FAQ:
Frequently Asked Questions

How does the PRISM deal with issues specific to co-morbidity?

Because the PRISM is specifically focused on co-morbidity, it is organized differently from other diagnostic interviews.

	The alcohol and drug sections of the PRISM appear near the beginning of the interview, before the mental disorder sections. This is so you will have the history of alcohol and drug use by the time you begin to assess mental disorders.
	The PRISM provides specific probes and guidelines. You are given specific questions to ask when assessing potential mental disorders in substance users and coding guidelines are provided throughout the interview.

How does the PRISM increase reliability in general?

Use of the PRISM has the potential to increase reliability and validity because of the following features:

	Introduction of specific rating guidelines throughout the interview, including frequency and duration requirements, exclusion specifications, and decision rules for frequently encountered sources of uncertainty.
	Separation of dissimilar components of individual criteria into different items, to ensure that interviewers assess all components, and to allow for simplified rating guidelines.
	Addition of standardized probes to indicate the questions usually needed to explore incomplete responses.
	Items in the introductory section designed to uncover indirect indications of alcohol, drug or psychiatric problems, i.e., interrupted education or employment history, treatment history.
	Development of computer programs to produce diagnoses from the interview data.
	Development of training package, consisting of a training manual, trainer-led session, and pre-scripted role-plays.

What is the evidence for the reliability of the PRISM?

The first test-retest reliability study of the earlier version of the PRISM was conducted with 172 patients being treated in dual diagnosis or substance abuse settings. Good to excellent reliability was shown for many diagnoses including mood disorders and substance use disorders. (Prism Reliability, Am J Psychiatry, 1996) A test-retest study of the PRISM 6.0 (n=285) was recently completed in inpatient and outpatient substance abuse, dual diagnosis, and mental health settings. Preliminary kappa indicate good to excellent reliability for many diagnoses including Major Depression, substance use disorders, psychotic disorders, Antisocial and Borderline Personality Disorder. (Paper in preparation).

How long does it take to administer the PRISM?

The full PRISM takes approximately 120 minutes to administer with subjects who report psychiatric and substance use symptoms. The time to administer varies depending on the interviewer’s level of experience, the complexity of the subject’s symptomatology, and the extent to which the subject is able to express himself or herself clearly and succinctly.

How are data collected, recorded, and analyzed using the PRISM?

Data are collected through face-to-face interviews with subjects and coded on the PRISM booklet. The interview takes approximately two hours to administer, and is easily adapted for specific research purposes. The PRISM is a contingency questionnaire, routing interviewers to relevant questions depending on subject responses.

Therefore, although the instrument allows for the investigation of many variables, only a subset of PRISM questions is administered to any single subject. PRISM data entry, data cleaning and diagnostic computer programs can be purchased. The data is entered using Microsoft Access-based data entry software. Cleaning and diagnostic programs are written in SAS.

Who can administer the PRISM?

Interviewers with different professional backgrounds can administer the PRISM provided they attain the proper training. Past trainee groups have included individuals with bachelor’s degrees in psychology, nurses, psychologists, and psychiatrists. Interviewers should have some work or training experience with substance-using and psychiatric populations.

Who should supervise the quality of PRISM diagnostic data?

A certified PRISM interviewer with clinical experience working with patients with dual-diagnosis and experience with PRISM administration can review interviews for accurate PRISM diagnosis, with periodic consensus coding to guard against interviewer drift.

Why is training necessary?

The PRISM has good to excellent reliability for many diagnoses when administered by interviewers who participate in the standardized PRISM training course. Training standardizes semi-structured interviewing techniques.

The training course accomplishes the following goals:

	Introduces the diagnostic concepts central to the PRISM focus on comorbidity: primary mental disorder, substance-induced disorder, and the expected effects of intoxication and withdrawal;
	Introduces the organization and conventions of the PRISM, as well as the structure of its sections;
	Provides practical information on actual interviewing, section by section, which illustrates how the diagnostic concepts are applied.

What is the cost of PRISM training, training material, interview, and software?

The cost for the complete PRISM training package varies depending on the size of the group and the number of PRISM modules required.

How do I arrange training?

A PRISM trainer will tailor a training session to the needs of your project depending on the size of your group and your research interests. Contact: Sharon Samet, M.S.W. at ss1456@columbia.edu or at 212 543-5508.

Is the PRISM available in other languages?

Yes. A Spanish (Castilian) version of the PRISM was developed by
Marta Torrens MD. Ph D.
For further information about the Spanish PRISM contact:
Dr. Marta Torrens Psychiatric Research Group
Servei de Psiquiatria i Toxicomanies
Hospital del Mar
Passeig Marítim 25-29
08003 Barcelona, Spain

Tel: 34 93 2211010 ext 4631
Fax: 34 93 2213237

e-mail:mtorrens@imim.es

How do I get a copy of the PRISM?

To download PRISM modules click here