Federal University of São Paulo, Brazil.
J Affect Disord. 2012 Nov;140(3):215-21. doi: 10.1016/j.jad.2011.12.033. Epub 2012 Jan 28.
Bipolar disorders are frequently diagnosed and treated as unipolar depression initially and accurate diagnosis is often delayed by 8 to 10years. It has been demonstrated that the bipolar spectrum disorders are associated with notable disability and that the current diagnostic gold standard, the Structured Clinical Interview for DSM-IV (SCID) is not sufficiently sensitive to the diagnosis of hypomania or subthreshold manic states. There is a need for better and simpler ways to identify these conditions.
Hirschfeld et al. (2000) developed and tested a self-report scale for bipolar disorder: the Mood Disorder Questionnaire (MDQ). Recently, another scale has been developed by Angst to assess hypomanic symptoms and to increase the detection of suspected and of manifest, but undertreated, cases of bipolar disorders. In this Brazilian study, 200 patients with the putative diagnosis of "depression" were interviewed using the Structured Clinical Interview for DSM-IV, Axis I Disorders - Clinician Version (SCID-CV; First et al., 1997), as modified by Benazzi and Akiskal (2003) to increase the sensitivity to BP II disorders. Before the interview patients were screened by both HCI-32-R(1) and MDQ and asked to complete them.
The HCI-32-R(1) showed a sensitivity of 79.8% and a specificity of 60.5% for the cut-off of 14. A sensitivity of 68.1% and a specificity of 63% were obtained for the Mood Disorder Questionnaire for the cut-off of 7.
Although not showing a good specificity, the MDQ seems to be a useful instrument for the screening phase, in which it is important that "cases" are recognized. The HCI-32-R(1) does not distinguish between BP I and BP II disorders. The sample size of patients should be increased in further studies.
The HCI-32-R(1) demonstrated two main factors identified as "active-elated" hypomania and "risk-taking/irritable" hypomania and showed to be a sensitive instrument for hypomanic symptoms. It is a simple and easy-to-use tool for the self-assessment of hypomanic symptoms and may be a valuable supplement to the clinician's interview. The Mood Disorder Questionnaire is a useful screening instrument for bipolar I, bipolar II disorders and other manifestations of bipolar spectrum. As such, this scale might increase the detection of under-treated cases of bipolar disorders. Further studies are needed to verify the accuracy of these tools in non-psychiatric settings and in the general population.
双相情感障碍常被误诊为单相抑郁，初诊误诊率高达 8 至 10 年。研究表明，双相情感障碍谱系障碍与显著的残疾有关，而目前的诊断金标准 DSM-IV 结构临床访谈 (SCID) 对轻躁狂或阈下躁狂状态的诊断不够敏感。因此，我们需要更好、更简单的方法来识别这些情况。
Hirschfeld 等人（2000 年）开发并测试了一种用于双相情感障碍的自我报告量表：心境障碍问卷（MDQ）。最近，Angst 开发了另一种量表来评估轻躁狂症状，并提高对疑似和未治疗的双相情感障碍病例的检测。在这项巴西研究中，200 名被诊断为“抑郁症”的患者接受了 DSM-IV 轴 I 障碍临床医师版（SCID-CV；First 等人，1997 年）的访谈，该访谈经过 Benazzi 和 Akiskal（2003 年）修改以提高对 II 型双相障碍的敏感性。在访谈之前，患者通过 HCI-32-R（1）和 MDQ 进行了筛查，并要求他们完成这些问卷。
HCI-32-R（1）在 14 分的截断值下，敏感性为 79.8%，特异性为 60.5%。在 7 分的截断值下，MDQ 的敏感性为 68.1%，特异性为 63%。
尽管 MDQ 的特异性不高，但它似乎是筛查阶段的有用工具，在这个阶段，识别“病例”很重要。HCI-32-R（1）无法区分 I 型和 II 型双相障碍。在进一步的研究中，应增加患者的样本量。
HCI-32-R（1）显示了两个主要因素，分别被确定为“活跃相关”的轻躁狂和“冒险/易怒”的轻躁狂，并显示出对轻躁狂症状的敏感性。它是一种简单易用的自我评估轻躁狂症状的工具，可能是临床医生访谈的有益补充。心境障碍问卷是一种用于评估双相 I 型、双相 II 型障碍和其他双相谱系障碍表现的有用的筛查工具。因此，该量表可能会增加对未经治疗的双相障碍病例的检测。需要进一步的研究来验证这些工具在非精神科环境和普通人群中的准确性。
