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Identifying hypomanic features in major depressive disorder using the hypomania checklist (HCL-32)

Forty, Elizabeth, Smith, Daniel J., Jones, Lisa, Jones, Ian Richard, Caesar, Sian, Fraser, Christine, Gordon-Smith, Katherine and Craddock, Nicholas John 2009. Identifying hypomanic features in major depressive disorder using the hypomania checklist (HCL-32). Journal of Affective Disorders 114 (1-3) , pp. 68-73. 10.1016/j.jad.2008.07.017

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Background Recent studies have challenged the traditional unipolar/bipolar divide with increasing support for a more dimensional view of affective disorders. We here examine the occurrence of hypomanic symptoms in individuals with a history of major depression selected to exclude indicators of underlying bipolarity. Methods The presence of hypomanic symptoms was assessed by the Hypomania Checklist (HCL-32) self-report questionnaire in a sample of almost 600 patients meeting DSM-IV criteria for Bipolar I disorder (BPI N = 260) or Major Recurrent Depressive disorder (MDDR N = 322). Subjects were recruited and assessed using consistent, robust methodology. Results We found that a score of 20 or more on the HCL-32 yielded the best combination of sensitivity (68%) and specificity (83%) to distinguish between BPI and MDDR. Within our highly selected and well defined MDDR sample (for which exclusion criteria included personal or family histories of bipolar or psychotic illness), 17% of MDDR subjects scored over the threshold of 20 on the HCL-32. Conclusions The HCL-32 identified a substantial number of patients meeting DSM-IV criteria for recurrent major depression (even when selected to exclude personal and family histories of bipolar illness) who reported bipolar symptoms at a level similar to that reported by patients meeting diagnostic criteria for bipolar disorder. This demonstrates the limitations of using DSM-IV criteria to distinguish those with and without bipolar features of illness.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Subjects: R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Uncontrolled Keywords: unipolar, bipolar, depression, symptoms, mania, hypomania, HCL-32
Publisher: Elsevier
ISSN: 0165-0327
Last Modified: 15 Jul 2021 01:21

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