G. C. Dunbar’s research while affiliated with Bristol-Myers Squibb and other places

The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.

Resumen La Entrevista Neuropsiquiátrica Internacional Reducida (MINI) es una entrevista diagnóstica estructurada breve, desarrollada en formatos clínicos (MINI-CR) y autoevaluados (MINI-PR), para 17 trastomos psiquiátricos del eje I del Manual Diagnóstico y Estadístico (DSM) III-R. Este estudio, que investiga la validez de la MINI en relación con la Entrevista Clínica Estructurada para el DSM III-R - Pacientes (SCID-P), se realizó conjuntamente con un estudio similar, que investigaba la validez de la MINI en relación con la Entrevista Diagnóstica Internacional Compuesta (CIDI) para la Gasificatión Estadística International de las Enfermedades (CIE) 10. Ambos estudios examinaron también la fiabilidad interevaluador y test-retest de la MINI. Trescientos setenta sujetos (330 en Florida y 40 en París) participaron en la validatión de la MINI frente a la SCID- P. Trescientos ocho de ellos tenían al menos un trastorno psiquiátrico y 62 eran controles adultos no pacientes. Ochenta de los sujetos (40 en Florida y 40 en París) participaron tambien en el estudio paralelo de la validez de la MINI frente a la CIDI. Los 330 sujetos de Florida realizaron primero la versión autoevaluada de la MINI. La MINI-CR se administró a todos los sujetos (después de la MINI-PR en el caso de los sujetos de Florida), seguida por la SCID-P. La MINI-CR fue evaluada por dos entrevistadores para 42 sujetos en Florida y 42 en París (prueba de fiabilidad interevaluador) y fue administrada de nuevo por un tercer entrevistador a ciegas uno o dos días después de la evaluatión inicial (prueba de fiabilidad test-retest). En conjunto, los resultados apoyaron la validez y la fiabilidad de la MINI. Además, la administratión de la MINI-CR llevó la mitad de tiempo que la administratión de las secciones correspondientes de la SCID-P. Se debate la aplicación de entrevistas estructuradas breves en entornos clínicos y de investigación.

Resumen La Entrevista Neuropsiquiátrica Internacional Reducida (MINI) es una entrevista diagnóstica estructurada (EDE) breve desarrollada en Francia y en los Estados Unidos para explorar 17 trastornos según los criterios diagnósticos del Manual Diagnóstico y Estadístico (DSM) III-R. La MINI está completamente estructurada para permitir su administratión por entrevistadores no especializados. Para mantener su brevedad, se centra en la existencia de trastornos actuales. Para cada trastorno, una o dos preguntas de detectión descartan el diagnóstico cuando reciben una respuesta negativa. Los sondeos para la gravedad, la discapacidad o los síntomas con explicación médica no se exploran síntoma por síntoma. Dos artículos conjuntos presentan la fiabilidad interevaluador y test-retest y la validez de la MINI frente a la Entrevista Diagnóstica Internacional Compuesta (CIDI) (en este artículo) y la Entrevista Clínica Estructurada para el DSM III-R - Pacientes (SCID-P) (artículo adjunto). Se administró la MINI y la CIDI como patrón de referencia a 346 pacientes (296 psiquiátricos y 50 no psiquiátricos). Dos investigadores entrevistaron a dos grupos de 42 sujetos y volvieron a hacerlo posteriormente en un plazo de dos días. Los entrevistadores habían sido adiestrados en el uso de ambos instrumentos. La duratión media de la entrevista fue de 21 min con la MINI y de 92 min para las secciones correspondientes de la CIDI. El coeficiente kappa, la sensibilidad y la especificidad fueron buenos o muy buenos para todos los diagnósticos, con la exceptión del trastorno por ansiedad generalizada (TAG) (kappa = 0,36), la agorafobia (sensibilidad = 0,59) y la bulimia (kappa = 0,53). Las fiabilidades interevaluador y test-retest fueron buenas. Se identificaron las razones principales para las discrepancias. La MINI proporcionaba diagnósticos fiables del DSM III-R en un marco temporal breve. El estudio permitió mejoras en las formulaciones para el TAG y la agorafobia en la versión actual para DSM IV de la MINI.

The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview, developed in clinician (MINI-CR) and patient-rated (MINI-PR) formats, for 17 Diagnostic and Statistical Manual (DSM)-III-R Axis I psychiatric disorders. This study, which investigates the validity of the MINI in relation to the Structured Clinical Interview for DSM-III-R Patients (SCID-P), was conducted in conjunction with a similar study, investigating the validity of the MINI in relation to the Composite International Diagnostic Interview (CIDI) for International Statistical Classification of Disease (ICD)-10. Both studies also examined the inter-rater and test-retest reliability of the MINI. Three hundred and seventy subjects (330 in Florida and 40 in Paris) participated in the validation of the MINI versus the SCID-P. Of these, 308 had at least one psychiatric disorder and 62 were non-patient adult controls. Eighty of the subjects (40 in Florida and 40 in Paris) also participated in the parallel study of the validity of the MINI versus the CIDI. The 330 Florida subjects first completed the patient-rated version of the MINI. All subjects were administered the MINI-CR (after the MINI-PR in the case of the Florida subjects), followed by the SCID-P. The MINI-CR was rated by two interviewers for 42 subjects in Florida and 42 in Paris (inter-rater reliability test) and readministered by a third blind interviewer one to two days after the initial rating (test-retest reliability test). Overall, the results supported the validity and reliability of the MINI. In addition, administration of the MINI-CR took half as long as administration of corresponding sections of the SCID-P. The application of short structured interviews in clinical and research settings is discussed.

The Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview (DSI) developed in France and the United States to explore 17 disorders according to Diagnostic and Statistical Manual (DSM)-III-R diagnostic criteria. It is fully structured to allow administration by non-specialized interviewers. In order to keep it short it focuses on the existence of current disorders. For each disorder, one or two screening questions rule out the diagnosis when answered negatively. Probes for severity, disability or medically explained symptoms are not explored symptom-by-symptom. Two joint papers present the inter-rater and test-retest reliability of the Mini the validity versus the Composite International Diagnostic Interview (CIDI) (this paper) and the Structured Clinical Interview for DSM-IH-R patients (SCID) (joint paper). Three-hundred and forty-six patients (296 psychiatric and 50 non-psychiatric) were administered the MINI and the CIDI ‘gold standard’. Forty two were interviewed by two investigators and 42 interviewed subsequently within two days. Interviewers were trained to use both instruments. The mean duration of the interview was 21 min with the MINI and 92 for corresponding sections of the CIDI. Kappa coefficient, sensitivity and specificity were good or very good for all diagnoses with the exception of generalized anxietydisorder (GAD) (kappa = 0.36), agoraphobia (sensitivity = 0.59) and bulimia (kappa = 0.53). Inter-rater and test-retest reliability were good. The main reasons for discrepancies were identified. The MINI provided reliable DSM-HI-R diagnoses within a short time frame, The study permitted improvements in the formulations for GAD and agoraphobia in the current DSM-IV version of the MINI.

A worldwide database was employed to assess the effect of paroxetine on symptoms of anxiety and agitation associated with depression. Data derived from the use of paroxetine (n = 2963), placebo (n = 554) and active control (n = 1151) in short-term clinical trials were compared. Paroxetine and active control were significantly better than placebo in reducing psychic anxiety. However, paroxetine was superior to active control from week 2 onwards. Both paroxetine and active control had a beneficial effect on somatic anxiety, but this effect was seen earlier with active control. Neither paroxetine nor active control caused emergent (new) anxiety symptoms. Paroxetine had a more robust effect in reducing baseline symptoms of agitation when compared with active control, while both therapies protected from emergent (new) agitation, when compared with placebo. There was no difference between the three groups in the spontaneously reported adverse events indicative of increased arousal. The use of major and minor tranquillizers in the paroxetine and active control groups was similar.

To assess the effects of treatment on symptoms of anxiety and agitation associated with depression, a data base of 2963 paroxetine treated patients was compared with 554 who received placebo and 1151 on active control. Paroxetine and active control both reduced baseline psychic anxiety more effectively than placebo. Both pharmacological treatments were effective in treating somatic anxiety with active control demonstrating an earlier onset of activity. Neither paroxetine nor active control induced new anxiety symptoms. Paroxetine was superior to placebo in the treatment of agitation at Weeks 4 and 6 and to active control at Week 4 only. Both paroxetine and active control were more protective against emergent (new) agitation than placebo. There was no difference between the three groups in the incidence of spontaneously reported adverse events indicative of anxiety.