Are diagnostic questionnaires useful?

The importance of an accurate and early diagnosis of any psychological or physical condition is well understood. Here our expert Professor Allan Young answers some key questions about how we can better diagnose mania with depressive symptoms which occurs in bipolar I patients and tends to be more severe with a poorer prognosis than mania alone.

Do you feel that the diagnosis of mania with depressive symptoms could be improved?

I think DSM-5 is a great advance on DSM-IV but it still doesn't capture the same subtle dimensional approach that was first outlined by professor Emil Kraepelin who formulated the concept of manic depressive illness which later became bipolar disorder. Kraepelin described six types of mixed states, from pure mania to pure depression based on various combinations of mood, will and thought processes; I think at some point we may get to the point where we can further our advance our nomenclature or even perhaps have different ratings, different ways of capturing clinical states from formal categorical diagnosis. That said, I think at the moment we need to let DSM-5 bed in and start using it and make sure it starts influencing clinical practice.

Do you feel that the new MINI questionnaire has aided diagnosis of mania with depressive symptoms?

One of the gaps in the toolkit for diagnosing mania with depressive symptoms was a brief self-report questionnaire. Along with colleagues at Lundbeck, I helped to try and develop this and I think we have a simple practical tool that helps screen and detect people who have depressive symptoms with mania. I believe this is the type of thing that can be very simple to use in clinical consultations and hopefully will improve awareness and detection of mania with depressive symptoms.

Have any of your patients reported gaining further insight into their own condition after completing the MINI questionnaire?

Absolutely. One of the most powerful things that we can do for patients is share knowledge about the illness and this is the whole basis of the psycho-educational strategy. Psycho-education has been shown to be very helpful for patients and it's very empowering for people to understand their own illnesses and indeed for carers and relatives to do so as well. We found that using the screening tool helps them understand the nature of the mania with depressive symptoms much better and also provides a springboard for further discussions when we talk about things like increased risk of suicidality.

How do you see the MINI tool evolving in time?

Well the first step is to validate the MINI tool; Eberhard, myself and other colleagues did this by presenting data at the ECNP 2014 in a poster about the use of the MINI questionnaire. The sample included over 1000 patients and how this crosschecks with psychiatrists judgement of their patients. The second step is to make the MINI questionnaire available and for clinicians to use it in a variety of clinical settings. I think there is also scope for other tools to be developed which was discussed at the conference. For example, in addition to focusing on mania with depressive symptoms, the questionnaire could be adapted to identify depression with manic symptoms, which is the other side of the coin.