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Screening for bipolar disorder among outpatients with substance use disorders

Published online by Cambridge University Press:  02 October 2011

A. Nallet ,
B. Weber ,
S. Favre ,
M. Gex-Fabry ,
R. Voide ,
F. Ferrero ,
D. Zullino ,
Y. Khazaal  and
J.M. Aubry
A. Nallet
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, Bipolar Program, 6-8, rue du 31-Décembre, 1207Geneva, Switzerland
B. Weber
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, Bipolar Program, 6-8, rue du 31-Décembre, 1207Geneva, Switzerland
S. Favre
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, Bipolar Program, 6-8, rue du 31-Décembre, 1207Geneva, Switzerland
M. Gex-Fabry
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, 2, chemin du Petit-Bel-Air, 1225Chêne-Bourg, Switzerland
R. Voide
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, Bipolar Program, 6-8, rue du 31-Décembre, 1207Geneva, Switzerland
F. Ferrero
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, 2, chemin du Petit-Bel-Air, 1225Chêne-Bourg, Switzerland
D. Zullino
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of Addictology, 2, rue Verte, 1205Geneva, Switzerland
Y. Khazaal
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of Addictology, 2, rue Verte, 1205Geneva, Switzerland
J.M. Aubry*
Affiliation:
Geneva University Hospital, Department of Mental Health and Psychiatry, Service of General Psychiatry, Bipolar Program, 6-8, rue du 31-Décembre, 1207Geneva, Switzerland
*
⁎Corresponding author. Tel.: +41 22 305 45 38; fax: +41 22 305 45 99. E-mail address:jean-michel.aubry@hcuge.ch (J.M. Aubry).
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Abstract

Background

Comorbidity of bipolar disorder and alcohol or substance abuse/dependence is frequent and has marked negative consequences on the course of the illness and treatment compliance. The objective of this study was to compare the validity of two short instruments aimed at screening bipolar disorders among patients treated for substance use disorders.

Methods

The Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32) were tested with reference to the mood section of the Structured Clinical Interview for DSM-IV axis I disorders (SCID) in 152 patients, recruited in two outpatient clinics providing specialized treatment for alcohol and opiate dependence.

Results

According to the SCID, 33 patients (21.7%) had a diagnosis within the bipolar spectrum (two bipolar I, 21 bipolar II and 10 bipolar not otherwise specified). The HCL-32 was more sensitive (90.9% vs. 66.7%) and the MDQ more specific (38.7% vs. 77.3%) for the whole sample. The MDQ displayed higher sensitivity and specificity in patients treated for alcohol than for opiate dependence, whereas the HCL-32 was highly sensitive but poorly specific in both samples. Both instruments had a positive predictive value under 50%.

Conclusions

Caution is needed when using the MDQ and HCL-32 in patients treated for substance use disorders.

Keywords

MDQHCL-32ComorbidityBipolar type I and IIAlcohol dependenceOpiate dependence
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 3 , March 2013 , pp. 147 - 153
Copyright
Copyright © European Psychiatric Association 2011

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References

Albanese, M.J.Clodfelter, R.C. Jr.Pardo, T.B.Ghaemi, S.N.Underdiagnosis of bipolar disorder in men with substance use disorder. J Psychiatr Pract 2006;12:124–127.CrossRefGoogle ScholarPubMed
Allen, R.Smith, D.Screening for bipolar disorder: strengths and limitations of currently available instruments. Prim Care Community Psychiatr 2008;13:47–51.Google Scholar
Angst, J.Adolfsson, R.Benazzi, F.Gamma, A.Hantouche, E.Meyer, T.D., et al.The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 2005;88:217–233.CrossRefGoogle ScholarPubMed
Baethge, C.Baldessarini, R.J.Khalsa, H.M.Hennen, J.Salvatore, P.Tohen, M.Substance abuse in first-episode bipolar I disorder: indications for early intervention. Am J Psychiatry 2005;162:1008–1010.CrossRefGoogle ScholarPubMed
Carta, M.G.Hardoy, M.C.Cadeddu, M.Murru, A.Campus, A.Morosini, P.L., et al.The accuracy of the Italian version of the Hypomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Questionnaire (MDQ) in a clinical sample. Clin Pract Epidemiol Ment Health 2006;2:2.CrossRefGoogle Scholar
Cassidy, F.Ahearn, E.P.Carroll, B.J.Substance abuse in bipolar disorder. Bipolar Disord 2001;3:181–188.CrossRefGoogle ScholarPubMed
Castel, S.Rush, B.Urbanoski, K.Toneatto, T.Overlap of clusters of psychiatric symptoms among clients of a comprehensive addiction treatment service. Psychol Addict Behav 2006;20:28–35.CrossRefGoogle ScholarPubMed
Cerullo, M.A.Strakowski, S.M.The prevalence and significance of substance use disorders in bipolar type I and II disorder. Subst Abuse Treat Prev Policy 2007;2:29.CrossRefGoogle ScholarPubMed
Chengappa, K.N.Levine, J.Gershon, S.Kupfer, D.J.Lifetime prevalence of substance or alcohol abuse and dependence among subjects with bipolar I and II disorders in a voluntary registry. Bipolar Disord 2000;2:191–195.CrossRefGoogle ScholarPubMed
Comtois, K.A.Russo, J.E.Roy-Byrne, P.Ries, R.K.Clinicians’ assessments of bipolar disorder and substance abuse as predictors of suicidal behavior in acutely hospitalized psychiatric inpatients. Biol Psychiatry 2004;56:757–763.CrossRefGoogle ScholarPubMed
Dalton, E.J.Cate-Carter, T.D.Mundo, E.Parikh, S.V.Kennedy, J.L.Suicide risk in bipolar patients: the role of co-morbid substance use disorders. Bipolar Disord 2003;5:58–61.CrossRefGoogle ScholarPubMed
Feinman, J.A.Dunner, D.L.The effect of alcohol and substance abuse on the course of bipolar affective disorder. J Affect Disord 1996;37:43–49.CrossRefGoogle ScholarPubMed
Forty, L.Smith, D.Jones, L.Jones, I.Caesar, S.Fraser, C., et al.Identifying hypomanic features in major depressive disorder using the hypomania checklist (HCL-32). J Affect Disord 2009;114:68–73.CrossRefGoogle Scholar
Forty, L.Kelly, M.Jones, L.Jones, I.Barnes, E.Caesar, S., et al.Reducing the Hypomania Checklist (HCL-32) to a 16-item version. J Affect Disord 2010;124:351–356.CrossRefGoogle Scholar
Gaudiano, B.A.Weinstock, L.M.Miller, I.W.Improving treatment adherence in patients with bipolar disorder and substance abuse: rationale and initial development of a novel psychosocial approach. J Psychiatr Pract 2011;17:5–20.CrossRefGoogle ScholarPubMed
Gervasoni, N.Weber Rouget, B.Miguez, M.Dubuis, V.Bizzini, V.Gex-Fabry, M., et al.Performance of the Mood Disorder Questionnaire (MDQ) according to bipolar subtype and symptom severity. Eur Psychiatry 2009;24:341–344.CrossRefGoogle ScholarPubMed
Goldberg, J.F.Bipolar disorder with comorbid substance abuse: diagnosis, prognosis, and treatment. J Psychiatr Pract 2001;7:109–122.CrossRefGoogle Scholar
Goldberg, J.F.Garno, J.L.Callahan, A.M.Kearns, D.L.Kerner, B.Ackerman, S.H.Overdiagnosis of bipolar disorder among substance use disorder inpatients with mood instability. J Clin Psychiatry 2008;69:1751–1757.CrossRefGoogle ScholarPubMed
Gorwood, P.LeStrat, Y.Wohl, M.Comorbidité addictive des troubles bipolaires. Encephale 2008;34(Suppl. 4):S138–S142.CrossRefGoogle Scholar
Grant, B.F.Stinson, F.S.Dawson, D.A.Chou, S.P.Dufour, M.C.Compton, W., et al.Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004;61:807–816.CrossRefGoogle ScholarPubMed
Griffin, M.L.Kolodziej, M.E.Weiss, R.D.Measuring principal substance of abuse in comorbid patients for clinical research. Addict Behav 2009;34:826–829.CrossRefGoogle ScholarPubMed
Hardoy, M.C.Cadeddu, M.Murru, A.Dell’Osso, B.Carpiniello, B.Morosini, P.L., et al.Validation of the Italian version of the “Mood Disorder Questionnaire” for the screening of bipolar disorders. Clin Pract Epidemiol Ment Health 2005;1:8.CrossRefGoogle ScholarPubMed
Healey, C.Peters, S.Kinderman, P.McCracken, C.Morriss, R.Reasons for substance use in dual diagnosis bipolar disorder and substance use disorders: a qualitative study. J Affect Disord 2009;113:118–126.CrossRefGoogle ScholarPubMed
Hendrick, V.Altshuler, L.L.Gitlin, M.J.Delrahim, S.Hammen, C.Gender and bipolar illness. J Clin Psychiatry 2000;61:393–396 [quiz 7].CrossRefGoogle ScholarPubMed
Hirschfeld, R.M.Williams, J.B.Spitzer, R.L.Calabrese, J.R.Flynn, L.Keck, P.E. Jr., et al.Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry 2000;157:1873–1875.CrossRefGoogle ScholarPubMed
Hirschfeld, R.M.Lewis, L.Vornik, L.A.Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry 2003;64:161–174.CrossRefGoogle ScholarPubMed
Hirschfeld, R.M.The mood disorder questionnaire: its impact on the field. Depress Anxiety 2010;27:627–630 [corrected].Google ScholarPubMed
Hoblyn, J.C.Balt, S.L.Woodard, S.A.Brooks, J.O.3rd. Substance use disorders as risk factors for psychiatric hospitalization in bipolar disorder. Psychiatr Serv 2009;60:50–55.CrossRefGoogle ScholarPubMed
Isometsa, E.Suominen, K.Mantere, O.Valtonen, H.Leppamaki, S.Pippingskold, M., et al.The mood disorder questionnaire improves recognition of bipolar disorder in psychiatric care. BMC Psychiatry 2003;3:8.CrossRefGoogle ScholarPubMed
Jaffee, W.B.Griffin, M.L.Gallop, R.Meade, C.S.Graff, F.Bender, R.E., et al.Depression precipitated by alcohol use in patients with co-occurring bipolar and substance use disorders. J Clin Psychiatry 2009;70:171–176.CrossRefGoogle ScholarPubMed
Jaworski, F.Dubertret, C.Ades, J.Gorwood, P.Presence of co-morbid substance use disorder in bipolar patients worsens their social functioning to the level observed in patients with schizophrenia. Psychiatry Res 2011;185:129–134.CrossRefGoogle ScholarPubMed
Jon, D.I.Hong, N.Yoon, B.H.Jung, H.Y.Ha, K.Shin, Y.C., et al.Validity and reliability of the Korean version of the Mood Disorder Questionnaire. Compr Psychiatry 2009;50:286–291.CrossRefGoogle ScholarPubMed
Kessler, R.C.Crum, R.M.Warner, L.A.Nelson, C.B.Schulenberg, J.Anthony, J.C.Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997;54:313–321.CrossRefGoogle ScholarPubMed
Krishnan, K.R.R.Psychiatric and medical comorbidities of bipolar disorder. Psychosom Med 2005;67:1–8.CrossRefGoogle ScholarPubMed
Kupka, R.W.Nolen, W.A.Altshuler, L.L.Denicoff, K.D.Frye, M.A.Leverich, G.S., et al.The Stanley Foundation Bipolar Network 2. Preliminary summary of demographics, course of illness and response to novel treatments. Br J Psychiatry Suppl 2001;41:s177–s183.CrossRefGoogle ScholarPubMed
Lish, J.D.Dime-Meenan, S.Whybrow, P.C.Price, R.A.Hirschfeld, R.M.The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord 1994;31:281–294.CrossRefGoogle ScholarPubMed
Manning, J.S.Tools to improve differential diagnosis of bipolar disorder in primary care. Prim Care Companion J Clin Psychiatry 2010;12:17–22.CrossRefGoogle ScholarPubMed
Mazza, M.Mandelli, L.Di Nicola, M.Harnic, D.Catalano, V.Tedeschi, D., et al.Clinical features, response to treatment and functional outcome of bipolar disorder patients with and without co-occurring substance use disorder: 1-year follow-up. J Affect Disord 2009;115:27–35.CrossRefGoogle ScholarPubMed
McLellan, A.T.Luborsky, L.Woody, G.E.O’Brien, C.P.An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. J Nerv Ment Dis 1980;168:26–33.CrossRefGoogle ScholarPubMed
McLellan, A.T.Luborsky, L.Woody, G.E.O’Brien, C.P.Druley, K.A.Predicting response to alcohol and drug abuse treatments. Role of psychiatric severity. Arch Gen Psychiatry 1983;40:620–625.CrossRefGoogle ScholarPubMed
McLellan, A.T.Kushner, H.Metzger, D.Peters, R.Smith, I.Grissom, G., et al.The fifth edition of the Addiction Severity Index. J Subst Abuse Treat 1992;9:199–213.CrossRefGoogle ScholarPubMed
Meyer, T.D.Bernhard, B.Born, C.Fuhr, K.Gerber, S.Schaerer, L., et al.The Hypomania Checklist-32 and the Mood Disorder Questionnaire as screening tools – going beyond samples of purely mood-disordered patients. J Affect Disord 2011;128:291–298.CrossRefGoogle ScholarPubMed
Miller, C.J.Klugman, J.Berv, D.A.Rosenquist, K.J.Ghaemi, S.N.Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. J Affect Disord 2004;81:167–171.CrossRefGoogle ScholarPubMed
Oquendo, M.A.Currier, D.Liu, S.M.Hasin, D.S.Grant, B.F.Blanco, C.Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry 2010;71:902–909.CrossRefGoogle Scholar
Regier, D.A.Farmer, M.E.Rae, D.S.Locke, B.Z.Keith, S.J.Judd, L.L., et al.Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990;264:2511–2518.CrossRefGoogle ScholarPubMed
Singh, J.Mattoo, S.K.Sharan, P.Basu, D.Quality of life and its correlates in patients with dual diagnosis of bipolar affective disorder and substance dependence. Bipolar Disord 2005;7:187–191.CrossRefGoogle ScholarPubMed
Stewart, C.El-Mallakh, R.S.Is bipolar disorder overdiagnosed among patients with substance abuse?. Bipolar Disord 2007;9:646–648.CrossRefGoogle ScholarPubMed
Strakowski, S.M.DelBello, M.P.The co-occurrence of bipolar and substance use disorders. Clin Psychol Rev 2000;20:191–206.CrossRefGoogle ScholarPubMed
Strakowski, S.M.DelBello, M.P.Fleck, D.E.Arndt, S.The impact of substance abuse on the course of bipolar disorder. Biol Psychiatry 2000;48:477–485.CrossRefGoogle ScholarPubMed
Strakowski, S.M.DelBello, M.P.Fleck, D.E.Adler, C.M.Anthenelli, R.M.Keck, P.E. Jr., et al.Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania. Arch Gen Psychiatry 2005;62:851–858.CrossRefGoogle ScholarPubMed
Strakowski, S.M.DelBello, M.P.Fleck, D.E.Adler, C.M.Anthenelli, R.M.Keck, P.E. Jr., et al.Effects of co-occurring cannabis use disorders on the course of bipolar disorder after a first hospitalization for mania. Arch Gen Psychiatry 2007;64:57–64.CrossRefGoogle ScholarPubMed
Sublette, E.M.Carballo, J.J.Moreno, C.Galfalvy, H.C.Brent, D.A.Birmaher, B., et al.Substance use disorders and suicide attempts in bipolar subtypes. J Psychiatr Res 2009;43:230–238.CrossRefGoogle Scholar
Tafalla, M.Sanchez-Moreno, J.Diez, T.Vieta, E.Screening for bipolar disorder in a Spanish sample of outpatients with current major depressive episode. J Affect Disord 2009;114:299–304.CrossRefGoogle Scholar
Vieta, E.Colom, F.Corbella, B.Martinez-Aran, A.Reinares, M.Benabarre, A., et al.Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord 2001;3:253–258.CrossRefGoogle ScholarPubMed
Vieta, E.Sanchez-Moreno, J.Bulbena, A.Chamorro, L.Ramos, J.L.Artal, J., et al.Cross validation with the mood disorder questionnaire (MDQ) of an instrument for the detection of hypomania in Spanish: the 32 item hypomania symptom check list (HCL-32). J Affect Disord 2007;101:43–55.CrossRefGoogle Scholar
Vornik, L.A.Brown, E.S.Management of comorbid bipolar disorder and substance abuse. J Clin Psychiatry 2006;67(Suppl. 7):24–30.Google ScholarPubMed
Weber-Rouget, B.Aubry, J.M.Dépistage des troubles bipolaires : une revue de la littérature. Encephale 2009;35:570–576.CrossRefGoogle Scholar
Weber, B.Aubry, J.M.Dépistage et diagnostic précoce. In: Ferrero, F.Aubry, J.M., editors. Traitements psychologiques des troubles bipolaires. Paris: Masson; 2009. p. 23–36.CrossRefGoogle Scholar
Weber-Rouget, B.Gervasoni, N.Dubuis, V.Gex-Fabry, M.Bondolfi, G.Aubry, J.M.Screening for bipolar disorders using a French version of the Mood Disorder Questionnaire (MDQ). J Affect Disord 2005;88:103–108.CrossRefGoogle Scholar
Weiss, R.D.Ostacher, M.J.Otto, M.W.Calabrese, J.R.Fossey, M.Wisniewski, S.R., et al.Does recovery from substance use disorder matter in patients with bipolar disorder? J Clin Psychiatry 2005;66:730–735 [quiz 808–9].CrossRefGoogle ScholarPubMed
Wilens, T.E.Biederman, J.Adamson, J.J.Henin, A.Sgambati, S.Gignac, M., et al.Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: a controlled study. Drug Alcohol Depend 2008;95:188–198.CrossRefGoogle ScholarPubMed
Winokur, G.Coryell, W.Akiskal, H.S.Maser, J.D.Keller, M.B.Endicott, J., et al.Alcoholism in manic-depressive (bipolar) illness: familial illness, course of illness, and the primary-secondary distinction. Am J Psychiatry 1995;152:365–372.Google ScholarPubMed
Yang, H.C.Yuan, C.M.Liu, T.B.Li, L.J.Peng, H.J.Liao, C.P., et al.Validity of the 32-item Hypomania Checklist (HCL-32) in a clinical sample with mood disorders in China. BMC Psychiatry 2011;11:84.CrossRefGoogle Scholar
Zimmerman, M.Posternak, M.A.Chelminski, I.Solomon, D.A.Using questionnaires to screen for psychiatric disorders: a comment on a study of screening for bipolar disorder in the community. J Clin Psychiatry 2004;65:605–610 [discussion 721].CrossRefGoogle Scholar
Zimmerman, M.Ruggero, C.J.Chelminski, I.Young, D.Is bipolar disorder overdiagnosed? J Clin Psychiatry 2008;69:935–940.CrossRefGoogle ScholarPubMed
Zimmerman, M.Galione, J.N.Ruggero, C.J.Chelminski, I.McGlinchey, J.B.Dalrymple, K., et al.Performance of the mood disorders questionnaire in a psychiatric outpatient setting. Bipolar Disord 2009;11:759–765.CrossRefGoogle Scholar
Zimmerman, M.Is underdiagnosis the main pitfall in diagnosing bipolar disorder? No. BMJ 2010;340:c855.CrossRefGoogle ScholarPubMed
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