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Dmitriev MN, Baeva DO, Slavgorodskaya MS. [A clinical case of the new-onset bipolar affective disorder in the postcovid period]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:125-129. [PMID: 38529873 DOI: 10.17116/jnevro2024124031125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
A large number of people who have had COVID-19 have developed mental symptoms and mood disorders. Anxiety and depression prevail among affective pathology. Evidence is accumulating that the Sars-CoV-2 virus can induce mania or hypomania in people with no personal psychopathological history. Some clinical, anamnestic and paraclinical patterns of new-onset mania and hypomania have been found. In cases of severe manic symptoms, it is possible to quickly assume the occurrence of bipolar affective disorder. The predominance of depressive and anxiety syndromes in the long-term disease and the presence of vivid vegetative symptoms can mask brief and syndromally incomplete episodes of hypomania, which distorts the understanding of the disease as a bipolar disorder. This article presents such a clinical case of the occurrence of bipolar affective disorder in a patient who had COVID-19 with an asymptomatic course. Approaches to rational diagnosis and treatment are discussed.
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Affiliation(s)
- M N Dmitriev
- Rostov State Medical University, Rostov-on-Don, Russia
| | - D O Baeva
- Rostov State Medical University, Rostov-on-Don, Russia
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Zhang X, Li W, Zhao N, Cheung T, Ungvari GS, Wang G, Xiang YT, Angst J. Use of the 33-Item Hypomania Checklist (HCL-33) to Distinguish Bipolar Disorder From Major Depressive Disorder in Older Adults. J Geriatr Psychiatry Neurol 2022; 35:410-417. [PMID: 34044653 DOI: 10.1177/08919887211016065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD) in older patients. This study examined the psychometric properties of the 33-item Hypomania Checklist (HCL-33) and its accuracy to differentiate BD from MDD among older adults. METHOD A total of 215 depressed older patients were recruited; 107 were diagnosed with BD (71 with BD-type I and 36 with BD-type II) and 108 with MDD. Principal components analysis (PCA) was used to explore the factor structure of the HCL-33. Cronbach's alpha was calculated to test the internal consistency. Intra-class correlation coefficient (ICC) was used to measure test-retest reliability. The receiver operating characteristic (ROC) analysis was used to generate the optimal cut-off value to differentiate between BD and MDD. RESULTS Two factors were identified in the PCA analysis accounting for 33.9% of the total variance. The Cronbach's alpha value for the HCL-33 was 0.912, with 0.922 for factor I and 0.664 for factor II. The test-retest reliability was excellent (ICC: 0.891). The optimal cut-off of the HCL-33 total score for discriminating between MDD and BD was 14, with a sensitivity of 88.8% and specificity of 82.4%. CONCLUSION The HCL-33 had satisfactory reliability and validity and could be used to distinguish BD from MDD in older adults.
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Affiliation(s)
- Xinqiao Zhang
- 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
| | - Wen Li
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Na Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.,University of Notre Dame Australia, Fremantle, Australia
| | - 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, Department of Public Health and Medicinal Administration, & Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Jules Angst
- Zurich University Psychiatric Hospital, Zurich, Switzerland
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Zhang Y, Li W, Zhang WY, He F, Pan HP, Cheung T, Ungvari GS, Li S, Xiang YT, Angst J. Validation of the 33-item Hypomania Checklist (HCL-33) in screening adolescents with bipolar disorder. J Affect Disord 2021; 281:786-791. [PMID: 33229023 DOI: 10.1016/j.jad.2020.11.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/13/2020] [Accepted: 11/08/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adolescents with bipolar disorder (BD) are often misdiagnosed with major depressive disorder (MDD), which delays the introduction of appropriate treatment resulting in adverse outcomes. This study examined the psychometric properties of the 33-item Hypomania Checklist (HCL-33) and its accuracy to distinguish BD from MDD in adolescents. METHOD A total of 248 participants (171 MDD and 77 BD patients) were recruited from a university-affiliated hospital in China. Depression was measured with the Hamilton Depression Rating Scale. All participants completed the assessment with the HCL-33. RESULTS A two-factor structure was found for the HCL-33, which explained 30.2% of the total variance. The internal consistency and split half reliability of the total scale were acceptable. The optimal cut-off value of 18 generated sensitivity of 0.52 and specificity of 0.73 for distinguishing BD from MDD. CONCLUSION The HCL-33 seems to be a useful screening instrument to distinguish BD from depressed adolescents. However, considering certain less than robust psychometric properties, the HCL-33 needs to be modified and further refined for adolescent patients.
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Affiliation(s)
- Yao Zhang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Wu-Yang Zhang
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fan He
- 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
| | - Hong-Ping Pan
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia; University of Notre Dame Australia, Fremantle, Australia
| | - Shuying Li
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China; Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China.
| | - Jules Angst
- Zurich University Psychiatric Hospital, Lenggstrasse 31, P.O. Box 1931, 8032 Zurich, Switzerland
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Koukopoulos AE, De Chiara L, Simonetti A, Kotzalidis GD, Janiri D, Manfredi G, Angeletti G, Sani G. The Koukopoulos mixed depression rating scale (KMDRS) and the assessment of mixed symptoms during the perinatal period. J Affect Disord 2021; 281:980-988. [PMID: 33039189 DOI: 10.1016/j.jad.2020.08.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/05/2020] [Accepted: 08/24/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Mixed symptoms in depression may underlie bipolar diathesis rather than unipolarity. Uncovering mixed depression (MxD) is crucial for appropriate management, especially in the perinatal period, as it may affect treatment planning and impact future child development. We used a scale specific for identifying MxD and tested its validity in pregnant and postpartum women with depression. METHODS Women developing a major depressive episode (MDE) during their perinatal period extending from pregnancy to one year postpartum from November-2012 through June-2019 were assessed with BPRS-18, EPDS, CGI-S, GAF, HAM-A, HAM-D, Koukopoulos' Mixed Depression Rating Scale (KMDRS), TEMPS, and YMRS. They were classified, based on KMDRS criteria, as with mixed (MxD) or without (nonMxD) mixed symptoms. We conducted ROC analysis and performed factor analysis of the KMDRS. RESULTS Of 45 included, MxD (N = 19) were biased towards diagnosis of bipolar disorder and nonMxD (N = 26) towards major depressive disorder. Other sociodemographic variables did not differ significantly between MxD and nonMxD. MxD scored higher on total YMRS, BPRS, and KMDRS, and on KMDRS-6 Subjective Feelings of Irritability and KMDRS-12 Suicidal Impulsiveness items. The KMDRS correlated in the entire sample, in MxD and nonMxD, with the YMRS and the BPRS, while correlating with the HAM-D in nonMxD only. The KMDRS showed acceptable AUC distribution, with a 68% sensitivity and 58% specificity. Best-fit was three-factor-structure, explaining 54.66% of cumulative variance. LIMITATIONS Small sample and cross-sectional design. CONCLUSIONS The KMDRS is fit for investigating MxD along with the YMRS and the BPRS in perinatal women with a MDE.
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Affiliation(s)
- Alexia E Koukopoulos
- Azienda Ospedaliera Universitaria Policlinico Umberto I, Viale dell'Università 30, Rome 00185, Italy; Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy.
| | - Lavinia De Chiara
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy; Center for Prevention and Treatment of Women's Mental Health at Sant'Andrea Hospital of Rome, Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Alessio Simonetti
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy; Department of Human Neurosciences, Sapienza University, Viale dell'Università 30, Rome 00185, Italy; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Georgios D Kotzalidis
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy; Center for Prevention and Treatment of Women's Mental Health at Sant'Andrea Hospital of Rome, Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Delfina Janiri
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; Department of Human Neurosciences, Sapienza University, Viale dell'Università 30, Rome 00185, Italy
| | - Giovanni Manfredi
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; Center for Prevention and Treatment of Women's Mental Health at Sant'Andrea Hospital of Rome, Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy; UOC Psichiatria, Day Hospital, Azienda Ospedaliera-Universitaria Sant'Andrea, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Gloria Angeletti
- Centro Lucio Bini, Via Crescenzio 42, Rome 00193, Italy; Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy; Center for Prevention and Treatment of Women's Mental Health at Sant'Andrea Hospital of Rome, Sapienza University, Via di Grottarossa 1035-1039, Rome 00189, Italy
| | - Gabriele Sani
- Departmentof Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Largo F. Vito 1, Rome 00168, Italy; Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Du YL, Hu JB, Huang TT, Lai JB, Ng CH, Zhang WH, Li C, Xu ZY, Zhou HT, Ruan LM, Xu Y, Hu SH. Psychometric properties of the Clinically Useful Depression Outcome Scale supplemented with DSM-5 Mixed subtype questionnaire in Chinese patients with mood disorders. J Affect Disord 2021; 279:53-58. [PMID: 33038700 DOI: 10.1016/j.jad.2020.09.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/22/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND With the modification of DSM-5 mixed features specifier, a brief scale to screen mixed features in patients with mood disorders is needed in clinical practice. This study aimed to explore the psychometric properties of the Chinese version of the Clinically Useful Depression Outcome Scale supplemented with DSM-5 Mixed subtype (CUDOS-M-C) for the Chinese patients with mood disorders. METHODS Overall, 300 patients with major depressive episode were recruited. All participants were assessed using CUDOS-M-C, Young Mania Rating Scale, Hamilton Anxiety Scale and Montgomery-Asberg Depression Rating Scale. The receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cut-off values of CUDOS-M-C score. The reliability and validity of CUDOS-M-C were examined using Cronbach's alpha, intraclass correlation coefficient (ICC) and principal component analysis (PCA). RESULTS The results of PCA indicated two-factor structure as the best solution for CUDOS-M-C, which explained 54.82% of cumulative variance. The Cronbach's alpha was 0.892 and the ICC was 0.853. The area under the ROC curve of the CUDOS-M-C for participants with mixed depression was 0.927 (p<0.001) and the suitable cut-off value was 8, with a sensitivity of 91.6% and specificity of 79.9%. LIMITATIONS Most of the patients were recruited from eastern China and further research with larger sample is warranted. And this study did not perform confirmatory factor analysis to identify the generalization of factor structure of CUDOS-M-C. Besides, the study performed the test-retest reliability of CUDOS-M-C and further analysis is needed to ascertain the patient's post-treatment changes. CONCLUSION The CUDOS-M-C demonstrated to have satisfactory psychometric properties as a self-report scale, and could be applied to screen patients with mixed depression in clinical practice.
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Affiliation(s)
- Yan-Li Du
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian-Bo Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Mental Disorder's Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Ting-Ting Huang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jian-Bo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Mental Disorder's Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Wei-Hua Zhang
- Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Chao Li
- Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Zhong-Ya Xu
- Department of Psychiatry, Jiaxing Kangci Hospital, Jiaxing, China
| | - He-Tong Zhou
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Mental Disorder's Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Lie-Min Ruan
- Department of Mental Health, Ningbo First Hospital, Ningbo, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Mental Disorder's Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China
| | - Shao-Hua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Mental Disorder's Management of Zhejiang Province, No. 79, Qingchun Road, Hangzhou 310003, China.
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6
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Zhang X, Li W, Zhao N, Jin Y, Cheung T, Ungvari GS, Cui XL, Wang G, Xiang YT, Angst J. Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients. Front Psychiatry 2021; 12:727992. [PMID: 34867517 PMCID: PMC8634141 DOI: 10.3389/fpsyt.2021.727992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) is common in depressed older adults. The self-rated HCL-33 and its external assessment version (HCL-33-EA) have been developed to screen for hypomanic symptoms. This study compared the screening ability of these two instruments to discriminate BD from MDD. Methods: A total of 215 patients (107 with BD and 108 with MDD) and their carers were recruited. Patients and their carers completed the HCL-33 and HCL-33-EA, respectively. The consistency of the total score and the positive response to each item between the two scales was calculated with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient separately. Receiver operating characteristics (ROC) curves were drawn for both instruments. The optimal cut-off points were determined according to the maximum Youden's Index. The areas under the ROC curve (AUC) of the HCL-33 and HCL-33-EA were calculated separately and compared. The sensitivity and specificity at the optimal cut-off values were also calculated separately for the HCL-33 and HCL-33-EA. Results: The intraclass correlation coefficient (ICC) between the total scores of the HCL-33 and HCL-33-EA was 0.823 (95% CI = 0.774-0.862). The positive response rate on all items showed high agreement between the two instruments. ROC curve analysis demonstrated that the total scores of both HCL-33 and HCL-33-EA differentiated well between MDD and BD, while there was no significant difference in the AUCs between the two scales (Z = 0.422, P = 0.673). The optimal cutoff values for the HCL-33 and HCL-33-EA were 14 and 12, respectively. With the optimal cutoff value, the sensitivities of the HCL-33 and HCL-33-EA were 88.8% and 93.5%, and their specificities were 82.4% and 79.6%. Conclusion: Both the HCL-33 and HCL-33-EA had good screening ability for discriminating BD from MDD in depressed older adults.
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Affiliation(s)
- Xinqiao Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Wen Li
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Na Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao SAR, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia.,University of Notre Dame Australia, Fremantle, WA, Australia
| | - Xi-Ling Cui
- Department of Business Administration, Hong Kong Shue Yan University, North Point, Hong Kong SAR, China
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao SAR, China
| | - Jules Angst
- Zurich University Psychiatric Hospital, Zurich, Switzerland
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Abstract
Bipolar spectrum disorders encompass heterogeneous clinical manifestations and comorbidities. A latent class analysis (LCA) was performed in 1846 subjects who experienced an episode of abnormally elevated or irritable mood to identify homogeneous groups of subjects, based on the distribution of 11 manic and 7 psychotic symptoms. LCA identified five classes: 1) two classes with irritability and with low and high level of psychosis (respectively "irritable," 29.1% of the sample, and "irritable-psychotic," 16.2%); 2) a class with expansive mood and hyperactivity ("expansive-hyperactive," 12.7%); and 3) two classes with manic symptoms and high and low level of psychosis ("manic-psychotic," 15.0%, and "manic," 27.2%). "Irritable" displayed lower rates of depressive episode, panic, and substance use disorders. Manic-psychotic displayed higher rates of depressive episode, panic, generalized anxiety, and substance use disorders. Use of mental health treatment more frequent in manic-psychotic and manic classes. Five classes of bipolar spectrum disorders were characterized by different sociodemographic and clinical patterns.
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Meyer TD, Crist N, La Rosa N, Ye B, Soares JC, Bauer IE. Are existing self-ratings of acute manic symptoms in adults reliable and valid?-A systematic review. Bipolar Disord 2020; 22:558-568. [PMID: 32232950 DOI: 10.1111/bdi.12906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Depression research historically uses both self- and clinician ratings of symptoms with significant and substantial correlations. It is often assumed that manic patients lack insight and cannot accurately report their symptoms. This delayed the development of self-rating scales for mania, but several scales now exist and are used in research. Our objective is to systematically review the literature to identify existing self-ratings of symptoms of (hypo)mania and to evaluate their psychometric properties. METHODS PubMed, Web of Knowledge, and Ovid were searched up until June 2018 using the keywords: "(hypo)mania," "self-report," and "mood disorder" to identify papers which included data on the validity and reliability of self-rating scales for (hypo)mania in samples including patients with bipolar disorder. RESULTS We identified 55 papers reporting on 16 different self-rating scales claiming to assess (hypo)manic symptoms or states. This included single item scales, but also some with over 40 items. Three of the scales, the Internal State Scale (ISS), Altman Self-Rating Mania Scale (ASRM), and Self-Report Manic Inventory (SRMI), provided data about reliability and/or validity in more than three independent studies. Validity was mostly assessed by comparing group means from individuals in different mood states and sometimes by correlation to clinician ratings of mania. CONCLUSIONS ASRM, ISS, and SRMI are promising self-rating tools for (hypo)mania to be used in clinical contexts. Future studies are, however, needed to further validate these measures; for example, their associations between each other and sensitivity to change, especially if they are meant to be outcome measures in studies.
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Affiliation(s)
- Thomas D Meyer
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Nicholas Crist
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Nikki La Rosa
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA.,Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Biyu Ye
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA.,The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jair C Soares
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
| | - Isabelle E Bauer
- McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, University of Texas HSC at Houston, Houston, TX, USA
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9
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Wang YY, Xu DD, Feng Y, Chow IHI, Ng CH, Ungvari GS, Wang G, Xiang YT. Short versions of the 32-item Hypomania Checklist: A systematic review. Perspect Psychiatr Care 2020; 56:102-111. [PMID: 31066059 DOI: 10.1111/ppc.12388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Bipolar disorder (BD) is frequently misdiagnosed, which can lead to negative outcomes. The 32-item Hypomania Checklist (HCL-32) is one of the most widely used self-reported screening instruments for hypomanic symptoms, which has several short versions. This systematic review examined the psychometric properties of HCL-32 short versions. DESIGN AND METHODS Five international databases were systematically and independently searched by two researchers for studies that developed the HCL short versions. Basic demographic and clinical characteristics and the psychometric properties of the HCL short versions were recorded. FINDINGS Eighteen studies were identified. The majority of the HCL short versions showed satisfactory to good psychometric properties. PRACTICE IMPLICATIONS Validated HCL short versions with satisfactory psychometric properties may be helpful in screening for BD.
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Affiliation(s)
- Yuan-Yuan Wang
- Division of Psychology, 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
- School of Food Engineering, Faculty of Science, Harbin University, Heilongjiang, China
| | - Yuan Feng
- 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, Beijing, China
| | - Ines H I Chow
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- Division of Psychiatry, University of Notre Dame Australia/Graylands Hospital, Perth, Australia.,Division of Psychiatry, University of Western Australia, Perth, Australia
| | - 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, 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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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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Weiner L, Weibel S, de Sousa Gurgel W, Keizer I, Gex-Fabry M, Giersch A, Bertschy G. Measuring racing thoughts in healthy individuals: The Racing and Crowded Thoughts Questionnaire (RCTQ). Compr Psychiatry 2018; 82:37-44. [PMID: 29407357 DOI: 10.1016/j.comppsych.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/04/2018] [Accepted: 01/11/2018] [Indexed: 02/05/2023] Open
Abstract
Racing thoughts refer to an acceleration and overproduction of thoughts, which have been associated with manic and mixed episodes. Phenomenology distinguishes 'crowded' from 'racing' thoughts, associated with mixed depression and mania, respectively. Recent data suggest racing thoughts might also be present in healthy individuals with sub-affective traits and symptoms. We investigated this assumption, with a 34-item self-rating scale, the Racing and Crowded Thoughts Questionnaire (RCTQ), and evaluated its reliability, factor structure, and concurrent validity. 197 healthy individuals completed the RCTQ, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - autoquestionnaire (TEMPS-A), the Beck Depression Inventory (BDI), the Altman Self-Rating Mania scale (ASRM), and the Ruminative Response Scale (RRS). Exploratory factor analysis yielded a three-factor solution, labeled 'thought overactivation', 'burden of thought overactivation', and 'thought overexcitability'. Internal consistency of each of the three subscales of the RCTQ was excellent. The TEMPS-A cyclothymia score was associated with the three factors, suggesting good concurrent validity. The 'thought activation' subscale was selectively associated with current elated mood and included items conveying both the notion of increased amount and velocity of thoughts, whereas the 'burden of thought overactivation' subscale was associated with current low mood. The 'thought overexcitability' subscale included items conveying the notion of distractibility, and was associated with both elated and low mood. Rumination was not a significant predictor of RCTQ subscores. These results suggest that the RCTQ has good psychometric properties. Racing and crowded thoughts, as measured by the RCTQ, are a multi-faceted phenomenon, distinct from rumination, and particularly associated with mood instability even in its milder forms.
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Affiliation(s)
- Luisa Weiner
- INSERM U1114, Strasbourg, France; Psychiatry Department, University Hospital of Strasbourg, France.
| | - Sébastien Weibel
- INSERM U1114, Strasbourg, France; Psychiatry Department, University Hospital of Strasbourg, France
| | | | - Ineke Keizer
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland
| | - Marianne Gex-Fabry
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland
| | | | - Gilles Bertschy
- INSERM U1114, Strasbourg, France; Psychiatry Department, University Hospital of Strasbourg, France; Translational Medicine Federation, University of Strasbourg, France
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12
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Abstract
A significant minority of people presenting with a major depressive episode (MDE) experience co-occurring subsyndromal hypo/manic symptoms. As this presentation may have important prognostic and treatment implications, the DSM-5 codified a new nosological entity, the "mixed features specifier," referring to individuals meeting threshold criteria for an MDE and subthreshold symptoms of (hypo)mania or to individuals with syndromal mania and subthreshold depressive symptoms. The mixed features specifier adds to a growing list of monikers that have been put forward to describe phenotypes characterized by the admixture of depressive and hypomanic symptoms (e.g., mixed depression, depression with mixed features, or depressive mixed states [DMX]). Current treatment guidelines, regulatory approvals, as well the current evidentiary base provide insufficient decision support to practitioners who provide care to individuals presenting with an MDE with mixed features. In addition, all existing psychotropic agents evaluated in mixed patients have largely been confined to patient populations meeting the DSM-IV definition of "mixed states" wherein the co-occurrence of threshold-level mania and threshold-level MDE was required. Toward the aim of assisting clinicians providing care to adults with MDE and mixed features, we have assembled a panel of experts on mood disorders to develop these guidelines on the recognition and treatment of mixed depression, based on the few studies that have focused specifically on DMX as well as decades of cumulated clinical experience.
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13
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Çelik SB, Bucaktepe GE, Uludağ A, Bulut İU, Erdem Ö, Altınbaş K. Screening mixed depression and bipolarity in the postpartum period at a primary health care center. Compr Psychiatry 2016; 71:57-62. [PMID: 27632572 DOI: 10.1016/j.comppsych.2016.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Mixed depression is a clinical condition accompanied by the symptoms of (hypo)mania and is considered to be a predictor for bipolar disorder. Compared to pure major depression, mixed depression is worse in progress. There are limited data on the prevalence of mixed depression since it is a relatively new entity. Therefore, the present study aimed to investigate the prevalence of mixed depression during the postpartum period which is risky for mood disorders. METHODS The study included 63 postpartum women. The participants were administered Beck Depression Scale, Edinburgh Postnatal Depression Scale (EPDS), Mood Disorders Questionnaire (MDQ), and Modified Hypomania Symptom Checklist-32 (mHCL-32). RESULTS The MDQ scores of the women with expected depression according to the EPDS cut-off scores, were significantly higher than the women with lower EPDS scores (t=-4.968; p<0.001). The modified hypomania scores were significantly higher in the women with higher depression scores compared to the women under EPDS cut-off scores (t=-4.713; p<0.001). According to the EPDS and BDS results, 27 (42.9%) and 14 (22.2%) women needed additional clinical examination for depression, respectively. In addition, 3 (4.8%) women require additional clinical examination for bipolar disorder. The scores for the first item of MDQ were above the cut-off value in 11 (17.5%) women. According to the mHCL-32 results, 50 (79.4%) women had at least 1 symptom, 45 (71.4%) women had at least 3 symptoms, and 43 (68.3%) women had at least 5 symptoms of mixed depression. CONCLUSION Postpartum mixed depression should be promptly diagnosed by using appropriate diagnostic tools, particularly by primary health care physicians. Patients with mixed depression should be closely monitored to avoid manic switch.
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Affiliation(s)
| | | | - Ayşegül Uludağ
- Department of Family Medicine, Canakkale Onsekiz Mart University Medical School, Canakkale, Turkey
| | | | - Özgür Erdem
- Kayapınar Peyas, Family Health Center, Diyarbakır, Turkey
| | - Kürşat Altınbaş
- Department of Psychiatry, Canakkale Onsekiz Mart University Medical School, Canakkale, Turkey.
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Fornaro M, De Berardis D, Mazza M, Pino M, Favaretto E, Bedani F, Wieser C, Indelicato L, Paternò VF, Lo Monaco F, Dugo F, Ventriglio A, Mungo S, Selle V, Valchera A, Elassy M, Martinotti G, De Bartolomeis A, Iasevoli F, Tomasetti C, Avvisati L, Tartaglione S, Perna G, Cattaneo CI, Consoli G, Romano A, Del Debbio A, Martino M, D' Angelo E, De Pasquale C, Koshy AS, Angst J. Factor structure and reliability of the Italian adaptation of the Hypomania Check List-32, second revision (HCL-32-R2). J Affect Disord 2015; 178:112-20. [PMID: 25805403 DOI: 10.1016/j.jad.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the psychometric properties of the Italian adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) treatment-seeking outpatients. METHODS A back-to-back Italian adaption of the "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" English module of the HCL-32-R2 was administered between March 2013 and October 2014 across twelve collaborating sites in Italy. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS In our sample (n=441, of whom, BD-I=68; BD-II=117; MDD=256), using a cut-off of 14 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=89% and specificity=79%. Area under the curve was .888; positive and negative predictive values were 75.34% and 90.99% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factor analyses, whereas items n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the scale slightly loaded onto F2 and F1 respectively. Cronbach׳s α=.88 for F1 and .71 for F2. LIMITATIONS No cross-validation with any additional validated screening tool; treatment-seeking outpatient sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, neither record of severity of current MDE. CONCLUSIONS Our results seem to indicate fair accuracy of HCL-32 as a screening instrument for BD, though replication studies are warranted.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy; Polyedra Research Group, Italy.
| | - Domenico De Berardis
- Polyedra Research Group, Italy; National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | - Monica Mazza
- Polyedra Research Group, Italy; Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy.
| | - Mariachiara Pino
- Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy.
| | - Ettore Favaretto
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Fulvio Bedani
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Christian Wieser
- Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy.
| | - Luisa Indelicato
- Department of Education Science, University of Catania, Catania, Italy.
| | - Vito Fabio Paternò
- Centro siciliano per la cura di Depressione e Ansia (CESIDEA), Catania, Italy; Ospedale San Raffaele, Milano, Italy.
| | | | - Febronia Dugo
- Department of Education Science, University of Catania, Catania, Italy.
| | - Antonio Ventriglio
- Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy.
| | - Sergio Mungo
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | - Alessandro Valchera
- Polyedra Research Group, Italy; Casa di Cura Villa San Giuseppe, Via dei Girasoli, n.6, 63100 Ascoli Piceno, Italy.
| | - Mai Elassy
- Department of Psychiatry, Mansoura Faculty of Medicine, Mansoura City, Egypt.
| | - Giovanni Martinotti
- Polyedra Research Group, Italy; Department of Neuroscience and Imaging, University "G. d׳Annunzio", Chieti, Italy.
| | - Andrea De Bartolomeis
- Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Felice Iasevoli
- Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Carmine Tomasetti
- Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy; National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy.
| | - Livia Avvisati
- Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy.
| | - Sergio Tartaglione
- National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy.
| | - Giampaolo Perna
- Polyedra Research Group, Italy; Department of Clinical Neuroscience, San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, Como, Italy.
| | | | | | - Anna Romano
- Department of Psychiatry, University of Pisa, Pisa, Italy.
| | | | - Matteo Martino
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | | | - Ann Sarah Koshy
- St. John׳s National Academy of Health Sciences, Bangalore, India.
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
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15
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Fornaro M, Elassy M, Mounir M, Abd-Elmoneim N, Ashour H, Hamed R, Al-Shehri A, Bedir S, Rashed I, Amer N, Mohammed TA, De Berardis D, Mazza M, Pino M, Koshy AS, De Pasquale C, Okasha T, Angst J. Factor structure and reliability of the Arabic adaptation of the Hypomania Check List-32, second revision (HCL-32-R2). Compr Psychiatry 2015; 59:141-50. [PMID: 25770763 DOI: 10.1016/j.comppsych.2015.02.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/12/2015] [Accepted: 02/22/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the psychometric properties of the Arabic adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) inpatients suffering a current major depressive episode (MDE). METHOD The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" Arabic module of the HCL-32-R2 was administered to mother-tongue Arabic MDE inpatients between March 2013 and October 2014. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS In our sample (n=500, of whom, BD-I=329; BD-II=70; MDD=101), using a cut-off of 17 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=82% and specificity=77%. Area under the curve was .883; positive and negative predictive values were 93.44% and 73.23% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factors analyses. Item n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the HCL-32 loaded onto F1, though very slightly. Cronbach's alphas were F1=.86 and F2=.60. LIMITATIONS No cross-validation with any additional validated screening tool. Inpatients only sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, or record of severity of current MDE. CONCLUSIONS In our sample, the HCL-32 fairly discriminated between MDD and BD-I but not BD-II, therefore soliciting for replication studies for use in Arabic-speaking depressed inpatients.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy.
| | - Mai Elassy
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | - Mina Mounir
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | | | - Hala Ashour
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | | | | | - Samir Bedir
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | - Ibrahem Rashed
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | - Noha Amer
- Department of Psychiatry, Mansoura University, Mansoura City, Egypt.
| | | | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | - Monica Mazza
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Mariachiara Pino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Ann Sarah Koshy
- St. John's National Academy of Health Sciences, Bangalore, India.
| | | | - Tarek Okasha
- Institute of Psychiatry, Ain Shams University, Cairo, Egypt.
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland.
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