title: Screening for bipolar disorder in a county jail at the time of criminal arrest.
abstract: OBJECTIVE
  This study assessed the operating characteristics of the mood disorder questionnaire (MDQ) among offenders arrested and detained at a county jail.
  
  
  METHODS
  The MDQ, a brief self-report instrument designed to screen for all subtypes of bipolar disorder (BP I, II and NOS) was voluntarily administered to adult detainees at the Ottawa County Jail in Port Clinton, Ohio. A confirmatory diagnostic evaluation was also performed using the mini-international neuropsychiatric interview (MINI). The MDQ was scored using a standard algorithm requiring endorsement of 7/13 mood items as well as two items that assess whether manic or hypomanic symptoms co-occur and cause moderate to severe functional impairment. In addition to the standard algorithm for scoring the MDQ, modifications were also tested in an attempt to improve overall sensitivity.
  
  
  RESULTS
  Among 526 jail detainees who completed the MDQ, 37 (7%) screened positive for bipolar disorder. Of 164 detainees who agreed to a research diagnostic evaluation, 32 (19.5%) screened positive on the MDQ, while 55 (33.5%) met criteria for bipolar disorder according to the MINI. When administered to the sample of 164 adult jail detainees, the sensitivity of the MDQ was 0.47 and the specificity was 0.94. The MDQ was significantly better at detecting BP I (0.59) than BP II/NOS (0.19; p=0.008). Modification of scoring the MDQ improved the sensitivity for detection of BP II from 0.23 to 0.54 with minimal decrease in specificity (0.84). The optimum sensitivity and specificity of the MDQ was achieved by decreasing the item threshold to 3/13 and eliminating the symptom co-occurrence and functional impairment items.
  
  
  CONCLUSIONS
  The MDQ was found to have limited utility as a screening tool for bipolar disorder in a correctional setting, particularly for the BP II subtype.
authors.affiliation: Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106, USA. kemp.david@gmail.com
authors.forename: David E
authors.initials: DE
authors.lastname: Kemp
authors.forename: Robert M A
authors.initials: RM
authors.lastname: Hirschfeld
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ganocy
authors.forename: Omar
authors.initials: O
authors.lastname: Elhaj
authors.forename: Renee
authors.initials: R
authors.lastname: Slembarski
authors.forename: Sarah
authors.initials: S
authors.lastname: Bilali
authors.forename: Carla
authors.initials: C
authors.lastname: Conroy
authors.forename: James
authors.initials: J
authors.lastname: Pontau
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003415:Crime / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D009111:Local Government; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011330:Prisons / Q000706:statistics & numerical data*; D011594:Psychometrics; D012372:ROC Curve; D011795:Surveys and Questionnaires; D013997:Time Factors