Bipolar Disorder Screening

Bipolar disorder is an episodic illness with a variable course:

• It is generally a lifetime condition associated with significant disability.
• It is frequently unrecognized, under diagnosed, and inappropriately treated.
• Symptomatic bipolar disorder patients spend, on average, 33% of their time in a depressive phase compared with 11% in a manic/hypomanic phase. (1)
• Patients generally do not recognize or spontaneously report prior hypomania as they view these periods as normal happiness or well-being. (2)

Mood Disorder Questionnaire (MDQ):

• The MDQ is designed to provide a tool to aid clinicians in the screening of present and past episodes of mania and hypomania.
• The MDQ includes 13 questions associated with the symptoms of bipolar disorder plus items assessing clustering of symptoms and functional impairment.
• The MDQ may be used in primary care settings to provide clinicians with an efficient way to identify patients most likely to have a bipolar disorder.

Composite International Diagnostic Interview (CIDI) Bipolar Disorder Screening Scale:

• The CIDI-based screening scale can accurately identify both threshold and sub-threshold bipolar disorder.
• The scale detected between 67-96% of true cases in clinical studies. (1)
• This compares very favorably with the widely-used MDQ screening scale for bipolar disorder, which was found in one study to detect only 28% of true cases in a general population sample, although higher sensitivity (58-73) has been reported in 3 studies using the MDQ in out-patient populations with depression. (3)

Differential Diagnosis of Bipolar Disorder I & II versus Major Depressive Disorders: This guide consists of questions that address factors that are found to be useful in differentiating bipolar disorder from major depressive disorder. The questions explore:

• Age of onset
• Frequency of previous depressive episodes
• Previous response to antidepressants
• Family history
• History of suicide attempts
• Substance abuse history

Obtaining a Family History through the use of a Genogram: According to Watson et al. (4) a Genogram is a helpful resource because it:

• Aids in screening for and identifying familial patterns of major depressive disorder and bipolar disorder
• Allows visualization of family relationships in other disease processes
• Can aid in disease prevention planning

References:

1. Post RM, Calabrese JR, Bipolar depression: the role of atypical antipsychotics; Expert Rev. Neurother. 2004 Nov; 4 (6 Suppl 2): S27-33.
2. Berk M, Dodd S, Bipolar II disorder: a review, Bipolar Disorders 2005:7; 11-21.
3. Kessler RC, et al; Validity of the assessment of bipolar disorder in the WHO composite international diagnostic interview; Journal of Affective Disorders 96 (2006) 259-269
4. Watson WJ, et al. Genograms: Seeing your patient through another window. Patient Care Canada 2005 16: 67-75.