Screening for Bipolar Disorder: Confusion between Case-Finding and Screening

hypomanic or manic episodes must be elicited. Recommendations for improving the detection of bipolar disorder include careful clinical evaluations, inquiring about a history of mania and hypomania, and the use of screening questionnaires [11–13] . Many scales have been developed to assess manic/hypomanic symptoms. Some of these instruments are crosssectional measures of symptom severity, and, prior to DSM-5, would not have been appropriate as diagnostic aids in currently depressed patients. The reason for the caveat regarding DSM-5 is because DSM-5 includes a mixed feature specifier for depressed patients which these scales might be useful in identifying. In the past few years, 4 self-report questionnaires have been developed to screen for bipolar disorder [14–17] . That is, they assess a lifetime history of manic/hypomanic symptoms. The purpose of the present article is twofold. First, I briefly describe the structure and content of these 4 scales and summarize the initial studies establishing the cutoff score derived by the scale developers that was recommended to screen for bipolar disorder. Second, I discuss the distinction between case-finding and screening, how this distinction is reflected in the derivation of a measure’s cutoff score, and examine how this applies to the 4 bipolar disorder screening instruments. Introduction