Combine these screening tools to detect bipolar depression

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Behavioral Health

Combine these screening tools to detect bipolar depression

J Fam Pract. 2018 August;67(8):500-503

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References

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The PHQ9 screens for current depressive symptoms/episodes (https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/218).

The value of combining the MDQ and PHQ9. The PHQ9 screens for and assesses the severity of depressive episodes along with clinician assessment, but it cannot distinguish between depressive episodes of MDD or BPD. A brief instrument, such as MDQ, screens for current or past manic or hypomanic symptoms, which, when combined with the clinical interview and patient history, enables detection of BPD if present and avoids erroneously assigning depressive symptoms to MDD.

One cross-sectional study found that the combined MDQ and PHQ9 questionnaires have a higher sensitivity in detecting mood disorder than does routine assessment by general practitioners (0.8 [95% confidence interval (CI), 0.71-0.81] vs 0.2 [95% CI, 0.12- 0.25]) and without loss of specificity (0.9 [95% CI, 0.86-0.96] vs 0.9 [95% CI, 0.88-0.97]).¹⁵ In this same study, using a structured clinical interview for DSM-III-R Axis I Disorders (SCID-I) as the gold standard, researchers also found the screening tools to be more accurate (Cohen’s Kappa 0.7 [SE=0.05; 95% CI, 0.5-0.7]) than the general practitioner assessment (Cohen’s Kappa 0.2 [SE=0.07 (95% CI, 0.12-0.27]).¹⁵

Delve deeper with a patient interview

Use targeted questions and laboratory tests to rule out other possible causes of depressed mood, such as substance abuse or medical conditions (eg, hypothyroidism). Keep in mind that even when MDD or BPD is present, other medical disorders or substance abuse could be coexistent. Also ask about a personal or family psychiatric history and assess for suicidality. If family members are available, they may be able to help in identifying the patient’s age when symptoms first appeared or in adding information about the affective episode or behavior that the patient may not recollect.

Depressive episodes predominate in bipolar disorder and symptoms can be indistinguishable from those of unipolar depression.

Beyond a history of manic, hypomanic, or mixed episodes, other symptoms and features may assist in distinguishing between bipolar and unipolar depression or in helping the clinician identify depressed patients who may be at higher risk for, or have, BPD. One meta-analysis of 3 multicenter clinical trials assessed sociodemographic factors and clinical features of BPD compared with unipolar depression. The average age of onset of mood symptoms in individuals with BPD was significantly younger (21.2 years) than that of patients with MDD (29.7 years).¹⁶ Another study found that patients with either bipolar I or bipolar II similarly experienced their first mood disorder episode 10 years earlier than those with MDD.¹⁷

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