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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BPD is often associated with more frequent depressive episodes and a higher number of depressive symptoms per episode than is MDD, as well as more frequent family psychiatric histories (especially of mood disorders), anxiety disorders, alcohol and drug use disorders, and personality disorders.¹⁷ Other factors more closely associated with BPD than MDD include atypical features such as hypersomnia and psychomotor retardation, psychotic symptoms during the depressive episode, and more frequent recurrences of depressive episodes.^18-22 Also, depressive episodes during the postpartum period indicate a higher risk of BPD than do episodes in women outside the postpartum period, with a hazard ratio (HR) of 1.66 (95% CI, 1.12-2.48).²³ The risk is much greater when postpartum depressive episodes are associated with anxiety symptoms (HR=10.15; 95% CI, 7.13-14.46).²³

Final thoughts

Increased awareness and screening for BPD in primary care—where most individuals with depressive symptoms are first encountered—should lead to more accurate diagnoses and decrease the years-long gaps between symptom onset and detection of BPD,^4,5 thereby improving treatment and patient outcomes. Still, some cases of BPD may be difficult to recognize—particularly patients who present predominantly with depression with past irritability and other hypomanic symptoms (but not euphoria).

A positive MDQ screen should also prompt, if possible, a more detailed clinical interview by a mental health care professional, particularly if there is uncertainty about the diagnosis. Complex cases of BPD may require the expertise of a psychiatrist.

THE CASE

The patient’s FP referred him to a psychiatrist colleague, whose inquiry also revealed low mood, anhedonia, hopelessness, difficulty sleeping, low energy, poor appetite, guilt, poor concentration, and psychomotor retardation. The patient had experienced multiple depressive episodes over the past 20 years. Significant interpersonal conflicts frequently triggered his depressive episodes, which were accompanied by mood irritability, racing thoughts, distractibility, increased libido, excessive spending, increased energy, and engagement in risky behaviors.

The MDQ and PHQ9 questionnaires, used together, are more sensitive in detecting mood disorder than is routine assessment by general practitioners alone.

The patient’s score on the MDQ administered by the psychiatrist was positive, with 7 points on question 1. He also had posttraumatic symptoms related to his police work, which were not the main reason for the visit. He had been divorced 3 times. In prior manic episodes, he had not displayed euphoria, grandiosity, psychotic symptoms, or anxiety, but rather irritability with other manic symptoms.

Continue to: Based on his MDQ results...