Screening for bipolar disorder among outpatients with substance use disorders

Area of Science:

• Psychiatry
• Addiction Medicine
• Clinical Psychology

Background:

• Comorbidity of bipolar disorder with alcohol or substance use disorders is common.
• This comorbidity negatively impacts illness course and treatment adherence.
• Accurate screening tools are crucial for effective management.

Purpose of the Study:

• To compare the diagnostic validity of two brief screening instruments for bipolar disorder.
• To assess the Mood Disorder Questionnaire (MDQ) and Hypomania Checklist-32 (HCL-32) in patients undergoing substance use disorder treatment.

Main Methods:

• The Mood Disorder Questionnaire (MDQ) and Hypomania Checklist-32 (HCL-32) were administered to 152 patients.
• Patients were recruited from outpatient clinics specializing in alcohol and opiate dependence treatment.
• Screening tool performance was validated against the Structured Clinical Interview for DSM-IV (SCID).

Main Results:

• Bipolar spectrum disorder was diagnosed in 21.7% of patients via SCID.
• The Hypomania Checklist-32 (HCL-32) demonstrated higher sensitivity (90.9%), while the Mood Disorder Questionnaire (MDQ) showed higher specificity (77.3%).
• Both instruments had a positive predictive value below 50%, indicating potential for false positives/negatives.

Conclusions:

• Caution is advised when utilizing the MDQ and HCL-32 for bipolar disorder screening in patients with substance use disorders.
• The diagnostic accuracy of these tools varies depending on the specific substance use disorder.
• Further research may be needed to develop more reliable screening methods for this complex patient group.