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Arbona-Lampaya A, Sung H, D’Amico A, Knowles EEM, Besançon EK, Freifeld A, Lacbawan L, Lopes F, Kassem L, Nardi AE, McMahon FJ. Strong Genetic Overlaps Between Dimensional and Categorical Models of Bipolar Disorders in a Family Sample. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.06.24.23291169. [PMID: 37425936 PMCID: PMC10327232 DOI: 10.1101/2023.06.24.23291169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Bipolar disorder (BD) presents with a wide range of symptoms that vary among relatives, casting doubt on categorical illness models. To address this uncertainly, we investigated the heritability and genetic relationships between categorical and dimensional models of BD in a family sample. Methods Participants in the Amish-Mennonite Bipolar Genetics (AMBiGen) study were assigned categorical mood disorder diagnoses by structured psychiatric interview and completed the Mood Disorder Questionnaire (MDQ), which assesses lifetime history of manic symptoms and associated impairment. Major MDQ dimensions were analyzed by Principal Component Analysis (PCA) in 726 participants. Heritability and genetic overlaps between categorical diagnoses and MDQ-derived dimensions were estimated with SOLAR-ECLIPSE within 432 genotyped participants. Results MDQ scores were significantly higher among individuals diagnosed with BD and related disorders, as expected, but varied widely among relatives. PCA suggested a three-component model for the MDQ. Heritability of the MDQ score was 30% (p<0.001), evenly distributed across its three principal components. Strong and significant genetic correlations were found between categorical diagnoses and most MDQ measures. Limitations Recruitment through probands with BD resulted in increased prevalence of BD in this sample, limiting generalizability. Unavailable genetic data reduced sample size for some analyses. Conclusion heritability and high genetic correlations between categorical diagnoses and MDQ measures support a genetic continuity between dimensional and categorical models of BD.
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Affiliation(s)
- Alejandro Arbona-Lampaya
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Heejong Sung
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexander D’Amico
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Emma E. M. Knowles
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily K. Besançon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Ally Freifeld
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Ley Lacbawan
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Fabiana Lopes
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Layla Kassem
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Francis J. McMahon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Ouali U, Zgueb Y, Jouini L, Aissa A, Jomli R, Ouertani A, Omrani A, Nacef F, Carta MG, Preti A. Accuracy of the Arabic HCL - 32 and MDQ in detecting patients with bipolar disorder. BMC Psychiatry 2023; 23:70. [PMID: 36703141 PMCID: PMC9878752 DOI: 10.1186/s12888-023-04529-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Studies about the two most used and validated instruments for the early detection of Bipolar Disorder (BD), the 32 - item Hypomania Checklist (HCL - 32) and the Mood Disorder Questionnaire (MDQ), are scarce in non-Western countries. This study aimed to explore the reliability, factor structure, and criterion validity of their Arabic versions in a sample of Tunisian patients diagnosed with mood disorders. METHODS The sample included 59 patients with BD, 86 with unipolar Major Depressive Disorder (MDD) and 281 controls. Confirmatory factor analysis was applied to show that a single global score was an appropriate summary measure of the screeners in the sample. Receiver Operating Characteristic analysis was used to assess the capacity of the translated screeners to distinguish patients with BD from those with MDD and controls. RESULTS Reliability was good for both tools in all samples. The bifactor implementation of the most reported two-factor model had the best fit for both screeners. Both were able to distinguish patients diagnosed with BD from putatively healthy controls, and equally able to distinguish patients diagnosed with BD from patients with MDD. CONCLUSION Both screeners work best in excluding the presence of BD in patients with MDD, which is an advantage in deciding whether or not to prescribe an antidepressant.
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Affiliation(s)
- Uta Ouali
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Yosra Zgueb
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010, La Manouba, Tunisia. .,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia. .,Research Laboratory LR18SP03, Tunis, Tunisia.
| | - Lamia Jouini
- grid.418149.10000 0000 8631 6364Centre de Compétences en Psychiatrie et Psychothérapie, Pôle de Psychiatrie et Psychothérapie, Hôpital du Valais (HVS)- Centre Hospitalier du Valais Romand, Sion, Switzerland
| | - Amina Aissa
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Rabaa Jomli
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Abdelhafidh Ouertani
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Adel Omrani
- Tunisian Bipolar Forum, Erable Médical Cabinet 324, Tunis, Tunisia
| | - Fethi Nacef
- Department Psychiatry A, Razi Hospital, Rue des Orangers, 2010 La Manouba, Tunisia ,grid.12574.350000000122959819Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia ,Research Laboratory LR18SP03, Tunis, Tunisia
| | - Mauro G. Carta
- grid.7763.50000 0004 1755 3242Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Preti
- grid.7605.40000 0001 2336 6580Department of Neuroscience, University of Turin, Turin, Italy
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Sayyah M, Delirrooyfard A, Rahim F. Assessment of the diagnostic performance of two new tools versus routine screening instruments for bipolar disorder: a meta-analysis. REVISTA BRASILEIRA DE PSIQUIATRIA 2022; 44:349-361. [PMID: 35588536 PMCID: PMC9169473 DOI: 10.1590/1516-4446-2021-2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Mehdi Sayyah
- Ahvaz Jundishapur University of Medical Sciences, Iran
| | | | - Fakher Rahim
- Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Iran; Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Iran
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Burman CJ, Dempsey RC, Priest HM. Exploring men’s experiences and sense-making of bipolar disorder diagnoses and mood management: a photo-elicitation investigation. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2021.2018572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Craig J. Burman
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Robert C. Dempsey
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Helena M. Priest
- School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
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Lukacs JN, Sicilia AC, Jones S, Algorta GP. Interactions and implications of Fuzzy-Trace theory for risk taking behaviors in bipolar disorder. J Affect Disord 2021; 293:305-313. [PMID: 34229283 DOI: 10.1016/j.jad.2021.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND According to Fuzzy-Trace Theory (FTT), qualitative, bottom-line, "gist" reasoning leads to less risk taking and more mature decision-making, less easily swayed by emotions than quantitative, detail-oriented, "verbatim" reasoning. In Bipolar disorder deleterious risky behaviors are common. Prior research confirmed the relationships posited between FTT and risk taking. We aim to understand whether FTT acts upon risk taking in the manner proposed in the FTT framework, namely, that (a) gist "values" mediate the role of "categorical gist". Furthermore, the roles of mania and impulsivity, cited as factors for risk-taking, remain to be clarified. In this study, we investigate if (b) manic symptoms and impulsivity moderate these relationships. METHODS Participants (N = 105) completed an online survey including demographics, clinical variables, symptomatology, FTT, risk taking and risk perception. RESULTS Mediational models indicated that (a) Gist Values mediated Categorical Gist's effect on risk taking, as expected by the FTT framework. (b) Impulsivity moderates risk taking, but manic-type symptomatology does not. LIMITATIONS Voluntary, self-report surveys may have low participant motivation and limit the diagnostic validity and the inpatient generalizability of the results. CONCLUSIONS The results move beyond a focus on mood-related aspects of Bipolar disorder and confirm the importance of understanding reasoning processes like FTT in combination with impulsivity, as potential behavioral factors of risk taking in Bipolar disorder. The clarifications on FTT's functioning as a mechanism prescribe possible openings for more efficacious reduction of risky behaviors through behavioral interventions focusing on value creation.
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Affiliation(s)
- Julia N Lukacs
- Department of Psychology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby, CA, USA
| | - Anna Chiara Sicilia
- Sussex Partnership NHS Foundation Trust, Worthing, UK; Director at in2gr8mentalhealth Ltd., London, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Guillermo Perez Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
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Ouali U, Jouini L, Zgueb Y, Jomli R, Omrani A, Nacef F, Preti A, Carta MG. The Factor Structure of the Mood Disorder Questionnaire in Tunisian Patients. Clin Pract Epidemiol Ment Health 2020; 16:82-92. [PMID: 33029185 PMCID: PMC7536729 DOI: 10.2174/1745017902016010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/02/2019] [Accepted: 05/08/2019] [Indexed: 11/28/2022]
Abstract
Background: The Mood Disorder Questionnaire (MDQ) is a frequently used screening tool for the early detection of Bipolar Disorder (BD), which is often unrecognized or misdiagnosed at its onset. In this study, data from Tunisia has been used to evaluate the psychometric properties of the Arabic MDQ. Methods: The sample included 151 patients with a current major depressive episode. The Arabic adapted version of the Structured Clinical Interview for DSM-IV-TR was used to formulate a diagnosis, yielding 62 patients with BD and 89 with unipolar Major Depressive Disorder (MDD). Principal component analysis with parallel analysis was used to establish the spontaneous distribution of the 13 core items of the MDQ. Confirmatory Factor Analysis (CFA) was used to check the available factor models. Receiver Operating Characteristic (ROC) analysis was used to assess the capacity of the MDQ to distinguish patients with BD from those with MDD. Results: Cronbach’s α in the sample was 0.80 (95%CI: 0.75 to 0.85). Ordinal α was 0.88. Parallel analysis suggested two main components, which explained 59% of variance in the data. CFA found a good fit for the existing unidimensional, the two-factor, and the three-factor models. ROC analysis showed that at a threshold of 7, the MDQ was able to distinguish patients with BD from those with MDD with extraordinary negative predictive value (0.92) and a positive diagnostic likelihood ratio of 3.8. Conclusion: The Arabic version of the MDQ showed good measurement properties in terms of reliability, factorial validity and discriminative properties.
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Gervasoni N, Weber Rouget B, Miguez M, Dubuis V, Bizzini V, Gex-Fabry M, Bondolfi G, Aubry JM. Performance of the Mood Disorder Questionnaire (MDQ) according to bipolar subtype and symptom severity. Eur Psychiatry 2020; 24:341-4. [DOI: 10.1016/j.eurpsy.2008.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 12/19/2008] [Accepted: 12/30/2008] [Indexed: 10/21/2022] Open
Abstract
AbstractObjectiveTo evaluate the performance of the French version of the Mood Disorder Questionnaire (MDQ) in patients attending a general psychiatric outpatient service as well as whether MDQ scores are independent of patient mood state at time of completion.Method183 patients completed the MDQ and were assessed with the MADRS and YMRS scales, before being interviewed with the SCID (time 1). MDQ, MADRS and YMRS assessment was repeated four to six weeks later (time 2).ResultsAccording to the SCID, 44 patients were suffering from bipolar spectrum disorder and 102 from unipolar disorder (37 patients dropped out). The MDQ provided high specificity (83.3%). Sensitivity was 63.6%, with better identification of bipolar I (85.0%) than bipolar II patients (45.8%). In the whole sample, test-retest reliability was satisfactory (kappa = 0.64). Modest correlations were observed between the number of endorsed MDQ items and YMRS scores at time 1 (Spearman r = 0.19; p = 0.021) and time 2 (r = 0.26; p = 0.002).ConclusionsDespite some fluctuations over time and a discrete influence of symptom severity, the screening algorithm can be used reliably, whether in the acute or remission phase of a depressive episode.
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Dumont CM, Sheridan LM, Besancon EK, Blattner M, Lopes F, Kassem L, McMahon FJ. Validity of the Mood Disorder Questionnaire (MDQ) as a screening tool for bipolar spectrum disorders in anabaptist populations. J Psychiatr Res 2020; 123:159-163. [PMID: 32065952 DOI: 10.1016/j.jpsychires.2020.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/23/2019] [Accepted: 01/24/2020] [Indexed: 11/17/2022]
Abstract
The Mood Disorder Questionnaire (MDQ) is an established screening tool for bipolar spectrum disorders (BSD), but has not been validated in diverse populations and the best scoring method remains uncertain. This study assessed diagnostic validity of the MDQ among Anabaptists, an underserved population frequently involved in genetic research. 161 participants completed the MDQ and were diagnosed by a best-estimate final diagnosis (BEFD). Diagnostic agreements between alternate MDQ scoring methods and the BEFD were quantified using Cohen's Kappa (κ), sensitivity (α), and specificity (β). Scoring criteria evaluated included >7 simultaneous symptoms and at least moderate impairment, >7 simultaneous symptoms, with at least mild impairment, >7 symptoms only, with no further requirement, and three novel scoring methods that require >5 symptoms or fewer. Diagnostic agreement varied. The original method proved most specific but had the lowest κ and sensitivity. κ increased with more liberal scoring criteria, reaching a maximum under the lower-threshold symptom methods, with little loss of specificity in the 5-symptom method. Decreasing the symptom threshold below 5 conferred little or no benefit. These results support the diagnostic validity of the MDQ among this Anabaptist sample and suggest that a 5-symptom scoring method may increase diagnostic sensitivity in populations at high risk for bipolar disorder.
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Affiliation(s)
- Cassandra M Dumont
- 10Center Drive R3D54, National Institute of Mental Health, Bethesda, MD, 20892, United States.
| | - Laura M Sheridan
- 10Center Drive R3D54, National Institute of Mental Health, Bethesda, MD, 20892, United States.
| | - Emily K Besancon
- 10Center Drive R3D54, National Institute of Mental Health, Bethesda, MD, 20892, United States
| | - Meghan Blattner
- 10Center Drive R3D54, National Institute of Mental Health, Bethesda, MD, 20892, United States
| | - Fabiana Lopes
- 10Center Drive R3D54, National Institute of Mental Health, Bethesda, MD, 20892, United States
| | - Layla Kassem
- 10Center Drive R3D54, National Institute of Mental Health, Bethesda, MD, 20892, United States
| | - Francis J McMahon
- 10Center Drive R3D54, National Institute of Mental Health, Bethesda, MD, 20892, United States.
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9
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Dempsey R, Gooding P, Jones S. A prospective study of bipolar disorder vulnerability in relation to behavioural activation, behavioural inhibition and dysregulation of the Behavioural Activation System. Eur Psychiatry 2020; 44:24-29. [DOI: 10.1016/j.eurpsy.2017.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/08/2017] [Accepted: 03/17/2017] [Indexed: 02/02/2023] Open
Abstract
AbstractBackground:The weak regulation, or “dysregulation”, of the Behavioural Activation System (BAS) is implicated in the development and recurrence of bipolar disorder. However, there has been a lack of prospective studies investigating the predictive role of BAS dysregulation in relation to bipolar-vulnerability. Furthermore, no studies have tested the prospective predictive utility of the DYS self-report measure of BAS dysregulation in an analogue sample. The goal of the current study was to redress this gap.Methods:Participants (n = 127) completed baseline self-report measures of mood symptoms (Internal States Scale [ISS]), the Hypomanic Personality Scale (HPS), behavioural activation, inhibition and dysregulation of BAS (BIS/BAS and DYS), and at six months, the Mood Disorders Questionnaire (MDQ).Results:Linear regression analysis indicated a significant main effect of BAS Dysregulation, and a significant interaction between BIS and BAS Fun Seeking, on prospective MDQ scores whilst controlling for baseline mood symptoms and HPS scores. The interaction effect indicated that the relationship between high BAS Fun Seeking and follow-up MDQ scores was strongest when BIS scores were high, whilst the lowest MDQ scores were observed for a combination of low BAS Fun Seeking and high BIS. However, DYS scores were the stronger predictor of MDQ scores compared to the BAS Fun Seeking and BIS interaction.Conclusions:Bipolar-vulnerability is prospectively associated with heightened BAS Dysregulation, as measured by the DYS subscale, similar to prior findings in clinical samples. Further research investigating the longer-term associations between BAS Dysregulation with the development of clinically significant bipolar mood symptoms is required.
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Shabani A, Mirzaei Khoshalani M, Mahdavi S, Ahmadzad-Asl M. Screening bipolar disorders in a general hospital: Psychometric findings for the Persian version of mood disorder questionnaire and bipolar spectrum diagnostic scale. Med J Islam Repub Iran 2019; 33:48. [PMID: 31456972 PMCID: PMC6708087 DOI: 10.34171/mjiri.33.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Indexed: 01/04/2023] Open
Abstract
Background: Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) are used to screen patients with bipolar disorders and have been examined in some psychiatric settings. The present study aimed to assess the validity and reliability of these 2 tools on inpatients in a general hospital.
Methods: In a cross-sectional study in 2011, a total of 207 inpatients admitted to different wards of Rasoul Akram hospital, Tehran, were selected by systematic random sampling. Demographic questionnaire, MDQ, and BSDS were completed. Also, Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) was performed for all participants within 72 hours. The SCID-I was used as the gold standard of psychiatric diagnoses to identify the predictive validity of the 2 screening tests. Sensitivity and specificity indices were identified using Roc curve. The 2 screening tools were recompleted by 20% of the patients (n=43) after 3-7 days to measure test-retest reliability using paired t test and correlation between measures in 2 separate occasions.
Results: In this study, 101 female and 106 male (m=36.9±15.5 yrs.) patients were entered the study, of them 56 (32 males) had bipolar disorder according to SCID-I. The most common bipolar disorder was bipolar disorder type II (9.7%). Pearson’s test showed a high test-retest reliability for both MDQ (r=0.72, p<0.001) and BSDS (r=0.77, p<0.001). For MDQ, the scores 5 (sensitivity=0.60; specificity=0.73) and 6 (sensitivity=0.56; specificity=0.77) were the best cutoff points. Positive and negative predictive values for the mentioned cutoff points were 0.45 and 0.83 (for the score 5) and 0.48 and 0.82 (for the score 6), respectively. The best cutoff point for BSDS was 11 with the sensitivity, specificity, and positive and negative predictive values of 0.74, 0.69, 0.47, and 0.87.
Conclusion: The Persian versions of MDQ and BSDS have acceptable validity and reliability to screen Persian patients with bipolar spectrum disorders in a general hospital.
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Affiliation(s)
- Amir Shabani
- Mental Health Research Center, Mood Disorders Research Group, Iran University of Medical Sciences, Tehran, Iran
| | - Mosleh Mirzaei Khoshalani
- Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedreza Mahdavi
- Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Ahmadzad-Asl
- Mental Health Research Center, Bipolar Disorders Research Group, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Wang YY, Xu DD, Liu R, Yang Y, Grover S, Ungvari GS, Hall BJ, Wang G, Xiang YT. Comparison of the screening ability between the 32-item Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ) for bipolar disorder: A meta-analysis and systematic review. Psychiatry Res 2019; 273:461-466. [PMID: 30684793 DOI: 10.1016/j.psychres.2019.01.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/29/2022]
Abstract
The frequent misdiagnosis of bipolar disorder (BD) is associated with detrimental consequences and inappropriate treatments. The 32-item Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ) are widely used self-report screening instruments for BD. This is a systematic review and meta-analysis to compare the psychometric properties of the HCL-32 and the MDQ based on the same patient samples. Two reviewers systematically and independently searched PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library databases. Studies using the HCL-32 and MDQ concurrently and reporting their psychometric properties were included. Eleven studies that met the entry criteria were included in the systematic review, and 9 studies with relevant data were included in the meta-analysis. Using study-defined cutoffs, summary sensitivities were 82% (95% CI: 72%-89%) and 80% (95% CI: 71%-86%), while specificities were 57% (95% CI: 48%-66%) and 70% (95% CI: 59%-71%) for the HCL-32 and the MDQ respectively. Both the HCL-32 and the MDQ have acceptable psychometric properties to identify BD and appear to be useful screening tools for BD.
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Affiliation(s)
- Yuan-Yuan Wang
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom; Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Dan-Dan Xu
- Faculty of science, Harbin University, Heilongjiang province, China
| | - Rui Liu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China
| | - Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Department of Psychiatry and Psychology, Southern Medical University Nanfang Hospital, Guangdong, China
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao SAR, China; Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Bipolar features in major depressive disorder: Results from the Iranian mental health survey (IranMHS). J Affect Disord 2018; 241:319-324. [PMID: 30142591 DOI: 10.1016/j.jad.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/07/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Past research suggests that individuals suffering from depressive disorders with bipolar features might have different clinical outcomes resembling bipolar disorders. The objectives of this study are to determine the prevalence of bipolar features among individuals meeting the criteria for 12-month major depressive disorder (MDD) in the Iranian population and to examine the demographic and clinical characteristics associated with these features. METHODS Data were drawn from the Iranian Mental Health Survey (IranMHS), a representative household survey of the Iranian population aged 15-64 years. The study sample consisted of all individuals with a 12-month MDD (n = 1014) ascertained by the Composite International Diagnostic Interview (CIDI 2.1) without a lifetime history of bipolar I or II disorders. Mood Disorder Questionnaire (MDQ) was used to screen for the lifetime history of bipolar features among participants with MDD. RESULTS Among participants meeting the 12-month MDD criteria, 22.1% (95% CI: 19.6-24.7) had a lifetime history of bipolar features. Compared with those without these features, participants with bipolar features had higher odds of endorsing suicidal ideations and suicide attempts, comorbid anxiety and substance use disorders, severe impairment, history of psychotic symptoms, some features of atypical depression and fewer depressive symptoms. Associations with comorbid anxiety disorders [Odds Ratio (OR) = 1.43; 95% confidence interval (CI): 1.00-2.03] and history of psychotic symptoms (OR = 2.63 95% CI: 1.81-3.81) persisted in multivariable models. LIMITATION Relying on self-reports of lifetime bipolar symptoms which is open to recall bias, and cross-sectional study design which limits interpretation of outcome and course of MDD are two major limitations of this study. CONCLUSION The presence of bipolar features is associated with a distinct demographic and clinical profile in MDD. Identifying these cases would enhance the homogeneity of the depressive disorder phenotype in general population surveys. Identifying MDD patients with these features has potential clinical implications.
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Zimmerman M, Holst CG. Screening for psychiatric disorders with self-administered questionnaires. Psychiatry Res 2018; 270:1068-1073. [PMID: 29908784 DOI: 10.1016/j.psychres.2018.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/06/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
Given the time demands of clinical practice it is not surprising that diagnoses are sometimes missed. To improve diagnostic recognition, self-administered screening scales have been recommended. A problem with much of the research effort on screening scales is the confusion between diagnostic testing and screening. It is important for a screening test to have high sensitivity because the more time intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. Investigators vary in how they analyze their data in determining the recommended cutoff score on a self-administered screening questionnaire. To illustrate this, in the present report we examined how often each of the different approaches towards determining a cutoff score on bipolar disorder screening scales were used. We reviewed 68 reports of the performance of the 3 most commonly researched bipolar disorder screening scales to determine how the recommended cutoff on the scale was derived. Most studies recommended a cutoff point on the screening scale that optimized the level of agreement with the diagnostic gold standard. Only 11 (16.2%) studies recommended a cutoff that prioritized the scale's sensitivity. It is important for clinicians to understand the difference between screening and diagnostic tests. The results of the present study indicate that most studies of the performance of the 3 most commonly studied bipolar disorder screening measures have taken the wrong approach in deriving the cutoff score on the scale for the purpose of screening.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA.
| | - Carolina Guzman Holst
- Department of Psychiatry and Human Behavior, Brown Medical School, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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Jones S, Riste L, Barrowclough C, Bartlett P, Clements C, Davies L, Holland F, Kapur N, Lobban F, Long R, Morriss R, Peters S, Roberts C, Camacho E, Gregg L, Ntais D. Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care – the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for theDiagnostic and Statistical Manual of Mental Disorders.InterventionsIn WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively.Main outcome measuresIn WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation.ResultsGroup PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio testp = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2;p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD:n = 72, 72% retention to follow-up; MI-CBT:n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans.LimitationsInferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group.ConclusionThe programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support.Future workFuture work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated.Trial registrationCurrent Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Clements
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Fiona Holland
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care NHS Trust, Manchester, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rita Long
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Chris Roberts
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
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Glaus J, Van Meter A, Cui L, Marangoni C, Merikangas KR. Factorial structure and familial aggregation of the Hypomania Checklist-32 (HCL-32): Results of the NIMH Family Study of Affective Spectrum Disorders. Compr Psychiatry 2018; 84:7-14. [PMID: 29655654 PMCID: PMC6002901 DOI: 10.1016/j.comppsych.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is substantial evidence that bipolar disorder (BD) manifests on a spectrum rather than as a categorical condition. Detection of people with subthreshold manifestations of BD is therefore important. The Hypomania Checklist-32 (HCL-32) was developed as a tool to identify such people. PURPOSE The aims of this paper were to: (1) investigate the factor structure of HCL-32; (2) determine whether the HCL-32 can discriminate between mood disorder subtypes; and (3) assess the familial aggregation and cross-aggregation of hypomanic symptoms assessed on the HCL with BD. PROCEDURES Ninety-six probands recruited from the community and 154 of their adult first-degree relatives completed the HCL-32. Diagnosis was based on semi-structured interviews and family history reports. Explanatory factor analysis and mixed effects linear regression models were used. FINDINGS A four-factor ("Activity/Increased energy," "Distractibility/Irritability", "Novelty seeking/Disinhibition, "Substance use") solution fit the HCL-32, explaining 11.1% of the total variance. The Distractibility/Irritability score was elevated among those with BP-I and BP-II, compared to those with depression and no mood disorders. Higher HCL-32 scores were associated with increased risk of BD-I (OR = 1.22, 95%CI 1.14-1.30). The "Distractibility/Irritability" score was transmitted within families (β = 0.15, p = 0.040). However, there was no familial cross-aggregation between mood disorders and the 4 HCL factors. CONCLUSIONS Our findings suggest that the HCL-32 discriminates the mood disorder subtypes, is familial and may provide a dimensional index of propensity to BD. Future studies should explore the heritability of symptoms, rather than focusing on diagnoses.
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Affiliation(s)
- Jennifer Glaus
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
| | - Anna Van Meter
- Ferkauf Graduate School, Yeshiva University, University in New York, 1165 Morris Park Ave, Bronx, New York 10461, United States.
| | - Lihong Cui
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
| | - Ciro Marangoni
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35 Convent Drive, MSC 3720, Bldg 35A, Bethesda, MD 20892, United States.
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Banks FD, Lobban F, Fanshawe TR, Jones SH. Associations between circadian rhythm instability, appraisal style and mood in bipolar disorder. J Affect Disord 2016; 203:166-175. [PMID: 27295373 DOI: 10.1016/j.jad.2016.05.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/30/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Internal appraisal styles, in addition to circadian and social rhythm instability, have been implicated in the development of mood experiences in bipolar disorder (BD), yet potential interactions between these variables remain under researched. METHODS This study used online questionnaires to examine relationships between social and circadian rhythm instability, appraisal style and mood within populations at varying vulnerability for BD. RESULTS Participants with BD (n=51), and those at behavioural high-risk (BHR; n=77), exhibited poor sleep quality and a stronger tendency to form internal appraisals of both positive and negative experiences compared to non-clinical controls (n=498) and participants with fibromyalgia (n=80). Participants with BD also exhibited a stronger tendency to adopt an internal, negative appraisal style compared to individuals at BHR. Sleep disturbance and internal appraisal styles were significantly associated with low mood in BD. LIMITATIONS Sleep quality and social rhythm stability were assessed using self-report measures only, which may differ from objective measures. Causal relationships between constructs could not be examined due to the cross-sectional design. CONCLUSIONS The findings suggest the importance of attending to internal appraisal styles and sleep quality when working therapeutically with individuals diagnosed with BD. Potential differences in the effect of appraisal style at the state and trait level warrant further exploration.
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Affiliation(s)
- Faye D Banks
- School of Psychology, Newcastle University, United Kingdom.
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Lancaster University, United Kingdom
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Lancaster University, United Kingdom
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17
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Woo YS, Bahk WM, Hong J, Yoon BH, Hwang TY, Kim MD, Jon DI. Use of a smartphone application to screen for bipolar spectrum disorder in a community sample. Health Informatics J 2016; 22:779-88. [DOI: 10.1177/1460458215589601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study describes the use of a smartphone application based on the Korean version of the Mood Disorder Questionnaire in screening for bipolar spectrum disorders in a large general population. All data were collected between May 2011 and July 2011. A total of 27,159 individuals participated in the survey, using a smartphone application. The prevalence of positive screening results for bipolar spectrum disorders among 27,159 participants using the smartphone Korean Mood Disorder Questionnaire application was 8.2 percent. These results are similar to traditional paper-based results. The Korean Mood Disorder Questionnaire positive group exhibited more frequent occurrences of previous psychiatric treatment than the group with negative results. In a logistic regression analysis involving subjects with past psychiatric history, age group significantly predicted Korean Mood Disorder Questionnaire results. The smartphone application may be a useful screening tool for bipolar spectrum disorders. This study included only individuals who actively participated, and thus, the possibility of a selection bias should be considered.
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Affiliation(s)
- Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeongwan Hong
- Department of Psychiatry, Namwon Sungil Mental Hospital, Namwon, Korea
| | - Bo-Hyun Yoon
- Department of Psychiatry, Naju National Hospital, Naju, Korea
| | - Tae-Yeon Hwang
- WHO Collaborating Center of Yongin Mental Hospital, Yongin, Korea
| | - Moon-Doo Kim
- Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea
| | - Duk-In Jon
- Department of Psychiatry, College of Medicine, Hallym University, Anyang, Korea
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Massidda D, Giovanni Carta M, Altoè G. Integrating Different Factorial Solutions of a Psychometric Tool Via Social Network Analysis. METHODOLOGY-EUROPEAN JOURNAL OF RESEARCH METHODS FOR THE BEHAVIORAL AND SOCIAL SCIENCES 2016. [DOI: 10.1027/1614-2241/a000113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract. Evaluating the factorial structure of a psychometric test is crucial to capture the complexity of a psychological phenomenon. Indeed, for the same test, several studies may find different factorial solutions which, in turn, may be explained by within and/or between sample variability. In this paper we introduce a novel quantitative approach to combine different factorial solutions of the same test. We propose to use a method based on Social Network Analysis to create and statistically evaluate an integrated factorial structure based on the information provided by previous researches. We present an application to the Mood Disorder Questionnaire by considering different factorial structures reported in the literature. The integrated factorial solution indicates the presence of three factors supporting the multidimensionality of the test. The role of single items in the composition of factors is also evaluated and discussed in terms of differences and similarities between the five original studies and the new integrated model. From an applied perspective, our approach may be useful to assist researchers in summarizing different factorial solutions for the same test efficiently. Furthermore, the resulting integrated factor solution could serve as baseline model to validate the structure of the test by applying confirmatory factor techniques to new data.
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Affiliation(s)
- Davide Massidda
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Italy
| | - Gianmarco Altoè
- Department of Developmental and Socialization Psychology, University of Padua, Italy
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19
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Prevalence of fibromyalgia and co-morbid bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2015; 188:134-42. [PMID: 26363263 DOI: 10.1016/j.jad.2015.08.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is a chronic disorder with high morbidity and significant health service utilization costs. Few studies have reported on the phenotypic overlap of FM and bipolar disorder (BD). The aim of this review is to qualitatively and quantitatively summarize the results and clinical implications of the extant literature on the co-occurrence of FM and BD. METHODS A systematic search of PubMed/Medline, Cochrane, PsycINFO, CINAHL and Embase was conducted to search for relevant articles. Articles were included if incidence and/or prevalence of BD was determined in the FM sample. Results of prevalence were pooled from all studies. Pooled odds ratio (OR) was calculated based on case-control studies using standard meta-analytic methods. RESULTS A total of nine studies were included. The pooled rate of BD comorbidity in samples of FM patients was 21% (n=678); however, results varied greatly as a function of study methodology. Case-controlled studies revealed a pooled OR of 7.55 of BD co-morbidity in samples of FM patients [95% Confidence Interval (CI)=3.9-14.62, FM n=268, controls n=413] with low heterogeneity (I(2)=0%). LIMITATIONS The current study was limited by the low number of available studies and heterogeneity of study methods and results. CONCLUSIONS These data strongly suggest an association between BD and FM. Future studies employing a validated diagnostic screen are needed in order to more accurately determine the prevalence of BD in FM. An adequate psychiatric assessment is recommended in FM patients with suspected symptoms consistent with BD prior to administration of antidepressants in the treatment of FM.
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20
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Clark CT, Sit DK, Driscoll K, Eng HF, Confer AL, Luther JF, Wisniewski SR, Wisner KL. DOES SCREENING WITH THE MDQ AND EPDS IMPROVE IDENTIFICATION OF BIPOLAR DISORDER IN AN OBSTETRICAL SAMPLE? Depress Anxiety 2015; 32:518-26. [PMID: 26059839 PMCID: PMC4588053 DOI: 10.1002/da.22373] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 03/09/2015] [Accepted: 03/11/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women with bipolar disorder (BD) are at high risk for postpartum affective episodes and psychosis. Although validated screening tools are available for postpartum unipolar depression, few screening tools for hypomania/mania exist. Screening tools for BD in the postpartum period are essential for improving detection and planning appropriate treatment. We evaluated whether adding the Mood Disorders Questionnaire (MDQ) to the Edinburgh Postnatal Depression Scale (EPDS) increased the identification of BD in the early postpartum period. METHODS Women (N = 1,279) who delivered a live infant and screened positive on the EPDS and/or MDQ at 4-6 weeks postbirth were invited to undergo an in-home Structured Clinical Interview for DSM-IV (SCID). RESULTS Positive EPDS and/or MDQ screens occurred in 12% of the sample (n = 155). In home SCID diagnostic interviews were completed in 93 (60%) of the mothers with positive screens. BD was the primary diagnosis in 37% (n = 34). Women with BD screened positive on the EPDS and/or MDQ as follows: EPDS+/MDQ+ (n = 14), EPDS+/MDQ- (n = 17), and EPDS-/MDQ+ (n = 3). The MDQ identified 50% (17/34) of the women with BD and 6 additional cases of BD when the MDQ question regarding how impaired the mother perceived herself was excluded from the screen criterion. CONCLUSION Addition of the MDQ to the EPDS improved the distinction of unipolar depression from bipolar depression at the level of screening in 50% of women with traditional MDQ scoring and by nearly 70% when the MDQ was scored without the impairment criterion.
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Affiliation(s)
- Crystal T. Clark
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dorothy K.Y. Sit
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kara Driscoll
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Heather F. Eng
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Andrea L. Confer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - James F. Luther
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Stephen R. Wisniewski
- Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, PA
| | - Katherine L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
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21
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Wang HR, Woo YS, Ahn HS, Ahn IM, Kim HJ, Bahk WM. THE VALIDITY OF THE MOOD DISORDER QUESTIONNAIRE FOR SCREENING BIPOLAR DISORDER: A META-ANALYSIS. Depress Anxiety 2015; 32:527-38. [PMID: 26010478 DOI: 10.1002/da.22374] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/23/2015] [Accepted: 03/28/2015] [Indexed: 11/07/2022] Open
Abstract
We conducted a meta-analysis to review the diagnostic accuracy of the Mood Disorder Questionnaire (MDQ) among patients with mood disorders. We used a bivariate random effects model to calculate summary sensitivity and specificity. Twenty-one studies were included. At the standard or modified cutoff value of 7, summary sensitivity was .62 and summary specificity was .85. When we pooled 11 studies including both patients with bipolar disorder (BD) and those with unipolar depression, the summary sensitivity was .76 and summary specificity was .81. However, among the six studies that excluded patients with known BD, the summary sensitivity was significantly reduced to .37 and summary specificity was .88. There were no significant differences on the diagnostic accuracy of the MDQ between studies from Eastern and Western countries after adjusting for various clinical correlates. The overall diagnostic accuracy of the MDQ was relatively good. However, when the MDQ is applied among patients with depression without previous diagnoses of BD, its sensitivity was significantly reduced. This suggests that when the MDQ is applied among this population, its optimal cutoff value should be adjusted to enhance its sensitivity.
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Affiliation(s)
- Hee Ryung Wang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Sup Woo
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Il Min Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.,Department of Literary Arts, Brown University, Providence, Rhode Island
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Won-Myong Bahk
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Imamura K, Kawakami N, Naganuma Y, Igarashi Y. Development of screening inventories for bipolar disorder at workplace: a diagnostic accuracy study. J Affect Disord 2015; 178:32-8. [PMID: 25795533 DOI: 10.1016/j.jad.2015.02.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to develop a new instrument for bipolar disorder screening, the Workplace Bipolar Inventory (WBI), and examine its efficiency as compared with Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) among workers on leave of the absence due to their mental health problems. METHODS Participants were recruited at a psychiatric outpatient clinic for return-to-work in Tokyo, Japan, during September to November 2009. 81 outpatients were recruited, 55 of whom (68%) agreed to participate in this study. Participants answered questionnaires including WBI, MDQ, BSDS, and demographic factors. Their diagnostic information according to the international statistical classification of diseases and related health problems 10th revision (ICD-10) was obtained from their attending psychiatrists. The WBI is a new self-rating 39-item questionnaire which developed with input from occupational mental health specialists and an analysis of WHO Composite International Diagnostic Interview (CIDI) items. The WBI contains 3 subtype scales: WBI-A (5 items), WBI-AB4 (9 items), and WBI-AB (39 items). RESULTS Reliability of these scales was moderate. In the AUC of these scales, BSDS was the best of them (0.83). In the optimal cut-off point of these scales, WBI-AB4 showed good efficiency of screening (sensitivity=0.78, specificity=0.75). Both MDQ and BSDS had high specificity, while low in sensitivity. LIMITATIONS The well validated diagnostic method (i.e., the structured clinical interview for DSM-IV [SCID] or CIDI) was not applied in this study. CONCLUSIONS The WBI, especially WBI-AB4 would be a useful workplace screening tool for workers with bipolar disorder.
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Affiliation(s)
- Kotaro Imamura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichi Naganuma
- Department of Social Work, School of Health Sciences, Tokai University, Kanagawa, Japan
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Pan PY, Yeh CB. Mood disturbance in adolescents screened by the Mood Disorder Questionnaire predicts poorer social adjustment. J Adolesc Health 2015; 56:652-7. [PMID: 26003581 DOI: 10.1016/j.jadohealth.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/06/2015] [Accepted: 02/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Early-onset bipolar disorder is associated with a more severe illness course and poorer outcome. Its identification in adolescents may provide the opportunity for adequate intervention to improve global functioning and long-term prognosis. Thus, this study aimed to screen mood disturbance in a sample of high school students using Mood Disorder Questionnaire (MDQ) and follow up their adaptive functioning 1 year later. METHODS In the first year, adolescents aged 15-17 years old from a Taiwanese senior high school (N = 1,151) completed the Chinese version of MDQ, the Impulsiveness Scale, and a set of questions about risky behaviors. A subgroup of respondents (N = 184) picked randomly were interviewed to validate the diagnosis of bipolar disorder. In the second year, the Social Adjustment Inventory for Children and Adolescents was applied for the same sample of subjects for the measurement of their adaptive functions. RESULTS The intraclass correlation coefficient and the Cronbach α coefficient of the MDQ were .68 and .61, respectively. MDQ score of at least 7 showed modest sensitivity (.57) and specificity (.64) for bipolar disorder. Higher MDQ score predicted risky behaviors in adolescents at baseline measurement. MDQ score was found significantly correlated with Impulsiveness Scale total score. In follow-up evaluation, participants with an MDQ score of ≥7 had poorer social adjustment. CONCLUSIONS Our findings suggest that untreated mood disturbance among adolescents leads to impaired social adaptive functioning in the next year. The application of MDQ in adolescents may help clinicians in early intervention for their emotional disturbance.
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Affiliation(s)
- Pei-Yin Pan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Todd NJ, Jones SH, Hart A, Lobban FA. A web-based self-management intervention for Bipolar Disorder 'living with bipolar': a feasibility randomised controlled trial. J Affect Disord 2014; 169:21-9. [PMID: 25129531 DOI: 10.1016/j.jad.2014.07.027] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Bipolar Disorder (BD) is a severe mental health problem. Psychological interventions are recommended by the National Institute for Health and Care Excellence (NICE) but patients experience severe inequalities in access. This study assessed the feasibility and potential effectiveness of a recovery informed web-based self-management intervention for people with BD. METHODS An online randomised controlled trial (n=122) compared treatment as usual (TAU) plus the 'Living with Bipolar' (LWB) intervention with a waiting list control (WLC) group. RESULTS The study recruited to target and the retention rates were high. Participants engaged with the approach. Compared with the WLC, those receiving LWB showed the most robust improvement in psychological and physical domains of quality of life, wellbeing and recovery at the end of the intervention. LIMITATIONS The trial was not definitive and requires further investigation. CONCLUSIONS There is preliminary evidence that a web-based treatment approach in BD is feasible and potentially effective. Such interventions could form part of the Improving Access to Psychological Therapy (IAPT) initiative in severe mental health.
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Affiliation(s)
- Nicholas J Todd
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom.
| | - Steven H Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
| | - Anna Hart
- Combining Health Information, Computation & Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
| | - Fiona A Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom
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Bae SO, Kim MD, Lee JG, Seo JS, Won SH, Woo YS, Seok JH, Kim W, Kim SJ, Min KJ, Jon DI, Shin YC, Bahk WM, Yoon BH. Is it useful to use the Korean version of the mood disorder questionnaire for assessing bipolar spectrum disorder among Korean college students? Asia Pac Psychiatry 2014; 6:170-8. [PMID: 23857742 DOI: 10.1111/appy.12026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 11/18/2012] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The purpose of this study was to assess the usefulness of the Korean version of the Mood Disorder Questionnaire (K-MDQ) as a screening tool for the identification of bipolar spectrum disorder (BSD) among Korean college students. METHODS The sample of 1,020 college students was stratified to reflect geographical differences among the students. The K-MDQ and an epidemiological survey were administered between November 2006 and February 2007. To validate the K-MDQ as a screening tool for BSD, the Korean version of the Bipolar Spectrum Diagnostic Scale (K-BSDS) and the Structured Clinical Interview for DSM-IV (SCID) were also administered. RESULTS The rates satisfying MDQ criterion 1, and all three MDQ criteria, were 55.5% and 2.3%, respectively. According to the K-BSDS, 59.9% of the sample met the criteria for BSD using a threshold of 10, while no statistical differences were observed among subgroups. When we examined the diagnostic agreement between K-MDQ and K-BSDS, 79.5% of students who met MDQ criterion 1 were also positive on the BSDS. Sixteen (21.6%) of the 74 students who participated in the SCID interview were diagnosed with BSD. DISCUSSION Although the K-MDQ is a useful tool to assess BSD among inpatients and outpatients, it does not appear useful as a screening tool to detect BSD among college students.
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Affiliation(s)
- Seung Oh Bae
- Department of Psychiatry, Gwangju Mirae Hospital, Gwangju, Korea
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Cyprien F, Guillaume S, Jaussent I, Lopez-Castroman J, Mercier G, Olie E, Courtet P. Impact of axis-I comorbidity and suicidal behavior disorders on sensitivity and specificity of the Mood Disorder Questionnaire in complex depressed inpatients. Compr Psychiatry 2014; 55:876-82. [PMID: 24625765 DOI: 10.1016/j.comppsych.2014.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study assessed the psychometric performance of the Mood Disorder Questionnaire (MDQ) and its modified MDQ7 version, to screen for bipolar disorders (BD) in depressive inpatients according to depression severity, number of current axis I psychiatric comorbidities and suicidal behavior disorders. METHODS Depressed adult inpatients (n=195) were consecutively enrolled. Psychiatric diagnoses were made using the standardized DSM-IV-TR structured interview MINI 5.0.0 and medical case notes. Depression severity was assessed with the Beck Depression Inventory and the Hamilton Depression Scale. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each MDQ version were evaluated in the whole sample and according to depression severity, current axis I psychiatric comorbidities and suicidal behavior. RESULTS The occurrence and the number of axis I disorders affected performance of both versions. Among depressed patients with two or more comorbidities, PPV and NPV of the MDQ were 65% and 80%, respectively, and they were respectively 56.2% and 87.9% with MDQ7. Current suicidal behavior disorders also dramatically reduced the PPV of MDQ (from 81.2% to 63.3%) and MDQ7 (from 72.2% to 52.6%) but the NPV remained above 80%. The performance of both versions of the MDQ tended to improve with the severity of depression. CONCLUSION The MDQ is not a suitable screening instrument to diagnose BD in subjects with a complex major depressive episode and/or a current history of suicidal behavior. Nevertheless MDQ particularly in its modified version may be useful for ruling out the presence of BD among these complex patients.
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Affiliation(s)
- Fabienne Cyprien
- Psychiatric Department, CHU Nîmes, Hopital Carémeau, Nîmes, France; Inserm U1061 Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Sébastien Guillaume
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France.
| | - Isabelle Jaussent
- Inserm U1061 Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Jorge Lopez-Castroman
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France; Department of Psychiatry, IIS-Fundacion Jimenez Diaz, CIBERSAM, Madrid, Spain
| | - Grégoire Mercier
- CHU Montpellier, Information Medical Department, Montpellier, France
| | - Emilie Olie
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France
| | - Philippe Courtet
- Inserm U1061 Montpellier, France; Psychiatric Emergency and Post Emergency Department, CHU Montpellier, Hôpital Lapeyronie, Pole Urgence, Montpellier, France; University of Montpellier 1, Montpellier, France
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Waugh MJ, Meyer TD, Youngstrom EA, Scott J. A review of self-rating instruments to identify young people at risk of bipolar spectrum disorders. J Affect Disord 2014; 160:113-21. [PMID: 24461633 DOI: 10.1016/j.jad.2013.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite 15-25 years being the peak age at onset for bipolar disorder (BD), recognition and introduction of appropriate treatment are typically delayed by 6 or more years. A major reason for these delays is the failure to identify prior mood episodes or risk factors for bipolarity, suggesting that there may be a particular benefit in using screening tools in this age group. METHODS We identified papers published between 1980 and 2012 that assessed the validity of measures specifically used to screen for BD, risk factors for bipolarity, or a prior history of depressive, hypomanic or manic episodes. From these, we identified those studies that included sufficient information about participants aged 15-25 years. RESULTS Searches yielded only eleven independent studies with available data on the target age group. The studies employed seven separate scales that demonstrated quite different screening properties. The cut-off scores for optimal sensitivity and specificity often differed from those reported for adult samples and varied according to sample characteristics. LIMITATIONS Our findings may be undermined by the small sample sizes and low number of individuals in the specified age range included in the studies identified. Although we explored all available methods for detecting studies and data sets, we cannot exclude the likelihood that other relevant studies on this age range exist. CONCLUSIONS Available screening tools for BD have mainly been validated in middle-aged adult samples with established mood disorders, and the instruments reviewed show sub-optimal screening properties when applied to adolescents and young adults. Overall, those measures that examine personality traits or temperament appear to perform better than those assessing discrete symptoms or episodes. However, all the measures need further testing and/or modification. In the interim, to improve screening for BD in those in the peak age range for onset of this disorder, it may be appropriate to combine a measure with high sensitivity with one that demonstrates high specificity for a given sampling frame.
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Affiliation(s)
- Meghan J Waugh
- Northumberland, Tyne & Wear NHS Foundations Trust, Newcastle upon Tyne, UK
| | | | | | - Jan Scott
- Institute of Neuroscience, Newcastle University, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
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Carta MG, Massidda D, Moro MF, Aguglia E, Balestrieri M, Caraci F, Dell'Osso L, Di Sciascio G, Drago F, Faravelli C, Hardoy MC, Calò S, Pollice R, Fortezzo A, Akiskal H. Comparing factor structure of the Mood Disorder Questionnaire (MDQ): In Italy sexual behavior is euphoric but in Asia mysterious and forbidden. J Affect Disord 2014; 155:96-103. [PMID: 24238869 DOI: 10.1016/j.jad.2013.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The introduction of screening questionnaires, such as the Mood Disorder Questionnaire (MDQ), has stimulated clinical and epidemiological studies on bipolar disorders. In this work, we studied the item response pattern of the MDQ in the Italian population and compared the results with those of the validation of the MDQ in Asian studies (Chinese and Korean), analyzing similarities and differences among the populations studied. METHODS The sample was made up of 2278 participants, distributed as follows: 56.6% females, 50.8% living in the north-central Italy, and 33.7% living in rural areas. The factor analysis was run on the matrix of tetrachoric correlations. The psychometric properties of the MDQ were also studied using the Rasch logistic model. RESULTS The parallel analysis found two significant components. The first includes symptoms referring to acceleration, danger and irritability as risky behaviors, social interaction problems and mental flow. The second includes symptoms referring to self-confidence and energy. With respect to the Korean/Chinese results, the Italian sample, item 11 ("much more sex"), appears related to self-confidence and energy, while in Asia it is connected with items expressing risky behaviors and irritability. LIMITATIONS Differences in the frequency of comorbid disorders in Asian and Italian populations should be considered. The results should be confirmed and compared with those of other populations. CONCLUSIONS Cultural differences appear to be associated with a different symptomatic expression of bipolar spectrum disorders. Future research will investigate the role of gene-environment interaction in the genesis of these differences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Audrey Fortezzo
- International Mood Center, University of California, San Diego, USA
| | - Hagop Akiskal
- International Mood Center, University of California, San Diego, USA
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Waleeprakhon P, Ittasakul P, Lotrakul M, Wisajun P, Jullagate S, Ketter TA. Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire Thai version. Neuropsychiatr Dis Treat 2014; 10:1497-502. [PMID: 25170269 PMCID: PMC4144938 DOI: 10.2147/ndt.s67842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Mood Disorder Questionnaire (MDQ) has been translated to many languages and has been used in many countries as a screening instrument for bipolar disorder. The main objective of this study was to evaluate validity of the Thai version of the MDQ as a screening instrument for bipolar disorder in a psychiatric outpatient sample, and to determine its optimum question #1 item threshold value for bipolar disorder. METHODS The English language Mood Disorder Questionnaire (MDQ) was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the prefinal version, as well as final adjustments. Two hundred and fifty major depressive disorder outpatients were further assessed by the Thai version of the MDQ and the Thai version of the Mini International Neuropsychiatric Interview (MINI). During the assessment, reliability and validity analyses, and receiver operating characteristic curve (ROC) analysis were performed. RESULTS The Thai version of the MDQ screening had adequate internal consistency (Cronbach's alpha =0.791, omega total =0.68, and omega hierarchical =0.69). The optimal question #1 item threshold value was at least five positive items, which yielded adequate sensitivity (76.5%), specificity (72.7%), positive predictive value (74.3%), and negative predictive value (75.0%). The ROC area under the curve (AUC) for this study was 0.82 (95% confidence interval: 0.70 to 0.90). CONCLUSION The Thai version of the MDQ had some useful psychometric properties for screening for bipolar disorder in a mood disorder clinic setting, with a recommended question #1 item threshold value of at least five positive items.
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Affiliation(s)
- Punjaporn Waleeprakhon
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pichai Ittasakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pattarabhorn Wisajun
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sudawan Jullagate
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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The Mood Disorder Questionnaire (MDQ) for detecting (hypo)manic episodes: its validity and impact of recall bias. J Affect Disord 2013; 151:203-8. [PMID: 23790555 DOI: 10.1016/j.jad.2013.05.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bipolar disorders often remain unrecognized in clinical practice, which may be a consequence of imprecise recall of manic symptoms earlier in life. This study will therefore examine the validity of the widely-used Mood Disorder Questionnaire (MDQ) in detecting a (hypo)manic episode and explore the impact of recall bias. METHODS As an indication of impairments in recalling manic symptoms, we examined the long-term reliability of the MDQ after two years of follow-up in a sample of 2087 persons. Then, the validity of the MDQ was tested against the gold standard of a CIDI-based DSM-IV (hypo)manic episode. Its performance was compared for detecting a lifetime episode (at T1) versus a recent episode in the past two years (at T2). RESULTS The long-term reliability of the MDQ was limited as the correct recall of individual items ranged from 44.6% to 68.8% after two years. The overall validity of the MDQ in detecting a lifetime (hypo)manic episode was limited and no adequate cut-off point with acceptable sensitivity and specificity could be identified. However, the MDQ accurately detected a recent episode with a sensitivity of 0.83 and a specificity of 0.82 for the standard and optimal cut-off point of ≥ 7. Taking into account two additional MDQ questions on clustering in time and severity of problems decreased its validity. LIMITATIONS Patients with a primary, clinical diagnosis of bipolar disorder were excluded. CONCLUSIONS The MDQ accurately detected recent (hypo)manic episodes, but imprecise recall may result in a limited performance for episodes earlier in life.
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Kessler RC, Calabrese JR, Farley PA, Gruber MJ, Jewell MA, Katon W, Keck PE, Nierenberg AA, Sampson NA, Shear MK, Shillington AC, Stein MB, Thase ME, Wittchen HU. Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders. Psychol Med 2013; 43:1625-1637. [PMID: 23075829 DOI: 10.1017/s0033291712002334] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. METHOD Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. RESULTS Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9-38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0-2.9, p = 0.09-0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81-0.86, sensitivity 68.0-80.2%, specificity 90.1-98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR- is 0.1 or less at informative thresholds for all diagnoses. CONCLUSIONS CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.
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Affiliation(s)
- R C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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Carta MG, Zairo F, Saphino D, Sevilla-Dedieu C, Moro MF, Massidda D, Kovess V. MDQ positive people's searching for effective and ineffective treatments for bipolar disorders: a screening study in France. J Affect Disord 2013; 149:84-92. [PMID: 23623740 DOI: 10.1016/j.jad.2013.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/14/2013] [Accepted: 01/14/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The objective was to estimate the rate of subjects who tested positive at a screening for bipolar disorders among the people insured by a French Health Company, and subsequently to measure treatment patterns. METHODS Cross-sectional postal survey on the "Mutuelle Générale de l'Education Nationale" (MGEN) policyholders. A self-rated questionnaire was sent by mail to 20,099 individuals randomly selected among MGEN policyholders. Tools: questionnaire on socio-demographic variables and health-care use; Mood Disorder Questionnaire (MDQ); Composite International Diagnostic Interview Short Form Self-Administered (CIDI-SA). RESULTS Responders were 10,288 (53%). The prevalence of MDQ positivity (MDQ(+)) was 3.6%. The respondents older than 65 showed the lowest frequencies. High frequencies were recorded by the people who had left work because of long term sickness and by people with invalidity. Subjects having a diagnosis of ICD-10 major depression were found to be at risk. Positive subjects had no more contacts with general practitioners than negative subjects; on the contrary they had more contacts with psychiatrists, alternative medicine professionals, psychologists, psychoanalysts, spiritual guides or welfare workers. MDQ+ subjects had a higher risk to use all kinds of psychodrugs, including antidepressants (27.7%, OR=2.7, CI95% 1.9-3.9). DISCUSSION The prevalence of MDQ(+) was similar to the surveys in the USA and Italy. The use of ADs in people with MDQ(+) and MDD diagnosis needs to be taken into account when managing the public health-care system. A large rate of positive subjects reported to have used ineffective treatments for bipolar disorders. LIMITS Relative low response rate and observational design.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy.
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Lee D, Cha B, Park CS, Kim BJ, Lee CS, Lee S. Usefulness of the combined application of the Mood Disorder Questionnaire and Bipolar Spectrum Diagnostic Scale in screening for bipolar disorder. Compr Psychiatry 2013; 54:334-40. [PMID: 23151598 DOI: 10.1016/j.comppsych.2012.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 09/14/2012] [Accepted: 10/02/2012] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to examine whether combined application of the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) is more effective than exclusive application of either tool in screening for bipolar disorder (BD). METHOD The MDQ and BSDS were completed by a total of 113 patients diagnosed with BD and major depressive disorder who were experiencing a current major depressive episode. The initial diagnosis of the subject was confirmed during a 1-year follow-up period. When each MDQ and BSDS optimal cutoff score was calculated, a modified scoring method for the MDQ that considered only one item was used to increase its performance in this population. The following three combinations of the cutoff scores for the two tools were used to screen for BD: (A) The score on either the MDQ or BSDS was greater than or equal to the cutoff score; (B) the scores on both the MDQ and BSDS were greater than or equal to the cutoff score; and (C) Reducing either cutoff score by 1 point resulted in the MDQ and BSDS scores being greater than or equal to the cutoff score. The sensitivity, specificity, positive predictive value, and negative predictive value of the three methods, the MDQ, and the BSDS were compared for screening BD. RESULTS The sensitivity and specificity of the MDQ were 0.741 and 0.844, respectively, and those for the BSDS were 0.731 and 0.742, respectively. These indicators for the combined application of the MDQ and BSDS were as follows, respectively: method A 0.901 and 0.688, method B 0.580 and 0.875, and method C 0.691 and 0.844. Method A was superior to using one measure alone as well as to methods B and C with regard to sensitivity and negative predictive values. Method A also showed a higher sensitivity for BD subtypes than did the individual tools. Compared with the use of individual instruments, method A showed a similar positive predictive value. CONCLUSION This study suggests that combined use of the MDQ and BSDS is more effective than the individual use of either of these measures in screening for BD. The data also showed that when both tools were used, the most effective interpretation of the results in terms of screening for BD was achieved when positive scores were defined as those that were equal to or greater than the cutoff for the MDQ or BSDS.
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Affiliation(s)
- Dongyun Lee
- Medical Unit of 9th Division, Korea Army, Goyang, Korea
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A Pilot Web Based Positive Parenting Intervention to Help Bipolar Parents to Improve Perceived Parenting Skills and Child Outcomes. Behav Cogn Psychother 2013; 42:283-96. [DOI: 10.1017/s135246581300009x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Children of bipolar parents are at elevated risk for psychiatric disorders including bipolar disorder. Helping bipolar parents to optimize parenting skills may improve their children's mental health outcomes. Clear evidence exists for benefits of behavioural parenting programmes, including those for depressed mothers. However, no studies have explored web-based self-directed parenting interventions for bipolar parents. Aims: The aim of this research was to conduct a pilot study of a web-based parenting intervention based on the Triple P-Positive Parenting Programme. Method: Thirty-nine self-diagnosed bipolar parents were randomly allocated to the web-based intervention or a waiting list control condition. Parents reported on their index child (entry criterion age 4–10 years old). Perceived parenting behaviour and child behaviour problems (internalizing and externalizing) were assessed at inception and 10 weeks later (at course completion). Fifteen participants (4 control group and 11 intervention group) did not provide follow-up data. Results: Levels of child behaviour problems (parent rated; Strengths and Difficulties Questionnaire) were above clinical thresholds at baseline, and problematic perceived parenting (self-rated; Parenting Scale) was at similar levels to those in previous studies of children with clinically significant emotional and behavioural problems. Parents in the intervention group reported improvements in child behaviour problems and problematic perceived parenting compared to controls. Conclusions: A web-based positive parenting intervention may have benefits for bipolar parents and their children. Initial results support improvement in child behaviour and perceived parenting. A more definitive study addressing the limitations of the current work is now called for.
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Bae SO, Kim MD, Lee JG, Seo JS, Won SH, Woo YS, Seok JH, Kim W, Kim SJ, Min KJ, Jon DI, Shin YC, Bahk WM, Yoon BH. Prevalence of bipolar spectrum disorder in Korean college students according to the K-MDQ. Neuropsychiatr Dis Treat 2013; 9:869-74. [PMID: 23836973 PMCID: PMC3699257 DOI: 10.2147/ndt.s39521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the prevalence of bipolar spectrum disorder (BSD) in the general Korean population. METHODS A sample of college students (n = 1026) was stratified to reflect geographical differences accurately in Korean college students. The Korean version of the Mood Disorder Questionnaire (K-MDQ) was administered and an epidemiological survey carried out between November 2006 and February 2007. BSD was defined as a score of at least seven K-MDQ symptoms that co-occurred and resulted in minimal or more functional impairment. RESULTS The prevalence of BSD was 18.6% (95% confidence interval [CI] 16.2-21.0) in total, being 19.8% (95% CI 16.3-23.2) in men and 17.5% (95% CI 14.2-20.8) in women. The prevalence of BSD was more common in rural dwellers than in urban dwellers (P = 0.008, chi-square test). Univariate and multivariate regression models showed that rural residence was a significant factor associated with BSD. There were significant relationships between BSD and gender, age, and socioeconomic status. CONCLUSION The prevalence of BSD found in the present study is higher than that reported by other epidemiological studies in Korea and in international studies.
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van Zaane J, van den Berg B, Draisma S, Nolen WA, van den Brink W. Screening for bipolar disorders in patients with alcohol or substance use disorders: performance of the mood disorder questionnaire. Drug Alcohol Depend 2012; 124:235-41. [PMID: 22341144 DOI: 10.1016/j.drugalcdep.2012.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/24/2011] [Accepted: 01/20/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Screening properties of the mood disorder questionnaire (MDQ) to detect bipolar disorder (BD) in patients with substance use disorders are unknown. METHODS 403 treatment seeking patients with a substance use disorder completed the MDQ and subsequently 111 MDQ positives and 59 MDQ negatives were assessed with the Structured Clinical Interview for DSM-IV to diagnose BD. In addition, given the overlap with BD symptoms, the presence of borderline personality disorder (BPD), antisocial personality disorder (APD) and attention deficit/hyperactivity disorder (ADHD), were assessed using the Diagnostic Interview Schedule and the Structured Interview for DSM-IV Personality. RESULTS Of the 170 patients with a SCID interview, 35 patients (20.6%) met criteria for a lifetime diagnosis of BD. Twenty-three patients (62.8%) with BD had a positive MDQ score and 47 of the 135 patients (34.8%) without BD had a negative MDQ score resulting in a weighted sensitivity of .43, a weighted specificity of .57, a positive predictive value of .21, a negative predictive value (NPV) of .80 and an area under the curve of .50. The area under the curve of the MDQ to detect BPD, APD, ADHD and any externalizing disorder ranged from .55 (APD) to .63 (ADHD). CONCLUSIONS The MDQ is not a suitable screening instrument for the detection of BD or other externalizing disorders but it could be used for ruling out the presence of BD in treatment seeking substance use disorder patients.
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Affiliation(s)
- Jan van Zaane
- Department of Psychiatry, EMGO institute, VU University Medical Center, Amsterdam, The Netherlands.
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An online randomised controlled trial to assess the feasibility, acceptability and potential effectiveness of ‘Living with Bipolar’: A web-based self-management intervention for Bipolar Disorder. Contemp Clin Trials 2012; 33:679-88. [DOI: 10.1016/j.cct.2012.02.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/19/2012] [Accepted: 02/17/2012] [Indexed: 02/02/2023]
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Todd NJ, Jones SH, Lobban FA. What do service users with bipolar disorder want from a web-based self-management intervention? A qualitative focus group study. Clin Psychol Psychother 2012; 20:531-43. [PMID: 22715161 DOI: 10.1002/cpp.1804] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic and recurrent severe mental health problem. A web-based self-management intervention provides the opportunity to widen access to psychological interventions. This qualitative study aims to identify what an ideal web-based intervention would look like for service users with BD. METHODS Twelve service users with BD were recruited in the UK and took part in a series of focus groups to inform and refine the development of a web-based self-management intervention. Reported here is a subset analysis of data gathered with the primary aim of identifying the needs and desires of service users for such an intervention for BD. We analysed service users' responses to questions about content, outcomes, format, barriers and support. Focus groups were transcribed verbatim, and thematic analysis was employed. RESULTS The data were ordered into four key themes: (1) gaining an awareness of and managing mood swings; (2) not just about managing mood swings: the importance of practical and interpersonal issues; (3) managing living within mood swings without losing the experience; (4) internet is the only format: freely accessible, instant and interactive; (5) professional and peer support to overcome low motivation and procrastination difficulties. LIMITATIONS The small group of participants are not representative of those living with BD. CONCLUSIONS These findings have significantly enhanced our understanding of what service users with BD want from a web-based self-management intervention and have clear implications for the future development of such approaches. KEY PRACTITIONER MESSAGE Service users desire a web-based self-management approach that gives them the techniques they need to not only manage their moods but also manage their lives alongside the disorder, including interpersonal and practical issues. Service users describe their primary outcome, not as a cure or reduction in their symptoms, but instead being able to live a fulfilling life alongside their condition. Service users see the internet as their preferred format because of the increased accessibility to evidence-based intervention. Service users discussed the potential barriers to web-based interventions including motivation and procrastination. Effective and acceptable content and low-level support provide potential solutions to these issues.
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Affiliation(s)
- Nicholas J Todd
- Spectrum Centre for Mental Health Research, Department of Health Research, Faculty of Health and Medicine, Lancaster University, UK.
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Chou CC, Lee IH, Yeh TL, Chen KC, Chen PS, Chen WT, Lu RB, Yang YK. Comparison of the validity of the Chinese versions of the Hypomania Symptom Checklist-32 (HCL-32) and Mood Disorder Questionnaire (MDQ) for the detection of bipolar disorder in medicated patients with major depressive disorder. Int J Psychiatry Clin Pract 2012; 16:132-7. [PMID: 22208673 DOI: 10.3109/13651501.2011.644563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The sensitivity and specificity of the Chinese versions of the Hypomania Symptom Checklist-32 (HCL-32) and Mood Disorder Questionnaire (MDQ) for detecting bipolar disorder in Taiwan were explored in this study. METHODS In total, 59 participants who were initially diagnosed with unipolar depression were recruited from an outpatient clinic and were screened for bipolar disorder using the HCL-32 and MDQ; each participant also underwent a diagnostic interview based on the Structured Clinical Interview for DSM-IV Axis disorder patients (SCID). RESULTS The results showed that the HCL-32 yielded the best combination of sensitivity (100%) and specificity (46.2%) at a cut-off point of 7/8, and the MDQ yielded the best combination of sensitivity (71.4%) and specificity (76.9%) at a cut-off point of 6/7. CONCLUSION The results of our study demonstrate that the HCL-32 and MDQ are of reasonable validity to distinguish between bipolar disorder and major depressive disorder. However small sample size may limit generalization of the results.
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Affiliation(s)
- Chia Chi Chou
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Parenting and the emotional and behavioural adjustment of young children in families with a parent with bipolar disorder. Behav Cogn Psychother 2012; 40:425-37. [PMID: 22414657 DOI: 10.1017/s1352465812000094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children of parents with bipolar disorder are at increased risk of disturbance. AIMS This study examined relationships between parental mood, parenting, household organization and child emotional and behavioural adjustment in families with a parent with bipolar disorder to determine areas of specific need for parenting support. METHOD 48 parents were recruited through advertisements via self-help organizations. The study was conducted online. Parental mood and activity was assessed by self-report questionnaires (CES-D, ISS, MDQ and SRM); parenting was assessed using the Parenting Scale (PS). The SDQ was used to assess the parent's view of their child's emotional and behavioural difficulties. The Confusion, Hubbub and Order Scale (CHAOS) assessed household organization. RESULTS Parents reported high levels of difficulties across all measures and scores were above clinical cut-offs on most scales. Children were reported as showing high levels of disturbance on the SDQ, including all sub-scales. Parenting and depression scores were significantly positively correlated, as were depression, parenting and CHAOS score. Regression analyses indicated that CHAOS was the strongest predictor of Total Difficulties and Emotional Symptoms on the SDQ. CONCLUSIONS Families are likely to benefit from interventions tailored to meet their parenting needs.
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Poon Y, Chung KF, Tso KC, Chang CL, Tang D. The use of Mood Disorder Questionnaire, Hypomania Checklist-32 and clinical predictors for screening previously unrecognised bipolar disorder in a general psychiatric setting. Psychiatry Res 2012; 195:111-7. [PMID: 21816486 DOI: 10.1016/j.psychres.2011.07.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 03/12/2011] [Accepted: 07/06/2011] [Indexed: 12/29/2022]
Abstract
Bipolar disorder is often unrecognised and misdiagnosed in the general psychiatric setting. This study compared the psychometric properties of the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32), examined the clinical predictors of bipolar disorder and determined the best approach for screening previously unrecognised bipolar disorder in a general psychiatric clinic. A random sample of 340 non-psychotic outpatients with no previous diagnosis of bipolar disorder completed the MDQ and HCL-32 during their scheduled clinic visits. Mood and alcohol/substance use disorders were reassessed using a telephone-based Structured Clinical Interview for DSM-IV. We found that the HCL-32 had better psychometric performance and discriminatory capacity than the MDQ. The HCL-32's internal consistency and 4-week test-retest reliability were higher. The area under the curve was also greater than that of the MDQ at various clustering and impairment criteria. The optimal cut-off of the MDQ was co-occurrence of four symptoms with omission of the impairment criterion; for the HCL-32, it was 11 affirmative responses. Multivariable logistic regression found that bipolar family history was associated with an increased risk of bipolar disorder (odds ratio=4.93). The study showed that simultaneous use of the HCL-32 and bipolar family history was the best approach for detecting previously unrecognised bipolar disorder.
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Affiliation(s)
- Yvette Poon
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
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Gan Z, Han Z, Li K, Diao F, Wu X, Guan N, Zhang J. Validation of the Chinese version of the "Mood Disorder Questionnaire" for screening bipolar disorder among patients with a current depressive episode. BMC Psychiatry 2012; 12:8. [PMID: 22293033 PMCID: PMC3299660 DOI: 10.1186/1471-244x-12-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 01/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Mood Disorder Questionnaire (MDQ) is a well-recognized screening tool for bipolar disorder, but its Chinese version needs further validation. This study aims to measure the accuracy of the Chinese version of the MDQ as a screening instrument for bipolar disorder (BPD) in a group of patients with a current major depressive episode. METHODS 142 consecutive patients with an initial DSM-IV-TR diagnosis of a major depressive episode were screened for BPD using the Chinese translation of the MDQ and followed up for one year. The final diagnosis, determined by a special committee consisting of three trained senior psychiatrists, was used as a 'gold standard' and ROC was plotted to evaluate the performance of the MDQ. The optimal cut-off was chosen by maximizing the Younden's index. RESULTS Of the 142 patients, 122 (85.9%) finished the one year follow-up. On the basis of a semi-structured clinical interview 48.4% (59/122) received a diagnosis of unipolar depression (UPD), 36.9% (45/122) BPDII and 14.8% (18/122) BPDI. At the end of the one year follow-up,9 moved from UPD to BPD, 2 from BPDII to UPD, 1 from BPDII to BPDI, the overall rate of initial misdiagnosis was 16.4%. MDQ showed a good accuracy for BPD: the optimal cut-off was 4, with a sensitivity of 0.72 and a specificity of 0.73. When BPDII and BPDI were calculated independently, the optimal cut-off for BPDII was 4, with a sensitivity of 0.70 and a specificity of 0.73; while the optimal cut-off for BPDI was 5, with a sensitivity of 0.67 and a specificity of 0.86. CONCLUSIONS Our results show that the Chinese version of MDQ is a valid tool for screening BPD in a group of patients with current depressive episode on the Chinese mainland.
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Affiliation(s)
- Zhaoyu Gan
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Zili Han
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Kanglai Li
- VIP Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Feici Diao
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Xiaoli Wu
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Nianhong Guan
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
| | - Jinbei Zhang
- Psychiatry Department, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
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TODD NICHOLASJ, JONES STEVENH, LOBBAN FIONAA. “Recovery” in bipolar disorder: How can service users be supported through a self-management intervention? A qualitative focus group study. J Ment Health 2011; 21:114-26. [DOI: 10.3109/09638237.2011.621471] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yang HC, Yuan CM, Liu TB, Li LJ, Peng HJ, Rong H, Liao CP, Shen QJ, Fang YR. Validity of the Chinese version Mood Disorder Questionnaire (MDQ) and the optimal cutoff screening bipolar disorders. Psychiatry Res 2011; 189:446-50. [PMID: 21402414 DOI: 10.1016/j.psychres.2011.02.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/27/2011] [Accepted: 02/04/2011] [Indexed: 12/01/2022]
Abstract
To investigate the validity of the Chinese version of Mood Disorder Questionnaire (C-MDQ) in China. Patients with bipolar disorders (BP, N=284) and patients with unipolar depressive disorder (UP, N=134) were assessed with the C-MDQ. The Eigenvalues of the first two factors were 3.15 and 2.09, respectively. The Cronbach's alpha of the C-MDQ was 0.79. The frequency of positive responses of UP patients was significantly lower than those of BP patients for 12 items except the seventh item. A C-MDQ screening score of seven or more was the best cutoff between BP and UP. The C-MDQ could distinguish between bipolar II disorder (BP-II) and UP, and the best cutoff was five. A cutoff of five had a sensitivity of 0.80 and a specificity of 0.54 between BP and UP. This study demonstrated the good validity of C-MDQ in China. The best cutoff between BP-II and UP can be regarded as the optimal cutoff between BP and UP to improve the sensitivity of screening for BP-II. Five should be the optimal cutoff between the BP and UP when only the 13 items of the questionnaire are used in China.
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Affiliation(s)
- Hai-Chen Yang
- Mental Health Institute, the 2nd Xiangya Hospital, Central South University, Changsha, PR China.
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Carta MG, Tondo L, Balestrieri M, Caraci F, dell'Osso L, Di Sciascio G, Faravelli C, Hardoy MC, Lecca ME, Moro MF, Bhat KM, Casacchia M, Drago F. Sub-threshold depression and antidepressants use in a community sample: searching anxiety and finding bipolar disorder. BMC Psychiatry 2011; 11:164. [PMID: 21985128 PMCID: PMC3206417 DOI: 10.1186/1471-244x-11-164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Accepted: 10/10/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To determine the use of antidepressants (ADs) in people with sub-threshold depression (SD); the lifetime prevalence of mania and hypomania in SD and the link between ADs use, bipolarity and anxiety disorders in SD. STUDY DESIGN community survey. STUDY POPULATION samples randomly drawn, after stratification from the adult population of municipal records. SAMPLE SIZE 4999 people from seven areas within six Italian regions. Tools: Questionnaire on psychotropic drug consumption, prescription; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Hamilton Depression Rating Scale (HAM-D); Mood Disorder Questionnaire (MDQ); Short Form Health Survey (SF-12). SD definition: HAM-D > 10 without lifetime diagnosis of Depressive Episode (DE). RESULTS SD point prevalence is 5.0%. The lifetime prevalence of mania and hypomania episodes in SD is 7.3%. Benzodiazepines (BDZ) consumption in SD is 24.1%, followed by ADs (19.7%). In SD, positive for MDQ and comorbidity with Panic Disorder (PD) or Generalized Anxiety Disorders (GAD) are associated with ADs use, whereas the association between a positive MDQ and ADs use, without a diagnosis of PD or GAD, is not significant. Only in people with DE the well-being (SF-12) is higher among those using first-line antidepressants compared to those not using any medication. In people with SD no significant differences were found in terms of SF-12 score according to drug use. CONCLUSIONS This study suggests caution in prescribing ADs to people with SD. In people with concomitant anxiety disorders and SD, it should be mandatory to perform a well-designed assessment and evaluate the presence of previous manic or hypomanic symptoms prior to prescribing ADs.
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Affiliation(s)
- Mauro G Carta
- Department of Public Health, University of Cagliari, Cagliari, Italy.
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Matteo Balestrieri
- Inter-University Center for Behavioural Neurosciences, DPMSC, University of Udine, Udine, Italy
| | - Filippo Caraci
- Department of Drug Sciences, University of Catania, Italy
| | - Liliana dell'Osso
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy
| | - Guido Di Sciascio
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Carlo Faravelli
- Department of Neurology and Psychiatry, Florence University, Firenze, Italy
| | - Maria Carolina Hardoy
- Department of Public Health, University of Cagliari, Cagliari, Italy,Department of Psychiatry, Reald University, Vlore, Albania
| | - Maria E Lecca
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | | | - Krishna M Bhat
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Massimo Casacchia
- Department of Science of Health, University of L'Aquila, L'Aquila, Italy
| | - Filippo Drago
- Department of Drug Sciences, University of Catania, Italy
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Mitchell PB, Frankland A, Hadzi-Pavlovic D, Roberts G, Corry J, Wright A, Loo CK, Breakspear M. Comparison of depressive episodes in bipolar disorder and in major depressive disorder within bipolar disorder pedigrees. Br J Psychiatry 2011; 199:303-9. [PMID: 21508436 DOI: 10.1192/bjp.bp.110.088823] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although genetic epidemiological studies have confirmed increased rates of major depressive disorder among the relatives of people with bipolar affective disorder, no report has compared the clinical characteristics of depression between these two groups. AIMS To compare clinical features of depressive episodes across participants with major depressive disorder and bipolar disorder from within bipolar disorder pedigrees, and assess the utility of a recently proposed probabilistic approach to distinguishing bipolar from unipolar depression. A secondary aim was to identify subgroups within the relatives with major depression potentially indicative of 'genetic' and 'sporadic' subgroups. METHOD Patients with bipolar disorder types 1 and 2 (n = 246) and patients with major depressive disorder from bipolar pedigrees (n = 120) were assessed using the Diagnostic Interview for Genetic Studies. Logistic regression was used to identify distinguishing clinical features and assess the utility of the probabilistic approach. Hierarchical cluster analysis was used to identify subgroups within the major depressive disorder sample. RESULTS Bipolar depression was characterised by significantly higher rates of psychomotor retardation, difficulty thinking, early morning awakening, morning worsening and psychotic features. Depending on the threshold employed, the probabilistic approach yielded a positive predictive value ranging from 74% to 82%. Two clusters within the major depressive disorder sample were found, one of which demonstrated features characteristic of bipolar depression, suggesting a possible 'genetic' subgroup. CONCLUSIONS A number of previously identified clinical differences between unipolar and bipolar depression were confirmed among participants from within bipolar disorder pedigrees. Preliminary validation of the probabilistic approach in differentiating between unipolar and bipolar depression is consistent with dimensional distinctions between the two disorders and offers clinical utility in identifying patients who may warrant further assessment for bipolarity. The major depressive disorder clusters potentially reflect genetic and sporadic subgroups which, if replicated independently, might enable an improved phenotypic definition of underlying bipolarity in genetic analyses.
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Affiliation(s)
- Philip B Mitchell
- UNSW School of Psychiatry, Prince of Wales Hospital, Randwick, Australia.
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Zimmerman M, Galione JN. Screening for bipolar disorder with the Mood Disorders Questionnaire: a review. Harv Rev Psychiatry 2011; 19:219-28. [PMID: 21916824 DOI: 10.3109/10673229.2011.614101] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Several research reports have suggested that bipolar disorder is underrecognized. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. The Mood Disorders Questionnaire (MDQ) has been the most widely studied screening instrument for bipolar disorder, with nearly two dozen published reports on its performance. We reviewed the literature on the MDQ's performance to assess its utility as a screening instrument. METHODS We conducted a Medline search on the terms Mood Disorders Questionnaire, MDQ, screening AND bipolar disorder, and recognition AND bipolar disorder. Only studies of adults were included. RESULTS Across all studies the sensitivity of the MDQ was 61.3%; specificity, 87.5%; positive predictive value, 58.0%; and negative predictive value, 88.9%. Compared to the studies using the MDQ for psychiatric outpatients, studies using it in the general population found it to have much lower sensitivity and positive predictive value, and higher specificity and negative predictive value. The MDQ's sensitivity was higher in detecting bipolar I disorder than bipolar II disorder (66.3% vs. 38.6%). Lowering the threshold to identify cases markedly improved the MDQ's sensitivity, with only a modest reduction in specificity. Studies of the best symptom cutoff to identify cases have produced inconsistent findings. CONCLUSIONS The MDQ's performance depends upon the setting in which it is used, the threshold to identify caseness, and the subtype of bipolar disorder examined. Conceptual issues in the use of a bipolar disorder screening questionnaire are discussed, and questions are raised about the clinical value of a self-report screening scale for bipolar disorder. Based on current available evidence, routine clinical use of the MDQ cannot be recommended because of the absence of studies simultaneously examining both the potential benefits (e.g., improved detection) and costs (e.g., overdiagnosis) of screening.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI 02905, USA.
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Sharma V, Xie B. Screening for postpartum bipolar disorder: validation of the Mood Disorder Questionnaire. J Affect Disord 2011; 131:408-11. [PMID: 21185082 DOI: 10.1016/j.jad.2010.11.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/10/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite the prevalent nature of postpartum depression in women with bipolar disorder, there are currently no screening instruments designed specifically for bipolar disorder in the postpartum period. METHODS Women with histories of major depressive disorder or bipolar disorder (type I or II) attending an outpatient perinatal clinic were administered the Mood Disorder Questionnaire during the first month after delivery. An experienced research coordinator, blind to the Mood Disorder Questionnaire results, conducted a face to face diagnostic interview using the Structured Clinical Interview for DSM-IV. RESULTS A total of 57 women with bipolar disorder (30 with bipolar II disorder and 27 with bipolar I disorder) and 68 women with major depressive disorder completed the Mood Disorder Questionnaire between two to four weeks after delivery. The traditional scoring criteria yielded a sensitivity of 75.44% [95%CI: 62.24%-85.87%] and a specificity of 86.76% [95%CI: 76.36%-93.77%]. The optimal cut-off score was eight or more endorsed symptoms without the supplementary questions (a sensitivity of 87.72% [95% CI: 76.32%-94.92%] and a specificity of 85.29% [95%CI: 74.61%-92.72%]). CONCLUSIONS The Mood Disorder Questionnaire with alternate scoring is a useful screening instrument for bipolar disorder in the postpartum period.
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Rouillon F, Gasquet I, Garay RP, Lancrenon S. Screening for bipolar disorder in patients consulting general practitioners in France. J Affect Disord 2011; 130:492-5. [PMID: 21109306 DOI: 10.1016/j.jad.2010.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 10/19/2010] [Accepted: 10/19/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recently, an unexpected 3-fold higher screen positive rate for bipolar disorder was found among low-income American patients who were seeking primary care at an urban general medicine clinic as compared with the general population of the United States. The social health system in France is characterized by its open access, where most bipolar patients ask for care and where the major problem is diagnosis by the general practitioner (GP). Therefore, we investigated the prevalence of bipolar disorder among patients attending GP offices in France. METHODS This observational, single visit survey was performed among 10,265 patients (47.2±18.0 years old, 40% males) attending primary care in 95 GP offices in France. The participating GP made available an MDQ-French version questionnaire to all patients aged 15 years and over, going to his office during a full week, independently of the reason for medical consulting. In addition to the MDQ-French version questionnaire, patients answered items concerning sex, age, professional situation and marital state. RESULTS One thousand twenty-five (1025) patients did not complete the questionnaire and were excluded from the analysis. Of the 9240 analyzed questionnaires, 8.3% were classified as MDQ positives (MDQ+). MDQ+ patients were significantly younger (41.6 years versus 46.6 years for MDQ- patients, p<0.0001), more frequently divorced or separated (19.2% versus 8.6%, p<0.0001) and more frequently unemployed (15.2% versus 6.4%, p<0.0001). The gender distribution was not significantly different between the two groups. CONCLUSIONS The prevalence of receiving positive screening results for bipolar disease in 9240 patients consulting 95 randomly selected french general practitioners was 8.3%, as assessed by the MDQ questionnaire. This is a similar and unexpected high value as that reported for low-income american patients (9.8%). Besides low socioeconomic status, other factors should explain the high screen positive rate for bipolar disorder in patients attending primary care.
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Zimmerman M, Galione JN, Chelminski I, Young D, Ruggero CJ. Performance of the Bipolar Spectrum Diagnostic Scale in psychiatric outpatients. Bipolar Disord 2010; 12:528-38. [PMID: 20712754 DOI: 10.1111/j.1399-5618.2010.00840.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Recent research has suggested that bipolar disorder, when defined to include milder variants such as bipolar II disorder and bipolar disorder not otherwise specified (NOS), is more prevalent than had been previously reported and often underrecognized. Recommendations for improving the detection of bipolar disorder have included careful clinical evaluations inquiring about a history of mania and hypomania and the use of screening questionnaires. The Bipolar Spectrum Diagnostic Scale (BSDS) was designed to be particularly sensitive to the milder variants of bipolar disorder. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the operating characteristics of the BSDS in a large sample of psychiatric outpatients presenting for treatment. METHODS A total of 1,100 psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV and asked to complete the BSDS. Missing data on the BSDS reduced the sample size to 961, approximately 10% (n = 90) of whom were diagnosed with bipolar disorder. RESULTS The sensitivity of the BSDS was similar for bipolar I disorder, bipolar II disorder, and bipolar disorder NOS/cyclothymia. A receiver operating curve (ROC) analysis indicated that cutoffs of 11 and 12 maximized the sum of sensitivity and specificity for the entire group of patients with bipolar disorder (area under curve = 0.80, p < 0.001). The cutoff point associated with 90% sensitivity for the entire sample of patients with bipolar disorder was 8. At this cutoff the specificity of the scale was 51.1% and positive predictive value was 16.0%. We compared the patients with and without bipolar disorder on each of the BSDS symptom items. The odds ratios were higher for the items assessing hypomanic/manic symptoms than items assessing depressive symptoms. We therefore examined the performance of a subscale composed only of the hypomania/mania items. The area under the curve in the ROC analysis was nearly identical to that of the entire scale (0.81, p < 0.001). CONCLUSIONS With its high negative predictive value, the BSDS was excellent at ruling out a diagnosis of bipolar disorder; however, the low positive predictive value indicates that it is not good at ruling in the diagnosis. These data raise questions about the use of the BSDS as a screening measure in routine clinical psychiatric practice.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.
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