The Hypomanic Check List
Selection of patients for studies in phases 1 to 3 and phase 4
Page 1: Introduction
Page 2: Research Goals & Development of HCL
Page 3: Selection of Patients for HCL Studies
Page 4: Epidemiological Studies & Comparison with Other Instruments
Page 5: Publications & References
Page 6: Contact Information (webgroup/mailing list)
The following are some general guidelines that we recommend to any researchers interested in using and validating the HCL:
In clinical studies of mood disorders about 150 patients (preferably MDD, BP-II and fewer BP-I patients) should be given the HCL-32 and diagnosed by experienced clinicians. This number of cases allows factor analyses and computations of sensitivity and specificity of different cut-offs. Patient samples could be either hospitalised and/or outpatients or patients in general practice.
In phase 4, any patients with and also without mood disorders (for instance GAD and Panic attacks), can be selected. The groups size can consist of about 50 or more patients per center.
The clinical diagnosis of hypomania can based on DSM-IV criteria but one has to be aware that the diagnostic criteria for DSM-IV hypomania have not been validated.
In addition softer criteria for bipolarity, for instance 1 (or 2) instead of 4 days minimum duration of hypomania can be applied but have to be specified.
The Zurich study point of view, suggests a strict and a broad diagnostic specifier for bipolarity. Both definitions include overactivity as criterion A in addition to euphoria/irritability. The strict definition requires 3 of 7 DSM-IV symptoms of mania plus social or personal consequences attributable to the syndrome (distress, social problems, impairment). The broad definition requires only 2 of the 7 symptoms of mania (DSM-IV).
It might also be of interest to identify suspected cases of bipolar depression by the HCL-32 in order to predict switches to hypomania under antidepressants. Such selected cases can be defined by the presence of major depression with a positive family history for bipolar/manic disorders. This study type requires a prospective design.
