Background: The goal of this study was to assess the frequency and spectrum of symptoms related to bipolar disorders in a community sample by means of a self-rating questionnaire. Method: The Mood Disorder Questionnaire, a self-rating scale which evaluates DSM-IV manic/hypomanic symptoms, was administered to a community sample of 1,034 individuals recruited through advertisements. Symptom interrelationships were studied by factor analysis. Results: 275 individuals (26.6%) reported moderate or severe impairment due to the symptoms. Manic/hypomanic symptoms were present in a high proportion of individuals. Factor analysis found a two-factor structure of bipolar spectrum symptoms (an elevated mood overactivity factor, and an irritable behavior factor). Conclusion: The findings of this study highlight the need of complementing clinical investigations on the bipolar spectrum with community studies. Subclinical manic-hypomanic symptoms may be present also in allegedly unipolar patients and may have implications on the course of illness.

Keywords:
Bipolar disorders, Manic/hypomanic syndromes, Mood Disorder Questionnaire, Subclinical symptoms
1.
Akiskal HS, Pinto O: The evolving bipolar spectrum: Prototypes I, II, III, and IV. Psychiat Clin North Am 1999;22:517–534.
2.
Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rossler W: Toward a re-definition of subthreshold bipolarity: Epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J Affect Disord 2003;73:133–146.
3.
Fava GA: Subclinical symptoms in mood disorders. Psychol Med 1999;29:47–61.
4.
Benazzi F: Prevalence and clinical correlates of residual depressive symptoms in bipolar II disorder. Psychother Psychosom 2001;70:232–238.
5.
Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, Solomon DA, Leon AC, Keller MB: A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatry 2003;60:261–269.
6.
Judd LL, Akiskal HS, Schettler PJ, Coryell W, Maser JD, Rice JA, Solomon DA, Keller MB: The comparative clinical phenotype and long term longitudinal episode course of bipolar I and II: A clinical spectrum or distinct disorders? J Affect Disord 2003;73:19–32.
7.
Judd LL, Akiskal HS: The prevalence and disability of bipolar spectrum disorders in the US population: Re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 2003;73:123–131.
8.
Post RM, Denicoff KD, Leverich GS, Altshuler LL, Frye MA, Suppes TM, Rush AJ, Keck PE Jr, McElroy SL, Luckenbaugh DA, Pollio C, Kupla R, Nolen WA: Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry 2003;64:680–690.
9.
Hirschfeld RMA, Williams JBW, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J: Development and validation of a screening instrument for bipolar spectrum disorder: The mood disorder questionnaire. Am J Psychiatry 2000;157:1873–1875.
10.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
11.
Hirschfeld RM, Calabrese JR, Weissman MM, Reed M, Davies MA, Frye MA, Keck PE Jr, Lewis L, McElroy SL, McNutty JP, Wagner KD: Screening for bipolar disorder in the community. J Clin Psychiatry 2003;64:53–59.
12.
Angst J: The emerging epidemiology of hypomania and bipolar II disorder. J Affect Disord 1998;50:143–151.
13.
Faravelli C, Abrardi L, Bartolozzi D, Cecchi C, Cosci F, D’Adamo D, Lo Iacono B, Ravaldi C, Scarpato MA, Truglia E, Rosi S: The Sesto Fiorentino study: Background, methods and preliminary results. Lifetime prevalence of psychiatric disorders in an Italian community sample using clinical interviewers. Psychother Psychosom 2004;73:216–225.
14.
Faravelli C, Abrardi L, Bartolozzi D, Cecchi C, Cosci F, D’Adamo D, Lo Iacono B, Ravaldi C, Scarpato MA, Truglia E, Rossi Prodi PM, Rosi S: The Sesto Fiorentino study: Point and one year prevalences of psychiatric disorders in an Italian community sample using clinical interviewers. Psychother Psychosom 2004;73:226–234.
15.
Wittchen HU: Continued needs for epidemiological studies of mental disorders in the community. Psychother Psychosom 2004;73:197–206.
16.
Zimmerman M, Posternak MA, Chelminski I, Solomon DA: Using questionnaires to screen for psychiatric disorders: A comment on a study of screening for bipolar disorder in the community. J Clin Psychiatry 2004;65:605–610.
17.
Benazzi F: Improving the Mood Disorder Questionnaire to detect bipolar II disorder. Can J Psychiatry 2003;48:770–771.
18.
Benazzi F, Akiskal HS: The dual factor structure of self-assessed MDQ hypomania: Energized-activity versus irritable-thought racing. J Affect Disord 2003;73:56–64.
19.
Akiskal HS, Hantouche EG, Allilaire JF: Bipolar II with and without cyclothymic temperament: ‘Dark’ and ‘sunny’ expressions of soft bipolarity. J Affect Disord 2003;73:49–57.
20.
Fava GA, Rafanelli C, Grandi S, Conti S, Belluardo P: Prevention of recurrent depression by cognitive behavior therapy. Arch Gen Psychiatry 1998;55:816–820.
21.
Fava GA, Ruini C, Sonino N: Management of recurrent depression in primary care. Psychother Psychosom 2003;72:3–9.
22.
Ruini C, Ottolini F, Rafanelli C, Tossani E, Ryff CD, Fava GA: The relationship of psychological well-being to distress and personality. Psychother Psychosom 2003;72:268–275.
23.
Fava GA, Ruini C, Rafanelli C: Psychometric theory is an obstacle to the progress of clinical research. Psychother Psychosom 2004;73:145–148.
24.
Bech P: Modern psychometrics in clinimetrics. Psychother Psychosom 2004;73:134–138.
25.
Faravelli C: Assessment of psychopathology. Psychother Psychosom 2004;73:139–141.
26.
Emmelkamp PMG: The additional value of clinimetrics needs to be established rather than assumed. Psychother Psychosom 2004;73:142–144.
© 2005 S. Karger AG, Basel
2005
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.