1. Screening for Bipolar Disorder
Flavio Guzmán, MD

2. Outline Why is it important? Why do we miss the diagnosis of BD?
Three critical aspects to include in any bipolarity evaluation
The DIGFAST mnemonic
Screening instruments: MDQ and BSDS

3. Why is an accurate diagnosis important?
Delayed diagnosis
Progression of comorbidities
Substance abuse
Less effective treatments
Pharmacological
Psychosocial
Vieta, E. (2013). Managing bipolar disorder in clinical practice. London: Springer Healthcare.

4. Why do we miss the diagnosis of bipolar disorder?
Not asking about manic and hypomanic symptoms
Not including a family member in evaluation
Clinician factors
Depressive episodes last longer than hypomanic episodes
Illness factors
Lack of insight about mania and hypomania
Patient factors
Goodwin, F., Jamison, K. & Ghaemi, S. (2007). Manic-depressive illness : bipolar disorders and recurrent depression. Oxford University Press.

5. Some interviewing challenges
False positives
Normal mood variations
Ask about other people’s perceptions
Diagnostic criteria at different points
Keep referring to defined period of time
Carlat, D. (2012). The psychiatric interview : a practical guide. Philadelphia, PA: Lippincott Williams & Wilkins.

6. Three aspects to consider in a screening
History of hospitalization
Interview with relatives and friends
Family history of bipolar disorder
Goodwin, F., Jamison, K. & Ghaemi, S. (2007). Manic-depressive illness : bipolar disorders and recurrent depression. Oxford University Press.

7. Use the mnemonic “DIGFAST”
Distractibility
Indiscretion
Grandiosity
Flight of ideas
Activity increase
Sleep deficit
Talkativeness
Carlat, D. (2012). The psychiatric interview : a practical guide. Philadelphia, PA: Lippincott Williams & Wilkins.

8. Screening Instruments

9. Screening instruments
Types of scales
Screening instruments
Symptom rating scales
Helpful for efficient screening of patients with depression
If positive, perform more comprehensive evaluation
Monitor mood status over time
Response to treatment
MDQ
BSDS
Depression: HAM-D, MADRS
Mania:
Young Mania Rating Scale (YMRS)
Bech Rafaelsen Mania Rating Scale (MAS)
Yildiz, A. (n.d.). (2015).The bipolar book: History, neurobiology, and treatment. (1st ed.). New York, N.Y.: Oxford University Press.

10. Screening instruments
Types of scales
Screening instruments
Symptom rating scales
Helpful for efficient screening of patients with depression
If positive, perform more comprehensive evaluation
Monitor mood status over time
Response to treatment
MDQ
BSDS
Depression: HAM-D, MADRS
Mania:
Young Mania Rating Scale (YMRS)
Bech Rafaelsen Mania Rating Scale (MAS)
Yildiz, A. (n.d.). (2015).The bipolar book: History, neurobiology, and treatment. (1st ed.). New York, N.Y.: Oxford University Press.

11. Mood Disorder Questionnaire
Self-rated screening instrument
13 questions about manic and hypomanic symptoms
Yes/No format
5 minutes
Miller, C. J, et al  (2009). Assessment tools for adult bipolar disorder. Clinical Psychology: Science and Practice, 16(2),

12. Mood Disorder Questionnaire
Self-rated screening instrument
13 questions about manic and hypomanic symptoms
Yes/No format
5 minutes
More than 7 items
Positive screen
Bipolar disorder assessment
Miller, C. J, et al  (2009). Assessment tools for adult bipolar disorder. Clinical Psychology: Science and Practice, 16(2),

13. Mood disorder questionnaire (MDQ)
Sensitivity
Specificity
0.7
0.9
10 patients with BD
7 correctly diagnosed
3 would be missed
10 patients without BD
9 successfully ruled out
1 false positive
Miller, C. J, et al  (2009). Assessment tools for adult bipolar disorder. Clinical Psychology: Science and Practice, 16(2),

14. Better performance in inpatient settings than in community
Limitations of the MDQ
Better performance in inpatient settings than in community
MDQ may capture common experiences
Less commonly endorsed in inpatient settings
Miller, C. J, et al  (2009). Assessment tools for adult bipolar disorder. Clinical Psychology: Science and Practice, 16(2),

15. Bipolar Spectrum Diagnostic Scale (BSDS)
Originally designed to improve detection of BD II
Written in story format
19 sentences that describe symptoms
10 minutes to complete
Ghaemi, S. N.,et al (2005). Sensitivity and specificity of a new bipolar spectrum diagnostic scale. Journal of affective disorders, 84(2),

16. General instructions for the BSDS
Read the 19 sentences in the passage
First scoring
How much the entire passage describes you: very well, fairly well, to some degree but not most or not at all
Go back and put a check after each sentence that describes you
Second scoring:
1 point per sentence
Ghaemi, S. N.,et al (2005). Sensitivity and specificity of a new bipolar spectrum diagnostic scale. Journal of affective disorders, 84(2),

17. General instructions for the BSDS
Read the 19 sentences in the passage
First scoring
How much the entire passage describes you: very well, fairly well, to some degree but not most or not at all
Go back and put a check after each sentence that describes you
Second scoring:
1 point per sentence
Ghaemi, S. N.,et al (2005). Sensitivity and specificity of a new bipolar spectrum diagnostic scale. Journal of affective disorders, 84(2),

18. The BSDS informs about the likelihood of BD
Range
Likelihood of bipolar disorder
20-25
Highly likely
13-19
Moderate probability
7-12
Low probability
0-6
Highly unlikely
Ghaemi, S. N.,et al (2005). Sensitivity and specificity of a new bipolar spectrum diagnostic scale. Journal of affective disorders, 84(2),

19. BSDS sensitivity and specificity
0.76 (BD I and BD II)
0.85
0.75 BDI
0.79 BDII
Ghaemi, S. N.,et al (2005). Sensitivity and specificity of a new bipolar spectrum diagnostic scale. Journal of affective disorders, 84(2),

20. Key points Importance of: Consider using a screening instrument
Hospitalization history
Positive family history
Interviewing a relative or close friend
Consider using a screening instrument
MDQ or BSDS
BSDS
Captures subtle bipolar symptoms
Informs about the likelihood of bipolar disorder