Screening Tool Effective for Identifying Bipolar I Disorder During a Depressive Episode

A newly developed, 6-item Rapid Mood Screener (RMS) could differentiate between bipolar 1 disorder (BPD-1) and major depressive disorder (MDD) among patients with depressive symptoms. These findings were presented at Psych Congress 2020 Virtual Experience, held online from September 11 to 13, 2020.

A comprehensive literature search was performed to identify key characteristics that best differentiate between the 2 mood disorders. A draft version of the questionnaire was formulated after a debriefing interview with patients (n=12) with BPD-1 or MDD. These interviews allowed for the investigators to test and refine the wording used in the tool.

Once the RMS was developed, it was further refined by 139 patients with clinically confirmed BPD-1 (n=67) and MDD (n=72). During this stage of development, the number of items included in the RMS was reduced from 10 to 6.

The first 3 items on the questionnaire assessed depressive symptoms (eg, have you experienced at least 2 weeks of deep depression; did you experience problems with depression during adolescence; have you changed antidepressant medication due to irritability or hyperactivity). The remaining 3 items assessed manic symptoms (eg, have you experienced at least 1 week of being more talkative or with racing thoughts; of requiring more sleep than normal; of being unusually happy, outgoing, or energetic).

Evaluation of the RMS was based on 4 scores. The sensitivity measure quantifies the proportion of patients with BPD who screen positive. The specificity measure quantifies the proportion of patients without BPD who screen negative. The positive predictive value quantifies the proportion of patients who have BPD. The negative predictive value quantifies the proportion of patients who do not have BPD.

During testing, when 4 or more of the RMS items were endorsed, it was able to differentiate between patients with BPD-1 and MDD with a sensitivity of 0.88, a specificity of 0.80, a positive predictive value of 0.80, and a negative predictive value of 0.88.

These results were compared against the commonly used mood disorder questionnaire (MDQ), which only assesses for manic symptoms, uses 15 items, and scores patients in a multistep manner. The MDQ was able to differentiate between the 2 mood disorders among the same study population with a sensitivity of 0.86, a specificity of 0.78, a positive predictive value of 0.78, and a negative predictive value of 0.86.

The RMS outperformed the MDQ using fewer than half of the questions. The RMS is a rapidly administered test, taking <2 minutes to assess each patient.

A possible limitation of this study is that the same patient population was used to refine the questionnaire and test its effectiveness.

The study authors concluded that the novel RMS screening tool was an efficient and pragmatic tool that was able to differentiate between BPD-1 and MMD. The RMS outperformed the widely used MDQ and may allow clinicians to better diagnose patients and perhaps reduce the high proportion of patients with BPD-1 (as high as 25%) who are misdiagnosed as having MMD.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original abstract for a full list of disclosures.

Reference

Masand PS, McIntyre RS, Patel M, et al. The Rapid Mood Screener: a novel and pragmatic screener tool for bipolar I disorder. Presented at: Psych Congress 2020 Virtual Experience; September 11-15, 2020. Poster 208.