Tool mania

Later sections discuss interviews and scales used for assessing symptom severity, including self-monitoring. Several types of bipolar disorder are recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association APA, , differentiated by the severity and duration of manic symptoms.

A diagnosis of bipolar I disorder is made based on a single lifetime episode of mania, which is in turn defined by euphoric or irritable mood, along with at least three additional symptoms or four if mood is only irritable that result in marked social or vocational impairment. The duration criterion for mania specifies that symptoms must last one week or require hospitalization.

Bipolar II disorder, in contrast, is defined by a history of at least one hypomanic episode and at least one major depressive episode. Criteria for hypomania are similar to those of mania, but in milder form: instead of impairment, a hypomanic episode is marked by a distinct change in functioning.

Cyclothymic disorder is an even milder subtype of bipolar disorder, and is diagnosed based on a period of at least two years of recurrent mood swings. In addition, the symptomatic two-year period cannot include any two-month span that is free of mood swings. Symptoms that are secondary to drugs such as cocaine, or medical conditions such as thyroid problems, will generally yield a diagnosis of substance-induced mood disorder or bipolar disorder not otherwise specified. The course of the disorder, however, may be strongly affected by psychosocial variables.

Manic episodes may be triggered by sleep disturbance Leibenluft et al. The diagnosis of bipolar disorder is based on a review of symptoms and potential medical explanations for those symptoms, as there is no biological marker for the disorder. In clinical practice, symptoms are frequently reviewed in an unstructured manner.

Improper diagnosis has serious repercussions because antidepressant treatment without mood-stabilizing medication can trigger iatrogenic mania Ghaemi et al. Several semistructured interviews have been developed to assess bipolar disorder in adults. Briefly, there is some evidence that the CIDI may systematically underdiagnose bipolar disorder e.

They differ, however, in the criteria they were designed to assess. RDC criteria are stricter in that psychotic symptoms are more likely to yield a diagnosis of schizoaffective disorder than would be applied in the DSM-IV criteria; within the DSM-IV criteria, psychotic symptoms must be present for at least two weeks outside of episode to be considered evidence of schizoaffective disorder.

Further details about these measures are provided next. We begin by describing the measures and their psychometric characteristics for assessing bipolar I disorder. We then turn toward some specific issues that complicate the assessment of milder forms of bipolar disorder.

Table 1 summarizes some of the well-supported measures for the diagnosis of bipolar disorder. The SCID is a semistructured interview that is divided into modules to cover different diagnoses. The modular design allows for the interview to be easily tailored to capture relevant diagnoses for a given research or clinical situation. Each SCID module contains probes to cover each of the core symptoms, and interviewers can use clinical judgment in gathering supplemental information if probes do not provide sufficient information for reliable symptom assessment.

The SCID, and more specifically its bipolar disorder module, demonstrated good interrater reliability both in a large international multisite trial Williams et al.

In patient samples, reliability for current and lifetime diagnoses of bipolar disorder has been adequate to excellent, ranging from. Results of one study indicated that the percentage of agreements with the gold standard were higher for the SCID as compared to standard clinician interviews Basco et al.

For each diagnosis, the probes focus on the symptoms for the most recent episode and then capture a broad overview of past episodes. The SADS has demonstrated good to excellent reliability for both symptoms and diagnoses Andreasen et al. Specifically, mania diagnoses have achieved good interrater reliability and achieved good test—retest reliability over 5 to 10 years among adults Coryell et al.

SADS diagnoses of bipolar disorder correlate robustly with other measures of mania Secunda et al. Hypomania is unique among DSM syndromes, in that by definition it does not cause any functional impairment.

Perhaps because of this quality, the presence of at least one major depressive episode is also required to achieve a diagnosis of bipolar II disorder. This presents a unique diagnostic challenge: the hypomanic episodes that separate bipolar II disorder from unipolar depression are by definition of only limited severity, making this a hard diagnosis to reliably detect.

Complicating this picture is the fact that there are important disagreements in the field regarding the best criteria for hypomanic episodes. For instance, current DSM criteria require three or four symptoms, in addition to elevated or irritable mood, lasting at least four days. In contrast, RDC criteria only require three symptoms lasting two days.

Given this uncertainty and relative lack of severity of hypomania, it is not surprising that the accurate assessment of bipolar II disorder is more difficult to achieve than bipolar I disorder. Given that hypomania is almost always accompanied by less distress than depressive episodes, one might be tempted to focus on detecting depression.

There is evidence, however, that the diagnosis of hypomania and hence, bipolar II disorder is important above and beyond the detection of depression. Diagnoses of bipolar II disorder are accompanied by increased mood lability Akiskal et al. In addition, at least three studies have demonstrated that people with bipolar II disorder are at a higher risk for suicide than are those with bipolar I disorder or unipolar depression Dunner, It is possible that the low mood of depression, combined with the impulsivity of hypomania, may be especially likely to lead to suicide attempts.

In addition to suicide risk, the misdiagnosis of bipolar II disorder can have harmful pharmacological implications. The prescription of antidepressants, which is likely if bipolar II disorder is misdiagnosed as unipolar depression, may cause or exacerbate manic symptoms Ghaemi et al.

Thus, identification of bipolar II disorder may be pivotal in administering effective treatments. The above-described difficulties in assessing hypomanic symptoms have manifested in low reliability for the SADS in detecting bipolar II disorder Andreasen et al.

Some research groups have achieved better estimates, however Simpson et al. Beyond the inconsistent estimates of interrater reliability, test—retest reliability over six months to two years likewise has been low for bipolar II disorder and cyclothymic disorder alike Andreasen et al. In sum, the best available diagnostic interviews are limited in their psychometric characteristics for the diagnosis of bipolar II disorder.

Although promising, such approaches have not yet been fully validated. In sum, a set of issues mars diagnosis of bipolar II disorder. Persons who meet criteria for bipolar II disorder may be at high risk for suicidality, and they may experience a worsening of manic symptoms if prescribed antidepressants.

On the other hand, available tools do not detect bipolar II disorder reliably. Thus a major goal for ongoing research is to develop ways to reliably capture diagnoses of bipolar II disorder. The most reliable and valid way to obtain a diagnosis of bipolar disorder is through a structured interview with a trained clinician Akiskal, Nonetheless, given the time commitment involved in conducting structured interviews, several self-report measures have been developed to help clinicians identify persons most likely to meet criteria for bipolar disorders.

It should be emphasized that these measures do not provide diagnostic accuracy, but, rather, might help identify people who should warrant more careful diagnostic interviews.

The General Behavior Inventory GBI was designed to cover the core symptoms of bipolar disorder, including both depressive and manic symptoms Depue et al. Different versions range from 52 to 73 items e. Although the GBI has the most robust psychometric properties of the available self-report screeners, the multiple versions make generalizations regarding psychometric properties difficult.

The full item version of the GBI has demonstrated excellent internal consistency and adequate test—retest reliability. Cutoff scores, however, have not been consistent across studies, further limiting the generalizability of the scale. At present, the GBI appears to be a useful screening tool for bipolar disorder, but future research to establish norms and cutoffs would increase its utility. To achieve a positive screen, seven items must be endorsed. Additional items assess if the identified symptoms co-occurred and caused at least moderate impairment.

The MDQ has attained adequate internal consistency Hirschfeld et al. In addition, at least one recent study has demonstrated that high MDQ scores are associated with greater impairment and suicidal ideation in a primary care setting Das et al.

Nonetheless, specificity has been low in some studies. A review of the content of MDQ items may help clarify why the scale has achieved better performance in inpatient settings than in community settings. Several of the items appear to capture common experiences in community samples.

These items may be less commonly endorsed by persons with schizophrenia and other severe psychopathology, explaining why the scale may appear more beneficial in an inpatient setting than in a community sampling. Hence, the MDQ may be a potentially useful tool in clinical settings to screen for bipolar disorder among those with severe psychopathology, but may be less helpful in community settings. Other scales appear helpful in nonclinical samples, but do not have enough data regarding their usefulness as screening tools in clinical settings.

To date, the HPS has only been studied in one clinical sample, achieving a positive predictive value of. Although the four-factor structure that includes dysthymic, cyclothymic, hyperthymic, and irritable temperaments has been examined in several countries and languages and psychometrically validated in clinical populations, research has not directly established the usefulness of this measure as a screen for bipolar spectrum disorders e.

At least one study, however, has demonstrated that the cyclothymic subscale of the TEMPS-A can prospectively predict bipolar spectrum diagnoses among clinically depressed children and adolescents over a two-year period Kochman et al. Although initial studies indicate that these scales demonstrate good psychometric properties, more research is needed to determine their usefulness as screening measures. With excellent psychometric characteristics for the assessment of bipolar I disorder, they fare less well in assessing bipolar II disorder.

This may be due to issues related to the definition of hypomania. As a diagnostic screening tool, the scale with the best support is the GBI, as it has consistently demonstrated sensitivity of approximately. Readers should be cautious, however, because multiple versions of the scale exist, and cutoffs for a positive screen have not been firmly established. The MDQ has been helpful in clinical populations, but suffers from poor discriminatory power in community settings.

Other promising scales require more psychometric development. When using self-report scales as screening tools, several broader issues must be kept in mind. Second, few studies provide direct comparisons of psychometric characteristics of the different measures.

Not all studies on the detection of bipolar disorder report all of these results, limiting the ability to compare studies or measures. Furthermore, sensitivity and specificity are commonly reported, but these indices may be dependent on sample characteristics. Fourth, authors have often modified the diagnostic interviews used as a reference standard to capture milder forms of bipolar spectrum disorder, yet limited information about these modifications is available.

Each of these issues makes comparisons between measures complex. The most common approach to measuring the severity of manic symptoms has been clinician-rated interviews. These scales have been commonly used to track changes in symptoms over time as treatment progresses. There has been growing recognition, though, of the need to track both clinician and patient perspectives on the course of treatment, and so we discuss available symptom severity measures that rely on self-report.

Some research has focused on measures useful for case conceptualization and treatment planning, but this literature is not covered in detail here: interested readers are referred to other reviews e. Table 2 summarizes some of the well-supported measures for assessing symptom severity in bipolar disorder. It was originally developed and tested within an inpatient population based on semi-structured interview and observation during an eight-hour period.

It should be noted that item 8, Bizarre Content, combines the assessment of the manic symptom of grandiosity with other psychotic symptoms, including hyperreligiousity, paranoia, ideas of reference, delusions, and hallucinations. The YMRS does not account for other DSM criteria of mania, including distractibility, increases in goal-directed activity, or excessive involvement in pleasurable activities with a high potential for painful consequences.

Seven items are rated on a severity scale ranging from 0 to 4, and four items are rated on a scale of 0 to 8. Four core symptoms irritability, speech, bizarre content, and disruptive—aggressive behavior are double-weighted to account for poor cooperation from severely ill patients. Although the weighting may make rating more complex, it has not been shown to affect the reliability, validity, or sensitivity of the scale. Scores also statistically differentiate patients before and after two weeks of treatment.

The YMRS has primarily been used to assess manic symptoms in treatment trials and was the primary measure of mania in the Systematic Treatment Enhancement Program for Bipolar Disorder study, the largest study to date on the effectiveness of treatments for bipolar disorder Sachs et al.

The MAS Bech et al. It has been widely used in treatment and basic research e. Scores on the MAS reliably differentiate placebo and treatment groups, as well as detect changes in symptoms associated with treatment Bech, Items are rated on a six-point scale that includes behavioral anchors.

Support for the scale in factor analytic studies has been mixed. One study found that all items loaded onto a single factor distinct from dysphoria, insomnia, and psychosis Rogers et al.

However, less factor analytic support was obtained in a study that examined the item loadings for the SADS-C and a nurse observation scale for mania Swann et al. The team has such an eye for design and their code is impeccable. I am so happy with the results! Carla Jones. We had a great collaborative experience working with Package Marketing Agency. Their work is exceptional, and we are very excited to launch our new campaign!

Martin Reed. The work that Package Marketing Agency produced gave an easy, seamless integration into our current branding. We loved the high energy their team brought to our company! Josie Lane. Package Marketing Agency delivered exceptional results well within the projected deadline.

A completely free program. Edit and Record Audio. Collection Organizers. Organize your movies and TV series, download information about movies and actors.

A powerful music organizer. Download discographies of artists, reviews, covers, photos, and more. Organize your paper books, e-books, audio books in one program.

Copy and synchronize your e-books with e-readers. Music Management.