From the Guidelines
A comprehensive psychiatric evaluation, incorporating the DSM-IV-TR criteria and standardized screening tools, is the most effective test for diagnosing bipolar disorder. This evaluation should be conducted by a qualified mental health professional, such as a psychiatrist or psychologist, and includes a detailed interview about symptoms, medical history, family history, and patterns of mood changes over time 1. The diagnostic assessment needs to incorporate both current and past history regarding symptomatic presentation, treatment response, psychosocial stressors, and family psychiatric history.
Some key points to consider in the evaluation process include:
- Manic-like symptoms of irritability and emotional reactivity may be found in various conditions, and a thorough assessment is necessary to distinguish bipolar disorder from other disorders 1
- The pattern of illness, duration of symptoms, and association with psychomotor, sleep, and cognitive changes are important diagnostic clues 1
- The illness represents a marked departure from baseline functioning and should be evident and impairing in different realms of the individual's life 1
- A life chart can be helpful in characterizing the course of illness, patterns of episodes, severity, and treatment response 1
Standardized screening tools, such as the Mood Disorder Questionnaire (MDQ), Bipolar Spectrum Diagnostic Scale (BSDS), or the Hypomania Checklist (HCL-32), can aid in identifying bipolar symptoms. However, it is essential to note that there is no single test, including blood tests or brain scans, that can diagnose bipolar disorder. The diagnosis relies on recognizing patterns of mood episodes and their impact on functioning.
A thorough evaluation may involve multiple appointments, as bipolar disorder often develops gradually, and symptoms can overlap with other mental health conditions. It is crucial to be honest about all symptoms, including elevated moods, increased energy, reduced need for sleep, and impulsive behaviors, as these can help distinguish bipolar disorder from other conditions like major depression 1.
From the Research
Screening Instruments for Bipolar Disorder
- The Mood Disorders Questionnaire (MDQ) is a widely studied screening instrument for bipolar disorder, with a sensitivity of 61.3% and specificity of 87.5% 2.
- The MDQ's performance depends on the setting, threshold, and subtype of bipolar disorder, with higher sensitivity in detecting bipolar I disorder than bipolar II disorder 2.
- Other screening instruments, such as observer-rated and self-completed instruments, are also available for assessing depressive, manic, and psychotic symptoms in patients with bipolar disorder 3.
Validation of the MDQ
- The MDQ has been validated in various populations, including Anabaptist populations, with diagnostic agreements between alternate MDQ scoring methods and best-estimate final diagnosis (BEFD) quantified using Cohen's Kappa (κ), sensitivity (α), and specificity (β) 4.
- A 5-symptom scoring method may increase diagnostic sensitivity in populations at high risk for bipolar disorder, with little loss of specificity 4.
- However, the MDQ's validity has been questioned, with low positive predictive value (0.29) for self-reported bipolar disorder and genetic correlations suggesting it may capture symptoms of general distress or psychopathology rather than hypomania/mania specifically 5.
Clinical Use of the MDQ
- The MDQ is not recommended for routine clinical use due to the absence of studies examining both the potential benefits and costs of screening 2.
- A positive MDQ test should be followed by assessment of the patient by a psychiatrist, as it is not a definitive diagnostic tool 6.
- The MDQ can be a useful screening instrument to improve recognition and treatment of bipolar disorder, particularly in populations with limited access to psychiatric care 6.