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Reducing the hypomania checklist (HCL-32) to a 16-item version

Forty, Elizabeth, Kelly, Mark James, Jones, Lisa, Jones, Ian Richard, Barnes, Emma J., Caesar, Sian, Fraser, Christine, Gordon-Smith, Katherine, Griffiths, Emily, Craddock, Nicholas John and Smith, Daniel J. 2010. Reducing the hypomania checklist (HCL-32) to a 16-item version. Journal of affective disorders 124 (3) , pp. 351-356. 10.1016/j.jad.2010.01.004

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Background The under-recognition of hypomanic symptoms by both clinicians and patients is a major clinical problem which contributes to misdiagnosis and diagnostic delay in patients with bipolar disorder. The recent development of validated screening instruments for hypomania, such as the Hypomania Checklist (HCL-32), may help to improve the detection of bipolar disorder. In this study, we assess whether it is possible to reduce the number of items on the HCL-32 without any loss in the screening tool's ability to reliably differentiate between bipolar disorder (BD) and major depressive disorder (MDD). Methods Using our large samples of patients with DSM-IV defined bipolar I disorder (BD-I) (n = 230) and recurrent MDD (n = 322), we performed item correlations in order to identify potentially redundant items in the HCL-32. We then tested the performance of a shortened 16-item HCL questionnaire within a separate sample of patients with BD (including BD-I, BD-II and BD-NOS) (n = 59) and MDD (n = 76). Results The structure of the 16-item HCL demonstrated two main factors similar to those identified for the HCL-32 (an ‘active-elated’ factor and a ‘risk-taking/irritable’ factor). A score of 8 or more on a shortened 16-item version of the HCL had excellent ability to distinguish between BD and MDD. The sensitivity (83%) and specificity (71%) of the 16-item version were very similar to those for the full 32-item HCL. Limitations The HCL-16 was derived after subjects had completed the full HCL-32. It will be important to test the validity of a ‘stand-alone’ 16-item HCL questionnaire. Conclusions A shortened 16-item HCL (the HCL-16) is potentially a useful screening tool for hypomania within busy clinical settings.

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: major depressive disorder, bipolar affective disorder, symptoms, HCL-32, hypomania checklist, screening
Publisher: Elsevier
ISSN: 0165-0327
Last Modified: 15 Jul 2021 01:22

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