Assessment of the diagnostic performance of two new tools versus routine screening instruments for bipolar disorder: a meta-analysis

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.

Tailoring the mental health assessment to older adults

“…In any mental health assessment, screening for a history of manic symptoms is vital, as treatment for BD is different than for unipolar depressive disorders; inaccurate diagnosis can lead to poor outcomes. Approximately 70% of people with bipolar I disorder are first misdiagnosed with a 5- to 10-year average delay from illness onset to diagnosis 34. There is limited scientific literature on BD in OAs.…”

“…Screening tools can be helpful but should not be considered definitive for diagnosis, as a significant number of people who have been diagnosed with BD do not have it 34. The clinician-administered Young Mania Rating Scale has been shown to be reliable and valid to detect BD in OAs and should be utilized when there is diagnostic uncertainty or a mixed-symptom presentation that fails to respond to standard treatment for unipolar depressive disorders 37.…”

“…The clinician-administered Young Mania Rating Scale has been shown to be reliable and valid to detect BD in OAs and should be utilized when there is diagnostic uncertainty or a mixed-symptom presentation that fails to respond to standard treatment for unipolar depressive disorders 37. Structured clinical interviews and observation are necessary to accurately diagnose BD, which requires extra diligence and time 34. Interviewing persons with knowledge of the OAs' longitudinal behavior patterns is often necessary to assist with detection of manic and hypomanic symptoms.…”

“…Approximately 70% of people with bipolar I disorder are fi rst misdiagnosed with a 5-to 10-year average delay from illness onset to diagnosis. 34 There is limited scientifi c literature on BD in OAs. Among patients with BD, approximately 25% are age 60 or older, and of those patients, 70% are female.…”

“…37 Structured clinical interviews and observation are necessary to accurately diagnose BD, which requires extra diligence and time. 34 Interviewing persons with knowledge of the OAs' longitudinal behavior patterns is often necessary to assist with detection of manic and hypomanic symptoms.…”