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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 (SAO PAULO, BRAZIL : 1999) 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] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The present meta-analysis was conducted to determine the diagnostic accuracy of the bipolarity index (BI) and Rapid Mode Screener (RMS) as compared with the Bipolar Spectrum Diagnostic Scale (BSDS), the Hypomania Checklist (HCL-32), and the Mood Disorder Questionnaire (MDQ) in people with bipolar disorder (BD). METHODS We systematically searched five databases using standard search terms, and relevant articles published between May 1990 and November 30, 2021 were collected and reviewed. RESULTS Ninety-three original studies were included (n=62,291). At the recommended cutoffs for the BI, HCL-32, BSDS, MDQ, and RMS, the pooled sensitivities were 0.82, 0.75, 0.71, 0.71, and 0.78, respectively, while the corresponding pooled specificities were 0.73, 0.63, 0.73, 0.77, and 0.72, respectively. However, there was evidence that the accuracy of the BI was superior to that of the other tests, with a relative diagnostic odds ratio (RDOR) of 1.22 (0.98-1.52, p < 0.0001). The RMS was significantly more accurate than the other tests, with an RDOR (95%CI) of 0.79 (0.67-0.92, p < 0.0001) for the detection of BD type I (BD-I). However, there was evidence that the accuracy of the MDQ was superior to that of the other tests, with an RDOR of 1.93 (0.89-2.79, p = 0.0019), for the detection of BD type II (BD-II). CONCLUSION The psychometric properties of two new instruments, the BI and RMS, in people with BD were consistent with considerably higher diagnostic accuracy than the HCL-32, BSDS, and MDQ. However, a positive screening should be confirmed by a clinical diagnostic evaluation for BD.
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Affiliation(s)
- Mehdi Sayyah
- Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Delirrooyfard
- Department of Emergency, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Research Center of Thalassemia & Hemoglobinopathies, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Gupta AK, B N S, Ghosh A, Basu D. The link between bipolarity and substance use: A controlled clinic based study. Asian J Psychiatr 2020; 47:101835. [PMID: 31731145 DOI: 10.1016/j.ajp.2019.10.015] [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: 07/22/2019] [Revised: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Because of high rates of co-occurrence, common familial risk, and phenotypic similarities, we conjectured that substance use and bipolar disorder might have a common substrate of origin in bipolarity and that they might lie on a continuum of bipolarity. Thus it was aimed to investigate the association between bipolarity and substance use through a controlled, clinic based study. METHODS Cross sectional assessment and comparison of bipolarity as trait in four groups, namely the substance use disorder (SUD), bipolar disorder (BPAD), dual diagnosis (DD), and the healthy control (HC) groups. Bipolar spectrum diagnostic scale (BSDS) was used. The quality of life in these four groups was also assessed using WHOQOL-Bref scale. RESULTS The mean Bipolar spectrum diagnostic scale (BSDS) score in SUD was 11.0 ± 5.3 which was more than that of HC (6.2 ± 3.9) and lesser than that in BPAD (18.4 ± 4.2) and DD (20.6 ± 3.6). Differences among all four groups were statistically significant. SUD group was found to have significantly higher score than healthy control. The BSDS score of DD and BPAD groups were higher than those of SUD but the difference between BPAD and DD was non-significant. DISCUSSION The results showed a potential association between substance dependence and bipolarity. Mood dysregulation appears to be the link between the two. The gradient of bipolarity detected by BSDS screener suggests a continuum model between substance use and bipolar disorder. However, this is a clinic based study and only male patients have been taken for study.
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Affiliation(s)
- Anoop Krishna Gupta
- Department of Psychiatry, National Medical College Teaching Hospital, Birganj, Nepal.
| | - Subodh B N
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Debasish Basu
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Bruce HA, Kochunov P, Mitchell B, Strauss KA, Ament SA, Rowland LM, Du X, Fisseha F, Kavita T, Chiappelli J, Wisner K, Sampath H, Chen S, Kvarta MD, Seneviratne C, Postolache TT, Bellon A, McMahon FJ, Shuldiner A, Elliot Hong L. Clinical and genetic validity of quantitative bipolarity. Transl Psychiatry 2019; 9:228. [PMID: 31527585 PMCID: PMC6746871 DOI: 10.1038/s41398-019-0561-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/04/2019] [Accepted: 04/10/2019] [Indexed: 12/19/2022] Open
Abstract
Research has yet to provide a comprehensive understanding of the genetic basis of bipolar disorder (BP). In genetic studies, defining the phenotype by diagnosis may miss risk-allele carriers without BP. The authors aimed to test whether quantitatively detected subclinical symptoms of bipolarity identifies a heritable trait that infers risk for BP. The Quantitative Bipolarity Scale (QBS) was administered to 310 Old Order Amish or Mennonite individuals from multigenerational pedigrees; 110 individuals had psychiatric diagnoses (20 BP, 61 major depressive disorders (MDD), 3 psychotic disorders, 26 other psychiatric disorders). Familial aggregation of QBS was calculated using the variance components method to derive heritability and shared household effects. The QBS score was significantly higher in BP subjects (31.5 ± 3.6) compared to MDD (16.7 ± 2.0), other psychiatric diagnoses (7.0 ± 1.9), and no psychiatric diagnosis (6.0 ± 0.65) (all p < 0.001). QBS in the whole sample was significantly heritable (h2 = 0.46 ± 0.15, p < 0.001) while the variance attributed to the shared household effect was not significant (p = 0.073). When subjects with psychiatric illness were removed, the QBS heritability was similar (h2 = 0.59 ± 0.18, p < 0.001). These findings suggest that quantitative bipolarity as measured by QBS can separate BP from other psychiatric illnesses yet is significantly heritable with and without BP included in the pedigrees suggesting that the quantitative bipolarity describes a continuous heritable trait that is not driven by a discrete psychiatric diagnosis. Bipolarity trait assessment may be used to supplement the diagnosis of BP in future genetic studies and could be especially useful for capturing subclinical genetic contributions to a BP phenotype.
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Affiliation(s)
- Heather A. Bruce
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Peter Kochunov
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Braxton Mitchell
- 0000 0001 2175 4264grid.411024.2Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Kevin A. Strauss
- grid.418640.fClinic for Special Children, Strasburg, PA 17579 USA
| | - Seth A. Ament
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Laura M. Rowland
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Xiaoming Du
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Feven Fisseha
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Thangavelu Kavita
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Joshua Chiappelli
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Krista Wisner
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Hemalatha Sampath
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Shuo Chen
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Mark D. Kvarta
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Chamindi Seneviratne
- 0000 0001 2175 4264grid.411024.2Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Teodor T. Postolache
- 0000 0001 2175 4264grid.411024.2Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - Alfredo Bellon
- 0000 0001 2097 4281grid.29857.31Hershey Medical Center, Department of Psychiatry, Penn State University School of Medicine, Hershey, PA 17033 USA
| | - Francis J. McMahon
- 0000 0004 0464 0574grid.416868.5Human Genetics Branch, National Institute of Mental Health Intramural Research Program, Bethesda, MD 20892 USA
| | - Alan Shuldiner
- 0000 0001 2175 4264grid.411024.2Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21228 USA
| | - L. Elliot Hong
- 0000 0001 2175 4264grid.411024.2Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228 USA
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Zimmerman M, Chelminski I, Dalrymple K, Martin J. Screening for Bipolar Disorder and Finding Borderline Personality Disorder: A Replication and Extension. J Pers Disord 2019; 33:533-543. [PMID: 30036171 DOI: 10.1521/pedi_2018_32_357] [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] [Indexed: 11/20/2022]
Abstract
The authors' group previously reported that patients who screened positive on the Mood Disorders Questionnaire (MDQ), the most frequently studied screening scale for bipolar disorder, were as likely to be diagnosed with borderline personality disorder (BPD) as with bipolar disorder. A limitation of that study was that the authors examined the performance of the MDQ in patients presenting for various psychiatric disorders, including depression. The recognition of bipolar disorder and its differential diagnosis with BPD is of greatest clinical relevance in depressed patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors attempted to replicate their initial findings in a new sample of psychiatric outpatients, and they also examined the performance of the MDQ in depressed patients. The results of the present study were consistent with the original report, thereby indicating that the MDQ is not effective in helping distinguish bipolar disorder from BPD.
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Affiliation(s)
| | | | | | - Jacob Martin
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
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Shabani A, Mirzaei Khoshalani M, Mahdavi S, Ahmadzad-Asl M. Screening bipolar disorders in a general hospital: Psychometric findings for the Persian version of mood disorder questionnaire and bipolar spectrum diagnostic scale. Med J Islam Repub Iran 2019; 33:48. [PMID: 31456972 PMCID: PMC6708087 DOI: 10.34171/mjiri.33.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Indexed: 01/04/2023] Open
Abstract
Background: Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) are used to screen patients with bipolar disorders and have been examined in some psychiatric settings. The present study aimed to assess the validity and reliability of these 2 tools on inpatients in a general hospital.
Methods: In a cross-sectional study in 2011, a total of 207 inpatients admitted to different wards of Rasoul Akram hospital, Tehran, were selected by systematic random sampling. Demographic questionnaire, MDQ, and BSDS were completed. Also, Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) was performed for all participants within 72 hours. The SCID-I was used as the gold standard of psychiatric diagnoses to identify the predictive validity of the 2 screening tests. Sensitivity and specificity indices were identified using Roc curve. The 2 screening tools were recompleted by 20% of the patients (n=43) after 3-7 days to measure test-retest reliability using paired t test and correlation between measures in 2 separate occasions.
Results: In this study, 101 female and 106 male (m=36.9±15.5 yrs.) patients were entered the study, of them 56 (32 males) had bipolar disorder according to SCID-I. The most common bipolar disorder was bipolar disorder type II (9.7%). Pearson’s test showed a high test-retest reliability for both MDQ (r=0.72, p<0.001) and BSDS (r=0.77, p<0.001). For MDQ, the scores 5 (sensitivity=0.60; specificity=0.73) and 6 (sensitivity=0.56; specificity=0.77) were the best cutoff points. Positive and negative predictive values for the mentioned cutoff points were 0.45 and 0.83 (for the score 5) and 0.48 and 0.82 (for the score 6), respectively. The best cutoff point for BSDS was 11 with the sensitivity, specificity, and positive and negative predictive values of 0.74, 0.69, 0.47, and 0.87.
Conclusion: The Persian versions of MDQ and BSDS have acceptable validity and reliability to screen Persian patients with bipolar spectrum disorders in a general hospital.
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Affiliation(s)
- Amir Shabani
- Mental Health Research Center, Mood Disorders Research Group, Iran University of Medical Sciences, Tehran, Iran
| | - Mosleh Mirzaei Khoshalani
- Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedreza Mahdavi
- Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Ahmadzad-Asl
- Mental Health Research Center, Bipolar Disorders Research Group, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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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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7
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Validation of the Bipolar Spectrum Diagnostic Scale in Mexican Psychiatric Patients. THE SPANISH JOURNAL OF PSYCHOLOGY 2018; 21:E60. [PMID: 30477597 DOI: 10.1017/sjp.2018.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The Bipolar Spectrum Diagnostic Scale (BSDS) is widely validated and used as a screening tool for bipolar disorder. However, there is no BSDS validated version for its use in Mexican population. The aim of the present study was to examine the BSDS diagnostic capacity, and to evaluate its criterion validity and internal consistency for its use in Mexican psychiatric patients. We recruited 200 patients who attended the psychiatric outpatient service of a Mental Health Specialized Hospital and were screened for bipolar disorder using BSDS. To determine the cut-off point, sensitivity and specificity, we used the SCID-I diagnosis as the gold standard in 100 participants with bipolar disorder and 100 with major depression. Internal consistency according to Cronbach's coefficient alpha was .81. The area under ROC curve for the overall discriminability of BSDS against the criterion of SCID-I for bipolar disorder was .90. Finally, a cut-off value of 12 reached the most stable sensitivity and specificity, with predictive powers higher than .80. In conclusion, the properties of the scale including internal consistency, sensitivity and specificity, make of BSDS a valuable instrument for screening bipolar disorder in Mexican psychiatric population.
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Chrobak AA, Siwek M, Dudek D, Rybakowski JK. Content overlap analysis of 64 (hypo)mania symptoms among seven common rating scales. Int J Methods Psychiatr Res 2018; 27:e1737. [PMID: 30058102 PMCID: PMC6877160 DOI: 10.1002/mpr.1737] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/31/2018] [Accepted: 06/26/2018] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Fried () quantified the overlap of items among seven widely used depression rating scales. The analysis revealed substantial heterogeneity of the depressive syndromes and a low overlap among the scales. To our best knowledge, there are no studies evaluating the content overlap of (hypo)mania scales. The goal of our study, therefore, is to quantify the overlap of items among seven widely used (hypo)manic scales, implementing the methodology developed by Fried (). METHODS Seven commonly used (hypo)manic scales underwent content analysis. Symptom overlap was evaluated with the use of the Jaccard index (0 = no overlap, 1 = full overlap). In case of every scale, rates of idiosyncratic symptoms and rates of specific versus compound symptoms were calculated. RESULTS The seven scales gathered 64 hypo(manic) symptoms. The mean overlap among all of the instruments was low (0.35), the mean overlap of each scale with all others ranged from 0.29 to 0.48, and the overlap among individual scales ranged from 0.20 to 0.65. Thirty-six percent of symptoms appeared only on one scale. Only 6% of the symptoms appeared on all of the instruments. CONCLUSIONS We have shown that using (hypo)manic scales as interchangeable measurements may be problematic.
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Affiliation(s)
- Adrian A Chrobak
- Department of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznań, Poland
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Hsieh CJ, Godwin D, Mamah D. Utility of Washington Early Recognition Center Self-Report Screening Questionnaires in the Assessment of Patients with Schizophrenia and Bipolar Disorder. Front Psychiatry 2016; 7:149. [PMID: 27616996 PMCID: PMC4999826 DOI: 10.3389/fpsyt.2016.00149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/15/2016] [Indexed: 12/19/2022] Open
Abstract
Early identification and treatment are associated with improved outcomes in bipolar disorder (BPD) and schizophrenia (SCZ). Screening for the presence of these disorders usually involves time-intensive interviews that may not be practical in settings where mental health providers are limited. Thus, individuals at earlier stages of illness are often not identified. The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen is a self-report questionnaire originally developed to identify clinical risk for developing bipolar or psychotic disorders. The goal of the current study was to investigate the utility of the WERCAP Screen and two complementary questionnaires, the WERC Stress Screen and the WERC Substance Screen, in identifying individuals with established SCZ or BPD. Participants consisted of 35 BPD and 34 SCZ patients, as well as 32 controls (CON), aged 18-30 years. Univariate analyses were used to test for score differences between groups. Logistic regression and receiver operating characteristic (ROC) curves were used to identify diagnostic predictors. Significant group differences were found for the psychosis section of the WERCAP (pWERCAP; p < 0.001), affective section of the WERCAP (aWERCAP; p = 0.001), and stress severity (p = 0.027). No significant group differences were found in the rates of substance use as measured by the WERC Substance Screen (p = 0.267). Only the aWERCAP and pWERCAP scores were useful predictors of diagnostic category. ROC curve analysis showed the optimal cut point on the aWERCAP to identify BPD among our participant groups was a score of >20 [area under the curve (AUC): 0.87; sensitivity: 0.91; specificity: 0.71], while that for the pWERCAP to identify SCZ was a score of >13 (AUC: 0.89; sensitivity: 0.88; specificity: 0.82). These results indicate that the WERCAP Screen may be useful in screening individuals for BPD and SCZ and that identifying stress and substance-use severity can be rapidly done using self-report questionnaires. Larger studies in undiagnosed individuals will be needed to test the WERCAP Screen's ability to identify mania or psychosis in the community.
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Affiliation(s)
- Christina J Hsieh
- Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
| | - Douglass Godwin
- Department of Psychiatry, Washington University Medical School , St. Louis, MO , USA
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School , St. Louis, MO , USA
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Carvalho AF, Takwoingi Y, Sales PMG, Soczynska JK, Köhler CA, Freitas TH, Quevedo J, Hyphantis TN, McIntyre RS, Vieta E. Screening for bipolar spectrum disorders: A comprehensive meta-analysis of accuracy studies. J Affect Disord 2015; 172:337-46. [PMID: 25451435 DOI: 10.1016/j.jad.2014.10.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bipolar spectrum disorders are frequently under-recognized and/or misdiagnosed in various settings. Several influential publications recommend the routine screening of bipolar disorder. A systematic review and meta-analysis of accuracy studies for the bipolar spectrum diagnostic scale (BSDS), the hypomania checklist (HCL-32) and the mood disorder questionnaire (MDQ) were performed. METHODS The Pubmed, EMBASE, Cochrane, PsycINFO and SCOPUS databases were searched. Studies were included if the accuracy properties of the screening measures were determined against a DSM or ICD-10 structured diagnostic interview. The QUADAS-2 tool was used to rate bias. RESULTS Fifty three original studies met inclusion criteria (N=21,542). At recommended cutoffs, summary sensitivities were 81%, 66% and 69%, while specificities were 67%, 79% and 86% for the HCL-32, MDQ, and BSDS in psychiatric services, respectively. The HCL-32 was more accurate than the MDQ for the detection of type II bipolar disorder in mental health care centers (P=0.018). At a cutoff of 7, the MDQ had a summary sensitivity of 43% and a summary specificity of 95% for detection of bipolar disorder in primary care or general population settings. LIMITATIONS Most studies were performed in mental health care settings. Several included studies had a high risk of bias. CONCLUSIONS Although accuracy properties of the three screening instruments did not consistently differ in mental health care services, the HCL-32 was more accurate than the MDQ for the detection of type II BD. More studies in other settings (for example, in primary care) are necessary.
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Affiliation(s)
- André F Carvalho
- (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
| | - Yemisi Takwoingi
- Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK
| | - Paulo Marcelo G Sales
- (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Joanna K Soczynska
- Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada
| | - Cristiano A Köhler
- Memory Research Laboratory, Brain Institute (ICe), Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Thiago H Freitas
- (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - João Quevedo
- Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil; Center for Experimental Models in Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA
| | | | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Eduard Vieta
- Bipolar Disorders Unit, Clinical Institute of Neurosciences, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain
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11
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Ghouse AA, Sanches M, Zunta-Soares GB, Soares JC. Lifetime mood spectrum symptoms among bipolar patients and healthy controls: a cross sectional study with the Mood Spectrum Self-Report questionnaire. J Affect Disord 2014; 166:165-7. [PMID: 25012426 PMCID: PMC4406378 DOI: 10.1016/j.jad.2014.04.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 04/25/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The "spectrum" model has advantages for the conceptualization of mental disorders, representing a complementary approach to the currently available categorical systems. We carried out a study in order to assess lifetime mood symptoms among patients with bipolar disorder (BD) and healthy controls from a dimensional perspective. METHODS The Mood Spectrum Self-Report instrument (MOODS-SR) was administered to 101 bipolar patients (52 BD I, 32 BD II, and 17 BD NOS, 36 males/65 females, mean age+SD=36.10±13.34 years) and 38 healthy controls (16 males/22females, mean age+SD=35.18±13.70 years). The scores of the different MOOD-SR scales and subscales among patients and controls were compared using non-parametric tests (Mann-Whitney and Kruskal-Wallis). RESULTS Bipolar patients scored significantly higher than healthy controls on the total MOOD-SR scores (BD: mean±SD=98.65±22.17; HC: mean±SD=12.92±10.72; p<0.01) and all subdomains. Multiple comparisons revealed lower scores among controls when compared to each one of the subtypes of BD, also regarding the total scores and all subdomains (p<0.01). Comparisons across the different subtypes of BD revealed statistically significant higher scores among BD I patients when compared to BD II and BD NOS patients, only in regard to the total MOOD-SR scores (BD I: mean±SD=102.94±22.79; BD II: mean±SD=93.53±21.97; BD NOS: mean±SD= 94.88±18.68; p=0.03) and two subdomains: mood mania and energy mania. CONCLUSIONS These results, although preliminary, suggest that even though the MOODS-SR seems effective in distinguishing BD patients from HC, it is not as good in discriminating different subtypes of BD, especially in respect to lifetime depressive symptoms. LIMITATIONS Our sample size was small, and comprised by outpatients. The MOOD-SR measures only lifetime symptoms and does not take into account the progression of mood symptoms or the current mood state of patients.
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Affiliation(s)
- Amna. A. Ghouse
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Marsal Sanches
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Giovana B. Zunta-Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - Jair C. Soares
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
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Bae SO, Kim MD, Lee JG, Seo JS, Won SH, Woo YS, Seok JH, Kim W, Kim SJ, Min KJ, Jon DI, Shin YC, Bahk WM, Yoon BH. Is it useful to use the Korean version of the mood disorder questionnaire for assessing bipolar spectrum disorder among Korean college students? Asia Pac Psychiatry 2014; 6:170-8. [PMID: 23857742 DOI: 10.1111/appy.12026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 11/18/2012] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The purpose of this study was to assess the usefulness of the Korean version of the Mood Disorder Questionnaire (K-MDQ) as a screening tool for the identification of bipolar spectrum disorder (BSD) among Korean college students. METHODS The sample of 1,020 college students was stratified to reflect geographical differences among the students. The K-MDQ and an epidemiological survey were administered between November 2006 and February 2007. To validate the K-MDQ as a screening tool for BSD, the Korean version of the Bipolar Spectrum Diagnostic Scale (K-BSDS) and the Structured Clinical Interview for DSM-IV (SCID) were also administered. RESULTS The rates satisfying MDQ criterion 1, and all three MDQ criteria, were 55.5% and 2.3%, respectively. According to the K-BSDS, 59.9% of the sample met the criteria for BSD using a threshold of 10, while no statistical differences were observed among subgroups. When we examined the diagnostic agreement between K-MDQ and K-BSDS, 79.5% of students who met MDQ criterion 1 were also positive on the BSDS. Sixteen (21.6%) of the 74 students who participated in the SCID interview were diagnosed with BSD. DISCUSSION Although the K-MDQ is a useful tool to assess BSD among inpatients and outpatients, it does not appear useful as a screening tool to detect BSD among college students.
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Affiliation(s)
- Seung Oh Bae
- Department of Psychiatry, Gwangju Mirae Hospital, Gwangju, Korea
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Perlis RH, Cusin C, Fava M. Proposed DSM-5 mixed features are associated with greater likelihood of remission in out-patients with major depressive disorder. Psychol Med 2014; 44:1361-1367. [PMID: 22417535 PMCID: PMC10034819 DOI: 10.1017/s0033291712000281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Draft DSM-5 criteria for a mixed major depressive episode have been proposed, but their predictive validity has not yet been established. We hypothesized that such symptoms would be associated with poorer antidepressant treatment outcomes. METHOD We examined outcomes among individuals with major depressive disorder participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, an effectiveness study conducted at primary and specialty care centers in the USA. Mixed features were derived from the six self-report items of the mania subscale of the Psychiatric Diagnosis Screening Questionnaire. Primary analyses examined the association between the presence of at least two of these in the 6 months before study entry, and remission across up to four sequential treatment trials, as well as adverse outcomes. RESULTS Of the 2397 subjects with a major depressive episode of at least 6 months' duration, 449 (18.7%) reported at least two mixed symptoms. The presence of such symptoms was associated with a greater likelihood of remission across up to four sequential treatments, which persisted after adjustment for potential confounding clinical and demographic variables (adjusted hazard ratio 1.16, 95% confidence interval 1.03-1.28). Two individual items, expansive mood and cheerfulness, were strongly associated with a greater likelihood of remission. CONCLUSIONS Proposed DSM-5 mixed state features were associated with a greater rather than a lesser likelihood of remission. While unexpected, this result suggests the potential utility of further investigation of depressive mixed states in major depression.
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Affiliation(s)
- R. H. Perlis
- Address for correspondence : R. H. Perlis, M.D., Massachusetts General Hospital, Center for Experimental Drugs and Diagnostics, 185 Cambridge Street, Boston, MA 02114, USA.
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14
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Lee D, Cha B, Park CS, Kim BJ, Lee CS, Lee S. Usefulness of the combined application of the Mood Disorder Questionnaire and Bipolar Spectrum Diagnostic Scale in screening for bipolar disorder. Compr Psychiatry 2013; 54:334-40. [PMID: 23151598 DOI: 10.1016/j.comppsych.2012.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 09/14/2012] [Accepted: 10/02/2012] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to examine whether combined application of the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) is more effective than exclusive application of either tool in screening for bipolar disorder (BD). METHOD The MDQ and BSDS were completed by a total of 113 patients diagnosed with BD and major depressive disorder who were experiencing a current major depressive episode. The initial diagnosis of the subject was confirmed during a 1-year follow-up period. When each MDQ and BSDS optimal cutoff score was calculated, a modified scoring method for the MDQ that considered only one item was used to increase its performance in this population. The following three combinations of the cutoff scores for the two tools were used to screen for BD: (A) The score on either the MDQ or BSDS was greater than or equal to the cutoff score; (B) the scores on both the MDQ and BSDS were greater than or equal to the cutoff score; and (C) Reducing either cutoff score by 1 point resulted in the MDQ and BSDS scores being greater than or equal to the cutoff score. The sensitivity, specificity, positive predictive value, and negative predictive value of the three methods, the MDQ, and the BSDS were compared for screening BD. RESULTS The sensitivity and specificity of the MDQ were 0.741 and 0.844, respectively, and those for the BSDS were 0.731 and 0.742, respectively. These indicators for the combined application of the MDQ and BSDS were as follows, respectively: method A 0.901 and 0.688, method B 0.580 and 0.875, and method C 0.691 and 0.844. Method A was superior to using one measure alone as well as to methods B and C with regard to sensitivity and negative predictive values. Method A also showed a higher sensitivity for BD subtypes than did the individual tools. Compared with the use of individual instruments, method A showed a similar positive predictive value. CONCLUSION This study suggests that combined use of the MDQ and BSDS is more effective than the individual use of either of these measures in screening for BD. The data also showed that when both tools were used, the most effective interpretation of the results in terms of screening for BD was achieved when positive scores were defined as those that were equal to or greater than the cutoff for the MDQ or BSDS.
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Affiliation(s)
- Dongyun Lee
- Medical Unit of 9th Division, Korea Army, Goyang, Korea
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15
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Nagata T, Yamada H, Teo AR, Yoshimura C, Kodama Y, van Vliet I. Using the mood disorder questionnaire and bipolar spectrum diagnostic scale to detect bipolar disorder and borderline personality disorder among eating disorder patients. BMC Psychiatry 2013; 13:69. [PMID: 23443034 PMCID: PMC3599106 DOI: 10.1186/1471-244x-13-69] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 02/14/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Screening scales for bipolar disorder including the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) have been plagued by high false positive rates confounded by presence of borderline personality disorder. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. METHODS Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. All participants completed the mood and eating disorder sections of the SCID-I/P and the borderline personality disorder section of the SCID-II, in addition to the MDQ and BSDS. Predictive validity of the MDQ and BSDS was evaluated by Receiver Operating Characteristic analysis of the Area Under the Curve (AUC). RESULTS Fifteen (19%) and twelve (15%) patients fulfilled criteria for bipolar II disorder and borderline personality disorder, respectively. The AUCs for bipolar II disorder were 0.78 (MDQ) and 0.78 (BDSD), and the AUCs for borderline personality disorder were 0.75 (MDQ) and 0.79 (BSDS). CONCLUSIONS Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder.
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Affiliation(s)
- Toshihiko Nagata
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abunoku, Osaka 545-8585, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Alan R Teo
- Department of Internal Medicine and Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Chiho Yoshimura
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuya Kodama
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abunoku, Osaka 545-8585, Japan
| | - Irene van Vliet
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Singh V, Bowden CL, Gonzalez JM, Thompson P, Prihoda TJ, Katz MM, Bernardo CG. Discriminating primary clinical states in bipolar disorder with a comprehensive symptom scale. Acta Psychiatr Scand 2013; 127:145-52. [PMID: 22774941 DOI: 10.1111/j.1600-0447.2012.01894.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We assessed the spectrum and severity of bipolar symptoms that differentiated bipolar disorder (BD) clinical states, employing the Bipolar Inventory of Symptoms Scale (BISS) which provides a broader item range of traditional depression and mania rating scales. We addressed symptoms differentiating mixed states from depression or mania/hypomania. METHOD One hundred and sixteen subjects who met DSM-IV-TR criteria for BD and were currently in a depressed, manic/hypomanic, mixed episode, or recovered state were interviewed using the BISS. RESULTS A subset of manic items differed between mixed episodes and mania/hypomania or depression. Most anxiety items were more severe in mixed subjects. BISS Depression and Manic subscales differentiated episodes from recovered status. The majority of depression and manic symptoms differentiated mood states in the predicted direction. Mixed episodes had overall greater mood severity than manic/hypomanic episodes or depressed episodes. CONCLUSION These results indicate that a small subset of symptoms, several of which are absent in DSM-IV-TR criteria and traditional rating scales for bipolar studies, aid in distinguishing mixed episodes from depressive or manic/hypomanic episodes. The results also support the utility of a comprehensive BD symptom scale in distinguishing primary clinical states of BD.
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Affiliation(s)
- V Singh
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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17
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Diagnosing bipolar disorder in the community setting. J Psychiatr Pract 2012; 18:395-407. [PMID: 23160244 DOI: 10.1097/01.pra.0000422737.41753.85] [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: 11/26/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a common psychiatric illness. Diagnosing this condition is challenging, due to the frequent need to make the diagnosis based on historical symptoms, the lack of specificity of many of the symptoms, and the absence of accurate objective measures to confirm the diagnosis. A lack of consensus among psychiatrists as to the breadth of the diagnosis, increasing pressures to make a diagnosis quickly in clinical settings, and the availability of broader spectrum treatments have also served to foster uncertainty in diagnosis. This article examines the process of diagnosing BD, reviews factors that can confound the diagnostic process, and discusses how the sensitivity and specificity of the diagnosis can be improved. METHODS A MEDLINE search and a manual search of textbooks and abstracts from scientific meetings were conducted. Results were limited to publications in English, but no timeframe limitations were used. RESULTS The standard for diagnosing BD remains the psychiatric interview, with laboratory, genetic, radiographic, and neuroimaging tests still investigational, and psychological tests and questionnaires serving an ancillary role. The sensitivity and specificity of the BD diagnosis is less than optimal, with the condition being both overlooked and diagnosed when it is not present. CONCLUSIONS Factors leading to diagnostic uncertainty and approaches to improve the sensitivity and specificity of the BD diagnosis are discussed. A paradigm for differentiating between BD and borderline personality disorder is offered.
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18
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Zimmerman M, Galione JN, Ruggero CJ, Chelminski I, Dalrymple K, Young D. Are screening scales for bipolar disorder good enough to be used in clinical practice? Compr Psychiatry 2011; 52:600-6. [PMID: 21406301 DOI: 10.1016/j.comppsych.2011.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/10/2011] [Accepted: 01/16/2011] [Indexed: 11/29/2022] Open
Abstract
Bipolar disorder is often underdiagnosed. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. The most widely studied screening scale is the Mood Disorders Questionnaire (MDQ). Studies of the performance of the MDQ in heterogeneous samples of psychiatric outpatients presenting for treatment have raised concerns about the adequacy of the MDQ as a screening measure because of its relatively low sensitivity. The sensitivity of a scale is not an inherent property of the instrument but depends on the threshold used to identify positive cases. Prior studies used the scoring recommendations of the developers of the MDQ to examine its performance; none examined the performance of the scale across the range of cutoff scores to determine whether a lower threshold would be more appropriate for the purposes of screening. The goal of the present study was to examine the operating characteristics of the MDQ at all cutoff scores to determine the cutoff point that would be appropriate for the purpose of screening. Seven hundred fifty-two psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV, and completed the MDQ. When MDQ caseness was based only on symptom score without regard to level of impairment, the cutoff score associated with at least 90% sensitivity was 5. At this cutoff the specificity of the MDQ was 60.7%, and its positive predictive value was 22.1%. These findings indicate that when the cutoff to identify cases on the MDQ was set to achieve a desired level of sensitivity as a screening instrument most cases screening positive on the scale did not have bipolar disorder. Low positive predictive value does not support the use of the MDQ or any bipolar disorder screening scale in psychiatric clinical practice.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Rhode Island Hospital, Brown Medical School, Providence, RI 02905, USA.
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19
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Goldberg JF. Ruling in and ruling out 'caseness' in the bipolar spectrum: implications for initial screening. Bipolar Disord 2010; 12:539-40. [PMID: 20712755 DOI: 10.1111/j.1399-5618.2010.00846.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Joseph F Goldberg
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
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