Mini-SCAN, a
psychiatric diagnostic instrument for daily practice and research
General information
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.
The
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:
- An extensive,
structured screening section
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.
- Differential diagnosis
and prompts
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.
- Better classification
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.
- Computerized diagnostic
algorithms
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.
- Automatic 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.
- Web based software
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.
Administration
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
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.
Contact
This version
of the mini SCAN ws developed by he head of he Dutch TRC, Fokko Nienhuis of the
University Center of Psychiatry in
The software
of the mini-SCAN was developed by Giant-Soft in
Contact
information
Fokko Nienhuis
Universitair Centrum
Psychiatrie
Hanzeplein 1
P.O.Box 30.001
Room 5.28
9700 RB
The
Phone
:+31.50.3612077
E-mail : f.j.nienhuis@med.umcg.nl
Hajé Vreeling
Giant-Soft
Emmakade 50
8933 AT
The
Phone: +31.58.2151245
E-mail: h.j.vreeling@giant-soft.nl
