The use of Mood Disorder Questionnaire, Hypomania Checklist-32 and clinical predictors for screening previously unrecognised bipolar disorder in a general psychiatric setting

Abstract

Bipolar disorder is often unrecognised and misdiagnosed in the general psychiatric setting. This study compared the psychometric properties of the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32), examined the clinical predictors of bipolar disorder and determined the best approach for screening previously unrecognised bipolar disorder in a general psychiatric clinic. A random sample of 340 non-psychotic outpatients with no previous diagnosis of bipolar disorder completed the MDQ and HCL-32 during their scheduled clinic visits. Mood and alcohol/substance use disorders were reassessed using a telephone-based Structured Clinical Interview for DSM-IV. We found that the HCL-32 had better psychometric performance and discriminatory capacity than the MDQ. The HCL-32's internal consistency and 4-week test-retest reliability were higher. The area under the curve was also greater than that of the MDQ at various clustering and impairment criteria. The optimal cut-off of the MDQ was co-occurrence of four symptoms with omission of the impairment criterion; for the HCL-32, it was 11 affirmative responses. Multivariable logistic regression found that bipolar family history was associated with an increased risk of bipolar disorder (odds ratio=4.93). The study showed that simultaneous use of the HCL-32 and bipolar family history was the best approach for detecting previously unrecognised bipolar disorder.

Available screening tools for adults suffering from bipolar affective disorder in primary care: An integrative literature review

“…“Optimal cut‐off criteria of MDQ in this population is ≥4 positive items, symptom clustering and omission of impairment criterion” (Poon et al., , Table ).…”

“…AUC is reported using a cutoff level that included Section 2 and removed Section 3 of the MDQ (Poon et al., ).…”

“…A more recently conducted study comparing the MDQ, translated into Chinese, and an abbreviated SCID, using only the mood and substance‐use modules, was administered to a general outpatient psychiatric clinic in Hong Kong (Poon et al., ). A total sample of 305 adults, aged 18–64, who had never been previously diagnosed with BPAD, psychotic disorders, mental retardation, dementia, or organic mental disorders were selected to participate in the study (Poon et al., ). Each of the participants completed the MDQ and then had a follow‐up telephone‐based SCID to reassess their previous diagnoses.…”

“…Each of the participants completed the MDQ and then had a follow‐up telephone‐based SCID to reassess their previous diagnoses. “The ROC [receiver operating characteristic] curves of the Chinese MDQ were compared at six threshold levels made up of different combinations of Sections 2 and 3 results” (Poon et al., , p. 113). Poon et al () reported that the original cutoff criterion for the MDQ yielded a sensitivity of 0.16 and specificity of 0.99, but by adjusting the threshold of the MDQ to include a clustering of four or more positive symptoms with omission of the impairment criterion the data improved to a sensitivity of 0.65 and specificity of 0.77 (Table ).…”

Comparing two short versions of the 32‐item Hypomania Checklist (HCL‐32) for patients with bipolar disorder

“…To detect BD more efficiently, several self‐reported questionnaires have been developed, including the 32‐item Hypomania Checklist (HCL‐32) and the Mood Disorder Questionnaire (MDQ) . The HCL‐32 was developed to identify hypomanic symptoms and had been validated in different countries …”