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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

Depressive symptoms experienced by patients during a manic episode, as evaluated by psychiatrists (Phase II).
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Fig2: Depressive symptoms experienced by patients during a manic episode, as evaluated by psychiatrists (Phase II).

Mentions: Psychiatrists diagnosed their patients during a clinical interview using DSM-5 criteria and logged the results on each patient's record form. Overall, psychiatrists reported that 74.8% (86/115) of patients experienced at least one depressive symptom during a manic episode. The most frequently observed depressive symptoms reported by psychiatrists were depressed mood, diminished interest/pleasure and fatigue; more severe symptoms (e.g. psychomotor retardation, recurrent thoughts of death/suicide) were less frequently observed (Figure 2). Similarly, 81.8% (81/99) of patients completing the M.I.N.I. module reported experiencing at least one depressive symptom during a manic episode. Consistent with the psychiatrists' DSM-5 diagnoses, patients mainly reported experiencing depressed mood, diminished interest/pleasure and fatigue; more severe symptoms again were less frequently reported (Figure 3). When matched records were compared, there was a high level of agreement in symptom reporting between psychiatrists and patients across all symptoms; the highest levels of agreement were for the most common symptom (depressed mood, 79%) and the most severe symptom (suicidal thoughts, 85%), and the lowest level of agreement was for the least severe symptom (fatigue, 64% to 65%) (Figure 4).Figure 2


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)

Depressive symptoms experienced by patients during a manic episode, as evaluated by psychiatrists (Phase II).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Depressive symptoms experienced by patients during a manic episode, as evaluated by psychiatrists (Phase II).
Mentions: Psychiatrists diagnosed their patients during a clinical interview using DSM-5 criteria and logged the results on each patient's record form. Overall, psychiatrists reported that 74.8% (86/115) of patients experienced at least one depressive symptom during a manic episode. The most frequently observed depressive symptoms reported by psychiatrists were depressed mood, diminished interest/pleasure and fatigue; more severe symptoms (e.g. psychomotor retardation, recurrent thoughts of death/suicide) were less frequently observed (Figure 2). Similarly, 81.8% (81/99) of patients completing the M.I.N.I. module reported experiencing at least one depressive symptom during a manic episode. Consistent with the psychiatrists' DSM-5 diagnoses, patients mainly reported experiencing depressed mood, diminished interest/pleasure and fatigue; more severe symptoms again were less frequently reported (Figure 3). When matched records were compared, there was a high level of agreement in symptom reporting between psychiatrists and patients across all symptoms; the highest levels of agreement were for the most common symptom (depressed mood, 79%) and the most severe symptom (suicidal thoughts, 85%), and the lowest level of agreement was for the least severe symptom (fatigue, 64% to 65%) (Figure 4).Figure 2

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