Artemisa en línea
LA DETECCIÓN DE CASOS DE TRASTORNO BIPOLAR POR MEDIO DE UN INSTRUMENTO DE TAMIZAJE: EL CUESTIONARIO DE TRASTORNOS DEL ANIMO VERSIÓN EN ESPAÑOL
Rodrigo Corona*, Carlos Berlanga**†, Doris Gutiérrez-Mora*, Ana Fresán**
Bipolar spectrum disorder which includes bipolar I, bipolar II, ciclothymia and bipolar disorder, not otherwise specified often goesunidentyfied, underdiagnosed, or confounded with major depressive disorder. There are several considerations that try to explain this frequent omission. One crucial aspect is that, the first mood episode at onset is often a depressive one, and some bipolar patients present multiple depressive episodes prior to their first episode of mania. Additionally, long-term evaluation of patients with bipolarI or II disorders, reveal that depressive symptoms occur more common than manic or hypomanic symptoms. Another plausible explanation is that bipolar patients frequently underreport symptoms of mania. Thus it is not surprising to find that in many patients, may elapse about 10 years from the first time for they seek treatment until a clinician finally makes the correct diagnosis. As a consequence,such patients may suffer poorer outcomes, subsyndromal symptoms and a course of illness marked by more sever symptoms, chronic mood episodes, increased recurrence and more impaired psychosocial functioning. The correct diagnosis of bipolar disorder becomes an important and crucial issue, if it is considered that there is a current trend to understand better this affective illness as a spectraldisorder. This concept helps to identify different subtle subtypes of bipolarity which often are unrecognized, by means of the actual diagnostic criteria. This diagnostic reformulation is based on the phenomenological manifestations of the entities, as well as in other specific clinical aspects, such as comorbidity, predominant episodes, genetic information and treatment response to among others.Thus, correct recognition of bipolar disorder will bring an important benefit to patients and may reduce erratic treatments and improve outcome. Several epidemiological studies report that the global prevalence of bipolar I disorder is around 1%, in the general population, but when considering all subtypes included in the bipolar spectrum, this lifetime prevalence increases up to 5%. As aconsequence of an incorrect diagnosis, patients are often undertreated or receive an erroneous pharmacological treatment, mainly with antidepressants, which complicate outcome by promoting manic or hypomanic reactions and may have devastating consequences in the further clinical intents to stabilize the disorder.
In order to increase the recognition of an illness, the correct utilization of a clinicalscreening procedure is mandatory. Several screening instruments exist for a variety of psychiatric disorders. However, only until recently, some of them have been developed specifically to identify bipolar disorders. The Mood Disorder Questionnaire, was the first screening instrument specifically developed to detect bipolar cases in clinical settings. It is a self-report, single-page, paper andpencil inventory than can be quickly and easily scored by a physician, a nurse or by trained medical staff assistance. It is composed of 13 questions which are answered with a positive or negative fashion, elaborated from the bipolar diagnostic criteria and clinical experience and inquires about possible manic symptoms. In the original report of its development and validation, it was concluded that itis a useful screening instrument for bipolar spectrum disorders, with a good sensitivity (0.73) and a very good specificity (0.90). Method The questionnaire has been translated to other languages and has been used in non-clinical settings, with very good standards of performance. Since there is not a Spanish version of it, we decided to translate this instrument and to design a trial for the...