High affective temperamental load as a clinical marker of bipolar disorder: applications in low-resource settings

Abstract

Objective We aimed to test the performance of the short version of the Temperamental Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire (Short-TEMPS-A) as a tool for bipolar disorder (BD) status detection in an outpatient sample with affective disorders, using Cyclothymic-Hyperthymic High Temperamental Load (HTL-CH) as the criterion for a positive test. Methods We enrolled 201 euthymic female and male adult outpatients (73.1% female; mean age 47.3 ± 16 years), with BD (42.79%), and other affective disorders (major depressive disorder (20.9%), or anxiety disorders (36.32%)) in a public general hospital in South-Central Chile. Diagnosis was made using the Structured Clinical Interview for axis I. All subjects completed the Short-TEMPS-A. HTL-CH was defined using a cutoff of ≥75% in the hyperthymic or cyclothymic subscales of the Short-TEMPS-A. We estimated the HTL-CH likelihood of BD versus non-BD using multiple logistic regression modeling to control for possible confounders. The performance of HTL-CH as a tool for BD status evaluation was assessed using area under receiver operating characteristic curve (AUC ROC) analysis. Results Patients with HTL-CH had an OR = 7.55 (CI95% = 2.11–26.96) of having a BD status. HTL-CH showed good psychometric properties for BD status detection, correctly classifying 74.13% of patients. AUC ROC was 0.74 (CI95%=0.68–0.81). Conclusions HTL-CH, as assessed by the Short-TEMPS-A, was able to detect BD status accurately and reliably in affective outpatients. The Short-TEMPS-A might be a useful tool in aiding clinicians to detect BD, particularly during initial assessment of affective patients in low-resource settings.