Department of Psychological Medicine, School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK.
J Affect Disord. 2010 Aug;124(3):351-6. doi: 10.1016/j.jad.2010.01.004. Epub 2010 Feb 2.
The under-recognition of hypomanic symptoms by both clinicians and patients is a major clinical problem which contributes to misdiagnosis and diagnostic delay in patients with bipolar disorder. The recent development of validated screening instruments for hypomania, such as the Hypomania Checklist (HCL-32), may help to improve the detection of bipolar disorder. In this study, we assess whether it is possible to reduce the number of items on the HCL-32 without any loss in the screening tool's ability to reliably differentiate between bipolar disorder (BD) and major depressive disorder (MDD).
Using our large samples of patients with DSM-IV defined bipolar I disorder (BD-I) (n=230) and recurrent MDD (n=322), we performed item correlations in order to identify potentially redundant items in the HCL-32. We then tested the performance of a shortened 16-item HCL questionnaire within a separate sample of patients with BD (including BD-I, BD-II and BD-NOS) (n=59) and MDD (n=76).
The structure of the 16-item HCL demonstrated two main factors similar to those identified for the HCL-32 (an 'active-elated' factor and a 'risk-taking/irritable' factor). A score of 8 or more on a shortened 16-item version of the HCL had excellent ability to distinguish between BD and MDD. The sensitivity (83%) and specificity (71%) of the 16-item version were very similar to those for the full 32-item HCL.
The HCL-16 was derived after subjects had completed the full HCL-32. It will be important to test the validity of a 'stand-alone' 16-item HCL questionnaire.
A shortened 16-item HCL (the HCL-16) is potentially a useful screening tool for hypomania within busy clinical settings.
临床医生和患者对轻躁狂症状的识别不足是一个主要的临床问题，这导致双相情感障碍患者的误诊和诊断延误。最近开发的用于轻躁狂的经过验证的筛查工具，例如轻躁狂清单（HCL-32），可能有助于提高双相情感障碍的检出率。在这项研究中，我们评估是否可以减少 HCL-32 的项目数量，而不会降低该筛查工具可靠地区分双相情感障碍（BD）和重性抑郁障碍（MDD）的能力。
使用我们的大样本 DSM-IV 定义的双相 I 型障碍（BD-I）患者（n=230）和复发性 MDD 患者（n=322），我们进行了项目相关性分析，以确定 HCL-32 中可能存在冗余的项目。然后，我们在另一组包括 BD-I、BD-II 和 BD-NOS 在内的 BD 患者（n=59）和 MDD 患者（n=76）中测试了缩短的 16 项 HCL 问卷的表现。
16 项 HCL 的结构显示出与 HCL-32 相似的两个主要因素（一个“活跃相关”因素和一个“冒险/易怒”因素）。缩短的 16 项 HCL 评分 8 分或以上对区分 BD 和 MDD 具有出色的能力。16 项版本的敏感性（83%）和特异性（71%）与完整的 32 项 HCL 非常相似。
16 项 HCL 是在受试者完成完整的 HCL-32 后得出的。测试“独立”的 16 项 HCL 问卷的有效性将非常重要。
缩短的 16 项 HCL（HCL-16）在繁忙的临床环境中可能是一种有用的轻躁狂筛查工具。
