Sensitivity and specificity of the mood disorder questionnaire and the bipolar spectrum diagnostic scale in Argentinean patients with mood disorders

Psinapsys Private Psychiatric Center, La Plata, Argentina.
Journal of Affective Disorders (Impact Factor: 3.38). 03/2011; 132(3):445-9. DOI: 10.1016/j.jad.2011.03.014
Source: PubMed


To assess the sensitivity and specificity of two self-report instruments for detection of bipolarity in a sample of Argentinean patients.
Spanish versions of the MDQ and the BSDS were administered over four months at 11 sites in Argentina. Diagnoses were made using DSM-IV criteria and the MINI. The study sample consisted of patients diagnosed with Bipolar Disorder (BD) Types I, II, or NOS. BDNOS diagnoses were made using extended guidelines for bipolar spectrum symptoms. Unipolar patients were used as a control group. Of 493 patients screened, 354 completed evaluation by MDQ and MINI, and 363 by BSDS and MINI.
Specificity of MDQ was 0.97 and BSDS was 0.81. MDQ sensitivity was 0.70 for bipolar type I (BD-I), 0.52 for bipolar II (BD-II) and 0.31 for bipolar not otherwise specified (BDNOS). BSDS sensitivities were 0.75, 0.70 and 0.51 respectively.
This study was performed in specialized outpatient settings and thus its results are not necessarily representative for other clinical settings. There was not a systematic evaluation of comorbid psychiatric disease or test-retest reliability.
The local versions of the MDQ and the BSDS showed a sensitivity and specificity comparable to previous research. Our results indicate that in this sample, MDQ was more specific for BD and BSDS was more sensitive to detect BD-II and NOS. Since BD-I is more readily recognized than bipolar spectrum disorders, enhanced sensitivity of BSDS for soft bipolarity may be an advantage.

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    • "A subsequent meta-analysis of 53 studies mostly in a mental health setting reported a sensitivity of 66% and specificity of 79% (Carvalho et al., 2014). There was general agreement that sensitivity for detecting bipolar disorder type I was better than for bipolar type II or NOS disorders (Zaratiegui et al., 2011). While the MDQ has been used in the general population, primary care patients, and psychiatric outpatients, there are few studies of psychiatric inpatients (Cyprien et al., 2014; Goldberg et al., 2012; Isometsa et al., 2003; Suresh et al., 2013). "
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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.
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    • "The findings of these studies were rather mixed. Some studies showed (very) good sensitivity and or specificity (Chung et al., 2008; Stang et al., 2007; Twiss et al., 2008; Zaratiegui et al., 2011). However, Zimmerman et al. (2009) reported inadequate sensitivity (0.64) and reasonable specificity (0.85) in a psychiatric outpatient sample. "
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    ABSTRACT: Screening properties of the mood disorder questionnaire (MDQ) to detect bipolar disorder (BD) in patients with substance use disorders are unknown. 403 treatment seeking patients with a substance use disorder completed the MDQ and subsequently 111 MDQ positives and 59 MDQ negatives were assessed with the Structured Clinical Interview for DSM-IV to diagnose BD. In addition, given the overlap with BD symptoms, the presence of borderline personality disorder (BPD), antisocial personality disorder (APD) and attention deficit/hyperactivity disorder (ADHD), were assessed using the Diagnostic Interview Schedule and the Structured Interview for DSM-IV Personality. Of the 170 patients with a SCID interview, 35 patients (20.6%) met criteria for a lifetime diagnosis of BD. Twenty-three patients (62.8%) with BD had a positive MDQ score and 47 of the 135 patients (34.8%) without BD had a negative MDQ score resulting in a weighted sensitivity of .43, a weighted specificity of .57, a positive predictive value of .21, a negative predictive value (NPV) of .80 and an area under the curve of .50. The area under the curve of the MDQ to detect BPD, APD, ADHD and any externalizing disorder ranged from .55 (APD) to .63 (ADHD). The MDQ is not a suitable screening instrument for the detection of BD or other externalizing disorders but it could be used for ruling out the presence of BD in treatment seeking substance use disorder patients.
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