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Berson TR, Sperry SH, Walsh MA, Kwapil TR. A critical examination of multidimensionality within the Hypomanic Personality Scale. Compr Psychiatry 2022; 115:152306. [PMID: 35315343 DOI: 10.1016/j.comppsych.2022.152306] [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: 09/23/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Hypomanic Personality Scale (HPS) assesses bipolar spectrum psychopathology and risk for bipolar disorders. Despite the developers' intent to create a scale that provides a unitary score, several studies have examined whether the HPS has a multidimensional structure. These models have been unable to identify a replicable multidimensional structure, with models varying from fairly similar to entirely dissimilar, and have suffered from theoretical and methodological concerns. PROCEDURES We therefore examined the multidimensional structure of the HPS in a large undergraduate and adult sample (n = 5002). MAIN FINDINGS We failed to reproduce factors with equal congruence to those of previously published models. PRINCIPLE CONCLUSIONS We concluded that the HPS lacks factorial validity in previous research as a multidimensional measure of bipolar spectrum psychopathology. We further recommend the creation of a novel multidimensional assessment of bipolar spectrum psychopathology developed from a theoretically driven, comprehensive model, rather than examining a multidimensional model of a pre-existing measure, such as the HPS.
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Affiliation(s)
- Talia R Berson
- University of Illinois at Urbana-Champaign, United States of America.
| | - Sarah H Sperry
- University of Illinois at Urbana-Champaign, United States of America
| | - Molly A Walsh
- University of Illinois at Urbana-Champaign, United States of America
| | - Thomas R Kwapil
- University of Illinois at Urbana-Champaign, United States of America.
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2
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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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3
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A piece of the puzzle: Does bipolarity partly explain the high prevalence of treatment resistance in depression? Psychiatry Res 2022; 307:114275. [PMID: 34847512 DOI: 10.1016/j.psychres.2021.114275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 12/28/2022]
Abstract
In this cross-sectional study we examined whether the prevalence of treatment resistant depression (TRD) can be partly attributed to level of bipolarity. We included data of 201 patients with either episodic depression or TRD, who received treatment for their depression at either an outpatient or 2nd opinion/daytime setting, within a specialised mental healthcare department in the Netherlands. Whether level of TRD, assessed by the 'Dutch Measure for quantification of Treatment Resistance in Depression', can be partly explained by level of bipolarity, assessed by 'the Bipolarity Index', was examined using linear regression. We found no direct association between level of TRD and level of bipolarity, nor did comorbid anxiety disorders obscure an existing association. In this study we found no evidence for overlooked bipolarity contributing to the high prevalence of TRD. If replicated, we could state that additional screening on bipolarity with an instrument such as the 'Bipolarity Index' in the specialised mental health care is unnecessary.
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4
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Hypomanic symptoms in early pregnancy: prevalence and associated factors. Arch Womens Ment Health 2021; 24:463-471. [PMID: 33094351 DOI: 10.1007/s00737-020-01078-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Given that the perinatal period is a time of increased risk for pregnant women to manifest mental health problems, the identification of antenatal hypomanic symptoms is particularly important. However, data on antenatal hypomanic symptoms is lacking. The present study was aimed at filling this research gap by investigating the prevalence of hypomanic symptoms, including the "active-elated" and "irritable/risk-taking" sides of hypomanic symptoms at the first trimester, and examining their associations with anxiety and depressive symptoms at the following time points: the first trimester, the second trimester, and up to 6-week postpartum. A prospective longitudinal design with a quantitative approach was adopted. A consecutive sample of 229 pregnant Chinese women in Hong Kong was assessed. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32). Of the sample, 43.6% had elevated levels of hypomanic symptoms in the first trimester. Multiple regression analysis showed that after adjusting for potential confounding factors, irritable/risk-taking symptoms were independently associated with higher anxiety symptoms in the first and second trimesters and in the 6-week postpartum period. Primary healthcare practitioners should be made aware of antenatal hypomanic symptoms in pregnant women to facilitate early identification and intervention for anxiety and depression to improve the well-being of both mothers and infants.
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5
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Mosolov S, Yaltonskaya P, Senko O, Angst J. Validation of the Russian version of the hypomania checklist (HCL-33) for the detection of bipolar disorder in patients with a current diagnosis of recurrent depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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6
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Wang YY, Feng Y, Fang M, Guo C, Ungvari GS, Hall BJ, Wang G, Xiang YT. Comparing Screening Abilities of the 33-Item Hypomania Checklist (HCL-33) and the 33-Item Hypomania Checklist External Assessment (HCL-33-EA) for the Detection of Bipolar Disorder. Front Psychiatry 2021; 12:518722. [PMID: 34239453 PMCID: PMC8257931 DOI: 10.3389/fpsyt.2021.518722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bipolar disorder (BD) is a severe psychiatric disorder that is often misdiagnosed and under-diagnosed in clinical settings. The 33-item Hypomania Checklist (HCL-33) is a newly developed self-administered scale for BD detection, while the 33-item Hypomania Checklist-external assessment (HCL-33-EA) is a version of the HCL-33 for external rating used by patient's carer (e.g., family member or friend). We aimed to compare the screening abilities between the HCL-33 and the HCL-33-EA, and evaluate the screening consistency between the two scales. Methods: The data were collected from 269 patients with diagnosed BD (n = 84) or major depressive disorder (MDD) (n = 185). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) between the HCL-33 and the HCL-33-EA for BD were compared against clinician diagnosis as the gold standard. Results: Using Youden's index, the optimal cut-off value of the HCL-33 is 20, while the corresponding figure for HCL-33-EA is 11. Using Youden's index, the HCL-33-EA showed a better performance than the HCL-33 (0.51 vs.0.41). The HCL-33-EA was more sensitive in correctly identifying BD patients from MDD patients than the HCL-33 (0.83 vs. 0.59), while the HCL-33 presented better specificity than the HCL-33-EA (0.82 vs. 0.68). There was significant screening consistency between the two scales (p < 0.001). Conclusions: Both scales have acceptable psychometric properties in detection BD from MDD. Use of the two scales should be considered based on the assessment purpose in clinical research or daily practice (i.e., prefer sensitivity or specificity). Noticeably, the current sample size is insufficient and future studies are recommended to further evaluate the scales.
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Affiliation(s)
- Yuan-Yuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meng Fang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chengwei Guo
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, WA, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia/Graylands Hospital, Perth, WA, Australia
| | - Brian J Hall
- New York University Shanghai, Shanghai, China.,School of Global Public Health, New York University, New York, NY, United States
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, 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, Macao, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, China
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7
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Kiesewetter M, Snyder M, Kitten S. Improving Knowledge and Increasing Use of a Screening Tool in an Outpatient Psychiatric Clinic. Issues Ment Health Nurs 2020; 41:645-649. [PMID: 32400253 DOI: 10.1080/01612840.2020.1716124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Less than half of providers use screening tools to diagnose adult psychiatric patients. The bipolar population is specifically vulnerable to an inaccurate diagnosis. The goal of this project was to improve use of screening tools, specifically the HCL-32 in a rural adult psychiatric clinic. Following the end of the project, guidelines were analyzed to determine factors that could have improved the outcome. A pre-survey was administered to the 11 participating providers. Following the survey, a 10-minute educational session was given to each provider. Two months following the education, a post-survey was conducted. A chart review was completed to confirm post-survey results.
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Affiliation(s)
| | - Marsha Snyder
- University of Illinois at Chicago, Chicago, Illinois, USA
| | - Suzanna Kitten
- Psychiatry, Carle Foundation Hospital, Urbana, Illinois, USA
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8
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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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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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10
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Wang YY, Feng Y, Wang F, Huang W, Ng CH, Ungvari GS, Wang G, Xiang YT. Comparing two short versions of the 32-item Hypomania Checklist (HCL-32) for patients with bipolar disorder. Perspect Psychiatr Care 2019; 55:396-400. [PMID: 30456867 DOI: 10.1111/ppc.12323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/17/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between Hypomania Checklist-20 (HCL-20) and HCL-16. DESIGN AND METHODS Altogether, 350 subjects with bipolar disorders (BD) or major depressive disorders (MDD) were included. The sensitivity, specificity, PPV, NPV, and area under the curve between the HCL-20 and the HCL-16 for BD and its subtypes were compared. FINDINGS The HCL-16 demonstrated superior performance in terms of sensitivity + specificity than HCL-20. For discriminating BD and BD-I patients from MDD patients, HCL-16 showed better sensitivity than HCL-20, while HCL-20 showed better specificity than HCL-16. PRACTICE IMPLICATIONS Our results showed that both HCL-20 and HCL-16 have a fair screening ability, but HCL-16 showed a relatively superior performance considering its length.
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Affiliation(s)
- Yuan-Yuan Wang
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom.,Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Fei Wang
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wei Huang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabor S Ungvari
- Department of Psychiatry, University of Notre Dame Australia/Graylands Hospital, Perth, Australia.,Division of Psychiatry, University of Western Australia Medical School, Perth, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
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11
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de Oliveira L, Portugal LCL, Pereira M, Chase HW, Bertocci M, Stiffler R, Greenberg T, Bebko G, Lockovich J, Aslam H, Mourao-Miranda J, Phillips ML. Predicting Bipolar Disorder Risk Factors in Distressed Young Adults From Patterns of Brain Activation to Reward: A Machine Learning Approach. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:726-733. [PMID: 31201147 PMCID: PMC6682607 DOI: 10.1016/j.bpsc.2019.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/09/2023]
Abstract
Background The aim of this study was to apply multivariate pattern recognition to predict the severity of behavioral traits and symptoms associated with risk for bipolar spectrum disorder from patterns of whole-brain activation during reward expectancy to facilitate the identification of individual-level neural biomarkers of bipolar disorder risk. Methods We acquired functional neuroimaging data from two independent samples of transdiagnostically recruited adults (18–25 years of age; n = 56, mean age 21.9 ± 2.2 years, 42 women; n = 36, mean age 21.2 ± 2.2 years, 24 women) during reward expectancy task performance. Pattern recognition model performance in each sample was measured using correlation and mean squared error between actual and whole-brain activation–predicted scores on behavioral traits and symptoms. Results In the first sample, the model significantly predicted severity of a specific hypo/mania-related symptom, heightened energy, measured by the energy manic subdomain of the Mood Spectrum Structured Interviews (r = .42, p = .001; mean squared error = 9.93, p = .001). The region with the highest contribution to the model was the left ventrolateral prefrontal cortex. Results were confirmed in the second sample (r = .33, p = .01; mean squared error = 8.61, p = .01), in which the severity of this symptom was predicted using a bilateral ventrolateral prefrontal cortical mask (r = .33, p = .009, mean squared error = 9.37, p = .04). Conclusions The severity of a specific hypo/mania-related symptom was predicted from patterns of whole-brain activation in two independent samples. Given that emerging manic symptoms predispose to bipolar disorders, these findings could provide neural biomarkers to aid early identification of individual-level bipolar disorder risk in young adults.
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Affiliation(s)
- Leticia de Oliveira
- Centre for Medical Image Computing, Department of Computer Science, London, United Kingdom; Department of Physiology and Pharmacology, Federal Fluminense University, Niterói, Brazil.
| | - Liana C L Portugal
- Centre for Medical Image Computing, Department of Computer Science, London, United Kingdom; Department of Physiology and Pharmacology, Federal Fluminense University, Niterói, Brazil
| | - Mirtes Pereira
- Department of Physiology and Pharmacology, Federal Fluminense University, Niterói, Brazil
| | - Henry W Chase
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michele Bertocci
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richelle Stiffler
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tsafrir Greenberg
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Genna Bebko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeanette Lockovich
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Haris Aslam
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Janaina Mourao-Miranda
- Centre for Medical Image Computing, Department of Computer Science, London, United Kingdom
| | - Mary L Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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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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13
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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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14
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Paterniti S, Bisserbe JC. Factors associated with false positives in MDQ screening for bipolar disorder: Insight into the construct validity of the scale. J Affect Disord 2018; 238:79-86. [PMID: 29864713 DOI: 10.1016/j.jad.2018.05.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/29/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Identifying bipolar patients in the first phases of the illness is essential to establish adequate treatment. The goal of this study was to examine the discriminant ability of the Mood Disorders Questionnaire (MDQ) in recognizing bipolar patients referred to a tertiary care structure. METHODS Between 2006 and 2012, we assessed 843 individuals referred to the Mood Disorders Program by family physicians in the community. The Structured Clinical Interview for DSM-IV-TR (SCID) was used to assess diagnoses. A nurse collected the information about lifetime symptoms of (hypo)mania in 759 individuals using the MDQ. Univariate chi-square test and logistic regression were used for the statistical analysis. RESULTS Overall, 86% of the sample had a current anxiety or depressive disorder. When compared to the diagnoses formulated through the SCID, the sensitivity of the MDQ was 75.0%, the specificity was 74%, the positive predictive value was 55%, and the negative predictive value was 88%. Among non-bipolar patients, current post-traumatic stress disorder, borderline personality disorder, current or early remission substance use disorder, and the history of childhood abuse were independently associated with false positive screening using the MDQ. LIMITATIONS Individuals with current substance use disorders were under-represented, whether or not the patients were aware of their diagnosis of bipolar disorder was not recorded, and the history of childhood abuse was collected based on an open interview. CONCLUSIONS The self-rated measure of the symptoms listed by the MDQ seems to measure a dimension shared by both bipolar disorder and other conditions characterized by affective instability and impulsivity.
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Affiliation(s)
- Sabrina Paterniti
- Royal Ottawa Mental Health Center, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
| | - Jean-Claude Bisserbe
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Université Paris Est Créteil, Paris, France
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15
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Stiles BM, Fish AF, Vandermause R, Malik AM. The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text]. J Am Psychiatr Nurses Assoc 2018; 24:415-425. [PMID: 29952230 DOI: 10.1177/1078390318784360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN An integrative review was conducted using standard criteria for evaluating research articles. RESULTS Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.
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Affiliation(s)
- Brandie M Stiles
- 1 Brandie M. Stiles, PhD, MSN, PMHNP-BC, University of Missouri-St. Louis, St. Louis, MO, USA; Centerpointe Hospital, St. Louis, MO, USA
| | - Anne F Fish
- 2 Anne F. Fish, PhD, RN, FAHA, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Roxanne Vandermause
- 3 Roxanne Vandermause, PhD, RN, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Azfar M Malik
- 4 Azfar M. Malik, MD, MBA, Centerpointe Hospital, St. Louis, MO, USA
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16
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Camacho M, Almeida S, Moura AR, Fernandes AB, Ribeiro G, da Silva JA, Barahona-Corrêa JB, Oliveira-Maia AJ. Hypomania Symptoms Across Psychiatric Disorders: Screening Use of the Hypomania Check-List 32 at Admission to an Outpatient Psychiatry Clinic. Front Psychiatry 2018; 9:527. [PMID: 30464747 PMCID: PMC6234765 DOI: 10.3389/fpsyt.2018.00527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/04/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Hypomania symptoms are best described as a continuum, ranging beyond Bipolar Spectrum Disorders (BSD). Other nosological entities, such as major depressive disorder, schizoaffective disorder, or borderline personality disorder, may also share symptoms with BSD, raising challenges for differential diagnosis. While the Hypomania Checklist-32 is one of the most widely used tools for screening hypomania, there is limited evidence describing its use in a real-world outpatient psychiatric clinical setting. Methods: Here we tested the psychometric properties of a European Portuguese adaptation of the HCL-32, establishing its factor structure, reliability and construct validity. Furthermore, we analyzed differences in hypomanic symptoms among several clinical groups and in a non-clinical sample. Data was obtained retrospectively in an ecological setting from a clinical sample of an outpatient psychiatry and psychology clinic, comprising 463 Portuguese individuals, 326 of whom had a psychiatric diagnosis, namely BSD (n = 66), major depressive disorder (n = 116), or other psychiatric disorders (n = 144). A separate non-clinical sample was also collected among healthy volunteers (n = 62). A battery of self-report measures of affective symptoms was applied, and in a subset of patients, diagnosis was established using a structured diagnostic interview. Results: Psychometric properties of the HCL-32 were adequate, with good internal consistency (Cronbach's α = 0.86) and test-retest stability (ICC = 0.86), and two subscores ("active/elated" and "risk-taking/irritable") defined by Principal Component Analysis. Receiver Operating Characteristic curve analysis demonstrated that the test score discriminated moderately between patients with BSD and other clinical samples as well as healthy volunteers, with a cut-off score of 17 for the total score of the HCL-32 rendering the best combination of sensitivity and specificity. When compared to the HCL-32 total score, the risk-taking/irritable subscore seems to provide additional benefit in discriminating between different clinical groups, namely regarding specificity in the discrimination from patients with a diagnosis of major depressive disorder that was low for the full scale and the alternate subscale. Conclusions: HCL-32 can be used as a screening tool for BSD among adult patients presenting in an outpatient psychiatric clinical setting.
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Affiliation(s)
- Marta Camacho
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sílvia Almeida
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Rita Moura
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana B Fernandes
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Gabriela Ribeiro
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Lisbon Academic Medical Center PhD Program, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim Alves da Silva
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - J Bernardo Barahona-Corrêa
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
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17
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Zimmerman M. Screening for bipolar disorder with self-administered questionnaires: A critique of the concept and a call to stop publishing studies of their performance in psychiatric samples. Depress Anxiety 2017; 34:779-785. [PMID: 28872771 DOI: 10.1002/da.22644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/21/2017] [Accepted: 04/18/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA.,Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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18
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Meyer TD, Castelao E, Gholamrezaee M, Angst J, Preisig M. Hypomania Checklist-32 - cross-validation of shorter versions screening for bipolar disorders in an epidemiological study. Acta Psychiatr Scand 2017; 135:539-547. [PMID: 28281293 DOI: 10.1111/acps.12715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Self-reports such as Hypomania Checklist (HCL-32) can be used to enhance recognition of bipolar disorders, but they are often too long and only validated in clinical samples. The objectives of this study are therefore to test whether (i) the HCL-32 can be used for screening in the community and (ii) whether two previously suggested shorter versions would do as well. METHOD Data stemmed from the CoLaus|PsyColaus, a prospective cohort study which included randomly selected residents aged 35-66 years from an urban area. Participants underwent semistructured interviews to assess DSM-IV disorders and 1712 of them completed the HCL-32. RESULTS Forty individuals (2.3%) were diagnosed as having BD. Compared to others, participants with BD scored significantly higher on the HCL-32. The HCL-32 had a sensitivity of 0.78 and specificity of 0.68. Very similar figures were found for two previously proposed shorter versions with 16 and 20 items. The results of confirmatory factor analysis and item response theory (IRT) models supported the postulated two-factor structure for the three HCL versions. CONCLUSION Despite the low base rate of BD in this sample, the screening properties of the HCL-32 remained almost as good. Importantly, two previously proposed shorter versions performed as well, suggesting that those could be used without losing essential information.
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Affiliation(s)
- T D Meyer
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Castelao
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - M Gholamrezaee
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - J Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - M Preisig
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
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19
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Feng Y, Wang YY, Huang W, Ungvari GS, Ng CH, Wang G, Yuan Z, Xiang YT. Comparison of the 32-item Hypomania Checklist, the 33-item Hypomania Checklist, and the Mood Disorders Questionnaire for bipolar disorder. Psychiatry Clin Neurosci 2017; 71:403-408. [PMID: 28094461 DOI: 10.1111/pcn.12506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/14/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022]
Abstract
AIM Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD) and hence reliable and culturally appropriate screening tools are needed. This study compared the 32-item Hypomania Checklist (HCL-32), the 33-item Hypomania Checklist (HCL-33), and the Mood Disorders Questionnaire (MDQ) for BD. METHODS Altogether, 350 depressed patients were included. The HCL-32, HCL-33, and MDQ were completed by patients to identify manic and/or hypomanic symptoms. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve among the HCL-32, HCL-33, and MDQ for BD and MDD were calculated and compared, using cut-offs suggested by respective validation studies. RESULTS Of the three scales, the MDQ had the highest sensitivity and NPV (sensitivity = 0.90, 0.81, and 0.90 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; NPV = 0.78, 0.86, and 0.86 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively), while the HCL-33 had the highest specificity and PPV (specificity = 0.74, 0.69, and 0.66 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; PPV = 0.74, 0.55, and 0.56 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively). CONCLUSION Compared to both HCL scales, the MDQ had higher sensitivity and lower specificity in screening for BD. These results contradict previous findings in Western populations. As a screening instrument for BD in Chinese clinical settings, the MDQ appears to be appropriate.
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Affiliation(s)
- Yuan Feng
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.,China Clinical Research Center for Mental Disorders, Beijing, China.,Center of Depression, Beijing Institute for Brain Disorders, Beijing, China.,Department of Psychiatry, Capital Medical University, Beijing, China
| | - Yuan-Yuan Wang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Wei Huang
- Department of Psychiatry, Harbin First Specialist Hospital, Heilongjiang, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia.,School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Gang Wang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China.,China Clinical Research Center for Mental Disorders, Beijing, China.,Center of Depression, Beijing Institute for Brain Disorders, Beijing, China.,Department of Psychiatry, Capital Medical University, Beijing, China
| | - Zhen Yuan
- Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Yu-Tao Xiang
- Faculty of Health Sciences, University of Macau, Macao SAR, China
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20
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Ng RMK, Heyes SB, McManus F, Kennerley H, Holmes EA. Bipolar risk and mental imagery susceptibility in a representative sample of Chinese adults residing in the community. Int J Soc Psychiatry 2016; 62:94-102. [PMID: 26271252 PMCID: PMC4712386 DOI: 10.1177/0020764015597951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We need to better understand the cognitive factors associated with risk for bipolar disorders. Recent research suggests that increased susceptibility to mental imagery may be one such factor. However, since this research was primarily conducted with Western students and at a single time-point, it is not known whether the relationship between imagery susceptibility and bipolar symptoms exists across cultures or within the general community, or whether this relationship remains stable over time. AIM This study evaluated whether Chinese adults identified as being at high (HR) versus low (LR) risk of developing bipolar disorders showed greater mental imagery susceptibility. We aimed to test whether such a relationship was stable over time by measuring imagery characteristics at baseline and at the 7-week follow-up. METHOD This prospective study recruited a community sample of N = 80 Chinese adults screened for the absence of neurotic and psychotic disorders. The sample was split into HR (n = 18) and LR (n = 62) groups at baseline based on a criterion cut-off score on a measure of hypomania, the Mood Disorder Questionnaire (MDQ). Participants completed measures of imagery susceptibility and its impact: the Spontaneous Use of Imagery Scale (SUIS) and the Impact of Future Events Scale (IFES), at baseline and 7 weeks later. RESULTS HR group reported greater tendency to use imagery in daily life (SUIS) and greater emotional impact of prospective imagery (IFES) than LR group at baseline. These results remained stable at follow-up. CONCLUSION This study provides preliminary evidence for increased susceptibility to mental imagery in individuals at high risk of bipolar disorders recruited from a community sample of Chinese adults. This extends previous research in Western student samples suggesting that imagery (both levels of use and its emotional impact) may be a cognitive factor with cross-cultural relevance that is stable over time.
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Affiliation(s)
| | - Stephanie Burnett Heyes
- School of Psychology, University of Birmingham, Birmingham, UK Department of Experimental Psychology and Department of Psychiatry, University of Oxford, Oxford, UK
| | - Freda McManus
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, UK
| | - Helen Kennerley
- Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, UK
| | - Emily A Holmes
- MRC Cognition and Brain Sciences Unit, Cambridge, UK Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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21
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Chung KF, Yeung WF, Ho FYY, Ho LM, Yung KP, Yu YM, Kwok CW. Comparison of scoring methods for the Brief Insomnia Questionnaire in a general population sample. J Psychosom Res 2015; 78:34-8. [PMID: 25466322 DOI: 10.1016/j.jpsychores.2014.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/30/2014] [Accepted: 11/14/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The Brief Insomnia Questionnaire (BIQ) is a lay-administered, structured interview to derive insomnia disorders according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), International Classification of Diseases, Tenth Edition (ICD-10) and research diagnostic criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2). The concordance between diagnoses derived from the BIQ and clinical interviews was only moderate and the prevalence estimates based on the BIQ were significantly different from estimates based on clinical interviews. We hypothesized that a modification of the scoring algorithm closer to the diagnostic criteria would improve the performance of the BIQ. METHODS Probability subsample of population-based epidemiological survey respondents (n=2011) completed clinical reappraisal (n=176) interviews. We compared the modified scoring with the original scoring in sensitivity, specificity, positive and negative predictive values, areas under the characteristic curve, and Cohen's kappa to detect DSM-IV-TR, ICD-10 and RDC/ICSD-2 insomnia diagnoses by the BIQ against clinical interviews. RESULT The diagnostic accuracy was improved with the modified scoring. The areas under the receiver operating characteristic curve for the DSM-IV-TR, ICD-10, RDC/ICSD-2 and any of the insomnia diagnoses ranged from 0.76 to 0.87. Using the modified scoring, there was no significant difference between prevalence estimates based on the BIQ classification and clinical interviews. CONCLUSIONS The BIQ with modified scoring enhanced case detection and produced more accurate prevalence estimates of DSM-IV-TR, ICD-10 and RDC/ICSD-2 insomnia disorders. With scoring algorithms now extended to DSM-5 and ICSD-3 diagnoses, the BIQ should be more widely used in clinical and research settings.
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Affiliation(s)
- Ka-Fai Chung
- Department of Psychiatry, University of Hong Kong, Hong Kong, China.
| | - Wing-Fai Yeung
- School of Chinese Medicine, University of Hong Kong, Hong Kong, China
| | - Fiona Yan-Yee Ho
- Department of Psychology, University of Hong Kong, Hong Kong, China
| | - Lai-Ming Ho
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Kam-Ping Yung
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, China
| | - Yee-Man Yu
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Chi-Wa Kwok
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
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22
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Meyer TD, Schrader J, Ridley M, Lex C. The Hypomania Checklist (HCL) - systematic review of its properties to screen for bipolar disorders. Compr Psychiatry 2014; 55:1310-21. [PMID: 24746530 DOI: 10.1016/j.comppsych.2014.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Bipolar disorders (BDs) are often not recognised with potentially drastic consequences for the individuals and their families. In clinical practice self-reports can be used to screen to enhance recognition. We therefore present a systematic review of the screening properties for the Hypomania Checklist (HCL-32). METHODS A systematic literature search was conducted to identify all relevant studies looking at the screening properties of the HCL-32 in adults. RESULTS Out of 196 papers 21 papers reported data on 22 independent samples. We narratively reviewed these studies. Weighted estimated Sensitivity was 80% regardless of whether a BD diagnosis was compared to unipolar depression or any other non-bipolar diagnosis. Specificity indicated that the HCL-32 was better when comparing BD to unipolar depression (65.3%) than to any other diagnostic category (57.3%). Fewer studies provided estimates for predictive powers, leading to less reliable overall estimates for these indicators. CONCLUSIONS Despite some limitations, using the HCL-32 as a first screening in patients seeking help for depression can be recommended, but should never be used on its own for diagnosing. Future research should examine whether screening properties can be improved by developing an algorithm incorporating the negative consequences reported for different areas in the HCL-32.
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Affiliation(s)
- Thomas D Meyer
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK.
| | - Julia Schrader
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK; Department of Psychology, Eberhard Karls University, Tübingen, Germany
| | - Matthew Ridley
- Newcastle University, Institute of Neuroscience, Newcastle upon Tyne, UK; School of Psychology, University of Nottingham, UK
| | - Claudia Lex
- Villach General Hospital, Department of Psychiatry, Austria
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23
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Mosolov S, Ushkalova A, Kostukova E, Shafarenko A, Alfimov P, Kostyukova A, Angst J. Bipolar II disorder in patients with a current diagnosis of recurrent depression. Bipolar Disord 2014; 16:389-99. [PMID: 24580856 DOI: 10.1111/bdi.12192] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/16/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The prevalence of bipolar II disorder (BD-II) in Russia has never been studied. Therefore, we sought to identify patients meeting diagnostic criteria for BD-II among patients with a current diagnosis of recurrent depressive disorder (RDD) through the use of the Russian versions of the Hypomania Checklist (HCL-32) and Bipolarity Index scales for differentiating between BD-II and RDD. METHODS In a non-interventional diagnostic study, we selected 409 patients aged between 18 and 65 years from two medical settings with (i) a current diagnosis of RDD, (ii) an illness duration of at least three years, and (iii) at least two affective episodes. The diagnosis was based on clinical assessment and confirmed by the Russian version of the Mini International Neuropsychiatric Interview. All patients were assessed by the HCL-32, the Bipolarity Index, and the Personal and Social Performance Scale. RESULTS Among patients with a current diagnosis of RDD, 40.8% had a diagnosis of bipolar disorder (bipolar I disorder: 4.9%; BD-II: 35.9%). The average time lag from onset to a correct diagnosis of BD-II was 15 years and patients were treated only with antidepressants. The sensitivity of the Russian version of the HCL-32 at the optimal cutoff point (≥14.0) was 83.7%, and its specificity was 71.9%. The Bipolarity Index showed significant differences between the total scores of the patients with BD-II and RDD (31.8 versus 20.2; p < 0.0001). The optimal threshold was ≥22.0 (sensitivity 73.5%; specificity 72.3%). CONCLUSIONS In Russia, diagnostic errors are an important cause of the non-detection of bipolar disorder, particularly BD-II. The Russian version of the HCL-32 and the Bipolarity Index, as additional tools, could be useful for bipolarity screening.
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Affiliation(s)
- Sergey Mosolov
- Department for Therapy of Mental Disorders, Moscow Research Institute of Psychiatry, Moscow, Russia
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24
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Mosolov SN, Ushkalova AV, Kostukova EG, Shafarenko AA, Alfimov PV, Kostyukova AB, Angst J. Validation of the Russian version of the Hypomania Checklist (HCL-32) for the detection of Bipolar II disorder in patients with a current diagnosis of recurrent depression. J Affect Disord 2014; 155:90-5. [PMID: 24230917 DOI: 10.1016/j.jad.2013.10.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are no validated screening tools for Bipolar Disorder (BD) in Russia. OBJECTIVE To validate the Russian version of the HCL-32 for the detection of Bipolar II disorder (BD II) in patients with Recurrent Depressive Disorder (RDD). METHODS 409 patients with a current diagnosis of RDD were recruited. The diagnosis was confirmed by the validated Russian version of the Mini International Neuropsychiatric Interview (MINI). Another investigator interviewed the patients using the НСL-32 questions. RESULTS The total HCL-32 score in patients with BD II was significantly higher than in patients with RDD: 18.2 (4.22) versus 10.85 (5.81) (p<0.001, d=1447). At the cut-off 14 points the sensitivity was 83.7%, specificity 71.9% (p<0.001). The Cronbach's alpha was 0.887 that means good internal consistency. The best discrimination was achieved with 8 items: decreased need for sleep, less shyness or inhibition, talkativeness, more jokes and puns, jumping thoughts distractibility, exhausting or irritating others and high and more optimistic mood. We proposed the reduced variant of the scale, that includes only these 8 variables, with sensitivity 90.5%, specificity 69.8% (AUC=0.88). CONCLUSIONS The Russian version of the HCL-32 displayed a good ratio of sensitivity to specificity and can be recommended as a validated screening instrument. An 8-item version of HCL needs further research. LIMITATIONS Limitations include the specific nature of the sample, the HCL-32 assessment carried out by a psychiatrist, no comparison with other BD screening scales. The results of the 8-item version may be sample and culture dependent.
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Affiliation(s)
- S N Mosolov
- Moscow Research Institute of Psychiatry, Russia.
| | | | | | | | - P V Alfimov
- Moscow Research Institute of Psychiatry, Russia
| | | | - J Angst
- Zurich University Psychiatric Hospital, Switzerland
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25
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Iasevoli F, Valchera A, Di Giovambattista E, Marconi M, Rapagnani MP, De Berardis D, Martinotti G, Fornaro M, Mazza M, Tomasetti C, Buonaguro EF, Di Giannantonio M, Perugi G, de Bartolomeis A. Affective temperaments are associated with specific clusters of symptoms and psychopathology: a cross-sectional study on bipolar disorder inpatients in acute manic, mixed, or depressive relapse. J Affect Disord 2013; 151:540-550. [PMID: 23856282 DOI: 10.1016/j.jad.2013.06.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/17/2013] [Accepted: 06/17/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to assess whether different affective temperaments could be related to a specific mood disorder diagnosis and/or to different therapeutic choices in inpatients admitted for an acute relapse of their primary mood disorder. METHOD Hundred and twenty-nine inpatients were consecutively assessed by means of the Structured and Clinical Interview for axis-I disorders/Patient edition and by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-questionnaire, Young Mania Rating Scale, Hamilton Scale for Depression and for Anxiety, Brief Psychiatry Rating Scale, Clinical Global impression, Drug Attitude Inventory, Barratt Impulsiveness Scale, Toronto Alexithymia Scale, and Symptoms Checklist-90 items version, along with records of clinical and demographic data. RESULTS The following prevalence rates for axis-I mood diagnoses were detected: bipolar disorder type I (BD-I, 28%), type II (31%), type not otherwise specified (BD-NOS, 33%), major depressive disorder (4%), and schizoaffective disorder (4%). Mean scores on the hyperthymic temperament scale were significantly higher in BD-I and BD-NOS, and in mixed and manic acute states. Hyperthymic temperament was significantly more frequent in BD-I and BD-NOS patients, whereas depressive temperament in BD-II ones. Hyperthymic and irritable temperaments were found more frequently in mixed episodes, while patients with depressive and mixed episodes more frequently exhibited anxious and depressive temperaments. Affective temperaments were associated with specific symptom and psychopathology clusters, with an orthogonal subdivision between hyperthymic temperament and anxious/cyclothymic/depressive/irritable temperaments. Therapeutic choices were often poorly differentiated among temperaments and mood states. LIMITS Cross-sectional design; sample size. CONCLUSIONS Although replication studies are needed, current results suggest that temperament-specific clusters of symptoms severity and psychopathology domains could be described.
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Affiliation(s)
- Felice Iasevoli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology-University "Federico II" of Naples, Italy.
| | - Alessandro Valchera
- Hermanas Hospitalarias, Villa San Giuseppe Hospital, Ascoli Piceno, Italy; FoRiPsi, Rome, Italy
| | | | - Massimo Marconi
- Hermanas Hospitalarias, Villa San Giuseppe Hospital, Ascoli Piceno, Italy
| | | | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", Asl 4, Teramo, Italy; Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. d'Annunzio" of Chieti, Italy
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. d'Annunzio" of Chieti, Italy
| | - Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy
| | - Monica Mazza
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carmine Tomasetti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology-University "Federico II" of Naples, Italy
| | - Elisabetta F Buonaguro
- Department of Neuroscience, Reproductive Sciences and Odontostomatology-University "Federico II" of Naples, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University "G. d'Annunzio" of Chieti, Italy
| | - Giulio Perugi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Andrea de Bartolomeis
- Department of Neuroscience, Reproductive Sciences and Odontostomatology-University "Federico II" of Naples, Italy
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Screening for Bipolar Disorder Symptoms in Depressed Primary Care Attenders: Comparison between Mood Disorder Questionnaire and Hypomania Checklist (HCL-32). PSYCHIATRY JOURNAL 2013; 2013:548349. [PMID: 24236281 PMCID: PMC3820078 DOI: 10.1155/2013/548349] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/10/2013] [Accepted: 03/14/2013] [Indexed: 11/17/2022]
Abstract
Objective. To describe the prevalence of patients who screen positive for bipolar disorder (BD) symptoms in primary care comparing two screening instruments: Mood Disorders Questionnaire (MDQ) and Hypomania Checklist (HCL-32). Participants. Adult patients presenting to their primary care practitioners for any cause and reporting current depression symptoms or a depressive episode in the last 6 months. Methods. Subjects completed MDQ and HCL-32, and clinical diagnosis was assessed by a psychiatrist following DSM-IV criteria. Depressive symptoms were evaluated in a subgroup with the Patient Health Questionnaire (PHQ-9). Results. A total of 94 patients were approached to participate and 93 completed the survey. Among these, 8.9% screened positive with MDQ and 43.0% with HCL-32. MDQ positive had more likely features associated with BD: panic disorder and smoking habit (P < .05). The best test accuracy was performed by cut-off 5 for MDQ (sensitivity = .91; specificity = .67) and 15 for HCL-32 (sensitivity = .64; specificity = .57). Higher total score of PHQ-9 was related to higher total scores at the screening tests (P < .001). Conclusion. There is a significant prevalence of bipolar symptoms in primary care depressed patients. MDQ seems to have better accuracy and feasibility than HCL-32, features that fit well in the busy setting of primary care.
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Abstract
This article provides recommendations for the diagnosis and treatment of mania, which characterizes bipolar I disorder (BD I). Failure to detect mania leads to misdiagnosis and suboptimal treatment. To diagnose mania, clinicians should include a detailed mood history within their assessment of patients presenting with depression, agitation, psychosis or insomnia. With regards to treatment, by synthesizing the findings from recent treatment guidelines, and reviewing relevant literature, this paper has distilled recommendations for both acute and long-term management. Antimanic agents including atypical antipsychotics and traditional mood stabilizers are employed to reduce acute manic symptoms, augmented by benzodiazepines if needed, and in refractory or severe cases with behavioural and/or psychotic disturbance, electroconvulsive therapy may occasionally be necessary. Maintenance/prophylaxis therapy aims to reduce recurrences/relapse, for which the combination of psychological interventions with pharmacotherapy is beneficial as it ensures adherence and monitoring of tolerability.
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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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