The use of extended sources of information is an important partof the
diagnostic process, since they corroborate, complementor correct information
provided by the patients themselves.
Sources of information relevant to the diagnostic enterpriseshould be
selected according to the objectives of the evaluationand the setting where
it is taking place (school, emergencyroom, police station, or detention
centre, for example). Normally,the minimum standard would be to consult the
records of anyprevious treatment and to contact one relevant person.
The use of extended sources is essential in circumstances thatprevent the
patient from providing adequate information: inthe emergency room, when the
patient is too young or too old,or when the patient is in a psychotic state,
intoxicated orunconscious.
The type of data to be collected through extended sources ofinformation
varies according to the patient's individual circumstances.Developmental
history, family history, diagnoses made duringprevious hospitalisations, and
current functioning are examplesof data that frequently the patient is unable
to provide fullyand must be obtained from other sources.
The need to use other sources of information should be discussedwith the
patient, whose consent should be requested wheneverpossible and in accordance
with cultural norms. Specific thoughtsand feelings that the patient might
have about these sourcesshould be explored. The patient should be assured of
confidentialityto the fullest extent possible. This may be crucial in
circumstanceswhere revealing a family secret might have serious consequences
for the relationship with the patient's primary support group.Whenever
confidentiality on the part of the clinician cannotbe complete, this should
be made explicit.
If the patient is a young child, the clinician should interviewthe
parents, other caregivers, teachers, youth-camp counsellors,school
psychologists, paediatricians, other relatives, andanyone else who can
provide information about the current behaviourand functioning of the child,
as well as the child's psychosocialfunctioning and adaptation.
Information from other sources should be treated with the samethoughtful
and critical attitude used for information providedby the patient. One must
remember that information offeredby other sources is not the ultimate truth
about the conditionof the patient, but a different perspective, and it might
bein fact another source of unreliability. Clinical judgementand experience
should be employed to detect sources of unreliability,and to weigh the
diagnostic value of all collected data.
Confidentiality should be assured to the person giving information,to the
fullest extent permissible by law and local customs.One must be aware that
the informant could be involved in aconflictual relationship with the
patient.
The patient's records and the records of relatives, as wellas judicial,
social, counselling and educational records, areall useful documentary
sources of information (Fig.
3.1).Usually the consent of the patient is necessary to consult
these sources.
Past records may be helpful but they should be reviewed witha critical
attitude. For example, when using old records onemust be attentive to
diagnostic practices prevalent at thetime the record was prepared: for
instance, bipolar disorderor borderline personality disorder could have been
erroneouslydiagnosed as schizophrenia.
Bird, H. R., Gould, M. S. & Staghezza, B.
(1992) Aggregating data from multiple informants in child
psychiatry. Journal of the American Academy of Child and Adolescent
Psychiatry, 31,
78-85[Medline] Herjanic, B., Herjanic, M., Brown, F., et al
(1975) Are children reliable reporters? Journal of
Abnormal Child Psychology, 3,
41-48.[Medline] Lavretsky, E. P. & Jarvik, L. F. (2000)
Psychiatric examination of the older patient. In Kaplan &
Sadock's Comprehensive Textbook of Psychiatry (7th edn, vol.
2), (eds B. J. Sadock & A. Sadock), pp.
2998-3010. Baltimore, MD: Williams &
Wilkins. Reich, W. & Earls, F. (1987) Rules for
making psychiatric diagnosis in children on the basis of multiple sources of
information: preliminary strategies. Journal of Abnormal Child
Psychology, 15,
601-616.[Medline] Rotondo, H. (1998) Orientaciones al estudiante
para la historia clínica psiquiátrica [Guidelines for students
on the psychiatric clinical history]. In Manual de
Psiquiatría Humberto Rotondo (2nd edn) (eds
A. Perales, A. Mendoza, G. Vásquez-Caicedo & M. Zambrano). Lima:
Editorial de la Universidad Nacional Mayor de San Marcos.