Bipolar vs Unipolar – Resources

General Factors Predicting Bipolar vs Unipolar

In general, the risk of having a bipolar type of mood disorder is higher when some or all of the following are present:

  • Early onset of mood symptoms. Especially having a first depressive episode before age 15.
  • A family history of mania or a strong family history of unipolar depression. A family history of any relative with mania roughly tripled the risk of bipolar vs unipolar mood disorder. But even a strong family history (several family members) of unipolar depression increased the risk.
  • More frequent mood episodes. Especially having had more than 7 mood episodes of any kind.
  • The presence of “mixed” symptoms, including irritability and impulsivity, when depressed.
  • A history of “sub threshold” hypomania in someone age 15-25 was found to identify a group at particularly high risk of developing bipolar (bipolar at risk) according to a study by Bechdolf, et al.
  • A history of psychotic symptoms when depressed.
  • Postpartum depression.

Bipolar Screening Tools

  • The Mood Disorder Questionnaire was one of the first tools (2002, HIrschfield) designed to screen for bipolar disorder in those currently depressed. Across multiple studies, the sensitivity is relatively low (false negative rate of 33 percent), and the false positive rate is about 20 percent. The instrument is particularly insensitive to people with bipolar 2, which is generally the hardest type of bipolar to distinguish from recurrent major depression. If you are currently a patient at Gateway Psychiatric, you may take the Mood Disorder Questionnaire, just request from your clinician.
  • The Sydney Bipolar Screener (SBS) is a brief, self-report questionnaire that assesses for symptoms of mania and hypomania, which are the two main mood states that characterize bipolar disorder. It is a valuable tool for identifying and distinguishing bipolar from unipolar disorder. If you are currently a patient at Gateway Psychiatric, you may take the self-report questionnaire by going to this link: Sydney Bipolar Screener.
  • The Rapid Mood Screener (RMS) is another tool designed to distinguish bipolar and unipolar depression. Again, if you are a Gateway Psychiatric patient you can fill out the Rapid Mood Screener with the link.
    • The RMS was developed using a targeted literature review and cognitive debriefing interviews with people with self-reported bipolar I disorder or MDD. An observational study was then conducted to evaluate the predictive validity of the RMS. Participants with clinically confirmed bipolar I or MDD diagnoses completed the 10-item draft RMS and other questionnaires. Data were analyzed to identify the smallest possible subset of items with the best sensitivity and specificity.
    • The final RMS consists of 6 items. When 4 or more items are endorsed, the RMS has a sensitivity of 0.88 and a specificity of 0.80. These properties are better than those of the Mood Disorder Questionnaire, which has 15 items.
  • The Bipolar Spectrum Diagnostic Scale (BSDS) – This is another tool designed to identify those with bipolar depression. It has been shown to have generally good sensitivity and specificity except for people with unstable mood due to a personality disorder such as borderline personality disorder, where it may over diagnose bipolar disorder. There is no online form to fill out for this one due to the two step structure of the test.

References

Dervic K, Garcia-Amador M, Sudol K, et al. Bipolar I and II versus unipolar depression: Clinical differences and impulsivity/aggression traits. European Psychiatry. 2015;30(1):106-113. doi:10.1016/j.eurpsy.2014.06.005

Bechdolf A, Ratheesh A, Cotton SM, Nelson B, Chanen AM, Betts J, Bingmann T, Yung AR, Berk M, McGorry PD. The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study. Bipolar Disord. 2014 Aug;16(5):493-504. doi: 10.1111/bdi.12205. Epub 2014 May 5. PMID: 24797824.

Malhi GS, Bargh DM, Coulston CM, Das P, Berk M. Predicting bipolar disorder on the basis of phenomenology: implications for prevention and early intervention. Bipolar Disord. 2014 Aug;16(5):455-70. doi: 10.1111/bdi.12133. Epub 2013 Oct 25. PMID: 24636153.

Hirschfeld RM. The Mood Disorder Questionnaire: A Simple, Patient-Rated Screening Instrument for Bipolar Disorder. Prim Care Companion J Clin Psychiatry. 2002 Feb;4(1):9-11. doi: 10.4088/pcc.v04n0104. PMID: 15014728; PMCID: PMC314375.

Roger S. McIntyre, Mehul D. Patel, Prakash S. Masand, Amanda Harrington, Patrick Gillard, Susan L. McElroy, Kate Sullivan, C. Brendan Montano, T. Michelle Brown, Lauren Nelson & Rakesh Jain (2021) The Rapid Mood Screener (RMS): a novel and pragmatic screener for bipolar I disorder, Current Medical Research and Opinion, 37:1, 135-144, DOI: 10.1080/03007995.2020.1860358

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