Modified Mini Screener

Clinician: *

Please select the clinician from the card given to you by the front desk:

Client Name: *

First Name Last Name

Number of days since last consumption of alcohol and/or other drugs: *

1. Have you been consistently depressed or down, most of the day, nearly every day, for the past two weeks? *

Yes No

2. In the past two weeks, have you been less interested in most things or less able to enjoy the things you used to enjoy most of the time? *

Yes No

3. Have you felt sad, low or depressed most of the time for the last two years? *

Yes No

4. In the past month did you think that you would be better off dead or wish you were dead? *

Yes No

5. Have you ever had a period of time when you were feeling ‘up’, or hyper or so full of energy or full of yourself that you got into trouble, or that other people thought you were not your usual self? (Do not consider times when you were intoxicated on drugs or alcohol) *

Yes No

6. Have you ever been so irritable, grouchy or annoyed for several days, that you had arguments, verbal or physical fights, or shouted at people outside your family? Have you or others noticed that you have been more irritable or overreacted, compared to other people, even when you thought you were right to act this way? *

Yes No

7. Have you had one or more occasions when you felt intensely anxious, frightened, uncomfortable or uneasy even when most people would not feel that way? Did these intense feelings get to be their worst within 10 minutes? (If “Yes” to both questions, check “yes”, otherwise check “No”) *

Yes No

8. Do you feel anxious, frightened, uncomfortable or uneasy in situations where help might not be available or escape might be difficult? *

Yes No

If yes, are any of the following examples troublesome for you?

Being in a crowd Standing in line Being alone away from home or being alone at home Crossing a bridge Traveling in a bus, train, or car

9. Have you been worried excessively or been anxious about several things over the past 6 months? (If you answered “no” to this question, please skip to question 11) *

Yes No

10. Are these worries present most days? *

Yes No

11. In the past month, were you afraid or embarrassed when others were watching you or when you were in the spotlight? Were you afraid of being humiliated? *

Yes No

If yes, are any of the following examples troublesome for you?

Speaking in public Eating in public or with others Writing while someone watches Being in social situations

12. In the past month, have you been bothered by thoughts, impulses, or images that you couldn’t get rid of, that were unwanted, distasteful, inappropriate, intrusive or distressing? *

Yes No

If yes, are any of the following examples troublesome for you?

Were you afraid that you would act on some impulse that would be really shocking? Did you worry a lot about being dirty, contaminated or having germs? Did you worry a lot about contaminating others, or that you would harm someone even though you didn’t want to? Did you have any fears or superstitions that you would be responsible for things that were going wrong? Were you obsessed with sexual thoughts, images, or impulses? Do you hoard or collect things? Did you have religious obsessions?

13. In the past month, did you do something repeatedly without being able to resist doing it? *

Yes No

If yes, are any of the following examples troublesome for you?

Washing or cleaning excessively Counting or checking things over and over Repeating, collecting, or arranging things Other superstitious rituals

14. Have you ever experienced or witnessed or had to deal with an extremely traumatic event that included actual or threatened death or serious injury to you or someone else? *

Yes No

If yes, have you experienced any of the following?

15. Have you re-experienced the awful event in a distressing way in the past month? *

Yes No

If yes, have you experienced any of the following?

Dreams Intense recollections Flashbacks Physical reactions

16. Have you ever believed that people were spying on you, or that someone was plotting against you, or trying to hurt you? *

Yes No

17. Have you ever believed that someone was reading your mind or could hear your thoughts, or that you could actually read someone’s mind or hear what another person was thinking? *

Yes No

18. Have you ever believed that someone or some force outside of yourself put thoughts in your mind that were not your own, or made you act in a way that was not your usual self? Or, have you ever felt that you were possessed? *

Yes No

19. Have you ever believed that you were being sent special messages through the TV, radio, or newspaper? Did you believe that someone you did not personally know was particularly interested in you? *

Yes No

20. Have your relatives or friends ever considered any of your beliefs strange or unusual? *

Yes No

21. Have you ever heard things other people couldn’t hear, such as voices? *

Yes No

22. Have you ever had visions when you were awake or have you ever seen things other people couldn’t see? *

Yes No

23. Have you ever lost considerable sums of money through gambling or had problems at work, in school, with your family and friends as a result of your gambling? *

Yes No

SCORING

SCORE: Number of "Yes" Answers

A score of 6 or greater = Screened positive for mental health disorder

OR

"Yes" to Question 4 = Suicidality

OR

"Yes" to Questions 14 AND 15 = Trauma

Modified Mini International Neuropsychiatric Interview
Alexander, M.J., Haugland G., Lin, S.P., Bertollo, D.N., & McCorry, F.A. (In press). Mental Health Screening in Addiction, Corrections and Social Service Settings: Validating the MMS. International Journal of Addictions.

Mini International Neuropsychiatric Interview (MINI)
Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G.C. The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-IO. Journal of Clinical Psychiatry, 59 (suppl. 20), 1998.