Modified MDQ effective for bipolar screening in pregnancy

By Mark Cowen

A modified version of the Mood Disorder Questionnaire (MDQ) is an effective screening tool for bipolar disorder (BD) during pregnancy and the postpartum period, researchers report.

Benicio Frey (McMaster University, Hamilton, Ontario, Canada) and team found that the MDQ had "excellent" sensitivity and specificity when using an alternative scoring system based on the presence of seven or more manic/hypomanic symptoms without the usual supplementary questions regarding the frequency and effects of such symptoms on daily life.

The use of an effective BD screening tool in pregnant and postpartum women may lead to "more appropriate treatment plans and prevent the well-known negative outcomes of undiagnosed illness," they say.

The team studied 150 women, aged 17-43 years, who had been referred for psychiatric assessment during pregnancy (n=95) or the postpartum period (n=55) between 2010 and 2011.

All of the participants completed the MDQ on referral, and DSM-IV-based clinical diagnosis provided by experienced psychiatrists was used to calculate the sensitivity and specificity of the screening tool.

In total, 18 women received a clinical DSM-IV-based diagnosis of BD. Of these, six were diagnosed with BD I, 10 with BD II, and two with BD not otherwise specified.

Using the traditional criteria (at least seven symptoms plus supplementary questions), the team found that the MDQ had poor sensitivity (39%) and excellent specificity (91%) as a screening tool for BD in the study population.

Further analysis showed that an alternative scoring system without the supplementary questions increased sensitivity to an excellent 89%, while maintaining excellent specificity, at 84%.

Frey et al conclude in the Journal of Clinical Psychiatry: "When an alternative scoring of seven manic/hypomanic symptoms without supplementary questions is used, the MDQ is an excellent screening tool for BD in pregnant and postpartum women seeking psychiatric assessment."

They add: "Future studies investigating the performance of the MDQ in obstetric, midwifery, and general practitioner clinics would shed light on the usefulness of this scale in nonpsychiatric perinatal setting."

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