Malt MINI Neuropsychiatric Interview

8/12/2019 Malt MINI Neuropsychiatric Interview

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M.I.N.I.MINI Neuropsychiatric InterviewUlrik Fredrik Malt, MD

Director Dept of Neuropsychiatry and PsychosomaticMedicine

Division of Clinical Neurosciences,Rikshospitalet University Hospital

and

Professor, Institute of Psychiatry, University of Oslo


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Diagnostic interviews

Requires clinical training:

MINI

MINI-plusor SCID

Schedule for Clinical

Assessment in

Neuropsychiatry (SCAN)

Does not require clinical

training

Diagnostic InterviewSchedule (DIS)- DSM-IV

Composite International

Diagnostic Interview (CIDI)ICD-10 research criteria or DSM-IV


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MINI-suites

Primary care:

MINI Kid screen

MINI screen (lbs/ftkg /cm)

General psychiatry:

MINI (DSM-IV or ICD-10)

MINI plus

Special versions:

MINI Kid-Parent

MINI for Bipolar Disorder studies(adults or kids/adolescents version)

MINI for schizophrenia andpsychotic disorder studies (adults orkids/adolescents version)

MINI tracking (rating scale version)

MINI track scale (Sucidality scale)

Sheehan et al. J Clin Psychiatry 1998; 59 [Suppl 20]: 22-33


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MINI screen: Yes No interview

Number of questions:

Depression 4

Hypomania/mania: 2

Panic 1

Agoraphobia 1

Social phobia 1

GAD 1

OCD 2

PTSD 3

Alcohol 1Illegal drugs 1

Height / Weight 2

Bulimia 2


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MINI: 17 diagnostic categoriesMajor depressive episode

Melancholia

Dysthymia

Suicidality

Hypomania / mania

Alcohol abuse and dependence

Drug abuse and dependence

Anorexia nervosa

Bulimia nervosa

Agoraphobia

Panic disorder

GAD

Social phobia

PTSD

OCD

Antisocial personlity disorder

Psychosis


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MINI-plus

Additional diagnostic modules

Interview focuses on both current and life-timediagnosis

More detailed information (e.g. psychosis, duration, number of

episodes)

Explicit questions on organic syndromes


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MINI-plus: additional categories

Premenstrual dysphoric disorder

Adjustment disorder

Simple phobia

Mixed depression and anxiety

Adjustment disorder


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Estimated duration of interview

MINI:

Structured interview: 15 minutes

Semistructured interview: 2530 minutes

MINI plus

Structured interview 3560 minutes

Semistructured interview > 1 hour (?)


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Comments onsome modules


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Mood

disorders


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MINI includes suicide risk

assessment

Low risk

Medium risk

High risk


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DSM-IV vs ICD-10:

Severity grading of the depressiveepisode

ICD-10: mild, moderat or severe

DSM-IV: major

Follow up assessments:

+ MINI-track or MADRS or HAM-D or IDSor..


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Some other limitations of MINI mood

disorders module

Psychotic mood disorder requires additional

questioning (MINI-plus modules or HAMD-D or

IDS or PANSS)

Recurrent Brief Depression not included

Personality disorders (axis 2) not included: risk ofmixing depressed mood as part of a personality

disorder with an axis 1 mood disorder


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Interictal spikes during depressive attack (Courtesy: Pl Gunnar Larsson)

After Dale


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Mania / hypomania


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Prevalence of pts with

bipolar spectrum disorders (Jules Angst 2003)

0

2

4

6

8

10

12

BIP I BIP II Hypo/cycl Min Bip

DSM-IV

Zrich hard

Zrich soft

%


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Paul Delvaux. Trains du Soir

Anxiety disorders


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Copyright restrictions may apply.

Kessler, R. C. et al. Arch Gen Psychiatry 2006;63:415-424.

Lifetime prevalence estimates of DSM-IV panic attacks (PAs) and panic disorder (PD)with and without agoraphobia (AG) [Data from National comorbidity study i USA].


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Diagnostic challenges:

Panic disorder vs Non-fearful panic disorder

GAD: MINI suggests skip it if another disorder

accounting for symptoms is more likely


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Acute stress and trauma

Not included in MINI or MINI-plus:

DSM-IV: Acute stress disorder

PTSD symptoms lasts for a minimum of 2 days and a maximum of 4 weeks

and occurs within 4 weeks of the traumatic event

ICD-10: Acute stress reaction

Anxiety or confusion within an hour after trauma. Symptoms usually begin

to diminish after 24-48 hours post-trauma.


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Miguel et al.Molecular Psychiatry(2005) 10, 258

275.

MINI:Only obsession or compulsion


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Psychosis


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Psychosis in MINI

No separate modules for specific types of

psychosis (e.g. Schizophrenia, Delusional

disorder)

Classification requires decision trees from MINI-

plus

Simple schizophrenia, Schizotypal disorder or

induced delusion (Folie deux) not included in

MINI or MINI-plus


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ADHD

Requires module(s) fromMINI-plus


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Caution

MINI requires clinical skills to detect false skip

responses

MINI focuses on current diagnosis: risk of false

diagnosis due to lack of longitudinal perspective,

e.g. Borderline personality disorder versus bipolardisorder with subsequent behavioural changes,

substance abuse and inability to feel


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No MINI-diagnosis does not have to imply no psychiatric disorder is present,e.g.:

Amnestic syndromes (F04)

Organic personaltiy change (F07.0)

Recurrent Brief Depression (F38.1)

Acute stress reaction (F43.0)

Dissosiative disorders (inkl. conversion) (F44)

Neurastenia (F48.0)

Non-organic sleep disorder (F51)

Sexual dysfunction not caused by organic disorder or disease (F52)

Psychological and behavioural factors associated with disorders or diseases classifiedelsewhere (F54)

Abuse of non-dependence-producing substances (F55)

Personality disorders (F60-61)

Enduring personality changes, not attributable to brain damage and disease (F62)

Habit and impulse disorders (F63)


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Clinical use

Choose modules covering the major disorders

and add modules for specific disorders of interest

Continous training is mandatory (inter rater

reliability, validity)

One person should be responsible for continouseducation and updates including teaching

treatment implications of positive findings


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eMINI

For notebook, laptop etc

Touch-screen or voice-prompt

Biometric access control (e.g. Finger print, eye)


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MINI in research(1):

Search word: MINI neuropsychiatric interview:

289 hits in PubMed(April 1st, 2008)

Topics: diagnosis, validation of scales etc

Type: treatment, epidemiology etc


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MINI in research(2):Acta Psychiatr Scand

Addiction,

Am J Geriatr Psychiatry,

Am J Psychiatry

Biol Psychiatry

Bipolar Disord

Br J Psychiatry

Canad J Psychiatry,

Eur Psychiatry

Gen Hosp Psychiatry,

Int Clin Psychopharmacol

Int J Neuropsychopharmacol

JAMA

J Affect Disord

J Clin Psychiatry,

J Clin Psychopharm

JPsychiatr Res

J Psychosom Res

Neurology

Neuropsychobiology,

Neurosci Lett,

Psychol Med

Psychol Rep.

Psychother Psychosom


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M.I.N.I.

Online from Medical Outcome Systems, Inc.

https://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htm

National contacts:

Denmark: Per Bech

Finland: M. Heikkinen

France: Yves Lecrubier

Germany: G. StotzIceland: J.G. Stefansson

Norway: Ulrik Fr Malt

Sweden: Christer Allgulander

US / UK: David Sheehan
https://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htmhttps://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htmhttps://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htmhttps://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htmhttps://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htmhttps://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htmhttps://www.medical-outcomes.com/HTMLFiles/MINI/MINI.htm

Malt MINI Neuropsychiatric Interview

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