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Detecting bipolar disorder among treatment-seeking substance abusers
K L Sloan1, D Kivlahan, A J Saxon
1VA Puget Sound Health Care System-Seattle Division, Washington 98108, USA. klsloan@u.washington.edu
The American Journal of Drug and Alcohol Abuse
|March 16, 2000
Summary
Detecting bipolar disorder in patients with substance use disorders is challenging. A brief self-report form focusing on diagnostic and treatment history, rather than symptoms, proved more effective for identifying bipolar disorder.
Area of Science:
- Psychiatry
- Addiction Medicine
- Clinical Psychology
Background:
- Bipolar disorder frequently co-occurs with substance use disorders.
- Diagnosing bipolar disorder can be difficult in patients with active substance use.
Purpose of the Study:
- To describe a brief, self-report screening tool for efficient bipolar disorder detection.
- To evaluate the efficacy of symptom-based versus history-based questions for diagnosis.
Main Methods:
- A 19-item self-report form was piloted in 373 substance abuse treatment applicants.
- Chart diagnosis served as the validating criterion for comparing scoring algorithms.
- Sensitivity and specificity of symptom self-report items were analyzed.
Main Results:
- The form demonstrated good internal consistency (alpha = .850).
- Self-report of bipolar diagnosis or treatment history (hospitalization, mood stabilizers) showed superior sensitivity and specificity compared to symptom-based items.
- Symptom self-report items had significantly poorer sensitivity and specificity.
Conclusions:
- Diagnostic and treatment history questions are more effective than symptom-based screening for identifying bipolar disorder.
- Further validation using structured interviews is planned.