Mini International Neuropsychiatric Interview 7.0 Pdf Download -golkes
Ray Kowalewski
Using the MINI as a diagnostic tool, 22.2 % of all patients (6.6 % of all men and 41.6 % of all women) were diagnosed with depression. No significant differences were found between depressive and non-depressive patients with regard to anthropometric measurements, lung function, functional capacity, or quality of life variables. The best models for the dependent variables representing functional capacity and quality of life revealed that the covariates SGRQTOTAL and gender (R2 = 16.7 %) were significant in explaining the response variable for functional capacity of the upper limbs. Results also showed that age, monthly income, insomnia, and the results of a 6MWT were significant in explaining overall quality of life (R2 = 46 %), and that the percentage of the predicted forced expiratory volume in the first second post-bronchodilator and gender were significant in explaining walking distance (R2 = 22 %). Depression, as diagnosed by the MINI, was not significant in explaining any of the dependent variables.
Mini International Neuropsychiatric Interview 7.0 Pdf Download -golkes
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Despite a high prevalence of depression in COPD patients, especially in women, depression, as diagnosed by the MINI, was not correlated with functional capacity tests or quality of life in patients with moderate to very severe COPD in the present study. This suggests that depression identified by this diagnostic test may be more accurate than depression diagnosed by tests that evaluate symptoms, as they may be influenced by the perceptions of the patient in relation to their health.
By 2020, chronic obstructive pulmonary disease (COPD) is projected to cause over 6 million deaths annually, worldwide, thus becoming the third leading cause of death in the world [1]. Patients with COPD manifest systemic complications such as intolerance to exercise and diminished health-related quality of life, which are considered to be important causes of morbidity and mortality [1].
In addition to the systemic manifestations of COPD, the presence of comorbidities, such as depression, may also have negative impacts on physical performance and quality of life. Therefore, depression in COPD patients should be identified and accounted for in order to achieve successful intervention [2, 3].
Another factor that may be important in accounting for cases of depression among patients with COPD is the method used to identify depression. Despite numerous reports of a higher prevalence of depression in patients with COPD, it is important to recognize that most studies analyze the symptoms of depression without emphasizing the diagnosis [5, 8]. Therefore, this study aimed to analyze the influence of depression using a diagnostic tool, the mini international neuropsychiatric interview plus (MINI), rather than an analysis of the symptoms, to determine the effect of depression on functional capacity and quality of life among patients with COPD.
Patients were included if they had a diagnosis of COPD based on the guidelines established by the Global Initiative for chronic obstructive lung disease (GOLD), were over 40 years of age, and had been free of COPD exacerbations, according to the criteria of GOLD [1], for at least 8 weeks. Patients under prolonged oxygen therapy; those with severe comorbidities (an incapacitating or severe lung disease other than COPD, asthma, congestive heart failure, advanced chronic kidney failure, severe liver disease, cancer, insulin-dependent diabetes, psychosis, or dementia); those with a body mass index (BMI) below 18.5 kg/m2; and those with osseous, articular, and/or neuromuscular diseases that would limit performance on the functional capacity tests, were excluded from the study (Fig. 1).
The following socio-demographic and clinical data were recorded for all patients: age, height, weight, gender, schooling, marital status, income, smoking habits, use of alcohol, complaints of insomnia and daytime sleepiness, associated diseases, medication being taken, past history of depression, family history of depression, duration of COPD (years since diagnosis), number of hospitalizations in the previous year, and type of family support.
Lung function was assessed to diagnose COPD and determine its severity based on the standardized method recommended by the American Thoracic Society (ATS) [9] using a Vitatrace VT-130 SL spirometer (Pro Mdico Ind Ltda). The parameters evaluated were forced vital capacity (FVC % predicted), forced expiratory volume in the first second (FEV1 % predicted), and FVC/FEV1 (%). The reference equations used followed the guidelines for lung function tests proposed by Pereira and Neder [10].
The UULEX assesses the strength of the upper limb musculature by recording the number of elevations of the arm, whilst holding a plastic stick, in addition to the time spent performing this activity. A plastic stick with a weight of 0.2 kg, diameter of 25 mm, and a length of 0.84 m, was used initially. Upon reaching the maximum height from shoulder flexion, the rod was exchanged for another weighing 0.5 kg more, with subsequent increases of 0.5 kg every minute, to a maximum weight of 2 kg. This test is limited by symptoms of fatigue or dyspnea [14]. All patients performed the UULEX at least twice, with a 30-minute rest interval between each test. A third test was performed when the results of the first two tests differed by more than 10 %. The UULEX was ended when the patient presented with peripheral oxygen desaturation or tachycardia. The test with the greatest number of arm elevations was selected for analysis.
The 6MWT was performed based on the criteria of the ATS guidelines [15]. The test was implemented twice, with a 30-minute rest interval between tests [16]. A third test was performed when the results of the first two tests differed by more than 10 %. The test with the longest distance walked during 6 min (6MWD) was selected for analysis. Calculation of the predicted values were then performed using the reference equations for the 6MWD, as proposed by Enright and Sherrill [17].
Both before and after the UULEX and 6MWT, vital signs (blood pressure, respiratory rate (RR) and heart rate (HR)), dyspnea (Borg scale) and peripheral oxygen saturation (SpO2) were determined. During the tests, HR and SpO2 were monitored continuously with the aid of an oximeter (Model 9500, Nonin Medical Onyx). The UULEX and 6MWT were performed on three consecutive days, with a maximal evaluation time of 90 min during each day.
Influence of depression diagnosed by the MINI on SGRQ domains. The light bars show the data of the non-depressive patients and the black bars show the data of the patients diagnosed with depression. Asterisk, bash Indicates statistical significance compared to SGRQ activity with impact domain in Depressive patients and non-depressive patients, respectively, (*p
Depression prior to evaluations, as reported from patient self-perception, was observed in 16.7 % of the men and 50 % of the women. However, diagnosis using the MINI for depression was positive in 6.6 % of the men and 41.6 % of the women. This shows that depression(MINI) was more prevalent among women.
The percentage of men and women in relation to the different degrees of dyspnea is summarized in Table 2. No patient had any exacerbations of COPD in the 6 months prior to the tests. However, 53.3 % of the men and 41.6 % of the women reported hospitalizations in the previous year. Thirty percent (30 %) of the men and 54.2 % of the women reported a family history of depression.
Therefore, our results show that the MINI diagnosed depression in 22.2 % of patients analyzed. Among depressive patients, most were female. Despite the fact that the MINI was effective for diagnosing depression, no influence from depression, as diagnosed by the MINI, was observed on the quality of life or the functional capacity of the COPD patients analyzed.
Previously, studies observing patients with COPD have shown that patients with depression and anxiety exhibit poorer quality of life and functional capacity [21, 22]. In this study, using the MINI as a diagnostic tool for depression, no association was found between depression(MINI) and functional capacity, as assessed by submaximal exercise tests, 6MWT and UULEX, or quality of life, as assessed by SGRQTotal, in patients with moderate to very severe COPD. Thus, our results suggest that the method used for the identification of depression may be important for ascertaining the impact of depression on functional capacity and quality of life among patients with COPD.
The majority of previous studies have shown that, among patients with COPD, depression is diagnosed twice as often as identified in this study [23], and that COPD consistently increases the risk of depression [24]. Several factors may be associated with depression in patients with COPD [25], including increased dyspnea, a reduction in exercise capacity [4], less social support [26], lower levels of education [27], and a lower BMI [4]. We believe that differences between our results and those from previous studies are due to the methodology used in identifying the presence of depression in COPD patients; specifically, using tools that focus on the symptoms, rather than the diagnosis. Under these circumstances, we suggest that many studies overestimate the presence of depression as a comorbidity of COPD.
Additionally, the diagnosis of depression in patients with COPD is complicated by the overlap of symptoms from both diseases [28], and the suggestion that depression may result from COPD is highly controversial [22, 24]. This shows the importance of studies that propose to validate tools enabling efficient identification of the presence or absence of depression as in COPD patients.
In the present study, we used the MINI as a diagnostic tool, as it is a structured diagnostic interview for depression, and is compatible with the diagnostic criteria of the DSM-IV and ICD-10. In addition, it has been validated in the Portuguese language, and is considered the standard for confirmation of the presence or absence of anxiety disorders in COPD patients. To our knowledge, no published studies exist that have used the MINI as an assessment methodology in patients with COPD [11, 29].
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