How to Rescreen Patients With Depression for Bipolar I Disorder
How can clinicians rescreen patients already diagnosed with depression when bipolar I disorder is still a concern?
Some patients initially labeled with depression may actually have unrecognized bipolar I disorder, and delayed recognition can contribute to inappropriate treatment and worse outcomes. This guide applies to outpatient clinicians reconsidering bipolar I disorder in patients with an existing depression diagnosis.
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Identify current depression patients who may need reassessment
Consider rescreening patients who already have a depression diagnosis when bipolar I disorder is suspected or diagnostic uncertainty persists. The article notes a potential role for the RMS not only in new evaluations but also in rescreening current patients with depression.
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Readminister the Rapid Mood Screener
Use the self-administered 6-item RMS for rescreening, since it was designed for patients with depressive symptoms and is brief enough for routine outpatient use. The article reports that many clinicians considered its less-than-2-minute completion time and easy scoring important for practice adoption.
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Apply the same positive threshold
Score the RMS by counting yes responses and use 4 or more yes answers as a positive screen for bipolar I disorder. This is the cutoff described in the article for a positive RMS result.
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Escalate to full diagnostic workup when results or suspicion warrant it
If the rescreen is positive, complete a more thorough diagnostic evaluation for bipolar disorder rather than relying on the screener alone. The article also advises full diagnostic evaluation when the result is subthreshold positive or when other clinical suspicions remain.
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Use an alternate screener if bipolar II is the concern
If the clinical question is possible bipolar II disorder rather than bipolar I disorder, use the MDQ or another tool that screens for bipolar II. The authors state this may be prudent because the RMS has not been validated in bipolar II disorder.
Clinical Considerations
- The article reports clinician willingness to rescreen with the RMS, but it does not prove that rescreening improves diagnostic accuracy or outcomes in real-world practice.
- The RMS should not be generalized to bipolar II disorder because it has not been validated in that population.
- Subthreshold RMS results do not rule out bipolar disorder when clinical suspicion persists.
Bottom Line
When bipolar I disorder is still possible in a patient already diagnosed with depression, repeat screening with the RMS and move to full diagnostic assessment for any positive or still-suspicious case.
