The HCL-32: Twards a self-assessment tool for hypomanic symptoms in outpatients

Zurich University Psychiatric Hospital, Lenggstrasse 31, P.O. Box 1931, 8032 Zurich, Switzerland.
Journal of Affective Disorders (Impact Factor: 3.38). 11/2005; 88(2):217-33. DOI: 10.1016/j.jad.2005.05.011
Source: PubMed


Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms in adolescence is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders.
The multi-lingual hypomania checklist (HCL-32) has been developed and is being tested internationally. This preliminary paper reports the performance of the scale in distinguishing individuals with BP (N=266) from those with major depressive disorder (MDD; N=160). The samples were adult psychiatry patients recruited in Italy (N=186) and Sweden (N=240).
The samples reported similar clinical profiles and the structure for the HCL-32 demonstrated two main factors identified as "active/elated" hypomania and "risk-taking/irritable" hypomania. The HCL-32 distinguished between BP and MDD with a sensitivity of 80% and a specificity of 51%.
Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders.
Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes.

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Available from: Alex Gamma, Apr 03, 2015
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    • "The use of screening tools specifically designed to detect hypomanic symptoms, such as the HCL-32, represent a valid aid also (Angst et al., 2005; Fornaro et al., 2015; Hidalgo-Mazzei et al., 2015). Unlike the Drancourt and cols' study (2013), no statistically significant differences in DUI according to bipolar subtype were found in this sample. "
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    ABSTRACT: Background: Growing interest has been given to the construct of Duration of untreated illness (DUI) on the outcome of bipolar disorder (BD), due to its potentially modifiable nature. The aim of this study was to identify possible clinical correlates of DUI in a sample of BD patients. Method: 119 BD spectrum patients included. DUI rate was calculated and dichotomized into short DUI and long DUI subgroups, cut-off 24 months. These subgroups were compared for socio-demographic and clinical variables. Significant results were included into direct logistic regressions to assess their impact on the likelihood of presenting with long DUI. Results: Mean DUI±SD was 75.6±98.3 months. Short DUI subgroup comprised 56 (47.1%), long DUI 60 (52.9%) patients. Age at onset of BD was lower in the long DUI subgroup (p=0.021), illness duration longer (p=0.011). Long DUI subgroup showed significantly more comorbidity with Axis I (p=0.002) and personality disorders (p=0.017), less interepisodic recovery (p<0.001) and less Manic Predominant Polarity (p=0.009). Direct logistic regression as a full model was significant, correctly classifying 76.7% of cases. A unique statistically significant contribution was made by: Manic Predominant Polarity, Personality Disorder Comorbidity, and Total Changes in Medications. Limitations: Partial retrospective data, cross sectional study. Conclusions: DUI was longer than 24 months in half of the sample. Psychotic /Manic onset contributed to a quick diagnostic classification. Personality disorders in depressed patients could delay a correct diagnosis of BD, factors associated with an increased likelihood of BD must be considered. More research on personality disorder comorbidities is needed.
    Journal of Affective Disorders 09/2015; 188:319-323. DOI:10.1016/j.jad.2015.09.009 · 3.38 Impact Factor
    • "The use of self-assessment instruments can help busy clinicians evaluate and standardize symptom assessment and documentation, as opposed to clinicianadministered instruments which take more time. There are several bipolar disorder self-assessment screening instruments, such as the MDQ (Mood Disorders Questionnaire), HCL-32 (Hypomania Check List-32), BSDS (Bipolar Spectrum Disorders Screening), and MSQ (Mood Swings Questionnaire) (Angst et al., 2005; Hirschfeld et al., 2000; Miller et al., 2004; Parker et al., 2006). "
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    ABSTRACT: Background: The Mood Disorders Questionnaire (MDQ) is a widely used screening instrument for bipolar disorders. The MDQ has seldom been used in the inpatient setting, and we report a clinical, real-world inpatient validation. Methods: Between April 2011 and August 2013, patients admitted to the inpatient Mood Disorders Unit completed an MDQ as part of their admission process. Patients with a discharge diagnosis of unipolar or bipolar disorders were included. The sensitivity and specificity were calculated for each number of questionnaire items checked positive, as well as the symptoms clustered around the same time and with moderate impairment in functioning. Results: A total of 1330 patient MDQ's were identified, and after excluding incomplete MDQ's and non-unipolar or bipolar diagnoses (e.g. anxiety, adjustment, or schizoaffective diagnoses), 860 MDQ's remained. One hundred fifty four patients (18%) were diagnosed with bipolar disorder, and 706 (82%) with unipolar depressive disorder. The average length of stay was 7.6 days. The optimal cutoff score was 8, resulting in a sensitivity/specificity of 86%/71%, compared to 92%/64% with a cutoff of 7. Limitations: Retrospective study using clinical diagnoses instead of research instrument diagnoses. Conclusions: The sensitivity of the MDQ in an inpatient mood disorders setting was higher than an outpatient psychiatric population, but the specificity was lower. A cutoff of 8 instead of the recommended outpatient cutoff of 7 was optimal. In today's busy clinical practices, a screening instrument for bipolar disorder is still useful, and the MDQ can be effectively utilized on an inpatient psychiatry mood disorders unit.
    Journal of Affective Disorders 09/2015; 188:97-100. DOI:10.1016/j.jad.2015.08.060 · 3.38 Impact Factor
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    • "This view is corroborated by Angst et al.'s study which showed that many young adults (about 9% of the young adult population) seem to belong to a minor BD group that could be erroneously treated for depression due to the rigidity of the categorical diagnostic system used to identify BD [7]. This problem is due to the fact that, while a scale for the identification of hypomanic components in unipolar depressive disorders exists [8], validated tools capable of identifying individuals with hypomanic personality in the general population have been lacking. Indeed, the lack of detection of hypomanic states in depression could explain the heterogeneity of the clinical forms of unipolar depressive disorders [9]. "
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    ABSTRACT: Background: Hypomanic Personality Scale (HPS) is a self-report questionnaire designed to identify vulnerable individuals at high risk of bipolar disorders in non-clinical samples. Our aim was to identify the factorial structure of HPS in a French non-clinical sample and to compare this with different factor solutions described in the literature. We carried out a survey in a French population using a French version of HPS. Methods: A total of 698 participants were included in the study. They completed the HPS, the Schizotypal Personality Questionnaire-Brief (SPQ-B), the Positive And Negative Affect Schedule (PANAS), and the Beck Depression Inventory (BDI-II). We tested the 1, 3 and 4-factor solutions and used a Confirmatory Factor Analysis to compare these with the factor solutions suggested by Rawling et al. and Schalet et al. Results: Goodness-of-fit indices showed that Schalet et al.'s solution "fits" our data better than Rawling et al.'s factorial solutions. HPS scores correlated with the PANAS Positive score and the SPQ-B total score. We confirmed the 3-factor structure of the HPS in a large non-clinical population of young adults and found consistent correlations with BDI, affectivity and schizotypal traits.
    Comprehensive psychiatry 09/2015; 62:105-113. DOI:10.1016/j.comppsych.2015.07.001 · 2.25 Impact Factor
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