Tests
1st tests to order
Primary Care Evaluation of Mental Disorders (PRIME-MD)
Test
A validated tool for identifying mental disorders, including bipolar depression, in primary care practice and research.[91]
Result
positive result can be used to further investigate for mental health disorders in primary care
Patient Health Questionnaire (PHQ-9)
Test
The PHQ-9 can be used as a diagnostic and disease management tool and has been validated for use in primary care settings to screen for depression.[92] The PHQ-9 is a self-administered 9-item questionnaire that reflects the DSM-IV-TR criteria. It classifies current symptoms based on duration on a scale of 0 (no symptoms) to 4 (daily symptoms). Repeating the PHQ-9 during treatment allows objective monitoring of response to therapy.
This questionnaire is still being used in clinical practice, despite the release of DSM-5-TR.
Result
positive result suggests depression
Rapid Mood Screener (RMS)
Test
A rapid (6-question) tool developed to screen for manic symptoms/bipolar I disorder features in patients presenting with a depressive episode, for example, in primary care.[94]
An answer of "yes" to at least 4 questions is considered a positive screening result.
A positive screening result is associated with a sensitivity of 88%, and a specificity of 80%.[94]
Result
positive screening result suggests potential diagnosis of bipolar disorder, and indicates a need for further diagnostic assessment
Mood Disorder Questionnaire (MDQ)
Test
The MDQ can be used as a diagnostic aid and has been validated as a screening instrument for bipolar disorder in a variety of settings, including primary care.[95]
This self-assessment instrument includes 13 questions about symptoms of mania/hypomania based on DSM-IV-TR criteria. A score of 7 or more positive responses to the 13 questions, as well as endorsing the clustering of the symptoms into an episode that caused at least moderate distress or negative consequences, is a positive MDQ screen and has been correlated with a diagnosis of bipolar disorder. Mood Disorder Questionnaire (MDQ) Opens in new window
This questionnaire is still being used in clinical practice, despite the release of DSM-5-TR.
Result
positive result can be used to further enquire about a history of mania or hypomania
Bipolarity Index
Test
This scoring system rates 5 dimensions of bipolarity: episode characteristics (mania or hypomania); age at onset; illness course; response to medications; family history. Each dimension is scored up to a maximum of 20 points, for a maximum total score of 100. A cutoff score of ≥50 on the Bipolarity Index corresponds to a sensitivity of 0.91 and specificity of 0.90 for distinguishing bipolar from nonbipolar disorders.[96] Bipolarity Index Opens in new window
Result
≥50 suggests potential diagnosis of bipolar disorder, and indicates a need for further diagnostic assessment
Young Mania Rating Scale (YMRS)
Test
A validated symptom severity scale with point-score ranges that are generally associated with degrees of severity. Contains 11 items that are scored based on subjective reporting of symptoms in the previous 48 hours and clinical observations during an interview. Commonly used to measure changes in manic symptoms in response to treatment.[97] Young Mania Rating Scale Opens in new window
Result
scores presence and severity of mania symptoms
CBC
Test
Should be performed to exclude other possible causes of mood symptoms.
Result
normal
thyroid function tests
Test
Hyperthyroidism may mimic manic or hypomanic states; hypothyroidism can produce depression.
Result
usually normal
serum vitamin D
Test
Should be performed to exclude other possible causes of mood symptoms.
Result
normal
toxicology screen
Test
Should be performed as guided by the individual clinical picture to exclude other possible causes of mood symptoms.
Symptoms observed in manic, mixed, or hypomanic episodes may occur as part of an intoxication or withdrawal phenomenon from a drug of misuse.
Result
negative
Tests to consider
fasting lipid profile
Test
Often abnormal, as lipid abnormalities are commonly found in patients with bipolar disorder.[98]
Test should be ordered as part of overall health evaluation, particularly given common co-occurrence of metabolic derangements in patients with bipolar disorder as well as complications from mood-stabilizing medications.
Result
abnormal if metabolic syndrome present
fasting glucose
Test
Often abnormal, as metabolic syndrome and hyperglycemia commonly occurs in patients with bipolar disorder.[98]
Test should be ordered as part of overall health evaluation, particularly given common co-occurrence of metabolic derangements in patients with bipolar disorder as well as complications from mood-stabilizing medications.
Result
may be elevated if metabolic syndrome present
MRI brain
Test
Some evidence points to whole brain and regional brain volume changes in people with bipolar disorder.[52]
Test should not routinely be ordered except in the case of new onset of mania or atypical presentations, to rule out an organic etiology, such as brain tumor or multiple sclerosis.
Result
typically normal
actigraphy
Test
Sleep disruptions are a feature of bipolar disorders. If there is a suspicion of obstructive sleep apnea, which is frequently comorbid with obesity, a sleep study might be recommended. A systematic review and meta-analysis of 13 studies using actigraphy to detect changes in activity and sleep patterns in bipolar patients versus healthy controls showed a decrease in activity mean and an altered pattern of sleep in bipolar patients. Further analyses suggested that these results might mean that a bipolar condition that underlies manic, depressed episodes and euthymic phases can be identified.[99]
Result
findings diagnostic of comorbid obstructive sleep apnea may be present
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