ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Is the Hypomania Checklist suitable for screening Bipolar II disorder?


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ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Is the Hypomania Checklist suitable for screening Bipolar II disorder?

Vol 1 - Iss 2 - Short Communication - Is the Hypomania Checklist suitable for screening Bipolar II disorder? #44

Is the Hypomania Checklist suitable for screening Bipolar II disorder?

J Angst1, E Hantouche2, H Akiskal3, S Lancrenon4, L Châtenet-Duchêne5, D A Gerard5
1 Zurich University Psychiatric Hospital, Zurich Switzerland
2 Mood Center, Université Paris VI, Hôpital Pitié-Salpêtrière, Paris- France
3 International Mood Center, UCSD, San Diego- USA
4 Sylia-Stat, Bourg-La-Reine- France
5 CNS Department Sanofi-Aventis, Paris - France

Rationale: The Hypomania Checklist (HC) is a 20-item questionnaire, which is easy to fill out and designed to help clinicians collect data for diagnosing bipolar disorder. Such a tool could be very useful in primary care where type II bipolar disorder is underdiagnosed, however, to date no suitable cut-off score correlating with a high probability of bipolar II disorder diagnosis has yet been validated.

Method: In a French clinico-epidemiological multi-center survey (EPIDEP) a national sample of patients with DSM-IV major depressive episode (MDE) were recruited and assessed at inclusion and four weeks later. Diagnoses of unipolar or bipolar disorder were made according to a semi-structured interview adapted from the DSM-IV. In addition, the HC and questionnaires on affective temperament were administered. In the analyses, diagnostic accuracy was computed in terms of sensitivity, specificity, predictive positive value and predictive negative value, by varying cut-off scores on the HC. The Receiver Operating Characteristic (ROC) statistical technique was used to compare the diagnostic value of HC with the semi-structured interview adapted from the DSM-IV.

Results: Of the 493 patients with a MDE DSM IV diagnosis, 468 filled out the HC, from which six groups were formed: strict unipolar disorder (UP, n=201), bipolar I disorder (BP-I, n=39), bipolar II disorder (BP-II, n=141), patients with mania or hypomania secondary to an antidepressant treatment (n=51), cyclothymia (n=14) and hyperthymia (n=22). Comparing the BP-II patient group (n=141) with the strict UP group (n=201) the most discriminating HC score was 9, which identified 81% of patients correctly, with sensitivity: 86.5, specificity: 77.1, predictive positive value: 72.6 and predictive negative value: 89.1.

Since, despite their identification as cyclothymics or hyperthymics by the affective temperament questionnaire, both groups were unipolar according to the DSM-IV, we included them in the unipolar group (n=237). The same score of 9 was validated, percentage of patients with correct diagnosis of unipolar depression: 78.3%, sensitivity: 86.5, specificity: 73.4, predictive positive value: 66.0 and predictive negative value: 90.1.
If patients with mania or hypomania secondary to an antidepressant treatment were included as a subgroup of BP-II , a score of ten appeared as the most relevant, percentage of patients with correct diagnosis: 79.0%, sensitivity: 80.2, specificity: 78.1, predictive positive value: 74.8 and predictive negative value: 83.0.
ROC curves confirmed these values.
Lastly when BP-I patients (n=39) were compared to the strict UP group (n=201) the most discriminating HC score was 11, percentage of patients with correct diagnosis: 86.3%, sensitivity: 74.4, specificity: 88.6, predictive positive value: 55.8 and predictive negative value: 94.7, but the BP-I group was too small to validate the score of 11.

Conclusions: These results indicate that a score of 9 on the HC is highly correlated with a BP-II diagnosis (score of 10 if patients with mania induced by antidepressants are considered as BP-II), and suggest that a wider use of the HC in primary care associated with strong GPs / Psychiatrists networks could improve the detection, and with appropriate treatment, the prognosis of Bipolar II disorder.

Funding source: unrestricted grant from Sanofi-Aventis

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