Simple hypomania checklist detects bipolar II disorder

By Lucy Piper, Senior medwireNews Reporter

A 15-item hypomania checklist has shown potential for differentiating bipolar disorder, particularly type II, from major depressive disorder (MDD).

Developed in Chinese, the checklist is a 15-item version of the 32-item hypomania checklist (HCL), which can take at least 6 to 10 minutes for a patient to complete.

At a cutoff score of 7, the shorter version was found to have a sensitivity and specificity comparable to that previously reported for the 32-item version.

It distinguished between bipolar disorder and MDD with a specificity as high as 93% and detected bipolar I disorder with a sensitivity of 46% and bipolar II disorder with a sensitivity of 78%. The overall accuracy in each case was 69% and 90%, respectively.

“Since differentiation of [bipolar I disorder] and MDD is not a major concern in clinical practice, these results indicated that HCL-15 could be a very practical aid in differentiating [bipolar II disorder] and MDD,” say the researchers, led by Guiyun Xu (Affiliated Hospital of Guangzhou Medical University, China) and Kangguang Lin (University of Hong Kong).

“After 2 min of self-assessment, the clinician should be alerted by HCL scores of 7 or above that the currently depressed patient might need further evaluation in order to differentiate [bipolar disorder], especially [bipolar II disorder], from MDD.”

The HCL-15 was tested in 623 individuals with a major depressive episode. According to DSM-IV criteria, 349 (56.0%) had MDD, 115 (18.5%) had bipolar I disorder, and 159 (25.5%) had bipolar II disorder.

The HCL-15 showed good internal reliability, at a Cronbach’s alpha coefficient of 0.93. And the frequency of positive response was generally high, at approximately 60–80% for all questions.

But the researchers note that items 11 and 12, which monitor the consumption of alcohol, coffee, and cigarettes had a low positive response rate in all individuals. This was consistent with most of the participants not drinking alcohol or smoking cigarettes, perhaps due to Chinese culture and custom.

They therefore suggest that these two items could be discarded from future versions of the HCL-15 and replaced with two additional items that reflect mood lability, given that this feature is more common in bipolar disorder than MDD.

The team concludes in General Hospital Psychiatry that HCL-15 is a “practical choice” for clinicians in busy clinics to use to screen patients when they first present with a depressive episode.

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