The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients.
BACKGROUND
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.


METHODS
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).


RESULTS
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%.


CONCLUSIONS
Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders.


CONCLUSIONS
Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes.
Angst
Jules
J
Zurich University Psychiatric Hospital, Lenggstrasse 31, P.O. Box 1931, 8032 Zurich, Switzerland. jangst@bli.unizh.ch
Adolfsson
Rolf
R
Benazzi
Franco
F
Gamma
Alex
A
Hantouche
Elie
E
Meyer
Thomas D
TD
Skeppar
Peter
P
Vieta
Eduard
E
Scott
Jan
J
D000553:Ambulatory Care; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007558:Italy; D007802:Language; D008297:Male; D008875:Middle Aged; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013548:Sweden