Frequently Asked Questions
What is the PRISM?
The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) is a semi-structured diagnostic interview designed to deal with the problems of psychiatric diagnosis when subjects/patients drink heavily or use drugs.
The PRISM assesses DSM-IV Axis I and Axis II disorders. With this interview, you will be able to differentiate primary disorders, substance-induced disorders and the expected effects of intoxication and withdrawal.
How does the PRISM deal with issues specific to co-morbidity?
Three PRISM features are specific to co-morbidity are: 1) specific rating guidelines throughout the interview, including requirements for differentiating primary disorders, substance-induced disorders, and expected effects of intoxication and withdrawal;
2) positioning of the substance screening and substance use disorders sections near the beginning of the interview, before the mental disorder sections, so that information regarding alcohol and drug use is available for the assessment of mental disorders;
and 3) structured alcohol and drug chronic intoxication and binge use assessment to provide a context for assessing co-morbid psychiatric disorders.
How is the PRISM different from other structured or semi-structured psychiatric diagnostic instruments (e.g., SCID, CIDI)?
Unlike other psychiatric diagnostic interviews, the PRISM was developed specifically to address diagnostic issues when heavy substance use and psychiatric disorders co-occur. Specific questions are provided to 1) assessing the timing of mood, anxiety,
and psychotic episodes in relation to heavy substance use, and 2) to assess psychiatric symptoms that mimic intoxication and withdrawal.
How is the PRISM different from other substance use instruments (e.g. ASI)?
The PRISM is different from two of the most widely used substance use instruments in that it assesses DSM-IV diagnoses. The Addiction Severity Index (ASI) gathers past and current information about drug and alcohol use and six other domains including psychiatric problems.
The ASI provides a severity rating of patient problems in each domain. The Alcohol Timeline Followback (TLFB) is a drinking assessment method that obtains retrospective estimates of daily drinking using a calendar that can vary from 30-days up to 12 months from the interview date.
What is the evidence for the reliability of the PRISM?
In the first test-retest reliability study of the pre-DSM-IV version of the PRISM good to excellent reliability was shown for many diagnoses including mood disorders and substance use disorders. (Hasin et. al., Am J Psychiatry, 1996).
A test-retest study of the PRISM 6.0-PV (n=285; Hasin et. al., Am J Psychiatry, 2006) was conducted in inpatient and outpatient substance abuse, dual diagnosis, and mental health settings. Reliability was good to excellent (kappas ≥ 0.65)
for most categories of DSM-IV substance abuse and dependence, primary and substance-induced major depression (k = .75 and .69, respectively). Reliability for psychotic disorders, eating disorders, antisocial personality disorder, and borderline personality disorder was in the same range.
Reliability for most anxiety disorders was lower.
What is the evidence for the validity of the PRISM?
An independently conducted validity study of the Spanish version of the PRISM compared diagnoses assessed using the Longitudinal, Expert, All-Data Diagnosis (LEAD) procedure (Spitzer, 1983) as the “gold standard”, to the SCID and the PRISM (Torrens et al., Am J Psychiatry, 2004).
Results showed that the concordance of the three assessments in substance dependence was good to excellent. However, PRISM-LEAD concordance was significantly better than SCID-LEAD concordance on current cannabis and cocaine dependence, as well as past alcohol abuse and dependence.
Concordance was fair for any current mood disorders between PRISM-LEAD and poor between SCID-LEAD. Concordance was fair for past mood disorders between both PRISM-LEAD and SCID-LEAD, although concordance on substance-induced depression was better between PRISM-LEAD than between SCID-LEAD.
What kinds of subjects can be diagnosed with the PRISM?
Any adult who is able to participate in an interview can be assessed using the PRISM. In instances when the respondent is too ill or too cognitively impaired to participate in an interview, collateral information (e.g., family report, hospital chart) can be used to complete the PRISM and formulate a diagnosis.
The PRISM is generally used in clinical and treatment studies, but can also be used for treatment screening and assessment.
Can the PRISM be used with adolescents?
The PRISM was designed for and tested in adult populations. However, many of the diagnostic sections in the PRISM can be used with adolescents or easily adapted for this age group.
Can anyone administer the PRISM?
Interviewers with different professional backgrounds can administer the PRISM provided they obtain the proper training. Past training 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.
Are the PRISM 6.0-Paper Version and the PRISM-CV-IV (computerized PRISM) structurally different?
A significant difference is the formatting of questions. Items in the paper version that contained multiple questions are broken down in the computer version into individual questions. Guidelines have been edited to reflect these changes. In the computerized version, substance dependence precedes substance abuse; in the paper version abuse precedes dependence.
Modules and items included in the computerized version that are not in the paper version are nicotine screening, nicotine abuse and dependence, a brief suicidality module, Attention Deficit Hyperactivity Disorder, and Pathological Gambling. The computerized version also includes additional questions that enable diagnoses to be made for the past 30 days.
What are the advantages of the computerized version of the PRISM (PRISM-CV-IV)?
The PRISM-CV-IV is user-friendly and much easier to administer than previous paper versions of the PRISM for various reasons:
How long does it take to administer the PRISM-CV-IV?
- The PRISM-CV-IV incorporates checks to ensure that information entered is logical and consistent with information already obtained. This eliminates the need for extensive data cleaning after the interview.
- All interview skips are programmed so the interviewer is automatically guided to the next appropriate question. This reduces interviewer errors as well as administration time.
- The PRISM-CV-IV can be tailored to your research or treatment needs by selecting specific modules to administer in the beginning of the interview.
- At the end of the interview, a diagnostic report is automatically generated and appears on the screen.
- Computerized administration saves many hours of data entry and avoids the errors that can occur in transferring data from paper into a computer database for analysis.
It takes approximately anywhere from 45 minutes to 2 hours to administer the complete PRISM-CV once interviewers have become familiar with the interview. The range of time required depends on several factors such as the complexity of the substance use and psychiatric history, the reporting style of the respondent,
and the respondent’s current medical, psychiatric, and psychological condition. Administration time can be reduced by excluding modules that are less relevant to your setting or study population.
In a pilot study of the PRISM-CV-IV (N=46), the mean administration time was 70 minutes (unpublished data). Respondents in the pilot study had an average of 3.2 diagnoses. This is a significant time savings compared to the time it takes to administer the paper version (mean = 2.03 hours; Hasin et. al., Am J Psychiatry, 2006).
Can PRISM-CV-IV data be extracted to SAS, SPSS, or STATA?
Yes. The PRISM-CV-IV package includes programs to export data to a SAS® data set. From SAS®, the data can be exported to any statistical program of your choice.
Do I need to purchase any additional software to use the PRISM-CV-IV interview?
The PRISM-CV-IV package includes all the software needed to run the interview. Blaise®, a powerful interviewing system for Windows®, was used as the platform for the PRISM-CV. A Blaise® annual license is required to run the PRISM-CV on your computer and for each additional
data collection workstation. For more information about Blaise®, contact firstname.lastname@example.org or visit http://www.westat.com/Westat/expertise/information_systems/blaise_distribution_and_training/index.cfm.
What kind of training is available for the PRISM-CV-IV?
A 2-day training session on the full PRISM-CV-IV consists of didactic and role play components (on-site or in our New York offices). For training on selected sections of the PRISM, a 1-day session may be arranged.
Certification is provided. Recorded interviews (video or audio) along with the PRISM generated diagnosis may be sent to our offices for review by an experienced PRISM interviewer. The reviewer will provide certification or recommend additional training.
The User Guide provides step-by-step technical instructions. The Training Manual contains a description of each section of the PRISM-CV-IV, and provides guidelines for correct administration.