ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2022-2-105-114ssmu-4820Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSПрименение скрининговых методик для ранней диагностики риска биполярного аффективного расстройства у подростковApplication of screening techniques for early diagnostics of bipolar afapplication of screening techniques for early diagnosis of a risk of bipolar disorder in adolescentshttps://orcid.org/0000-0002-8034-4457ОсиповаН. Н.OsipovaN. N.

Осипова Наталья Николаевна – кандидат медицинских наук, доцент, кафедра психиатрии и наркологии

127473, г. Москва, ул. Делегатская, 20/1

20/1, Delegatskaya Str., 127473, Моscow

natinen@yandex.ruhttps://orcid.org/0000-0002-1171-5517БарденштейнЛ. М.BardenshteynL. M.

Барденштейн Леонид Михайлович – доктор медицинских наук, профессор, заслуженный врач РФ, зав. кафедрой психиатрии и наркологии

127473, г. Москва, ул. Делегатская, 20/1

20/1, Delegatskaya Str., 127473, Моscow

barden@mail.ruhttps://orcid.org/0000-0002-9173-3044ЛямецЛ. Л.LyametsL. L.

Лямец Леонид Леонидович – кандидат технических наук, доцент, заведующий кафедрой физики, математики и медицинской информатики

214019, г. Смоленск, ул. Крупской, 28

28, Krupskoy Str., 214019, Smolensk

LLL1965@mail.ruhttps://orcid.org/0000-0003-0375-0870ДмитриеваЕ. В.DmitrievaE. V.

Дмитриева Елена Владимировна – старший преподаватель, кафедра физики, математики и медицинской информатики

214019, г. Смоленск, ул. Крупской, 28

28, Krupskoy Str., 214019, Smolensk

vernulas@mail.ruМосковский государственный медико-стоматологический университет (МГМСУ) им. А.И. ЕвдокимоваРоссияA.I. Yevdokimov Moscow State University of Medicine and DentistryRussian FederationСмоленский государственный медицинский университет (СГМУ)РоссияSmolensk State Medical UniversityRussian Federation202217072022212105114Copyright © Осипова Н.Н., Барденштейн Л.М., Лямец Л.Л., Дмитриева Е.В., 20222022Осипова Н.Н., Барденштейн Л.М., Лямец Л.Л., Дмитриева Е.В.Osipova N.N., Bardenshteyn L.M., Lyamets L.L., Dmitrieva E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/4820Цель

Цель. Изучение возможности комплексного применения скрининговых методик в ранней диагностике риска биполярного расстройства (БР) у подростков.

Материалы и методы

Материалы и методы. В исследовании приняли участие 139 подростков в возрасте 13–16 лет. Были использованы клинико-психопатологический метод и скрининговые методы исследования: диагностическая шкала расстройств биполярного спектра (Bipolar Spectrum Diagnostic Scale, BSDS, R. Pies, 2005); вопросник расстройства настроения (Mood Disorder Questionnaire MDQ, R.M. Hirschfeld, 2000).

Результаты

Результаты. При клинико-психопатологическом исследовании подростков в соответствии с критериями МКБ-10 (класс V: психические расстройства и расстройства поведения (F00-F99)) психические расстройства, в том числе аффективная патология, не выявлены. По результатам скрининговой методики MDQ показан риск БР у 63 респондентов (45,3%; 95-й доверительный интервал (ДИ): 36,8–53,9). С помощью методики BSDS риск БР отмечен у 16,2% респондентов (ДИ: 11,9–28,3). Совместное использование скрининговых шкал (MDQ и BSDS) продемонстрировало согласованность их работы по выявлению значений, как не превышающих пороговые (48,7% случаев), так и превышающих пороговые показатели (17,1% случаев).

Заключение

Заключение. Ранняя диагностика риска БР у подростков наряду с клинико-психопатологическим методом может включать использование скрининговых шкал. Комплексное использование нескольких скрининговых методов обосновано проблемой полиморфизма начальных гипоманиакальных и депрессивных состояний, а также трудностями субъективной оценки симптомов биполярного аффективного расстройства подростками.

Aim

Aim. To assess the possibility of combined application of screening methods for early detection of risks of bipolar disorder in adolescents.

Materials and methods

Materials and methods. The study included 139 adolescents aged 13–16 years. A clinical psychopathology assessment as well as screening methods were used. The screening methods included the Bipolar Spectrum Diagnostic Scale ((BSDS), R. Pies, 2005) and the Mood Disorder Questionnaire ((MDQ), R.M. Hirschfeld, 2000).

Results

Results. The clinical psychopathology assessment was performed in accordance with criteria of ICD-10, Class V. No mental and behavioral disorders (F00-F99), including affective pathology, were identified. Following the MDQ screening, the risk of bipolar disorder was revealed in 63 individuals (45.3%; 95 % confidence interval (CI): (36.8–53.9). When the BSDS method was used, the risk of bipolar disorder was revealed in 16.2% of cases (CI: (11.9–28.3)). The combined use of the screening scales (MDQ and BSDS) confirmed their consistency in detecting values both not exceeding (48.7% of the cases) and exceeding the threshold rates (17.1% of the cases).

Conclusion

Conclusion. Early diagnosis of a risk of bipolar disorder in adolescents, along with a clinical psychopathology assessment, may include application of screening scales. Сombined use of several screening methods is justified by polymorphism of initial hypomanic and depressive states, as well as by difficulties in subjective assessment of symptoms of bipolar disorder in adolescents.

подросткибиполярное аффективное расстройствогипоманияскрининговые методыadolescentsbipolar disorderhypomaniascreening methodsReferencesBaldessarini R.J., Tondo L., Vázquez G.H. Pharmacological treatment of adult bipolar disorder. Mol. Psychiatry. 2019;24(2):198–217. DOI: 10.1038/s41380-018-0044-2.Baldessarini R.J., Tondo L., Vázquez G.H. Pharmacological treatment of adult bipolar disorder. Mol. Psychiatry. 2019;24(2):198–217. DOI: 10.1038/s41380-018-0044-2.Hayes J.F., Miles J., Walters K., King M., Osborn D.P.J. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr. Scand. 2015;131(6):417–425. DOI: 10.1111/acps.12408.Hayes J.F., Miles J., Walters K., King M., Osborn D.P.J. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr. Scand. 2015;131(6):417–425. DOI: 10.1111/acps.12408.Ösby U., Westman J., Hällgren J., Gissler M. Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987–2010. Eur. J. Public. Health. 2016;26(5):867–871. DOI: 10.1093/eurpub/ckv245.Ösby U., Westman J., Hällgren J., Gissler M. Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987–2010. Eur. J. Public. Health. 2016;26(5):867–871. DOI: 10.1093/eurpub/ckv245.Dickerson F., Origoni A., Schroeder J., Adamos M., Katsafanas E., Khushalani S. et al. Natural cause mortality in persons with serious mental illness. Acta Psychiatr. Scand. 2018;137(5):371–379. DOI: 10.1111/acps.12880.Dickerson F., Origoni A., Schroeder J., Adamos M., Katsafanas E., Khushalani S. et al. Natural cause mortality in persons with serious mental illness. Acta Psychiatr. Scand. 2018;137(5):371–379. DOI: 10.1111/acps.12880.Chen T.Y., Kamali M., Chu C.S., Yeh C.B., Huang S.Y., Mao W.C. et al. Divalproex and its effect on suicide risk in bipolar disorder: A systematic review and meta-analysis of multinational observational studies. J. Affect. Disord. 2019;245:812–818. DOI: 10.1016/j.jad.2018.11.093.Chen T.Y., Kamali M., Chu C.S., Yeh C.B., Huang S.Y., Mao W.C. et al. Divalproex and its effect on suicide risk in bipolar disorder: A systematic review and meta-analysis of multinational observational studies. J. Affect. Disord. 2019;245:812–818. DOI: 10.1016/j.jad.2018.11.093.Yildiz A. The bipolar book. History, neurobiology, and treatment. New York: Oxford University Press, 2015:710.Yildiz A. The bipolar book. History, neurobiology, and treatment. New York: Oxford University Press, 2015:710.Vieira D.C., de Azevedo Cardoso T., Mondin T.C., Jansen K., da Silva R.A., de Mattos Souza L.D. et al. Mood disorders and prospective suicidality in young adults: a population-based cohort study. Acta Psychiatr. Scand. 2018;137(2):109–115. DOI: 10.1111/acps.12846.Vieira D.C., de Azevedo Cardoso T., Mondin T.C., Jansen K., da Silva R.A., de Mattos Souza L.D. et al. Mood disorders and prospective suicidality in young adults: a population-based cohort study. Acta Psychiatr. Scand. 2018;137(2):109–115. DOI: 10.1111/acps.12846.Van Meter A., Moreira A.L.R., Youngstrom E. Updated Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J. Clin. Psychiatry. 2019;80(3):18r12180. DOI: 10.4088/JCP.18r12180.Van Meter A., Moreira A.L.R., Youngstrom E. Updated Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J. Clin. Psychiatry. 2019;80(3):18r12180. DOI: 10.4088/JCP.18r12180.Crockett M.A., Martínez V., Jiménez-Molina Á. Subthreshold depression in adolescence: Gender differences in prevalence, clinical features, and associated factors. J. Affect. Disord. 2020;272:269–276. DOI: 10.1016/j.jad.2020.03.111.Crockett M.A., Martínez V., Jiménez-Molina Á. Subthreshold depression in adolescence: Gender differences in prevalence, clinical features, and associated factors. J. Affect. Disord. 2020;272:269–276. DOI: 10.1016/j.jad.2020.03.111.Post R.M., Altshuler L.L., Kupka R., McElroy S.L., Frye M.A., Rowe M. et al. Verbal abuse, like physical and sexual abuse, in childhood is associated with an earlier onset and more difficult course of bipolar disorder. Bipolar. Disord. 2015;17(3):323– 330. DOI: 10.1111/bdi.12268.Post R.M., Altshuler L.L., Kupka R., McElroy S.L., Frye M.A., Rowe M. et al. Verbal abuse, like physical and sexual abuse, in childhood is associated with an earlier onset and more difficult course of bipolar disorder. Bipolar. Disord. 2015;17(3):323– 330. DOI: 10.1111/bdi.12268.Ковалев В.В. Психиатрия детского возраста: руководство для врачей. М.: Медицина, 1979:608.Ковалев В.В. Психиатрия детского возраста: руководство для врачей. М.: Медицина, 1979:608.Личко А.Е. Психопатии и акцентуации характера у подростков. Л.: Медицина, 1983:255.Личко А.Е. Психопатии и акцентуации характера у подростков. Л.: Медицина, 1983:255.Axelson D., Goldstein B., Goldstein T., Monk K., Yu H., Hickey M.B. et al. Diagnostic Precursors to Bipolar Disorder in Offspring of Parents with Bipolar Disorder: A Longitudinal Study. Am. J. Psychiatry. 2015;172(7):638–646. DOI: 10.1176/appi.ajp.2014.14010035.Axelson D., Goldstein B., Goldstein T., Monk K., Yu H., Hickey M.B. et al. Diagnostic Precursors to Bipolar Disorder in Offspring of Parents with Bipolar Disorder: A Longitudinal Study. Am. J. Psychiatry. 2015;172(7):638–646. DOI: 10.1176/appi.ajp.2014.14010035.Birmaher B., Merranko J.A., Goldstein T.R., Gill M.K., Goldstein B.I., Hower H., Yen S. et al. A risk calculator to predict the individual risk of conversion from subthreshold bipolar symptoms to bipolar disorder I or II in Youth. J. Am. Acad. Child. Adolesc. Psychiatry. 2018;57(10):755–763.e4. DOI: 10.1016/j.jaac.2018.05.023.Birmaher B., Merranko J.A., Goldstein T.R., Gill M.K., Goldstein B.I., Hower H., Yen S. et al. A risk calculator to predict the individual risk of conversion from subthreshold bipolar symptoms to bipolar disorder I or II in Youth. J. Am. Acad. Child. Adolesc. Psychiatry. 2018;57(10):755–763.e4. DOI: 10.1016/j.jaac.2018.05.023.Päären A., von Knorring A.L., Olsson G., von Knorring L., Bohman H., Jonsson U. Hypomania spectrum disorders from adolescence to adulthood: a 15-year follow-up of a community sample. J. Affect. Disord. 2013;145(2):190–199. DOI: 10.1016/j.jad.2012.07.031.Päären A., von Knorring A.L., Olsson G., von Knorring L., Bohman H., Jonsson U. Hypomania spectrum disorders from adolescence to adulthood: a 15-year follow-up of a community sample. J. Affect. Disord. 2013;145(2):190–199. DOI: 10.1016/j.jad.2012.07.031.Post R.M., Kalivas P. Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation. Br. J. Psychiatry. 2013;202(3):172– 176. DOI: 10.1192/bjp.bp.112.116855.Post R.M., Kalivas P. Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation. Br. J. Psychiatry. 2013;202(3):172– 176. DOI: 10.1192/bjp.bp.112.116855.Benazzi F., Akiskal H. Irritable-hostile depression: further validation as a bipolar depressive mixed state. J. Affect. Disord. 2005;84(2-3):197–207. DOI: 10.1016/j.jad.2004.07.006.Benazzi F., Akiskal H. Irritable-hostile depression: further validation as a bipolar depressive mixed state. J. Affect. Disord. 2005;84(2-3):197–207. DOI: 10.1016/j.jad.2004.07.006.Fredskild M.U., Mintz J., Frye M.A., McElroy S.L., Nolen W.A., Kupka R. et al. Adding Increased Energy or Activity to Criterion (A) of the DSM-5 Definition of Hypomania and Mania: Effect on the Diagnoses of 907 Patients From the Bipolar Collaborative Network. J. Clin. Psychiatry. 2019;80(6):19m12834. DOI: 10.4088/JCP.19m12834.Fredskild M.U., Mintz J., Frye M.A., McElroy S.L., Nolen W.A., Kupka R. et al. Adding Increased Energy or Activity to Criterion (A) of the DSM-5 Definition of Hypomania and Mania: Effect on the Diagnoses of 907 Patients From the Bipolar Collaborative Network. J. Clin. Psychiatry. 2019;80(6):19m12834. DOI: 10.4088/JCP.19m12834.American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5TM; 5th ed. Arlington: American Psychiatric Association, 2013.American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5TM; 5th ed. Arlington: American Psychiatric Association, 2013.Reed G.M., First M.B., Kogan C.S., Hyman S.E., Gureje O., Gaebel W. et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3–19. DOI: 10.1002/wps.20611.Reed G.M., First M.B., Kogan C.S., Hyman S.E., Gureje O., Gaebel W. et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry. 2019;18(1):3–19. DOI: 10.1002/wps.20611.Angst J., Ajdacic-Gross V., Rössler W. Bipolar disorders in ICD-11: current status and strengths. Int. J. Bipolar. Disord. 2020;8(1):3. DOI: 10.1186/s40345-019-0165-9.Angst J., Ajdacic-Gross V., Rössler W. Bipolar disorders in ICD-11: current status and strengths. Int. J. Bipolar. Disord. 2020;8(1):3. DOI: 10.1186/s40345-019-0165-9.Goodday S., Levy A., Flowerdew G., Horrocks J., Grof P., Ellenbogen M. et al. Early exposure to parental bipolar disorder and risk of mood disorder: the Flourish Canadian prospective offspring cohort study. Early Interv. Psychiatry. 2015;12(2):160–168. DOI: 10.1111/eip.12291.Goodday S., Levy A., Flowerdew G., Horrocks J., Grof P., Ellenbogen M. et al. Early exposure to parental bipolar disorder and risk of mood disorder: the Flourish Canadian prospective offspring cohort study. Early Interv. Psychiatry. 2015;12(2):160–168. DOI: 10.1111/eip.12291.Tijssen M.J., van Os J., Wittchen H.U., Lieb R., Beesdo K., Mengelers R. et al. Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study. Br. J. Psychiatry. 2010;196(2):102–108. DOI: 10.1192/bjp.bp.109.065763.Tijssen M.J., van Os J., Wittchen H.U., Lieb R., Beesdo K., Mengelers R. et al. Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study. Br. J. Psychiatry. 2010;196(2):102–108. DOI: 10.1192/bjp.bp.109.065763.Bardenshteyn L.M., Slavgorodsky Y.M., Beglyankin N.I., Kekelidze D.Z., Aleshkina G. A. Early recognition of bipolar depression. International Journal of Neuropsychopharmacology. 2016;19(S1):21–22. DOI: 10.1093/ijnp/pyw043.062.Bardenshteyn L.M., Slavgorodsky Y.M., Beglyankin N.I., Kekelidze D.Z., Aleshkina G. A. Early recognition of bipolar depression. International Journal of Neuropsychopharmacology. 2016;19(S1):21–22. DOI: 10.1093/ijnp/pyw043.062.Malhi G.S., Bell E. Prepubertal bipolar disorder: a diagnostic quandary? Int. J. Bipolar. Disord. 2020;8(1):20. DOI: 10.1186/s40345-020-00187-0.Malhi G.S., Bell E. Prepubertal bipolar disorder: a diagnostic quandary? Int. J. Bipolar. Disord. 2020;8(1):20. DOI: 10.1186/s40345-020-00187-0.Toohey M.J. Irritability characteristics and parameters in an international sample. J. Affec.t Disord. 2020;263:558–567. DOI: 10.1016/j.jad.2019.11.021.Toohey M.J. Irritability characteristics and parameters in an international sample. J. Affec.t Disord. 2020;263:558–567. DOI: 10.1016/j.jad.2019.11.021.Kroon J.S., Wohlfarth T.D., Dieleman J., Sutterland A.L., Storosum J.G., Denys D. et al. Incidence rates and risk factors of bipolar disorder in the general population: a population-based cohort study. Bipolar. Disord. 2013;15(3):306–313. DOI: 10.1111/bdi.12058.Kroon J.S., Wohlfarth T.D., Dieleman J., Sutterland A.L., Storosum J.G., Denys D. et al. Incidence rates and risk factors of bipolar disorder in the general population: a population-based cohort study. Bipolar. Disord. 2013;15(3):306–313. DOI: 10.1111/bdi.12058.Swahn M.H., Bossarte R.M. Gender, early alcohol use, and suicide ideation and attempts: findings from the 2005 youth risk behavior survey. J. Adolesc. Health. 2007;41(2):175–181. DOI: 10.1016/j.jadohealth.2007.03.003.Swahn M.H., Bossarte R.M. Gender, early alcohol use, and suicide ideation and attempts: findings from the 2005 youth risk behavior survey. J. Adolesc. Health. 2007;41(2):175–181. DOI: 10.1016/j.jadohealth.2007.03.003.Fava G.A., Tossani E. Prodromal stage of major depression. Early Interv. Psychiatry. 2007;1(1):9–18. DOI: 10.1111/j.1751-7893.2007.00005.x.Fava G.A., Tossani E. Prodromal stage of major depression. Early Interv. Psychiatry. 2007;1(1):9–18. DOI: 10.1111/j.1751-7893.2007.00005.x.Van Meter A.R., Burke C., Youngstrom E.A., Faedda G.L., Correll C.U. The bipolar prodrome: Meta-analysis of symptom prevalence prior to initial or recurrent mood episodes. J. Am. Acad. Child. Adolesc. Psychiatry. 2016;55(7):543–555. DOI: 10.1016/j.jaac.2016.04.017.Van Meter A.R., Burke C., Youngstrom E.A., Faedda G.L., Correll C.U. The bipolar prodrome: Meta-analysis of symptom prevalence prior to initial or recurrent mood episodes. J. Am. Acad. Child. Adolesc. Psychiatry. 2016;55(7):543–555. DOI: 10.1016/j.jaac.2016.04.017.Sewall C.J.R., Girard J.M., Merranko J., Hafeman D., Goldstein B.I., Strober M. et al. A Bayesian multilevel analysis of the longitudinal associations between relationship quality and suicidal ideation and attempts among youth with bipolar disorder. J. Child. Psychol. Psychiatry. 2021;62(7):905–915. DOI: 10.1111/jcpp.13343.Sewall C.J.R., Girard J.M., Merranko J., Hafeman D., Goldstein B.I., Strober M. et al. A Bayesian multilevel analysis of the longitudinal associations between relationship quality and suicidal ideation and attempts among youth with bipolar disorder. J. Child. Psychol. Psychiatry. 2021;62(7):905–915. DOI: 10.1111/jcpp.13343.Hirschfeld R.M., Williams J.B., Spitzer R.L., Calabrese J.R., Flynn L., Keck P.E.Jr. et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questiоnnaire. Аm. J. Psychiatry. 2000;157(11):1873– 1875. DOI: 10.1176/appi.ajp.157.11.1873.Hirschfeld R.M., Williams J.B., Spitzer R.L., Calabrese J.R., Flynn L., Keck P.E.Jr. et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questiоnnaire. Аm. J. Psychiatry. 2000;157(11):1873– 1875. DOI: 10.1176/appi.ajp.157.11.1873.Ghaemi S.N., Miller C.J., Berv D.A., Klugman J., Rosenquist K.J., Pies R.W. Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J. Affect. Disord. 2005;84(2– 3):273–277. DOI: 10.1016/S0165-0327(03)00196-4.Ghaemi S.N., Miller C.J., Berv D.A., Klugman J., Rosenquist K.J., Pies R.W. Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J. Affect. Disord. 2005;84(2– 3):273–277. DOI: 10.1016/S0165-0327(03)00196-4.Angst J., Adolfsson R., Benazzi F., Gamma A., Hantoche E., Meyer T.D. et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J. Affect. Disord. 2005;88(2):217–233. DOI: 10.1016/j.jad.2005.05.011.Angst J., Adolfsson R., Benazzi F., Gamma A., Hantoche E., Meyer T.D. et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J. Affect. Disord. 2005;88(2):217–233. DOI: 10.1016/j.jad.2005.05.011.Mosolov S.N., Ushkalova A.V., Kostukova E.G., Shafarenko A.A., Alfimov P.V., Kostyukova A.B. et al. Validation of the Russian version of the Hypomania Checklist (HCL-32) for the detection of bipolar II disorder in patients with a current diagnosis of recurrent depression. J. Affect. Disord. 2014;155: 90–95. DOI: 10.1016/j.jad.2013.10.029.Mosolov S.N., Ushkalova A.V., Kostukova E.G., Shafarenko A.A., Alfimov P.V., Kostyukova A.B. et al. Validation of the Russian version of the Hypomania Checklist (HCL-32) for the detection of bipolar II disorder in patients with a current diagnosis of recurrent depression. J. Affect. Disord. 2014;155: 90–95. DOI: 10.1016/j.jad.2013.10.029.Hosang G.M., Cardno A.G., Freeman D., Ronald A. Characterization and structure of hypomania in a British nonclinical adolescent sample. J. Affect. Disord. 2017;207:228–235. DOI: 10.1016/j.jad.2016.08.033.Hosang G.M., Cardno A.G., Freeman D., Ronald A. Characterization and structure of hypomania in a British nonclinical adolescent sample. J. Affect. Disord. 2017;207:228–235. DOI: 10.1016/j.jad.2016.08.033.Päären A., von Knorring A.L., Olsson G., von Knorring L., Bohman H., Jonsson U. Hypomania spectrum disorders from adolescence to adulthood: a 15-year follow-up of a community sample. J. Affect. Disord. 2013;145(2):190–199. DOI:10.1016/j.jad.2012.07.031.Päären A., von Knorring A.L., Olsson G., von Knorring L., Bohman H., Jonsson U. Hypomania spectrum disorders from adolescence to adulthood: a 15-year follow-up of a community sample. J. Affect. Disord. 2013;145(2):190–199. DOI:10.1016/j.jad.2012.07.031.Vázquez G.H., Romero E., Fabregues F., Pies R., Ghaemi N., Mota-Castillo M. Screening for bipolar disorders in Spanish-speaking populations: sensitivity and specificity of the Bipolar Spectrum Diagnostic Scale-Spanish Version. Compr. Psychiatry. 2010;51(5):552–556. DOI: 10.1016/j.comppsych.2010.02.007.Vázquez G.H., Romero E., Fabregues F., Pies R., Ghaemi N., Mota-Castillo M. Screening for bipolar disorders in Spanish-speaking populations: sensitivity and specificity of the Bipolar Spectrum Diagnostic Scale-Spanish Version. Compr. Psychiatry. 2010;51(5):552–556. DOI: 10.1016/j.comppsych.2010.02.007.Hirschfeld R.M., Holzer C., Calabrese J.R., Weissman M., Reed M., Davies M. et al. Validity of the mood disorder questionnaire: a general population study. Am. J. Psych. 2003;160(1):178–180. DOI: 10.1176/appi.ajp.160.1.178.Hirschfeld R.M., Holzer C., Calabrese J.R., Weissman M., Reed M., Davies M. et al. Validity of the mood disorder questionnaire: a general population study. Am. J. Psych. 2003;160(1):178–180. DOI: 10.1176/appi.ajp.160.1.178.Zimmerman M., Galione J.N., Chelminski I., Young D., Ruggero C.J. Performance of the Bipolar Spectrum Diagnostic Scale in psychiatric outpatients. Bipolar Disorders. 2010;12(5):528– 538. DOI: 10.1111/j.1399-5618.2010.00840.x.Zimmerman M., Galione J.N., Chelminski I., Young D., Ruggero C.J. Performance of the Bipolar Spectrum Diagnostic Scale in psychiatric outpatients. Bipolar Disorders. 2010;12(5):528– 538. DOI: 10.1111/j.1399-5618.2010.00840.x.Lee D., Cha B., Park C.S., Kim B.J., Lee C.S., Lee S. Usefulness of the combined application of the Mood Disorder Questionnaire and Bipolar Spectrum Diagnostic Scale in screening for bipolar disorder. Compr. Psychiatry. 2013;54(4):334–340. DOI: 10.1016/j.comppsych.2012.10.002.Lee D., Cha B., Park C.S., Kim B.J., Lee C.S., Lee S. Usefulness of the combined application of the Mood Disorder Questionnaire and Bipolar Spectrum Diagnostic Scale in screening for bipolar disorder. Compr. Psychiatry. 2013;54(4):334–340. DOI: 10.1016/j.comppsych.2012.10.002.Shabani А., Koohi-Habibi L., Nojomi M., Chimeh N., Ghaemi S.N., Soleimani N. The Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire in Screening the Patients with Bipolar Disorder. Archives of Iranian Medicine. 2009;12(1):41–47.Shabani А., Koohi-Habibi L., Nojomi M., Chimeh N., Ghaemi S.N., Soleimani N. The Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire in Screening the Patients with Bipolar Disorder. Archives of Iranian Medicine. 2009;12(1):41–47.

The authors declare that there are no conflicts of interest present.