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
    • "In brief, inclusion criteria for the initial sample were: individuals aged 13–35 years, sufficient German speaking ability, meeting at least one of the following at-risk criteria (1) a risk syndrome as defined by the Structured Interview of Prodromal Syndromes and the corresponding Scale for Prodromal Syndromes (SIPS/SOPS) (McGlashan et al. 2010), and/or (2) an at-risk state according to BS criteria [i.e. criteria for cognitive-perceptive symptoms (COPER) and/or cognitive disturbances (COGDIS)] as defined by the Schizophrenia Proneness Instrument (Schultze-Lutter, 2007; Schultze-Lutter & Koch, 2010) and/or (3) a potential risk for bipolar spectrum disorders, as defined by a score of either 514/32 hypomanic symptoms as assessed with the Hypomania Checklist (Angst et al. 2005), or a score of 512 on the Hamilton Depression Rating Scale (HAMD, Hamilton, 1960). Exclusion criteria were: (1) estimated premorbid IQ < 80, (2) meeting DSM-IV criteria for current substance dependence, any psychotic disorder confirmed by research diagnostic interviews, and/or a medical condition known to affect the brain, and for the present analysis (3) not fulfilling APSS or BS criteria. "
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    ABSTRACT: Background: The attenuated positive symptoms syndrome (APSS) is considered an at-risk indicator for psychosis. However, the characteristics and developmental aspects of the combined or enriched risk criteria of APSS and basic symptom (BS) criteria, including self-experienced cognitive disturbances (COGDIS) remain under-researched. Method: Based on the Structured Interview of Prodromal Syndromes (SIPS), the prevalence of APSS in 13- to 35-year-old individuals seeking help in an early recognition program for schizophrenia and bipolar-spectrum disorders was examined. BS criteria and COGDIS were rated using the Schizophrenia Proneness Instrument for Adults/Children and Youth. Participants meeting APSS criteria were compared with participants meeting only BS criteria across multiple characteristics. Co-occurrence (APSS+/BS+, APSS+/COGDIS+) was compared across 13-17, 18-22 and 23-35 years age groups. Results: Of 175 individuals (age = 20.6 ± 5.8, female = 38.3%), 94 (53.7%) met APSS criteria. Compared to BS, APSS status was associated with suicidality, higher illness severity, lower functioning, higher SIPS positive, negative, disorganized and general symptoms scores, depression scores and younger age (18.3 ± 5.0 v. 23.2 ± 5.6 years, p < 0.0001) with age-related differences in the prevalence of APSS (ranging from 80.3% in 13- to 17-year-olds to 33.3% in 23- to 35-year-olds (odds ratio 0.21, 95% confidence interval 0.11-0.37). Within APSS+ individuals, fewer adolescents fulfilled combined risk criteria of APSS+/BS+ or APSS+/COGDIS+ compared to the older age groups. Conclusions: APSS status was associated with greater suicidality and illness/psychophathology severity in this help-seeking cohort, emphasizing the need for clinical care. The age-related differences in the prevalence of APSS and the increasing proportion of APSS+/COGDIS+ may point to a higher proportion of non-specific/transient, rather than risk-specific attenuated positive symptoms in adolescents.
    No preview · Article · Dec 2015 · Psychological Medicine
    • "(2) Ultra-high-risk status for schizophrenia (UHR-SZ, n = 91) as rated by the Structured Interview for Prodromal Syndromes (SIPS, McGlashan et al., 2001), with at least one attenuated psychotic symptom, or at least one brief limited intermittent psychotic symptom, or a positive state-trait criterion (reduction in global assessment of functioning of >30% in the past year, plus either schizotypal personality disorder or first degree relative with psychosis). (3) At-risk state for bipolar disorder (HR-BIP, n = 31), defined with a score of >14 on Hypomania Checklist (HCl, Angst et al., 2005) and/or a score of >12 on the Hamilton Depression Scale (HAMD, Williams, 1988) or a positive state criterion (first degree relative with a bipolar disorder and a reduction in global assessment of functioning of >30% in the past year). "
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    ABSTRACT: Objectives: The Loudness Dependence of Auditory Evoked Potentials (LDAEP) is considered as an indicator of central serotonergic activity. Alteration of serotonergic neurotransmission was reported in bipolar disorders and schizophrenia. In line with previous reports on clinically manifest disorders, we expected a weaker LDAEP in subjects at risk for bipolar disorders and schizophrenia compared to healthy controls. Methods: We analyzed LDAEP of individuals at risk for developing bipolar disorders (n=27), with high-risk status (n=74) and ultra-high-risk status for schizophrenia (n=86) and healthy controls (n=47). Results: The LDAEP did not differ between subjects at risk for schizophrenia or bipolar disorders and controls. Among subjects without medication (n=122), the at-risk-bipolar group showed a trend towards a weaker LDAEP than both the high-risk and the ultra-high-risk groups for schizophrenia. Conclusions: The LDAEP did not appear as a vulnerability marker for schizophrenia or bipolar disorders. This suggests that an altered LDAEP may not be measurable until the onset of clinically manifest disorder. However, the hypothesis that pathogenic mechanisms leading to bipolar disorders may differ from those leading to schizophrenia is supported. Significance: This is the first study investigating LDAEP in a population at risk for bipolar disorders.
    No preview · Article · Nov 2015 · Clinical Neurophysiology
    • "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.
    No preview · Article · Sep 2015 · Journal of Affective Disorders
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