title: Screening for bipolar disorder among patients undergoing a major depressive episode: report from the BRIDGE study in Egypt.
abstract: BACKGROUND
  To estimate the frequency of bipolar disorder (BPD) among patients with a major depressive episode (MDE) and elucidate clinically-relevant factors predictive of bipolarity.
  
  
  METHODS
  We evaluated 306 patients undergoing a MDE at facilities throughout Egypt. Patients were given the HCL-32 R2 questionnaire to assess the presence of manic/hypomanic symptoms; those scoring >14 were considered bipolar. We also investigated how various clinical criteria for bipolarity changed the incidence of bipolar diagnosis. Finally, we examined if demographics, psychiatric history, clinical characteristics, and the incidence of co-morbid conditions differed significantly between bipolar and unipolar patients.
  
  
  RESULTS
  The positive screen rate for BPD based on HCL-32 R2 scores was 62.2% (188/302). However, only 26% (80/306) of patients had been diagnosed previously as bipolar. In contrast, when DSM-IV criteria were used, only 13.7% (42/306) of patients qualified as bipolar. A number of factors were highly predictive of bipolarity including: seasonality, number of past mood episodes, history of psychiatric hospitalization, mixed state, and mood reactivity. Of the comorbidities examined, only borderline personality disorder occurred at a higher rate in bipolar than in unipolar patients.
  
  
  CONCLUSIONS
  Participating centers were not randomly selected and there could be a bias if only psychiatrists having specific interest in BPD were included.
  
  
  CONCLUSIONS
  The positive HCL-32-R2-based bipolar screen rate of 62% suggests that a substantial proportion of patients with a MDE may have BPD. Further, a number of factors in the patient's psychiatric history as well as clinical aspects of the episode itself may signal an increased likelihood of bipolarity.
authors.affiliation: Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt. tokasha@internetegypt.com
authors.forename: Tarek
authors.initials: T
authors.lastname: Okasha
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fikry
authors.forename: Aref
authors.initials: A
authors.lastname: Kowailed
authors.forename: Tamer
authors.initials: T
authors.lastname: El-Guwiely
authors.forename: Hisham
authors.initials: H
authors.lastname: Sadek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult