PURPOSE: Evaluation of patients with severe asthma (SA) benefits from a systematic approach which includes the identification and management of psychosocial comorbidities (PSCM). We show preliminary results related to the use of two versions of the Mini International Neuropsychiatric Interview (MINI) screen test - the MINI screen 5.0 and 6.0, which are used as screening tools for DSM-IV disorders.
METHODS: A retrospective chart review was completed of patients evaluated through the Edmonton Regional Severe Asthma Clinic (ERSAC). A standardised evaluation tool was used to assess psychological health: The MINI screen 5.0 or 6.0. Half of the patients had been administered version 5.0 and the other half received version 6.0. There were only very slight differences between these two versions.
RESULTS: Charts were reviewed for 20 individuals seen at ERSAC with moderate and severe asthma. The average age was 48 (range 18-81). Seven were male and 13 were female. Sixteen of 20 (80%) patients screened positive for a possible PSCM using the MINI screen. Of the 10 patients assessed using the MINI 5.0, nine screened positive, whereas only 7 of 10 patients assessed with the MINI 6.0 screened positive; however these results are not statistically significant (p=0.2636). The most common possible PSCM identified included posttraumatic stress disorder (n=7), generalized anxiety disorder (n=6), substance/ alcohol abuse (n=6), manic episode (n=5), depressive episode (n=5), panic disorder (n=4), agoraphobia (n=4), and obsessive compulsive disorder (n=4).
CONCLUSIONS: Psychological co-morbidity is common in patients with SA. The MINI screen appears to be a simple and useful clinical tool to screen for untreated / sub-optimally managed psychosocial comorbidities in individuals with SA that may significantly impact management decisions.
CLINICAL IMPLICATIONS: The MINI screen's application in clinical practice can assist in identifying at-risk individuals that need further review within appropriate psychiatry/ psychology/ social work structures. The MINI screen also identifies a sub-group who may be at significant risk of overtreatment due to psychogenic dyspnea - this group requiring an alternate treatment pathway as opposed to escalation of asthma specific therapy.
DISCLOSURE: The following authors have nothing to disclose: Dilini Vethanayagam
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