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M.I.N.I.

MINI Neuropsychiatric Interview


Ulrik Fredrik Malt, MD Director Dept of Neuropsychiatry and Psychosomatic Medicine Division of Clinical Neurosciences, Rikshospitalet University Hospital and Professor, Institute of Psychiatry, University of Oslo

Diagnostic interviews
Requires clinical training: MINI MINI-plus or SCID Schedule for Clinical Assessment in Neuropsychiatry (SCAN) Does not require clinical training Diagnostic Interview Schedule (DIS)- DSM-IV Composite International Diagnostic Interview (CIDI)
ICD-10 research criteria or DSM-IV

MINI-suites
Primary care:
Special versions: MINI Kid-Parent MINI for Bipolar Disorder studies
(adults or kids/adolescents version)

MINI Kid screen


MINI screen (lbs/ft kg /cm)

MINI for schizophrenia and psychotic disorder studies (adults or


kids/adolescents version)

General psychiatry: MINI


(DSM-IV or ICD-10)

MINI tracking (rating scale version) MINI track scale


(Sucidality scale)

MINI plus

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

MINI screen: Yes No interview


Number of questions: Depression 4 PTSD Alcohol Illegal drugs Height / Weight Bulimia 3 1 1 2 2

Hypomania/mania: 2 Panic 1

Agoraphobia
Social phobia GAD OCD

1
1 1 2

MINI: 17 diagnostic categories


Major depressive episode Melancholia Dysthymia Suicidality Hypomania / mania Agoraphobia Panic disorder

GAD
Social phobia PTSD

OCD
Alcohol abuse and dependence Drug abuse and dependence Antisocial personlity disorder

Anorexia nervosa Bulimia nervosa

Psychosis

MINI-plus
Additional diagnostic modules Interview focuses on both current and life-time diagnosis More detailed information (e.g. psychosis, duration, number of
episodes)

Explicit questions on organic syndromes

MINI-plus: additional categories


Premenstrual dysphoric disorder Adjustment disorder

Simple phobia
Mixed depression and anxiety Adjustment disorder <17 years of age

ADHD

adolescents
adults

Psychosomatic (somatoform) disorders


(Hypochondria, Body dysmorphic disorder, Somatization, Pain disorder)

+ explicit questions about relationship to disease, medication or substance use

Estimated duration of interview


MINI: Structured interview: Semistructured interview: 15 minutes 25 30 minutes

MINI plus
Structured interview 35 60 minutes

Semistructured interview

> 1 hour (?)

Comments on some modules

Mood disorders

MINI includes suicide risk assessment


Low risk Medium risk High risk

DSM-IV vs ICD-10:
Severity grading of the depressive episode
ICD-10: mild, moderat or severe
DSM-IV: major

Follow up assessments:
+ MINI-track or MADRS or HAM-D or IDS or..

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 of mixing depressed mood as part of a personality disorder with an axis 1 mood disorder

Interictal spikes during depressive attack

(Courtesy: Pl Gunnar Larsson)

After Dale

Mania / hypomania

Prevalence of pts with bipolar spectrum disorders


%
12 10 8 6 4 2 0 BIP I BIP II Hypo/cycl Min Bip DSM-IV Zrich hard Zrich soft

(Jules Angst 2003)

Anxiety disorders

Paul Delvaux. Trains du Soir

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].

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

Copyright restrictions may apply.

Diagnostic challenges:
Panic disorder vs Non-fearful panic disorder
GAD: MINI suggests skip it if another disorder accounting for symptoms is more likely

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.

MINI: Only obsession or compulsion


Miguel et al. Molecular Psychiatry (2005) 10, 258275.

Psychosis

Psychosis in MINI
No separate modules for specific types of psychosis (e.g. Schizophrenia, Delusional disorder)
Classification requires decision trees from MINIplus

Simple schizophrenia, Schizotypal disorder or induced delusion (Folie deux) not included in MINI or MINI-plus

ADHD Requires module(s) from MINI-plus

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 bipolar disorder with subsequent behavioural changes, substance abuse and inability to feel

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 classified elsewhere (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)

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 continous education and updates including teaching treatment implications of positive findings

eMINI
For notebook, laptop etc Touch-screen or voice-prompt

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

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

MINI in research (2):


Acta Psychiatr Scand Addiction, Am J Geriatr Psychiatry, Am J Psychiatry Biol Psychiatry Bipolar Disord JAMA J Affect Disord J Clin Psychiatry, J Clin Psychopharm J Psychiatr Res J Psychosom Res

Br J Psychiatry
Canad J Psychiatry, Eur Psychiatry Gen Hosp Psychiatry, Int Clin Psychopharmacol Int J Neuropsychopharmacol

Neurology
Neuropsychobiology, Neurosci Lett, Psychol Med Psychol Rep. Psychother Psychosom

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. Stotz Iceland: J.G. Stefansson Norway: Ulrik Fr Malt Sweden: Christer Allgulander US / UK: David Sheehan