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Mini International Neuropsychiatric Interview (MINI)

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Lindsay Rubinfeld

on 3 October 2013

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Transcript of Mini International Neuropsychiatric Interview (MINI)

M.I.N.I
Mini International Neuropsychiatric Interview
General
Description
MINI FAMILY
Format & Administration
Additional Administration Notes
Psychometric Studies
Format/Structure
Authors:
David V. Sheehan & Yves Lecrubier
1990
Current Version:
MINI 6.0 - 2010
Available Languages:
40+ Languages
MINI
MINI-Plus
MINI-Kid
MINI-Screen
Goals in Development
What is it?:
Original Version:
A short semi- structured diagnostic interview
Short
Inexpensive
Easy to administer
High sensitivity
Specific
Compatible with International diagnostic criteria (ICD-10 & DSM-IV)
Captures subsyndromal variants
Useful in both clinical and research settings
19 Disorders: 17 axis I disorders, a suicidality module, and one Axis II disorder (antisocial personality disorder)
For most included disorders, no life-time diagnosis available
15 mins
MINI-CR and MINI-PR
DSM-IV mood, anxiety, somatoform, substance use, psychotic, eating, conduct, and adjustment disorder(s); ADHD; Antisocial personality disorder
Questions on rule-outs, disorder subtyping, and chronology
45-60 mins
6-17 years
Screens for common disorders of children and adolescents
24 DSM-IV and ICD-10 psychiatric disorders and suicidality)
Appropriate language for children and adolescents
For children younger than 13 years of age, it is recommended that the interview is administered with the parent present
Child and Parent versions
Takes ~30 minutes to administer
Patient-rated
5 mins
Summary Sheet
General Instructions
16 Modules
Overall
Module
Branching tree logic
Yes/No Ratings
Beginning of each module (except psychotic disorders)
2-4 screening questions
End of each module
diagnostic box(es) to indicate if criteria met
Be conscious/sensitive to cultural diversity of beliefs
Rater should ask for clarification and examples
Patient encouraged to ask for clarification
Validity
Reliability
Psychometrics
Strengths & Weaknesses
Potential Uses
1997 - Agreement with the SCID-P and the CIDI - DSM-III-R
Two sites
U.S.A - Sheehan
France - Lecrubier
Agreement with Expert Opinion
Patient Acceptance
Psychometric studies with translated versions
Psychometric studies in different settings and populations
SCID-P
Sample
370 participants (308 psychiatric and 62 controls)
Evenly distributed by gender
Age = 18+ Mean Age = 44.8
Excluded: dementia, mental retardation, or serious medical illness
MINI-CR
MINI-PR
MINI-CR vs. MINI-PR
CIDI
Sample
345 participants (296 psychiatric and 50 controls)
Evenly distributed by gender
Age = 18+ Mean Age = 42.2
Excluded: dementia, mental retardation, or serious medical illness
MINI vs. CIDI
Expert
Four countries: France, Italy, Spain, UK
Participants:
~10 general practitioners (GPs)/country
~10 patients/GP
Patient Age = 18+
Excluded: dementia, mental retardation, or serious medical illness
409 patients (~100 from each country)
62% women
61% of patients met criteria for at least 1/11 psychiatric diagnoses explored

Opinion
Patient
Acceptance
111 patients
Age: 18-64 Mean age: 37
52% Female
Administered the MINI
Short questionnaire administered to assess patients’ views about the interview
Views of MINI were positive
94% reported that the MINI covered all their symptoms
Interrater
Test-Retest
From SCID-P and CIDI Studies
From SCID-P and CIDI Studies
Procedure: 42 participants at each site administered the MINI by two interviewers
Results: Excellent interrater reliability
All of the kappa values were above 0.75 and the majority (70%) were 0.90 or higher

Procedure: 42 participants at each site administered the MINI by two interviewers and again 1-2 days later by a third blind interviewer
Results: 14/23 (61%) kappa values were above 0.75 and only one value (for current mania) was below 0.45

Additional source of error by having a third interviewer was used for the retest
Analysis expected to produce a very conservative estimate of the stability of the MINI-CR diagnoses
Concordance: good or very good kappa values, with exception of 'current drug dependence < 0.50
Sensitivity: 0.70 or greater for all but three
dysthymia - 0.67
OCD - 0.62
Current drug dependence - 0.45
Specificity: > 0.85 across all diagnoses
Negative predictive values: > 0.85 across all diagnoses
Positive Predictive values: ranging from lower acceptable range (dysthymia - 0.45) to very high (anorexia - 0.90)
Concordance:
Consistently lower Kappa values than those observed with MINI-CR comparison
Eight diagnoses <0.40
Other diagnoses
Good for mild to moderate psychopathology
Poor for severe psychopathology (psychotic disorder and mania)
difficulty focusing
Sensitivity: fair to good - exception dysthymia - 0.17)
Specificity: fair to good
Negative predictive values: fair to good - exception dysthymia - 0.11)
Positive Predictive values: unacceptable for nine diagnoses (< 0.40)
Concordance: Ranged from relatively low (<0.50) to very high (>0.75)
Compared CIDI and MINI for non-psychotic disorders
Dysthymia, hypomania, OCD, and anorexia left out because of low prevalence amonst participants
Concordance: Good for most diagnoses expect simple phobia and GAD
Reasons for discrepancies were easy to explain and changes were made in future versions of the MINI
Sensitivity:
Lowest -> phobia (0.46) ; agoraphobia (0.59)
Highest -> depressive episode (0.94)
Specificity: Good (0.72-0.97)
Negative predictive values: Good (0.88 - 0.99)
Positive Predictive values: Low for...
GAD (0.34)
Lifetime bulimia (0.52)
Current manic episode (0.56)
Social phobia (0.55)
Compared CIDI and MINI for psychotic disorders
Concordance: Good (0.68-0.82)
whether comparison was based on diagnostic, syndromal, or symptomatic approach
Sensitivity: (0.87-0.94)
Specificity: (0.89-0.95)
Negative predictive values: (0.95-0.98)
Positive Predictive values: (0.62-0.87)
MINI diagnosis by GP vs. Expert psychiatrist diagnosis
Concordance: Agreement for 85% of the patients
Outdated psychometric studies
Aside from psychometric studies with different populations and with different translations, there are no readily available psychometrics on the most recent version of the MINI
No lifetime
diagnoses available for most included disorders
Limited disorder subtyping
Compatible with both DSM-IV and ICD-10 systems
~15 Minutes
Quick to learn to administer
Training takes approximately 2 hours for psychiatrists and psychologists and 3 hours for general practitioner
Validation studies across cultures and populations
Available in over 40 Languages
Broader than other short structured interviews

Examples: SDDs and PRIME-MD
Translations meet 3 requirements:
1) concordance with existing translations
2) conceptual equivalence across languages
3) linguistic consistency within language
Quick to Administer
Shorter to administer than the SCID-P and the CIDI
Patient Accepted
Computerized options
eMINI
Electronic version
Dolphine EDC
Web-based
Patients can complete any time anywhere
Can chart patient's progress over time
e-mail notifications (completion or suicide risk)

Based on results of validation studies, the developers strengthened several questions on the MINI and made other data-driven improvements to enhance its sensitivity, specificity, and positive predictive value
BUT the MINI designed to provide just enough information to make good clinical decisions and lifetime diagnosis in absence of current diagnosis rarely calls for action
HOWEVER, if need more detail, can incorporate modules from the MINI-Plus
Research
The MINI or modules of the MINI can be used for rapid screening of homogenous samples for treatment studies and clinical trials

Clinical practice & primary care
The MINI can be used as a diagnostic screening tool for inpatient and outpatient health settings
Managed care
The MINI can be used:
as a first step in outcome tracking and continuous quality improvement
by properly trained health information technicians or physician extenders
to generate databases from the computerized version to assist in calculating precise capitated costs and negotiating payments
to reduce 'diagnostic drift' (in the direction of diagnoses that provide the best reimbursement)
Full transcript