Mini-SCAN, a psychiatric diagnostic instrument for daily practice and research
With the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), a semi-structured psychiatric diagnostic interview of the World Health Organization, most Axis I disorders can be assessed. It enables the user to make a DSM-IV or ICD-10 classification. This is done with a diagnostic algorithm, written for SCAN. The SCAN does not assess or classifiy personality disorders. The SCAN was intended to be used mainly in research and not in clinical practice, though this is done by some users.
mini-SCAN is an abbreviated version of SCAN 2.1 and is suitable for use in
clinical practice. The first version of the mini SCAN (called Short Present
State Examination) was written by Prof Aksel Bertelsen from the Danish Training
and Research Center (TRC) in
Computerizing the mini-SCAN
By computerizing the mini-SCAN, its practical use and utility have increased significantly. It increases the structure of the interview and the scores are automatically fed into the algorithms, thus producing the diagnosis. The main changes and additions to the booklet are:
At the beginning of the interview the interviewer is forced to screen for problems in a number of domains of psychopathology, like mood, anxiety, psychosis, substance use etc. On the basis of a positive screening the program selects the corresponding sections which are to be administered. They are presented on the screen after the screening phase.
In a phase best comparable to the differential diagnosis, the program decides which final questions are needed to make the final diagnosis or diagnoses. As an example, if the criteria for a depressive episode are met, queries (called prompts) are presented on the screen about manic, depressive or mixed episodes in the past (if any). By combining current syptoms with the history of the patient the final diagnosis is made, which in this case can be depression (single episode or recurrent) or a bipolar disorder, most recent episode depressed. In the case of co-existing psychotic symptoms, these are also included in the diagnosis. The algorithms thus combine the symptoms of all the sections, then define which prompts are needed and then make the diagnosis. This process emulates how clinicians think and operate.
The process summarized under 2 leads to a more reliable and valid classificaton than the paper version. In the booklet questions about duration, interference with functioning and across-sections prompts are lacking. Also, there is no algorithm.
The core of the software are the diagnostic algorithms. After administration of the interview the algorithms are run to check whether the criteria for any disorder(s) are met. This is literally done with a click on the button. The results are shown on the screen as a report.
A report is generated containing the personal data of the patient and interviewer, date of administration, definition of the episode, the diagnosis, answers to administered questions and observed behavior. These data are presented in the format of a report. Thus more information is provided than just the diagnoses. The interviewer can easily review his/her ratings and analyze why a certain diagnosis was (not) met.
The software of the mini-SCAN is web based. This means that the interview can be admnistered over the internet or on a proprietary intranet. The software can be linked to an electronic patient file.
Screenshots of the mini SCAN can be seen at the bottom of the page.
The primary source of information is the patient. Other information can be added, e.g. obtained from a significant informer or from medical records. The interviewer should indicate what the source of information is by ticking the source fields.
Target group and application
The target group are mental health professionals. These are (training) psychiatrists, psychologists and community mental health nurses. In general the instrument can be applied in settings where the object is to arrive at an axis I diagnosis. This can be in outpatient or inpatient settings and in private practices. In many settings the final diagnoses is determined by merging multidisciplinary information. The mini-SCAN report can be very helpful in this process, since it gives detailed diagnostic information.
Training is required for responsible admnistration of the mini-SCAN. During the training attention is given to interview issues (patient related and interviewer related), then to the functionality of the program and finally to the interviewing technique. Also the concepts of symptoms and classification are dealt with in detail. Pivotal is the interviewing technique, required to assess symptoms. The interviewer judges whether a given symptom is present or absent, based on the information given by the patient. This judgement is made on the basis of frequency, severity and interference of the experience, e.g. depressed mood. The mini SCAN offers the first querie of a symptom, but the interviewer has to probe further with regard to frequency, severity and interference. This process is trained during the course.
The users are assumed to be familiar with classification system.
Duration of administration
Admnistration takes typically between 30-40 minutes, based on an “average” outclinic patient with depressive and/or anxiety symptoms. The duration of the interview depends on the nature and breadth of the patient’s psychopathology, the experience of the interviewer and the cooperation of the patient.
of the mini SCAN ws developed by he head of he Dutch TRC, Fokko Nienhuis of the
University Center of Psychiatry in
of the mini-SCAN was developed by Giant-Soft in
Universitair Centrum Psychiatrie
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