Bipolar ii assessment tool

If all of those things check out well, the doctor may ask a few questions about your moods and behaviors and perhaps do an initial mental health screening. When it's warranted, the doctor will refer you to see a psychiatrist, therapist, or both for an appropriate assessment, diagnosis, and treatment. Be aware that it can be a bit confusing even for mental health professionals to properly diagnose bipolar disorder. This is because many of the symptoms of bipolar disorder overlap with symptoms of other mental health disorders.

A good mental health professional will want to get it right. Bear in mind that getting a proper diagnosis may take at least a few sessions, so be patient with your doctors and therapists. In fact, many mental health professionals like to have their patients start a journal where they can document their moods and behavior. This makes it easier for doctors and therapists to look for patterns of moods and behavior, which will lead them to the correct disorder and the correct category of the disorder.

Journaling is a common way to help test for bipolar disorder. A person is said to have rapid-cycling bipolar disorder when they have at least four episodes of major depression, mania, hypomania, or mixed states within a year. Which bipolar screening tool for bipolar disorder works best?

One tool doesn't stand above the rest. What helps the most in diagnosing and treating any category of bipolar disorder is getting matched with the right therapist at BetterHelp.

Making that connection is the best first step to overall better mental health. Advice Home. By: Toni Hoy. Medically Reviewed By: Kelly L. Previous Article. Next Article. The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use. Learn More. Nonetheless, given the time commitment involved in conducting structured interviews, several self-report measures have been developed to help clinicians identify persons most likely to meet criteria for bipolar disorders.

It should be emphasized that these measures do not provide diagnostic accuracy, but, rather, might help identify people who should warrant more careful diagnostic interviews.

The General Behavior Inventory GBI was designed to cover the core symptoms of bipolar disorder, including both depressive and manic symptoms Depue et al. Different versions range from 52 to 73 items e.

Although the GBI has the most robust psychometric properties of the available self-report screeners, the multiple versions make generalizations regarding psychometric properties difficult. The full item version of the GBI has demonstrated excellent internal consistency and adequate test—retest reliability. Cutoff scores, however, have not been consistent across studies, further limiting the generalizability of the scale.

At present, the GBI appears to be a useful screening tool for bipolar disorder, but future research to establish norms and cutoffs would increase its utility. To achieve a positive screen, seven items must be endorsed. Additional items assess if the identified symptoms co-occurred and caused at least moderate impairment.

The MDQ has attained adequate internal consistency Hirschfeld et al. In addition, at least one recent study has demonstrated that high MDQ scores are associated with greater impairment and suicidal ideation in a primary care setting Das et al.

Nonetheless, specificity has been low in some studies. A review of the content of MDQ items may help clarify why the scale has achieved better performance in inpatient settings than in community settings. Several of the items appear to capture common experiences in community samples. These items may be less commonly endorsed by persons with schizophrenia and other severe psychopathology, explaining why the scale may appear more beneficial in an inpatient setting than in a community sampling.

Hence, the MDQ may be a potentially useful tool in clinical settings to screen for bipolar disorder among those with severe psychopathology, but may be less helpful in community settings.

Other scales appear helpful in nonclinical samples, but do not have enough data regarding their usefulness as screening tools in clinical settings. To date, the HPS has only been studied in one clinical sample, achieving a positive predictive value of. Although the four-factor structure that includes dysthymic, cyclothymic, hyperthymic, and irritable temperaments has been examined in several countries and languages and psychometrically validated in clinical populations, research has not directly established the usefulness of this measure as a screen for bipolar spectrum disorders e.

At least one study, however, has demonstrated that the cyclothymic subscale of the TEMPS-A can prospectively predict bipolar spectrum diagnoses among clinically depressed children and adolescents over a two-year period Kochman et al. Although initial studies indicate that these scales demonstrate good psychometric properties, more research is needed to determine their usefulness as screening measures.

With excellent psychometric characteristics for the assessment of bipolar I disorder, they fare less well in assessing bipolar II disorder. This may be due to issues related to the definition of hypomania. As a diagnostic screening tool, the scale with the best support is the GBI, as it has consistently demonstrated sensitivity of approximately. Readers should be cautious, however, because multiple versions of the scale exist, and cutoffs for a positive screen have not been firmly established.

The MDQ has been helpful in clinical populations, but suffers from poor discriminatory power in community settings. Other promising scales require more psychometric development. When using self-report scales as screening tools, several broader issues must be kept in mind. Second, few studies provide direct comparisons of psychometric characteristics of the different measures. Not all studies on the detection of bipolar disorder report all of these results, limiting the ability to compare studies or measures.

Furthermore, sensitivity and specificity are commonly reported, but these indices may be dependent on sample characteristics. Fourth, authors have often modified the diagnostic interviews used as a reference standard to capture milder forms of bipolar spectrum disorder, yet limited information about these modifications is available.

Each of these issues makes comparisons between measures complex. The most common approach to measuring the severity of manic symptoms has been clinician-rated interviews. These scales have been commonly used to track changes in symptoms over time as treatment progresses. There has been growing recognition, though, of the need to track both clinician and patient perspectives on the course of treatment, and so we discuss available symptom severity measures that rely on self-report.

Some research has focused on measures useful for case conceptualization and treatment planning, but this literature is not covered in detail here: interested readers are referred to other reviews e. Table 2 summarizes some of the well-supported measures for assessing symptom severity in bipolar disorder. It was originally developed and tested within an inpatient population based on semi-structured interview and observation during an eight-hour period.

It should be noted that item 8, Bizarre Content, combines the assessment of the manic symptom of grandiosity with other psychotic symptoms, including hyperreligiousity, paranoia, ideas of reference, delusions, and hallucinations. The YMRS does not account for other DSM criteria of mania, including distractibility, increases in goal-directed activity, or excessive involvement in pleasurable activities with a high potential for painful consequences.

Seven items are rated on a severity scale ranging from 0 to 4, and four items are rated on a scale of 0 to 8. Four core symptoms irritability, speech, bizarre content, and disruptive—aggressive behavior are double-weighted to account for poor cooperation from severely ill patients. Although the weighting may make rating more complex, it has not been shown to affect the reliability, validity, or sensitivity of the scale.

Scores also statistically differentiate patients before and after two weeks of treatment. The YMRS has primarily been used to assess manic symptoms in treatment trials and was the primary measure of mania in the Systematic Treatment Enhancement Program for Bipolar Disorder study, the largest study to date on the effectiveness of treatments for bipolar disorder Sachs et al. The MAS Bech et al. It has been widely used in treatment and basic research e.

Scores on the MAS reliably differentiate placebo and treatment groups, as well as detect changes in symptoms associated with treatment Bech, Items are rated on a six-point scale that includes behavioral anchors.

Support for the scale in factor analytic studies has been mixed. One study found that all items loaded onto a single factor distinct from dysphoria, insomnia, and psychosis Rogers et al. However, less factor analytic support was obtained in a study that examined the item loadings for the SADS-C and a nurse observation scale for mania Swann et al. We will also discuss other measures under development. Items are scored on a 0 absent to 4 present nearly all the time scale, with total scores ranging from 0 to Although the brevity can be an advantage, the scale covers fewer symptoms than other mania scales.

The ASRM has demonstrated good psychometric properties. A cutoff score of 5. The ASRM also shows good sensitivity to treatment, with an average decrease of five points after discharge from the hospital Altman et al. It should be noted that both of the published validation studies for the ASRM were conducted by the same research group.

Normative data have been reported in three small studies of inpatients, and these studies each provided estimates of good internal consistency Altman et al. In two studies, the SRMI was found to have good discriminant validity, differentiating people with bipolar disorder from those with other psychopathology Braunig et al. The scale appears sensitive to change in symptoms.

It may not be well suited for inpatient assessment, however, because seven of the SRMI items describe behaviors that would not be possible within a hospital setting Altman et al. The Activation subscale five items assesses racing thoughts and behavioral activation, specifically feeling restless, sped-up, overactive, and impulsive.

These items appear to capture general arousal more than symptoms of mania. The overall scale has demonstrated correlations with other measures of mania ranging from. The measure is sensitive to symptom decreases during treatment Altman et al. Despite these strengths, the ISS scale has a low sensitivity to manic symptoms at the time of hospitalization Altman et al.

In addition, scoring algorithms vary substantially across studies, as do means and standard deviations of score distributions Altman et al. Thus, the ISS is not currently recommended. Continuous monitoring of symptoms and functioning is pivotal for people suffering from chronic, recurrent conditions like bipolar disorder e.

In addition, there is increasing consensus regarding the benefits of a collaborative care model for bipolar disorder, in which patients play an active role in managing their illness Bauer et al. In addition to the tracking of bipolar symptoms such as sleep disturbance and mood, self-monitoring may also provide broader information regarding important issues such as medication adherence and psychosocial functioning.

These facts have led to a growing literature supporting the use of self-monitoring tools for bipolar disorder. Frequent monitoring of bipolar symptoms can produce so much data that entering and organizing it into a useful format may be incredibly time-consuming.

In response to this, some research has focused on the use of palmtop computers and other electronic formats for self-monitoring. Most of the research in support of self-monitoring in bipolar disorder should be considered preliminary, but promising. In addition to the methods described above, many clients find it helpful to create their own self-monitoring forms or to complete brief checklists to track their progress over time.

Many consumer-oriented websites, such as that maintained by the Depression and Bipolar Support Alliance, provide such forms. To increase awareness of symptoms, these self-monitoring forms can be compared to clinician-rated interviews. This is an important area for future study, and it is the hope of the authors that self-monitoring methods continue to be refined and validated for bipolar disorder. Self-report measures can be completed quickly, but brevity and ease of use may also result in reduced precision.

Self-monitoring may also be useful to help increase awareness about symptoms and to track progress over time, but further research is required in this domain. This article has summarized assessment tools for screening, diagnosis, and symptom monitoring within bipolar disorder.

We would note that there are many important aspects of assessment in bipolar disorder that we have not addressed. Although the symptom severity and diagnostic scales covered above predominately address manic symptoms, we urge readers to evaluate a broader range of outcomes, including depression, quality of life, and social functioning.

People with bipolar disorder experience at least some depressive symptoms at least one-third of the weeks in a year Judd et al. High risk for suicide has been documented during depression within bipolar disorder Angst et al. Whereas measures of these constructs have been developed for other disorders such as depression and schizophrenia, this is a realm that remains largely untapped for bipolar disorder, with at least one exception e.

In addition, there is some debate regarding the ultimate treatment goals for bipolar disorder. Proper care must take individual needs into account, but to date little research has directly addressed this issue. Overall, it is highly recommended that researchers and clinicians pay attention to issues that extend far beyond the level of mania. Returning to the focus of this article, though, the good news is that well-validated tools exist for the assessment of mania in adults.

Reliable and valid measures are available for the diagnosis of bipolar I disorder, and indeed, the psychometric characteristics of these tools are as good as those seen for most Axis I disorders.

Similarly, scales are available to measure symptoms using both interviewer and client perspectives. On the other hand, much work remains to be done in this domain. A first goal would be the refinement of diagnostic measures for bipolar II disorder and other milder forms of bipolar disorder. Ideally, research and dialogue in the near future will help to establish accepted standards for defining hypomanic episodes. A second major goal is the refinement of screening tools.

With the possible exception of the GBI, no self-report measure has consistently achieved acceptable levels of sensitivity and specificity within community samples, and conclusions regarding the GBI are limited by the existence of several different versions and cutoffs. One might expect that the most pressing need would be for screening tools that were viable for community or outpatient screening, as by the time a person is hospitalized, symptoms may be so extreme as to be easily diagnosed.

Intriguingly, although researchers have now begun to examine the relative weight to give ratings from different informants in understanding juvenile bipolar disorder Findling et al.

Rather, researchers focused on adult bipolar disorder have often failed to take into account patient perspectives on severity. We are hopeful that future research will continue to refine this field, and that this review has illuminated research challenges to be tackled. National Center for Biotechnology Information , U.

Clin Psychol New York. Author manuscript; available in PMC Mar Christopher J. Miller , Sheri L. This new and increasingly popular free bipolar disorder test can be taken here:. The BSDS is preferred as a specific Bipolar 2 Test as it is thought to be more effective for detecting the more subtle forms of the disorder.

Take the BSDS online and score it for free. As you can see, a bipolar self-test can be completed online, based on traditional paper and pencil questionnaires. In the simplest form you are asked if you experience the bipolar symptoms described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV — the textbook psychiatrists use as a definitive source of diagnostic and treatment standards for many mood disorders and other mental health problems.

The DSM has since been updated to a new edition i. Obviously it is crucial that you have excellent insight into your own emotions and behaviors and are able to be honest and accurate in your answers. As you can see from the two tests we have provided here, testing for Bipolar Disorder involves simple and straightforward questions — not analyzing ink blots or other complicated, abstract psychoanalytic processes. PLEASE see a skilled and licensed psychiatrist, psychologist, or other mental health professional with experience in treating mood disorders to obtain a diagnosis!

The diagnostic evaluation is long, in-depth, and very personal, but the purpose is to get a thorough history of the client. This evaluation, along with the behavioral observations made of the client during the session, is how a clinician arrives at a diagnosis. As you can see, a lot goes into an evaluation before a definitive diagnosis is made. Tests and assessments serve to support a diagnostic evaluation.

This is just one example of the importance of diagnostic tests and assessments, but any responsible and ethical clinician will tell you that you cannot and should not base a diagnosis simply on the results of a Bipolar assessment. The clinician should always meet with the client and conduct a clinical interview. Diagnosing Bipolar Disorder and differentiating between the two types of the disorder is often wrought with uncertainty, as there is a lot of overlap of symptoms; therefore, an experienced and competent clinician will always be thorough and conduct a full and comprehensive assessment.

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