Prevalence Of Bipolar Disorder Research Articles

Prevalence of Bipolar Disorder Diagnoses and Psychotropic Drug Therapy Among Privately Insured Children and Adolescents

To estimate the treated prevalence of bipolar disorder in a privately insured population, describe the characteristics of children and adolescents receiving these diagnoses, and describe patterns of their psychotropic drug therapy. Retrospective, repeated cross-sectional study. MarketScan Commercial Claims and Encounters inpatient, outpatient, and pharmacy claims databases. A total of 22,360 children and adolescents (aged 0-17yrs) with one inpatient or two or more outpatient claims for any bipolar spectrum disorder between January 1, 2005, and December 31, 2007. Annual cross-sections were used to estimate the treated prevalence of bipolar disorder diagnoses, patient characteristics, and psychotropic drugs used 30days after a child's latest recorded bipolar disorder diagnosis within each year. The annual treated prevalence of any bipolar spectrum disorder in this privately insured population was 0.24% in 2005 and 0.26% in 2006 and 2007. Approximately 25% of diagnoses were for children younger than 13years. Approximately 30% of children had coexisting attention-deficit-hyperactivity disorder during the year. In each year, 35% of patients used no psychotropic drug therapy in the 30-day period after their most recent diagnosis. Twenty-five percent used one psychotropic drug, and 40% used two or more drugs. The most common drug regimens were antipsychotic or mood stabilizer (lithium or anticonvulsant) monotherapy and the combination of mood stabilizers and antipsychotics. Drug therapy patterns suggest that children and adolescents with bipolar diagnoses receive complex treatment regimens, often involving multiple classes of psychotropic drugs. Research on treatment combinations, particularly antipsychotic and mood stabilizer combinations, should be prioritized to better understand the safety and effectiveness of commonly prescribed treatments.

Trends in bipolar disorder or depression as a cause of death on death certificates of US residents, 1999–2009

Temporal trends in mortality from bipolar disorder (BD) or depression in the US population, based on multiple causes (MC) rather than underlying cause (UC) alone on death certificates, apparently have not been examined. The annual US age-standardized rate (ASR) for deaths per 100,000 US residents age 15+ years, and age-specific rates, for BD or depression using MC versus UC alone was examined for 1999-2009; percentage change (PC) from 1999 to 2009 was calculated. The ASRs at age 15+ years were much higher using MC than UC alone. For BD using MC, the ASR increased from 1999 to 2009 (PC +69.2%) with larger increases in age groups within 15-64years (PCs about 200%). For depression using MC, the ASR rose from 1999 to 2003 and then declined, but the decline was restricted to age 65+ years; the ASR at age 15-64years increased from 1999 to 2009 (PC +55.5%). For deaths at age 15-64years with BD or depression as other than UC, the ASRs increased for external causes, cardiovascular diseases, external causes, and neoplasms as UC. The large increases in mortality from BD using MC are consistent with reported increases in BD prevalence rates in the US population. The temporal increases in death rates related to mood disorders at age 15-64years may provide further support for the need for interventions to address the mediators of excess mortality identified from cohort studies.

A descriptive study of older bipolar disorder residents living in New York City’s adult congregate facilities

Much of the research on geriatric bipolar disorder is from outpatient populations or epidemiological surveys with small samples. In contrast, in this study a descriptive analysis was conducted of geriatric and younger adult residents with bipolar disorder or mania in non-clinical adult congregate facilities (ACFs) in the greater New York City region. A total of 2602 ACF residents were evaluated in 19 facilities, across multiple demographic and health domains. Within this sample, 200 residents had chart diagnoses of bipolar disorder or mania. Among these, 50 geriatric residents (age ≥ 60) were compared to 50 younger adult residents (age < 50) on a number of demographic and health measures. Based on chart diagnoses, the overall prevalence of bipolar disorder was 7.8%. Compared to other studies of outpatient, epidemiological, and census samples, both older and younger residents with bipolar disorder had higher rates of cognitive impairment, impairment in executive functioning, vision impairment, and proportion of residents who had never been married. The younger group also had higher rates of obesity and the elderly group had a greater proportion of residents without high-school education. Both age groups had rates of lithium or valproate use comparable to those found in outpatient studies. Comparing the two age groups, the elderly sample had lower overall cognitive and executive functioning, and was using a larger number of medication classes than the younger group. The elderly group also had a larger proportion of residents who were separated/divorced or widowed compared to the younger group, which had higher rates of never-married residents. Overall, both age groups had relatively high rates of bipolar disorder, with significant cognitive impairment, medical burden, obesity, mental health service use, and lower education levels, as compared to outpatient, epidemiological, and census samples. Of note was the significant cognitive impairment across age groups.

Screening for bipolar disorder in the primary care: A Brazilian survey

Two recent studies conducted in the US and in France found an unexpectedly high prevalence of a positive screen for bipolar disorder (BD) in primary care (PC). There are few studies of the prevalence of BD in PC and no information exists on the epidemiology of BD in Brazilian PC services. This study investigated the prevalence and correlates of a positive screen for BD among patients attending three Brazilian PC centers. This cross-sectional survey recruited a systematic sample of 720 patients between 18 and 70 years of age who were seeking primary care treatment. Study measures included the Mood Disorder Questionnaire, the Center for Epidemiologic Studies Depression Scale, the World Health Organization Quality of Life instrument-Abbreviated version, the Functional Comorbidity Index, the Functioning Assessment Short Test, data on past mental health care, service utilization and a review of medical records for coded diagnosis. The prevalence of receiving positive screen for BD was 7.6% (n=55; 95% CI: 5.6-9.5%), but only 2 (3.6%) were recognized by general practitioners. A positive screen for BD was associated with significant depressive symptoms (CES-D score ≥16; 70.9%) and more general medical conditions, along with higher primary care utilization. Patients who screened positive for BD reported worse health-related quality of life as well as impaired functioning, compared to those who screened negative. Co-morbid mental disorders were not assessed. The cross-sectional design prevents firm cause-effect inferences. The prevalence of a positive screening for BD is high, clinically significant and under-recognized in Brazilian PC settings.

Are bipolar disorders underdiagnosed in patients with depressive episodes? Results of the multicenter BRIDGE screening study in Germany

Recent reports indicate that the prevalence of bipolar disorder (BD) in patients with an acute major depressive episode might be higher than previously thought. We aimed to study systematically all patients who sought therapy for major depressive episode (MDE) within the BRIDGE study in Germany, reporting on an increased number (increased from 2 in the international BRIDGE report to 5) of different diagnostic algorithms. A total of 252 patients with acute MDE (DSM-IV confirmed) were examined for the existence of BD (a) according to DSM-IV criteria, (b) according to modified DSM-IV criteria (without the exclusion criterion of 'mania not induced by substances/antidepressants'), (c) according to a Bipolarity Specifier Algorithm which expands the DSM-IV criteria, (d) according to HCL-32R (Hypomania-Checklist-32R), and (e) according to a criteria-free physician's diagnosis. The five different diagnostic approaches yielded immensely variable prevalences for BD: (a) 11.6; (b) 24.8%; (c) 40.6%; (d) 58.7; e) 18.4% with only partial overlap between diagnoses according to the physician's diagnosis or HCL-32R with diagnoses according to the three DSM-based algorithms. The diagnosis of BD in patients with MDE depends strongly on the method and criteria employed. The considerable difference between criteria-free physician's diagnosis and the remaining algorithms indicate the usefulness of criteria lists within the everyday clinical setting. Diagnoses based on DSM were only made with checklists. The diagnoses of (hypo-) manic episodes in the patient history were not systematically verifiable by indirect anamnesis.

Mania With and Without Depression in a Community Sample of US Adolescents

There are limited data on the manifestations of mania in general community samples of adolescents. To present the prevalence and clinical correlates of mania with and without depressive episodes in a representative sample of US adolescents. Cross-sectional survey of adolescents using a modified version of the Composite International Diagnostic Interview. Ten thousand one hundred twentythree adolescents aged 13 to 18 years identified in household and school settings. Mania/hypomania with or without depression among those who met DSM-IV criteria for bipolar I or II disorder or major depressive disorder. Two and a half percent of youth met criteria for lifetime bipolar I or II disorder and 1.7%, for mania only. Twelve-month rates of mania with and without depression were 2.2% and 1.3%, respectively. There was a nearly 2-fold increase in rates of mania from ages 13-14 to 17-18 years. Mania with depression was associated with a greater number of all indictors of clinical severity including symptom number and severity, role disability, severe impairment, comorbidity, and treatment compared with depression alone, whereas correlates of mania were similar among those with mania with or without depression. The increasing prevalence of bipolar disorder with increasing age and the comparable rate of bipolar disorder with those of adult samples highlight adolescence as the peak period of onset of mania. The clinical significance of mania plus depression as demonstrated by a 1 in 5 suicide attempt rate and nearly 2 months per year of role impairment in adolescence has important implications for early intervention. The evidence for independence of mania from depression warrants additional scrutiny in the diagnostic nomenclature and etiologic dissection of bipolar disorder.

Pregnancy and Bipolar Disorder

The postpartum period is generally considered a time of heightened vulnerability to bipolar disorder; however, there is controversy about the effect of pregnancy on the course of bipolar disorder. This article reviews the literature on the relationship between pregnancy and bipolar disorder and suggests areas for future research. Three electronic databases, MEDLINE (1966-2010), PsycINFO (1840-2010), and EMBASE, were searched on April 30, 2010, using the following keywords: pregnancy, bipolar disorder, manic depressive disorder, suicide, hospitalization, pharmacotherapy, and psychotherapy. The reference lists of articles identified were also searched. All relevant papers published in English were included. A total of 70 articles were identified and included in the review. Evidence from studies using nonclinical samples, some retrospective studies, and studies on psychiatric hospitalization rates is suggestive of a positive effect of pregnancy on bipolar disorder; however, recent studies conducted at tertiary care facilities have reported high rates of recurrence following discontinuation of mood stabilizers. Understanding the relationship between pregnancy and bipolar disorder has implications for perinatal treatment and etiologic understanding of the disorder. Research is urgently needed to estimate the prevalence of bipolar disorder during pregnancy, using both clinical and nonclinical samples.

Prevalence of Bipolar Disorder and Schizophrenia in Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic Patients

Psychiatric conditions require aggressive management that is challenging to provide in free clinics. The purpose of this study was to determine the prevalence of certain mental illnesses and comorbid conditions among the patients of a student-managed free clinic for the homeless. The authors conducted a retrospective analysis of the records of patients who visited the student-run Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic from May 2007 through May 2008. They assessed the prevalence of bipolar disorder and schizophrenia among patients. They compared demographics, health insurance status, comorbid medical conditions, and social habit data of patients with these mental illnesses with those of other clinic patients. Of 286 patients (74.5% male, mean age 45.8 years), 25 (8.7%) had a diagnosis of schizophrenia and 45 (15.7%) had bipolar disorder. Compared with other clinic patients, patients with bipolar disorder or schizophrenia were less likely to be male (P < .0001) and were more likely to have publicly funded insurance (P = .024). They were also more likely to have certain comorbid conditions, including asthma (P = .0004), seizures (P = .0007), kidney disease (P = .01), and heart disease (P = .02). The high prevalence of these mental illnesses combined with the increased burden of medical comorbidity among HOMES Clinic patients has implications for student-managed free clinics, which often operate on limited budgets. Strategies for providing care for these patients in this setting include integrated care, street medicine, and case management.

Misuse of the Mood Disorders Questionnaire as a case‐finding measure and a critique of the concept of using a screening scale for bipolar disorder in psychiatric practice

Under-recognition of bipolar disorder (BD) is common and incurs significant costs for individuals and society. Clinicians are often encouraged to use screening instruments to help them identify patients with the disorder. The Mood Disorder Questionnaire (MDQ) is the most widely studied measure for this purpose. Some studies, however, have used the MDQ as a case-finding instrument rather than a screening scale. Such inappropriate use of screening scales risks distorting perceptions about many facets of BD, from its prevalence to its consequences. Studies using the MDQ were reviewed to identify those reports that have used the scale as a case-finding measure rather than a screening scale. Multiple studies were identified in the BD literature that used the MDQ as a diagnostic proxy. The findings of these studies were misinterpreted because of the failure to make the distinction between screening and case-finding. Inappropriate conclusions have been drawn regarding the prevalence, morbidity, and diagnostic under-recognition of BD in studies that rely on the MDQ as a diagnostic proxy. A conceptual critique is offered against the use of self-administered screening questionnaires for the detection of BD in psychiatric settings.

Recent Progress in Understanding Pediatric Bipolar Disorder

Bipolar disorder is one of the most severe psychiatric illnesses, particularly when onset occurs during childhood or adolescence. With recent empirical evidence, questions regarding the existence of bipolar disorder among children and adolescents have given way to questions regarding prevalence. There are substantial risks inherent in misapplying diagnoses and treatments of bipolar disorder when not warranted and in withholding these diagnoses and treatments when they are warranted. As with adults, the course of bipolar disorder among children and adolescents diagnosed using unmodified diagnostic criteria is characterized by recovery and recurrence, functional impairment, suicidality, and high rates of comorbid psychiatric and medical problems. Discrepancies between increasing billing diagnoses and a stable epidemiologic prevalence of bipolar disorder suggest the possibility that diagnostic criteria are not being systematically applied in some clinical settings. Introducing new diagnoses may exacerbate rather than mitigate concerns regarding misdiagnosis and excessive use of mood-stabilizing medications. Several medications, particularly second-generation antipsychotics, are efficacious for treating acute manic episodes of bipolar I disorder. However, less is known regarding the treatment of other mood states and subtypes of bipolar disorder. Psychosocial treatments provide a forum in which to educate children and families regarding bipolar disorder and its treatment, and may be especially beneficial for reducing depressive symptoms. Offspring of parents with bipolar disorder are at increased risk of developing the illness, as are youth with major depressive disorder and certain psychiatric comorbidities. Preliminary findings regarding biomarkers offer hope that, in the future, these biomarkers may inform diagnostic and treatment decisions.

Prevalence of bipolar disorder in children and adolescents with attention-deficit hyperactivity disorder

Prevalence of bipolar disorder in children and adolescents with attention-deficit hyperactivity disorder

P-222 - The 5HTTLPR is associated with bipolar disorder and affective temperaments as measured by TEMPS-A in chinese population

Increasing evidence supports that 5HTTLPR polymorphism of the serotonin transporter gene(5HTTLPR) might associate to bipolar disorder and affective temperaments as measured by TEMPS-A. But the results are discrepant, furthermore, there are no data from Chinese population. The present study was designed to investigate association between 5HTTLPR and bipolar disorder and affective temperaments of patients with bipolar disorder in the specific Chinese population and add new evidence to the field. There hundred and five patients with bipolar disorder and 272 normal controls were included in the present case-control study⌧Temperament Evaluation of Memphis, Pisa, Paris and San Diego -autoquestionnaire version (TEMPS-A) in Chinese was used to assess affective temperament. Chi-square test, T test, Nonparametric test and ANOVA were employed to explore association between 5HTTLPR polymorphism and bipolar disorder and affective temperament of patients with bipolar disorder. 5-HTTLPR L/S polymorphism was associated with bipolar disorder in female (genotype χ 2 = 6.769⌧P = 0.034⌧allele χ 2 = 6.028⌧P = 0.014) and the S allele was associated with anxious temperament (t = 8.248⌧P = 0.005) in patients with bipolar disorder. The LA allele of 5-HTTLPR rs25531 A/G polymorphism was associated with hyperthymic temperament in patients with bipolar disorder (Z = −2.205⌧P = 0.027). 5-HTTLPR might have an effect on the prevalence of bipolar disorder in female and regulate affective temperaments of patients with bipolar disorder in some degree in Chinese population.

Cognitive functions in euthymic adolescents with juvenile bipolar disorder

Introduction Bipolar disorder in adolescents is often referred to as juvenile bipolar disorder. A peak in the prevalence of bipolar disorder has been documented between the ages of 15 and 19 years. Wide-ranging neuropsychological deficits have been found in many studies of juvenile bipolar disorder. Persistent neuropsychological deficits present in the euthymic state suggest that such deficits could be vulnerability trait markers of the illness. Aim To identify and assess cognitive functioning in euthymic adolescents diagnosed with bipolar disorder. Participants and methods A case–control cross sectional study, in which 30 euthymic bipolar adolescents were recruited from the psychiatric adolescent clinic of Kasr al Ainy and compared with 30 healthy controls. Psychometric procedure The Hamilton Rating Scale of Depression, the Young Mania Rating Scale, the letter cancellation test, the digit span and digit symbol/coding tests, the Bender gestalt test and the Wisconsin card sorting test were used. Results Cases had significantly higher mean scores than controls in the letter cancellation test and its omission errors as well as in the perseverative errors of the Wisconsin card sorting test, and lower mean scores in the digit span, digit symbol coding and the Bender gestalt tests. There was a significant positive correlation between the number of omission errors on the letter cancellation test and both of the number of manic episodes and the age of onset of the illness. Conclusion There are neuropsychological deficits in the areas of sustained attention, set shifting, processing speed and visual and auditory short-term memory in euthymic bipolar adolescent patients, type I. There is a significant correlation between the number of manic episodes as well as age of illness onset and sustained attention.

Comparison of clinical and sociodemographic features of bipolar disorder according to gender

However the lifetime prevalence of bipolar disorder is not different between men and women, some of the features of the disease vary between the genders. The aim of this study was to compare the clinical and sociodemographic features of bipolar disorder according to gender. In this study the data of 125 bipolar disorder tip I patients who had been admitted to Department of Psychiatry of Gulhane Military Medical Faculty between 2009-2011 were examined. Data of these patients were obtained by examining the patients files . 95 of 125 patients (%76.0) were male, and 30 (%24.0) were female. Age of disease onset in bipolar male patients was 22,5 ± 6,9; %6.3 had a history of suicid attempt and %11.6 had a history of substance abuse. Age of disease onset in bipolar female patients was 28,7 ± 9.7. %23.3 had a history of suicide attempt. There was no history of substance abuse in female patients. Psychotic features and history of substance abuse were more prominent in men. The later age of disease onset and longer duration of hospitalization were determined in women. Our results were appeared to be in line with the results of the studies about gender differences in bipolar disorder. Making prospective studies about this subject is considered to be useful to determine the epidemiological characteristics of mood disorders.

The lifetime prevalence of bipolar disorders and the use of antidepressant drugs in bipolar depression in Italy

The prevalence of bipolar spectrum disorders in the community is under debate and the prescription of antidepressant drugs (ADs) in bipolar depression appears to be an underestimated problem. To evaluate the prevalence of bipolar disorders by means of a screening instrument in seven communities within six regions of Italy and evaluate the appropriateness and number of prescriptions for ADs in bipolar depression. community survey. samples randomly drawn, after stratification from the adult population of municipal records. 4999 people from seven communities within six regions of Italy. Tools: questionnaire on psychotropic drug consumption, prescription, health services utilization; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Mood Disorder Questionnaire (MDQ). Training: interviewers were trained psychologists or medical doctors. the population studied did not represent a nationally representative multistage clustered area probability sample of households. 3398 subjects were interviewed (68% of recruited sample). Positivity at MDQ (MDQ+) was higher in males (3.4% vs. 2.8%) but the difference was not significant (OR=1.2, P=0.37). The association between MDQ+ and Major Depressive Disorder (MDD) was statistically significant for both males (OR=14.9, P<0.0001) and females (OR=8.3, P<0.001); 30% of subjects with MDQ+ and MDD lifetime diagnosis were taking ADs. These overall rates of being MDQ+ are similar to community surveys conducted within USA and the use of ADs in people with MDQ+ and MDD diagnoses are.

Broadening bipolar disorder — by design or by accident?

Broadening bipolar disorder — by design or by accident?

A Multicenter Study of Bipolar Disorder among Emergency Department Patients in Latin-American Countries

This multicenter study estimated the prevalence of bipolar disorder (BPD) among emergency department (ED) patients in Latin America. To identify patients with BPD, a combination of DSM IV-criteria interview and the Mood Disorder Questionnaire (MDQ) was used. Data from 1,505 patients from hospitals in Argentina, Brazil, Chile, Colombia, and Mexico was analyzed. The prevalence ofBPD in this sample was 5.2% (95% CI = 4.5% to 6.9%). The mean age was 37 years (response rate of 83.0%). Compared to non-BPD patients, BPD patients were more likely to report asthma (16.7% vs. 9%), thyroid problems (12.8% vs. 5.8%), seizures (23.1% vs. 3.0%), obesity (39.7% vs. 26.9%), alcohol abuse (30.8% vs. 10.0%), attention deficit hyperactivity disorders (50.0% vs. 12.0%), depression (81.6% vs. 45.7%), obsessive compulsive disorder (20.1% vs. 3.0%), panic disorders (23.1% vs. 12.3%), phobic disorders (11.2% vs. 3.1%), and any anxiety disorder (82.1 % vs. 41.8%; all p < or = 0.05). Suicidal plans and attempts were also significant higher in the bipolar group (11.5% vs. 2.8% and 10.3% vs. 1.8% respectively). Multivariate analysis identified ADHD, depression, alcohol abuse, anxiety disorder, and last month suicide plans and attempts to be independently associated with BPD. Our study supports that BPD is prevalent in ED in Latin-American countries and that comorbidity is the rule, not the exception. Patients presenting at ED with irritability, anxiety, pressure speech, euphoria, with suicidal tendencies, involved in risky behaviors, alcohol abuse, dependence or those with history of mental health hospitalization in the past 12 months must be assessed for comorbid BPD.

Estimates of the treated prevalence of bipolar disorders by mental health services in the general population: comparison of results from administrative and health survey data

Informed provision of population mental health services requires accurate estimates of disease burden. We estimated the treated prevalence of bipolar disorders by mental health services in the Calgary Zone, a catchment area in Alberta with a population of over one million. Administrative data in a central repository provides information of mental health care contacts for about 95% of publically funded mental health services. We compared this treated prevalence against self-reported data in the 2002 Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Of the 63 016 individuals aged 18 years plus treated in the Calgary Zone in 2002-2008, 3659 (5.81%) and 1065 (1.70%) were diagnosed with bipolar I and bipolar II disorder, respectively. The estimated treated population prevalence of these disorders was 0.41% and 0.12%, respectively. We estimated that 0.44% to 1.17% of the Canadian population was being treated by psychiatrists for bipolar I disorder from CCHS 1.2. For bipolar I disorder the estimate based on local administrative data is close to the lower end of the health survey range. The degree of agreement in our estimates reinforces the utility of administrative data repositories in the surveillance of chronic mental disorders.

Changes in the prevalence of bipolar disorders between 1998 and 2008 in an Australian population

To identify any changes in the prevalence of bipolar disorder (BD) between 1998, 2004, and 2008. Cross-sectional population-based surveys were conducted involving random and representative samples of South Australian adults aged ≥ 15 years. BD was assessed using the mood module of the Primary Care Evaluation of Mental Disorders instrument (PRIME-MD), a single question related to doctor-diagnosed BD and the Mood Disorder Questionnaire (MDQ), which defines bipolar spectrum disorder. The PRIME-MD-derived prevalence of BD increased significantly from 0.5% [95% confidence interval (CI): 0.27-0.79] in 1998 to 1.0% (95% CI: 0.61-1.31) in 2004 and 1.5% (95% CI: 1.05-1.91) in 2008, demonstrating a significant increased linear trend (χ² =13.91, df=2, p=0.002). Similarly, reported doctor-diagnosed BD increased significantly from 1.1% (95% CI: 0.75-1.51) in 1998 to 1.7% (95% CI: 1.26-2.18) in 2004 and 2.9% (95% CI: 2.28-3.48) in 2008 (Linear trend test χ²=24.55, df=2, p<0.001). The MDQ-derived diagnosis of bipolar spectrum disorder changed from 2.5% (95% CI: 1.96-3.08) in 2004 to 3.3% (95% CI: 2.66-3.94) in 2008 (χ² =3.22, df=1, p<0.10), but this difference did not attain statistical significance. Confining the analysis to those positive for BD on all three methods, there was a significant increase in the prevalence of the detection of BD using all three measures (χ² =4.43, df=1, p=0.03) between 2004 and 2008. There has been an increased prevalence of BD in South Australia over the last decade, but this may be related to changing diagnostic practices rather than a true increase.

P01-208-Prevalence of hypomania in patients with diagnosis of affective disorder

IntroductionRecent epidemiological studies suggest that the prevalence of bipolar disorder might be misdiagnosed initially as unipolar depression due to the difficulty to detect episodes of hypomania. The Hypomania Checklist (HCL-32), validated in Spanish, is a self-report questionnaire with 32 hypomania items designed to screen for hypomanic episodes.ObjectivesTo examine the prevalence of hypomania in patients with unipolar depression. Corroborate the efficacy of the HCL-32 to detect symptoms of hypomania.MethodsThe presence of hypomanic symptoms was assessed by the HCL-32 in a sample of 128 subjects diagnosed with bipolar I disorder (n = 30), bipolar II disorder (n = 1), unipolar depression (n = 57), and anxiety disorder (n = 15) according to DSM-IV-TR criteria. A control group of healthy subjects was selected (n = 25).ResultsThe discriminative capacity was analyzed by the ROC curve. The AUC was 0.65 which did not indicate a good capacity. The sensitivity (S), specificity (E) and prevalence (P) of hypomania in unipolar patients for the following cut-off points were :14: S = 81.6%,95%CI(69.8, 93.5); E = 30.1%,95%CI(19.7,40.6); P = 74.1%; 15: S = 77.6%,95%CI(64.9,90.3); E = 37.4%,95%CI(26.3,48.4); P = 67.2%; 16: S = 59.2%,95%CI(44.4,73.9); E = 55.4%,95%CI(44.1,74.0); P = 51.7%; 17: S = 55.1%,95%CI(40.2,70.1); E = 57.8%,95%CI(46.6,69.1); P = 48.3%.ConclusionsThe HCL-32 has a high sensitivity but a low specificity as screening instrument. This might explain the high proportion of hypomania found in this study. The difference with previous studies is that our sample was heterogeneous, unstable and serious. This suggests that the HCL-32 is not valid for any psychiatric sample. Future research should develop more specific instruments with better external validity.