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Evaluating depressive symptoms in hypomanic and manic episodes using a structured diagnostic tool: validation of a new Mini International Neuropsychiatric Interview (M.I.N.I.) module for the DSM-5 'With Mixed Features' specifier.

Hergueta T, Weiller E - Int J Bipolar Disord (2013)

Bottom Line: In summary, the M.I.N.I. module demonstrated good concurrent validity with psychiatrists' evaluation of DSM-5 mixed features in manic patients, accurately detecting mixed features with limited risk of over-diagnosis.Due to its simplicity, the M.I.N.I. module could be incorporated into routine psychiatric evaluation of patients with manic episodes.It could also provide a valuable standardised tool for clinical and epidemiological research.

View Article: PubMed Central - PubMed

Affiliation: Département de Neurologie, IMMA Pavillon François Lhermitte, GHU Pitié-Salpêtrière, Charles Foix, 47, boulevard de l'hôpital, Paris, 75013 France.

ABSTRACT

Background: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), includes a new 'With Mixed Features' specifier for mood episodes. In (hypo-)manic episodes, the specifier is given if three or more depressive symptoms are present nearly every day during the episode. A new module of the Mini International Neuropsychiatric Interview (M.I.N.I.) has been developed as a patient-completed questionnaire to evaluate the DSM-5 specifier for (hypo-)manic episodes. The objective of this study was to validate this new module.

Methods: In Phase I, patients with a manic episode in the past 6 months completed the module and were asked whether the wording was clear, understandable, relevant and specific. Based on their feedback, the module was refined and finalised. In Phase II, psychiatrists each invited five patients to complete the module. The psychiatrists completed record forms for these five patients, which included their diagnoses, made according to DSM-5 criteria during clinical interviewing. The module was validated by comparing depressive symptoms reported by the patients themselves using the M.I.N.I. module with those evaluated by their psychiatrist using DSM-5 criteria during clinical interviewing.

Results and discussion: In Phase I, a few changes were made to the M.I.N.I. module based on feedback from 20 patients (60% of whom had mixed features). In Phase II, 23 psychiatrists completed record forms for 115 patients, 99 (86.1%) of whom completed the M.I.N.I. module. Agreement between psychiatrists' DSM-5 diagnoses and patients' M.I.N.I. responses was substantial (Cohen's kappa coefficient, 0.60). The overall sensitivity of the M.I.N.I. was 0.91 and its specificity was 0.70. Sensitivity ranged from 0.63 for psychomotor retardation to 0.90 for suicidal thoughts. Specificity ranged from 0.63 for diminished interest/pleasure to 0.90 for suicidal thoughts. The module's positive and negative predictive values were 0.72 and 0.90, respectively. In summary, the M.I.N.I. module demonstrated good concurrent validity with psychiatrists' evaluation of DSM-5 mixed features in manic patients, accurately detecting mixed features with limited risk of over-diagnosis. Due to its simplicity, the M.I.N.I. module could be incorporated into routine psychiatric evaluation of patients with manic episodes. It could also provide a valuable standardised tool for clinical and epidemiological research.

No MeSH data available.


Related in: MedlinePlus

Treatments received by patients to manage their manic episodes, as reported by psychiatrists (Phase II).
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Fig1: Treatments received by patients to manage their manic episodes, as reported by psychiatrists (Phase II).

Mentions: When psychiatrists were asked what proportion of their patients with bipolar disorder exhibit depressive symptoms (regardless of severity) during a manic episode, 78% reported values of 21% to 50%; the mean proportion reported was 36%. When asked how they currently assess depressive symptoms in patients with bipolar disorder, all the psychiatrists replied that they do so through clinical examination and questioning of the patient, and most (96%) replied that they also speak to the patient's caregivers; 65% use diagnostic criteria (e.g. DSM-IV, ICD-10), and 22% use a validated tool to measure depression. Psychiatrists reported that patients receive a variety of treatments to manage their manic episodes; most commonly, antipsychotics (quetiapine, 34%; olanzapine, 25%) and mood stabilisers (lithium, 23%; valproate semisodium, 19%; sodium valproate, 18%), with approximately 10% of patients also prescribed antidepressants (Figure 1).Figure 1


Evaluating depressive symptoms in hypomanic and manic episodes using a structured diagnostic tool: validation of a new Mini International Neuropsychiatric Interview (M.I.N.I.) module for the DSM-5 'With Mixed Features' specifier.

Hergueta T, Weiller E - Int J Bipolar Disord (2013)

Treatments received by patients to manage their manic episodes, as reported by psychiatrists (Phase II).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230688&req=5

Fig1: Treatments received by patients to manage their manic episodes, as reported by psychiatrists (Phase II).
Mentions: When psychiatrists were asked what proportion of their patients with bipolar disorder exhibit depressive symptoms (regardless of severity) during a manic episode, 78% reported values of 21% to 50%; the mean proportion reported was 36%. When asked how they currently assess depressive symptoms in patients with bipolar disorder, all the psychiatrists replied that they do so through clinical examination and questioning of the patient, and most (96%) replied that they also speak to the patient's caregivers; 65% use diagnostic criteria (e.g. DSM-IV, ICD-10), and 22% use a validated tool to measure depression. Psychiatrists reported that patients receive a variety of treatments to manage their manic episodes; most commonly, antipsychotics (quetiapine, 34%; olanzapine, 25%) and mood stabilisers (lithium, 23%; valproate semisodium, 19%; sodium valproate, 18%), with approximately 10% of patients also prescribed antidepressants (Figure 1).Figure 1

Bottom Line: In summary, the M.I.N.I. module demonstrated good concurrent validity with psychiatrists' evaluation of DSM-5 mixed features in manic patients, accurately detecting mixed features with limited risk of over-diagnosis.Due to its simplicity, the M.I.N.I. module could be incorporated into routine psychiatric evaluation of patients with manic episodes.It could also provide a valuable standardised tool for clinical and epidemiological research.

View Article: PubMed Central - PubMed

Affiliation: Département de Neurologie, IMMA Pavillon François Lhermitte, GHU Pitié-Salpêtrière, Charles Foix, 47, boulevard de l'hôpital, Paris, 75013 France.

ABSTRACT

Background: The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), includes a new 'With Mixed Features' specifier for mood episodes. In (hypo-)manic episodes, the specifier is given if three or more depressive symptoms are present nearly every day during the episode. A new module of the Mini International Neuropsychiatric Interview (M.I.N.I.) has been developed as a patient-completed questionnaire to evaluate the DSM-5 specifier for (hypo-)manic episodes. The objective of this study was to validate this new module.

Methods: In Phase I, patients with a manic episode in the past 6 months completed the module and were asked whether the wording was clear, understandable, relevant and specific. Based on their feedback, the module was refined and finalised. In Phase II, psychiatrists each invited five patients to complete the module. The psychiatrists completed record forms for these five patients, which included their diagnoses, made according to DSM-5 criteria during clinical interviewing. The module was validated by comparing depressive symptoms reported by the patients themselves using the M.I.N.I. module with those evaluated by their psychiatrist using DSM-5 criteria during clinical interviewing.

Results and discussion: In Phase I, a few changes were made to the M.I.N.I. module based on feedback from 20 patients (60% of whom had mixed features). In Phase II, 23 psychiatrists completed record forms for 115 patients, 99 (86.1%) of whom completed the M.I.N.I. module. Agreement between psychiatrists' DSM-5 diagnoses and patients' M.I.N.I. responses was substantial (Cohen's kappa coefficient, 0.60). The overall sensitivity of the M.I.N.I. was 0.91 and its specificity was 0.70. Sensitivity ranged from 0.63 for psychomotor retardation to 0.90 for suicidal thoughts. Specificity ranged from 0.63 for diminished interest/pleasure to 0.90 for suicidal thoughts. The module's positive and negative predictive values were 0.72 and 0.90, respectively. In summary, the M.I.N.I. module demonstrated good concurrent validity with psychiatrists' evaluation of DSM-5 mixed features in manic patients, accurately detecting mixed features with limited risk of over-diagnosis. Due to its simplicity, the M.I.N.I. module could be incorporated into routine psychiatric evaluation of patients with manic episodes. It could also provide a valuable standardised tool for clinical and epidemiological research.

No MeSH data available.


Related in: MedlinePlus