Different patterns of manic/hypomanic symptoms in depression: A pilot modification of the hypomania checklist-32 to assess mixed depression

Miguel L Prieto; Eric A Youngstrom; Aysegul Ozerdem; Kursat Altinbas; Danilo Quiroz; Omer Aydemir; Nefize Yalin; Jennifer R Geske; Scott E Feeder; Jules Angst; Mark A Frye

doi:10.1016/j.jad.2014.09.047

Different patterns of manic/hypomanic symptoms in depression: A pilot modification of the hypomania checklist-32 to assess mixed depression

J Affect Disord. 2015 Feb 1:172:355-60. doi: 10.1016/j.jad.2014.09.047. Epub 2014 Oct 13.

Authors

Affiliations

¹ Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile; Mayo Clinic Depression Center, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
² Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Psychiatry, Dokuz Eylul University, Izmir, Turkey; Department of Neuroscience, Dokuz Eylul University, Izmir, Turkey.
⁴ Department of Psychiatry, Canakkale Onsekiz Mart University, Canakkale, Turkey.
⁵ Efeso Mood Clinic, Santiago, Chile.
⁶ Department of Psychiatry, Celal Bayar University, Manisa, Turkey.
⁷ Mayo Clinic Depression Center, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA.
⁸ Zürich University Psychiatric Hospital, Zurich, Switzerland.
⁹ Mayo Clinic Depression Center, Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA. Electronic address: mfrye@mayo.edu.

PMID: 25451437
DOI: 10.1016/j.jad.2014.09.047

Abstract

Background: There are no self-report scales that assess manic/hypomanic symptoms in patients with depression. The aim of this study was to explore the use of a modified screening instrument for bipolar disorder to assess current manic/hypomanic symptoms in patients with a depressive episode.

Methods: The study sample consisted of 188 patients with Structured Clinical Interview for DSM-IV-TR disorders (SCID) confirmed bipolar or major depressive disorder. We modified the Hypomania Checklist-32 (mHCL-32) to assess current instead of lifetime symptoms. An Exploratory Factor Analysis (EFA) was conducted to identify clusters of mHCL-32 items that were endorsed concurrently. A Latent Class Analysis (LCA) was carried out to identify groups of patients with similar mHCL-32 item endorsement patterns.

Results: The EFA identified 3 factors: factor #1 ("elation-disinhibition-increased goal directed activity"), factor #2 ("risk-taking-impulsivity-substance use") and factor #3 (distractibility-irritability). The LCA yielded 3 classes (2 showing manic/hypomanic features). While class #1 patients endorsed more items related to disinhibition and racing thoughts, class #2 patients recognized more items associated with irritability and substance use.

Limitations: Lack of an adequate gold standard measure of mixed depression to compare to, the cross-sectional design and the lack of a validation sample.

Conclusions: The mHCL-32 scale allowed a comprehensive and convergent delineation of hypomanic/manic symptoms in depression. Further validation of these findings is needed.

Keywords: Bipolar disorder; Manic/hypomanic; Mixed depression; mHCL-32 scale.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bipolar Disorder / diagnosis*
Checklist / standards
Cross-Sectional Studies
Cyclothymic Disorder / diagnosis*
Depression / diagnosis*
Depressive Disorder, Major / diagnosis*
Diagnosis, Differential
Diagnostic and Statistical Manual of Mental Disorders
Factor Analysis, Statistical
Female
Humans
Interview, Psychological / standards*
Male
Middle Aged
Pilot Projects
Psychomotor Agitation / diagnosis
Risk Factors