Screening for bipolar depression in family medicine practices: prevalence and clinical correlates.

BACKGROUND: To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning. METHODS: In this cross-sectional study, participants (N=1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into 'bipolar' and 'unipolar' depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire. RESULTS: The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4-5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression. LIMITATIONS: The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed. CONCLUSIONS: Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.

Screening for bipolar disorder in the primary care: a Brazilian survey.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. LIMITATIONS: Co-morbid mental disorders were not assessed. The cross-sectional design prevents firm cause-effect inferences. CONCLUSIONS: The prevalence of a positive screening for BD is high, clinically significant and under-recognized in Brazilian PC settings.

Validity of the Mood Disorder Questionnaire in a Brazilian psychiatric population / Validação da versão em português do Questionário de Transtornos do Humor em uma população brasileira de pacientes psiquiátricos

OBJECTIVE: Bipolar spectrum disorders are prevalent and frequently underdiagnosed and undertreated. This report describes the development and validation of the Brazilian version of the Mood Disorder Questionnaire, a screening instrument for bipolar spectrum disorders, in an adult psychiatric population. METHOD: A total of 114 consecutive patients attending an outpatient psychiatric clinic completed the Brazilian version of the Mood Disorder Questionnaire. A research psychiatrist, blind to the Mood Disorder Questionnaire results, interviewed patients by means of the mood module of the Structured Clinical Interview for DSM-IV ('gold standard'). RESULTS: The internal consistency of the Brazilian Mood Disorder Questionnaire, evaluated with Cronbach's alpha coefficient was 0.76 (95 percent CI; 0.69-0.92). Principal component analysis with varimax rotation indicated an 'irritability-racing thoughts' factor and 'energized-activity' factor, which explained 39.1 percent of variance. On the basis of the SCID, 69 (60.5 percent) individuals received a diagnosis of bipolar disorders. A Brazilian Mood Disorder Questionnaire screening score of 8 or more items yielded sensitivity of 0.91 (95 percent CI; 0.85-0.98), specificity of 0.70 (95 percent CI; 0.62-0.75), a positive predictive value of 0.82 (95 percent CI; 0.75-0.88) and a negative predictive value of 0.84 (95 percent CI; 0.77-0.90). CONCLUSION: The present data demonstrate that the Brazilian Mood Disorder Questionnaire is a valid instrument for the screening of bipolar disorders. The instrument needs to be validated in other settings (e.g., in general practice).

OBJETIVO: Transtornos do espectro bipolar são prevalentes e comumente subdiagnosticados e subtratados. O presente trabalho descreve o desenvolvimento e a validação da versão brasileira do questionário de transtornos do humor, um instrumento de rastreio para transtornos bipolares, em uma população psiquiátrica adulta. MÉTODO: 114 pacientes consecutivos de um ambulatório psiquiátrico completaram a versão brasileira do questionário de transtornos do humor. Um psiquiatra pesquisador, cego para os escores da versão brasileira do questionário de transtornos do humor, entrevistou os participantes por meio do módulo de transtornos do humor da entrevista clínica estruturada para o DSM-IV ("padrão-ouro"). RESULTADOS: A consistência interna da versão brasileira do questionário de transtornos do humor, avaliada por meio do coeficiente alfa de Cronbach, foi de 0,76 (IC 95 por cento; 0,69-0,92). Uma análise de componentes principais com rotação ortogonal indicou fator de "irritabilidade-pensamentos acelerados" e outro de "energia-atividade", que explicaram 39,1 por cento da variação dos escores. De acordo com o padrão-ouro, 69 (60,5 por cento) dos participantes tiveram um diagnóstico de transtornos bipolares. Um escore do questionário de transtornos do humor de 8 ou mais itens apresentou uma sensibilidade de 0,91 (IC 95 por cento; 0,85-0,98), especificidade de 0,70 (IC 95 por cento; 0,62-0,75), valor preditivo positivo de 0,82 (IC 95 por cento; 0,75-0,88) e valor preditivo negativo de 0,84 (IC 95 por cento; 0,77-0,90). CONCLUSÃO: Os resultados do presente estudo demonstram que a versão brasileira do questionário de transtornos do humor é um instrumento válido para o rastreio de transtornos bipolares. O instrumento necessita de validação em outros contextos (p.ex., serviços primários).

Validity of the Mood Disorder Questionnaire in a Brazilian psychiatric population.

OBJECTIVE: Bipolar spectrum disorders are prevalent and frequently underdiagnosed and undertreated. This report describes the development and validation of the Brazilian version of the Mood Disorder Questionnaire, a screening instrument for bipolar spectrum disorders, in an adult psychiatric population. METHOD: A total of 114 consecutive patients attending an outpatient psychiatric clinic completed the Brazilian version of the Mood Disorder Questionnaire. A research psychiatrist, blind to the Mood Disorder Questionnaire results, interviewed patients by means of the mood module of the Structured Clinical Interview for DSM-IV ('gold standard'). RESULTS: The internal consistency of the Brazilian Mood Disorder Questionnaire, evaluated with Cronbach's alpha coefficient was 0.76 (95% CI; 0.69-0.92). Principal component analysis with varimax rotation indicated an 'irritability-racing thoughts' factor and 'energized-activity' factor, which explained 39.1% of variance. On the basis of the SCID, 69 (60.5%) individuals received a diagnosis of bipolar disorders. A Brazilian Mood Disorder Questionnaire screening score of 8 or more items yielded sensitivity of 0.91 (95% CI; 0.85-0.98), specificity of 0.70 (95% CI; 0.62-0.75), a positive predictive value of 0.82 (95% CI; 0.75-0.88) and a negative predictive value of 0.84 (95% CI; 0.77-0.90). CONCLUSION: The present data demonstrate that the Brazilian Mood Disorder Questionnaire is a valid instrument for the screening of bipolar disorders. The instrument needs to be validated in other settings (e.g., in general practice).

Validity of the Mood Disorder Questionnaire in a Brazilian psychiatric population.

OBJECTIVE: Bipolar spectrum disorders are prevalent and frequently underdiagnosed and undertreated. This report describes the development and validation of the Brazilian version of the Mood Disorder Questionnaire, a screening instrument for bipolar spectrum disorders, in an adult psychiatric population. METHOD: A total of 114 consecutive patients attending an outpatient psychiatric clinic completed the Brazilian version of the Mood Disorder Questionnaire. A research psychiatrist, blind to the Mood Disorder Questionnaire results, interviewed patients by means of the mood module of the Structured Clinical Interview for DSM-IV ('gold standard'). RESULTS: The internal consistency of the Brazilian Mood Disorder Questionnaire, evaluated with Cronbach's alpha coefficient was 0.76 (95% CI; 0.69-0.92). Principal component analysis with varimax rotation indicated an 'irritability-racing thoughts' factor and 'energized-activity' factor, which explained 39.1% of variance. On the basis of the SCID, 69 (60.5%) individuals received a diagnosis of bipolar disorders. A Brazilian Mood Disorder Questionnaire screening score of 8 or more items yielded sensitivity of 0.91 (95% CI; 0.85-0.98), specificity of 0.70 (95% CI; 0.62-0.75), a positive predictive value of 0.82 (95% CI; 0.75-0.88) and a negative predictive value of 0.84 (95% CI; 0.77-0.90). CONCLUSION: The present data demonstrate that the Brazilian Mood Disorder Questionnaire is a valid instrument for the screening of bipolar disorders. The instrument needs to be validated in other settings (e.g., in general practice).

Validity of the Brazilian Portuguese version of the bipolar spectrum diagnostic scale / Validade da versão brasileira em português da escala diagnóstica do espectro bipolar

OBJECTIVE: Bipolar spectrum disorders (BSDs) are prevalent and frequently unrecognized and undertreated. This report describes the development and validation of the Brazilian version of the bipolar spectrum diagnostic scale (B-BSDS), a screening instrument for bipolar disorders, in an adult psychiatric population. METHOD: 114 consecutive patients attending an outpatient psychiatric clinic completed the B-BSDS. A research psychiatrist, blind to the B-BSDS scores, interviewed patients by means of a modified version of the mood module of the Structured Clinical Interview for DSM-IV ("gold standard"). Subthreshold bipolar disorders were defined as recurrent hypomania without a major depressive episode or with fewer symptoms than those required for threshold hypomania. RESULTS: The internal consistency of the B-BSDS evaluated with Cronbach's alpha coefficient was 0.89 (95 percent CI; 0.86-0.91). On the basis of the modified SCID, 70 patients (61.4 percent) of the sample received a diagnosis of BSDs. A B-BSDS screening score of 16 or more items yielded: sensitivity of 0.79 (95 percent CI; 0.72-0.85), specificity of 0.77 (95 percent CI; 0.70-0.83), a positive predictive value of 0.85 (95 percent CI; 0.78-0.91) and a negative predictive value of 0.70 (95 percent CI; 0.63-0.75). CONCLUSION: The present data demonstrate that the B-BSDS is a valid instrument for the screening of BSDs.

OBJETIVO: Transtornos do espectro bipolar (TEB) são prevalentes e comumente subdiagnosticados e subtratados. O presente trabalho descreve o desenvolvimento e a validação da versão brasileira da escala diagnóstica do espectro bipolar (B-EDEB), um instrumento de rastreio para transtornos bipolares, em uma população psiquiátrica adulta. MÉTODO: 114 pacientes consecutivos de um ambulatório psiquiátrico completaram a versão brasileira da B-EDEB. Um psiquiatra pesquisador, cego para os escores do B-EDEB, entrevistou os participantes por meio de uma versão modificada do módulo de transtornos do humor da entrevista clínica estruturada para o DSM-IV ("padrão-ouro"). RESULTADOS: A consistência interna da B-EDEB, avaliada mediante o coeficiente alfa de Cronbach, foi de 0,89 (IC 95 por cento; 0,86-0,91). De acordo com o padrão-ouro, 70 (61,4 por cento) participantes tiveram diagnóstico de TEB. Um escore da B-EDEB de 16 ou mais itens apresentou sensibilidade de 0,79 (IC 95 por cento; 0,72-0,85), especificidade de 0,77 (IC 95 por cento; 0,70-0,83), valor preditivo positivo de 0,85 (IC 95 por cento; 0,78-0,91) e valor preditivo negativo de 0,70 (IC 95 por cento; 0,63-0,75). CONCLUSÃO: Os resultados do presente estudo demonstram que a B-EDEB é um instrumento válido para o rastreio de TEB.