Structured Clinical Interviews (SCID, MINI)

Structured clinical interviews are scripted diagnostic interviews that assess psychiatric disorders against current diagnostic criteria. The Structured Clinical Interview for diagnostic disorders (SCID) is clinician administered and detailed. The Mini International Neuropsychiatric Interview (MINI) is a shorter, modular interview designed for rapid assessment.

They improve diagnostic reliability compared with unstructured interviews and are used in research, specialist services and medicolegal assessment.

Usage. They are used to confirm a diagnosis after a positive screening questionnaire, to document comorbidity, and in research settings.

Indications. Diagnostic clarification when the presentation is complex, confirmation of a diagnosis after a positive screen, medicolegal and disability assessments, and research.

Preparation and technique. The interviewer is trained in the instrument and administers modules in sequence, branching depending on responses. The SCID takes about 45 to 90 minutes or longer depending on the number of modules. The MINI takes about 15 to 20 minutes.

Contraindications and precautions. Acute intoxication, severe agitation, and active psychosis limit the reliability of the interview. Assessment is deferred until the patient is able to take part.

Interpretation.

• Each module reports whether criteria for a disorder are met, not met or uncertain.
• Current and lifetime diagnoses are distinguished.
• The interviewer records clinical judgement where the patient's account conflicts with the observed picture.

Causes of a discordant result. Under reporting of symptoms, cultural differences in describing distress, comorbid medical illness, substance use, and interviewer inexperience.

Critical values and findings needing immediate action. Disclosure of intent to harm self or others during the interview requires immediate risk assessment and action, regardless of the module being administered.

Limitations and artefacts. The interview is time consuming and requires training. It does not replace clinical judgement. The MINI favours sensitivity over specificity and can over diagnose. Results depend on the patient's insight and willingness to disclose.

Follow up tests. Collateral history from family or other informants, physical examination, thyroid function tests, toxicology screen where substance use is suspected, and neuropsychological testing where cognitive disorder is suspected.

Special groups. Children and adolescents are assessed using age adapted versions, with parent and teacher informants. Older adults with cognitive impairment need informant based assessment.