Page 17 - e-book CPG - Bipolar Disorder
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CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
In a nationwide cross-sectional study on awareness and acceptability of RMS and MDQ in BD
screening among 200 healthcare practitioners (HCP) in both primary and secondary care, the
In a nationwide cross-sectional study on awareness and acceptability of RMS and MDQ in BD
findings were: 17, level III
screening among 200 healthcare practitioners (HCP) in both primary and secondary care, the
only 32% of HCP used a screening tool for BD compared with 82% for MDD
findings were: 17, level III
although 85% of the HCP were aware of MDQ, only 29% reported on its current use
only 32% of HCP used a screening tool for BD compared with 82% for MDD
RMS was significantly better than MDQ in terms of accuracy, brevity, practicality and
although 85% of the HCP were aware of MDQ, only 29% reported on its current use
easy scoring
RMS was significantly better than MDQ in terms of accuracy, brevity, practicality and
HCPs were significantly more likely to use RMS than MDQ (81% vs 19%)
easy scoring
HCPs were significantly more likely to use RMS than MDQ (81% vs 19%)
Bipolarity index (BI) is a tool that can increase diagnostic confidence of BD. This tool is
clinician-rated. It is useful when symptoms of mania are difficult to elicit, patients deny the
Bipolarity index (BI) is a tool that can increase diagnostic confidence of BD. This tool is
presence of manic symptoms or manic symptoms stem from another diagnosis. The scale has
clinician-rated. It is useful when symptoms of mania are difficult to elicit, patients deny the
five sections; episode characteristics, age of onset, course of illness, response to treatment
presence of manic symptoms or manic symptoms stem from another diagnosis. The scale has
and family history. In a diagnostic study using BI to screen for BD in outpatient psychiatric
five sections; episode characteristics, age of onset, course of illness, response to treatment
practice, the sensitivity and specificity of BI were 0.91 and 0.90, at a cut-off point of 50, PPV
and family history. In a diagnostic study using BI to screen for BD in outpatient psychiatric
of 0.88, NPV of 0.93 and AUC of 0.97. 18, level III
practice, the sensitivity and specificity of BI were 0.91 and 0.90, at a cut-off point of 50, PPV
of 0.88, NPV of 0.93 and AUC of 0.97. 18, level III
It may be difficult to screen for BD in the general population. A group of researchers from the
University of Melbourne introduced Bipolar at-risk (BAR) criteria which may assist in identifying
It may be difficult to screen for BD in the general population. A group of researchers from the
those at risk of BD in the age range of 15 - 25 years. It included sub-threshold mania,
University of Melbourne introduced Bipolar at-risk (BAR) criteria which may assist in identifying
depressive symptoms, cyclothymic features and genetic risk. 19, level III Refer to Table 1 for
those at risk of BD in the age range of 15 - 25 years. It included sub-threshold mania,
further description of the criteria. 19, level III Refer to Table 1 for
depressive symptoms, cyclothymic features and genetic risk.
further description of the criteria.
Table 1: Bipolar At-Risk Criteria
Criterion Table 1: Bipolar At-Risk Criteria
Description
Group Description
Criterion 1: Subthreshold 2 - 4 consecutive days of abnormally and persistently
mania elevated, expansive or irritable mood with at least two of the
Group 1: Subthreshold 2 - 4 consecutive days of abnormally and persistently
mania following:
elevated, expansive or irritable mood with at least two of the
1. inflated self-esteem or grandiosity
following:
2. decreased need for sleep (e.g. feels rested after only
1. inflated self-esteem or grandiosity
three hours of sleep)
2. decreased need for sleep (e.g. feels rested after only
3. more talkative than usual or pressure to keep talking
three hours of sleep)
4. flight of ideas or subjective experience that thoughts are
3. more talkative than usual or pressure to keep talking
racing
4. flight of ideas or subjective experience that thoughts are
5. distractibility
racing
6. increased goal-directed activity (socially, at work or
5. distractibility
sexually) or psychomotor agitation
6. increased goal-directed activity (socially, at work or
Group 2: Depression and Depression defined as at least one week of depressed mood
sexually) or psychomotor agitation
cyclothymic features or loss of interest/pleasure with at least two of the following:
Group 2: Depression and Depression defined as at least one week of depressed mood
1. significant weight loss
cyclothymic features or loss of interest/pleasure with at least two of the following:
2. insomnia or hypersomnia nearly every day
1. significant weight loss
3. psychomotor retardation or agitation
2. insomnia or hypersomnia nearly every day
4. fatigue or loss of energy
3. psychomotor retardation or agitation
5. feelings of worthlessness or excessive/inappropriate guilt
4. fatigue or loss of energy
6. diminished ability to think or concentrate
5. feelings of worthlessness or excessive/inappropriate guilt
7. recurrent thoughts of death and/or recurrent suicidal
6. diminished ability to think or concentrate
ideation
7. recurrent thoughts of death and/or recurrent suicidal
Cyclothymic features are defined as numerous episodes with
ideation
subthreshold manic symptoms not meeting group 1 criteria
Cyclothymic features are defined as numerous episodes with
and numerous episodes with depressive symptoms. e.g. sub-
subthreshold manic symptoms not meeting group 1 criteria
threshold mania as defined in group 1 only for four hours
and numerous episodes with depressive symptoms. e.g. sub-
within a 24-hour period and at least four cumulative lifetime
threshold mania as defined in group 1 only for four hours
days meeting the criteria
within a 24-hour period and at least four cumulative lifetime
days meeting the criteria
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