The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients

Abstract

Background Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms in adolescence is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders. Methods The multi-lingual hypomania checklist (HCL-32) has been developed and is being tested internationally. This preliminary paper reports the performance of the scale in distinguishing individuals with BP ( N = 266) from those with major depressive disorder (MDD; N = 160). The samples were adult psychiatry patients recruited in Italy ( N = 186) and Sweden ( N = 240). Results The samples reported similar clinical profiles and the structure for the HCL-32 demonstrated two main factors identified as “active/elated” hypomania and “risk-taking/irritable” hypomania. The HCL-32 distinguished between BP and MDD with a sensitivity of 80% and a specificity of 51%. Limitations Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders. Conclusions Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes.