The use of 15-point hypomanic checklist in differentiating bipolar I and bipolar II disorder from major depressive disorder.
OBJECTIVE
Individuals with bipolar disorder (BP) are often misdiagnosed with major depressive disorder (MDD). In this study, we developed a Chinese version of 15-point hypomania scale (HCL-15) in order to determine its sensitivity and specificity in the diagnosis of BP and BP-II in particular.


METHODS
A total of 623 individuals suffering a major depressive episode (MDE) were systematically interviewed with both Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Patient Edition, and HCL-15. A cutoff score of 8 or more in HCL-15 was suggested for BP.


RESULTS
Of the 623 depressed patients, 115 (18.5%) actually required a diagnosis of BP-I, and another 159 (25.5%) could be more appropriately diagnosed with BP-II, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The sensitivity of 15-HCL in detection of BP-II was 0.78 and 0.46 for BP-I; the specificity was 0.9 and 0.69, respectively. The specificity of HCL-15 for BP versus MDD was as high as 0.93. Approximately 60%-80% of all questions in the HCL-15 questionnaire revealed positive responses from patients, while items 11 and 12, measuring the consumption of alcohol, coffee and cigarettes, demonstrated a low positive response rate.


CONCLUSIONS
The HCL-15 assessment scale was fairly sensitive and highly specific for a BP-II diagnosis but not for a BP-I diagnosis. Some items in the HCL-15 symptom list need to be further modified to better fit Chinese culture and customs. The HCL-15 scale could be a useful tool in clinical practice for screening individuals with BP-II in order to avoid a misdiagnosis of MDD.
Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University.
Hongbo
H
He
Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University; Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University. Electronic address: xuguiyun2908@hotmail.com.
Guiyun
G
Xu
Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University.
Bin
B
Sun
Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University.
Huiyi
H
Ouyang
Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University.
Yamei
Y
Dang
Psychiatric Neuroscience Research Institute, Guangzhou Brain Hospital, Affiliated hospital of Guangzhou Medical University; Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University.
Yangbo
Y
Guo
Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University.
Guodong
G
Miao
International Mood Center, University of California, San Diego, La Jolla, CA, USA.
Catherine
C
Rios
International Mood Center, University of California, San Diego, La Jolla, CA, USA.
Hagop S
HS
Akiskal
Department of Affective Disorder, Guangzhou Brain Hospital, Affiliated Hospital of Guangzhou Medical University; Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong; Laboratory of Cognitive Affective Neuroscience, The University of Hong Kong, Hong Kong. Electronic address: Klin@hku.hk.
Kangguang
K
Lin
D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis*; D057189:Checklist / Q000592:standards; D002681:China; D003865:Major Depressive Disorder / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012680:Sensitivity and Specificity
15-Point hypomanic checklist; Bipolar disorder; Major depressive disorder; Psychometrics