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 Aarhus, Denmark. The second and computerized version was written by the head of the University Center of Psychiatry in Groningen, the Netherlands. The pocket book version is available from some SCAN TRC’s. The mini-SCAN contains abbreviated queries and definitions of practically all Axis I related symptoms. The definitions and queries are visible at a glance on opposing pages. After administering this paper and pencil version one can make the diagnosis by consulting the classificatory rules of either DSM-IV or ICD-10. The pocket book version is used in some institutions by medical students, residents and other clinicians. It is also suitable for clinical training.

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:

  1. 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.

 

  1. 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.

 

  1. 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.

 

  1. 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.

 

  1. 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.

 

  1. 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 Groningen. He was involved in developing the mini-SCAN and is responsible for the design of the program and the diagnostic algorithms.

The software of the mini-SCAN was developed by Giant-Soft in Leeuwarden, the Netherlands. The software is part of a knowledge system that enables web based administration of the mini SCAN over the internet. Administration from a server in any given organization is also possible. Output can be linked to an electronic patient file. Giant-Soft also provides support and licences, required to use the computerized version of the instrument. The contact person for Giant Soft is Hajé Vreeling.

 

Contact information

Fokko Nienhuis

                       

Universitair Centrum Psychiatrie

Hanzeplein 1

P.O.Box  30.001 

Room 5.28

9700 RB Groningen

The Netherlands

Phone :+31.50.3612077

E-mail : f.j.nienhuis@med.umcg.nl

 

 

Hajé Vreeling

 

Giant-Soft

Emmakade 50

8933 AT Leeuwarden

The Netherlands

Mobile: +31.6.45608081

Phone: +31.58.2151245

E-mail: h.j.vreeling@giant-soft.nl

www.giant-soft.nl