Screening for Bipolar Disorder Symptoms in Depressed Primary Care Attenders: Comparison between Mood Disorder Questionnaire and Hypomania Checklist (HCL-32)
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 ( ). 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 ( ). 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. 1. Introduction Bipolar disorder (BD) has an estimated lifetime prevalence rate between 2% and 6% when wider range of bipolar spectrum disorders is considered [1]. It is a complex mood disorder frequently associated with medical and psychiatric comorbidity and high suicide rate [2]. Suicidal risk in BD is esteemed to be 15–20 times higher than the general population, and self-harm ideation is reported by 79% of patients [3, 4]. Nevertheless, an average delay of 8–10 years from first onset of mood symptoms to a formal diagnosis of bipolar disorder occurs [5, 6]. Longitudinal researches show that a patient is euthymic for half of the time, while manic or hypomanic symptoms are present only in the 12%; in the rest of the time, a patient has depressive symptoms [7, 8]. Hypomanic symptoms are often perceived as egosyntonic, while it is depression that usually leads the patient to the physician [9]. Thus, any loss or lack of information on hypomanic symptoms increases the bias in favour of a diagnosis of depression [10]. Primary care is the health service entry point for the majority of people suffering from depressive disorders and therefore could play a key role in the detection and management of BD. Although prevalence of
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