. certain mental and neurological factors and
5.2 age, educational level, cognitive status); causes of symptoms and disorders and to
The purposes of these supplementary characteristics of the setting in which the localise sites of lesions. Neuropsychological
assessments are: procedure will be used (e.g. primary care tests also appraise cognitive strengths and
practice, psychiatric hospital, community weaknesses and other behavioural cap-
(a) to accurately identify and describe signs
survey); qualifications and training of user acities of the patient for the purpose of
and symptoms in terms of their type,
(e.g. psychiatrist, general medical profes- planning treatment and rehabilitation.
extent and severity;
sional, lay interviewer); culture of the
(b) to increase the reliability and validity of patient and the evaluator (e.g. first lan-
clinical diagnoses, to aid in the process 5.9
guage, translations, concepts of health and
of differential diagnosis, and to identify illness); psychometric properties of the Physical examination and laboratory tests
potential aetiological factors; instrument or procedure (e.g. reliability, (e.g. of blood or urine) are useful to rule
(c) to document patients’ cognitive skills validity); cultural validation in the popu- in or out general medical conditions or sub-
and limitations for the purposes of esti- lation of interest; and other characteristics stances of misuse as a case of mental disor-
mating capacity for self-care, treatment (e.g. time frame of interest, time and cost ders, and also aid in the diagnosis of other
adherence, and ability to carry out of administration, training required). physical conditions or disorders that might
activities of daily living; affect treatment or clinical management.
Brain imaging such as computed tomogra-
(d) to identify particular targets and goals 5.5
phy or magnetic resonance imaging is help-
for treatment and rehabilitation and to Diagnostic checklists and interviews are use- ful in documenting structural and functional
measure change over time and treat-
ful for trained clinicians to ensure that ade- brain abnormalities. Electrophysiological
ment outcome;
quate information has been gathered from tests such as electroencephalography can
(e) to document psychological and behav- the patient, informants or other sources, so identify abnormal brainwave activity. All
ioural injuries, rehabilitation potential, that a differential nosological diagnosis of these procedures help in formulating a
and need for treatment; capacity perti- according to specified diagnostic criteria more definitive clinical diagnosis.
nent to legal proceedings; (as set out in one of the international
(f) to support research into mental disorder classifications of mental disorders) can be
5.10
evaluation, treatment and aetiology. made.
The effective use of supplementary psycho-
pathological, neuropsychological and bio-
5.3 5.6 logical assessment procedures requires
Various types of supplementary assessment Brief screening scales or instruments that appropriate training in their application.
procedures should be considered for use, include exploratory questions and The competent interpretation of the results

s4 8
 I G D A . 5 : S U P P L E M E N TA RY A S S E S S M E N T P R
ROOC E DUR E S

requires training in and familiarity with
indications for use, applications to particu-
lar patient groups and settings, and
strengths and weaknesses of the procedures
involved.
FURTHER READING
American Psychiatric Association (2000) Handbook
of Psychiatric Measures.Washington,
Measures.Washington, DC: APA.
Bech, P. (1993) Rating Scales for Psychopathology. Health
Status and Quality of Life: A Compendium on
Documentation in Accordance with the DSM ^ III ^ R and
WHO Systems.
Systems. Berlin: Springer.
IGDA Working Group, WPA (2003) IGDA. 6:
Group,WPA
Supplementary assessment procedures ^ functioning,
social context, cultural framework and quality of life.
British Journal of Psychiatry,
Psychiatry, 182 (suppl. 45), s50^ s51.
Mezzich, J. E., Jorge M. R. & Salloum, I. M. (1994)
Psychiatric Epidemiology: Assessment Methods.
Methods. Baltimore,
MD: Johns Hopkins University Press.
Robin, L. N., Wing, J., Wittchen, H.-U., et al (1988)
The Composite International Diagnostic Interview. An
epidemiologic instrument suitable for use in conjunction
with different diagnostic systems and in different
cultures. Archives of General Psychiatry,
Psychiatry, 45,
45, 1069^1077.
Sartorius, N. & Janc
a, A. (1996) Psychiatric
Janca,
assessment instruments developed by the World
Health Organization. Social Psychiatry and Psychiatric
Epidemiology,
Epidemiology, 31,
31, 55^69.

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