Discriminative hypomania checklist-32 factors in unipolar and bipolar major depressive patients.
BACKGROUND
Although manic or hypomanic episodes define bipolar disorder (BD), most patients show a predominance of depressive symptomatology, often associated with delayed or disregarded BD diagnosis. The Hypomania Checklist-32 (HCL-32) has therefore been developed and tested internationally to facilitate BD recognition.


METHODS
Five hundred seventy-one (563 eligible) patients diagnosed with a major depressive episode according to DSM-IV criteria were consecutively enrolled in a cross-sectional, multicenter, observational study (Come To Me). Lifetime manic or hypomanic features were assessed by the HCL-32, and severity of depressive and anxious symptomatology was assessed using the Zung's self-report questionnaires for depression and anxiety.


RESULTS
Among the patients diagnosed with BD (n = 119), either type I or type II, the occurrence of (hypo)manic symptoms was significantly higher compared to major depressive disorder (MDD) symptoms according to HCL-32 total and subscale scores obtained using a score of 14, which ensured an optimal discrimination between BD and MDD with a sensitivity of 0.85 and a specificity of 0.78.


CONCLUSIONS
Although some false positives might occur, the HCL-32 was confirmed to be a useful instrument in the detection of past hypomania in MDD patients, finally contributing to proper therapeutic choices.
Department of Psychiatry, University of Pisa, Pisa, Italy. giulio.perugi@med.unipi.it
Giulio
G
Perugi
Michele
M
Fornaro
Icro
I
Maremmani
Pier Luigi
PL
Canonico
Paolo
P
Carbonatto
Claudio
C
Mencacci
Giovanni
G
Muscettola
Luca
L
Pani
Riccardo
R
Torta
Claudio
C
Vampini
Fabio
F
Parazzini
Arina
A
Dumitriu
Jules
J
Angst
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis*; D057189:Checklist / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation; D012680:Sensitivity and Specificity