ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Screening for Bipolarity: A Brief Review of Available Measures and Recommendations for Future Research


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ASPOFAFF :: Journal - Volume 1 :: Issue 2 :: Vol 1 - Iss 2 - Short Communication - Screening for Bipolarity: A Brief Review of Available Measures and Recommendations for Future Research

Vol 1 - Iss 2 - Short Communication - Screening for Bipolarity: A Brief Review of Available Measures and Recommendations for Future Research #16

Screening for Bipolarity: A Brief Review of Available Measures and
Recommendations for Future Research

Eric Youngstrom, Ph.D. 1, Jennifer Kogos Youngstrom, Ph.D. 2, Joseph R. Calabrese, M.D. 3

1 Case Western Reserve University, 2 Applewood Centers, Incorporated, 3 Case Western Reserve
University & University Hospitals of Cleveland

Correspondence and requests for reprints should be addressed to:
Dr/Prof Eric Youngstrom, Ph.D.
Department of Psychology
10900 Euclid Avenue
Cleveland, OH, 44106-7123
USA
Tel: 01-216-368-2686
Fax: 01-216-368-4891
Email: Eric.Youngstrom@case.edu

Abstract

Objectives:
This paper reviews the rapid progress in developing diagnostic aids for detecting bipolarity. Extant research is compared to the guidelines for evidence based assessment (1, 2).The paper offers a hierarchy of methodology and clinical relevance, to help clinicians select among multiple reports and measures.

Methodology:
Studies were identified via MedLine and PsycINFO searches using the MeSH terms “bipolar” OR “mania” AND “sensitivity” OR “specificity.” Studies were critiqued according to the guidelines offered in Bossuyt et al. (2003).

Results:
Multiple measures are available that have demonstrated diagnostic efficacy, at least within specific clinical populations. Some data exist that afford comparisons between measures. These studies are especially useful in guiding clinical assessment strategies.

Conclusion:
Findings indicate that collateral informants may be important to the evaluation process, especially for children and adolescents. However, teacher report does not appear clinically useful for any of the measures evaluated so far. Multiple suggestions for further research are offered. These include: (a) consistently using a reference diagnosis based on a semi-structured interview or a consensus methodology that incorporates additional clinical information, (b) supplementing sensitivity and specificity with more generalizable statistics, such as Areas Under the Curve and likelihood ratios, (c) providing information about base rates of bipolarity and competing differential diagnoses in multiple settings, (d) carefully describing inclusion and exclusion criteria to conform to the reporting guidelines offered in the “evidence based medicine” framework, and (e) conducting direct comparisons of multiple measures in the same samples whenever possible, in order to accelerate the adoption of the most effective screening tools. Bipolarity presents significant challenges in the context of screening, which should not be surprising given the phenomenological complexity of bipolar spectrum disorders. However, multiple tools are available that should facilitate screening and differential diagnosis of bipolarity in various clinical settings.

Key Words: Bipolar Disorder, Mania, Screening, Sensitivity and Specificity

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