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
- Post RM, Calabrese JR, Bipolar depression: the role of atypical antipsychotics; Expert Rev. Neurother. 2004 Nov; 4 (6 Suppl 2): S27-33.
- Berk M, Dodd S, Bipolar II disorder: a review, Bipolar Disorders 2005:7; 11-21.
- 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
- Watson WJ, et al. Genograms: Seeing your patient through another window. Patient Care Canada 2005 16: 67-75.