Patients with bipolar disorder experience manic or hypomanic episodes (euphoria) and depression. Type II bipolar disorder (hypomanic) patients are especially difficult to diagnose since their manic episodes are not very marked and they are usually diagnosed as depression patients. Choosing an incorrect treatment can be counterproductive. A study led by IDIBAPS, with the participation of PSYNCRO and 10 more hospital centres and the support of GSK, demonstrates how the HCL-32 test identifies bipolar depression in a simple way and with success above 80%. This work has been done with the Spanish version of this test.
Type II bipolar disorder is an underdiagnosed disease which can be easily confused with depression. Contrarily to what happens in type I bipolar disorder, depressive symptoms and, above all, manic symptoms alternated in this form of the disease are not evident and difficult to identify. In fact, patients suffering from it usually go to the doctor because they are depressed, without thinking that they have also had slight manic episodes (euphoria and other cognition disorders). Medical centre lack tools to identify successfully this pathology, which can take 8-10 years to be correctly diagnosed. Furthermore, antidepressant treatment can be counterproductive in patients with type II bipolar disorder. Dr. Eduard Vieta, of the group Biological Basis of the Psychic Disorder and Nuclear Psychiatry of the Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), has coordinated a study in order to validate the Spanish version of the test Hypomania symptom check list (HCL-32), which is being developed in an ample international collaboration.
The last issue of Journal of Affective Disorders published results confirming the usefulness of this simple questionnaire of 32 questions to distinguish major depression from bipolar disorder. In 2005, researchers from IDIBAPS collaborated in the international design of this test (J Affect Disord, 2005; 88(2):217-33). The main difference between HCL-32 and the test used until today -the Mood disorder questionnaire (MDQ)- is the open character of the questions, facilitating the patient’s sincerity. In these questions lay essential information to assess retrospectively the energy/activity levels of patients and problems of disinhibition, self-control and attention they have suffered in the past. This new study compares the sensitivity of both questionnaires, and concludes that the HCL-32 is more precise than the MDQ in the identification of type II bipolar disorder patients. This work has been supported by GlaxoSmithKline (GSK) and had the participation of PSYNCRO, a neuropsychological research enterprise, located in the Parc Científic de Barcelona (PCB), which has worked in collaboration with the Department of Psychology of the Universitat de Girona.
A total of 237 people from 15 different psychiatric departments (see annex list), filled out the HCL-32. Except those belonging to the control group (60), the rest were correctly diagnosed, stable and receiving a correct treatment for their pathology, which could be type I (62) and type II (56) bipolar disorder, or major depression (58). This test was able to identify more than 80% of patients with bipolar disorder. Although it could not distinguish between types I and II, this decision is relatively easy to take from the clinical data of the patient. For the first time, a tool to identify bipolar disorder is available for patients going to the medical centre claiming depression. Although it is necessary to go on with studies in patients of wider populations, the HCL-32 test can provide very useful information to psychiatrists and even to primary-care physicians.
The above story is based on materials provided by IDIBAPS - Institut d'Investigacions Biomediques August Pi i Sunyer. Note: Materials may be edited for content and length.
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