How to Screen Patients With Depressive Symptoms for Bipolar I Disorder
How should clinicians use the Rapid Mood Screener to identify possible bipolar I disorder in patients presenting with depressive symptoms or a depression diagnosis?
Many patients with bipolar I disorder seek care during depression rather than mania, so bipolarity may be missed and misclassified as major depressive disorder. This guide applies to outpatient clinicians evaluating new or existing patients with depressive symptoms when bipolar I disorder is part of the differential.
-
Select patients with depressive presentations
Use bipolar I screening in patients who present with depressive symptoms or already carry a depression diagnosis. The article describes the RMS specifically as a tool developed to differentiate bipolar I disorder from major depressive disorder in patients with depressive symptoms.
-
Administer the 6-item Rapid Mood Screener
Have the patient complete the self-administered RMS, which includes questions about hallmark manic symptoms and depressive characteristics more likely to indicate bipolar disorder than MDD, such as earlier age at depression onset, prior negative response to antidepressant treatment, and multiple depressive episodes. The article states that the RMS can be completed in less than 2 minutes.
-
Use flexible outpatient workflow options
Integrate the RMS during or outside the clinical visit using practical formats supported in the article, such as online, through the electronic medical record system, or in the waiting room. Survey respondents most often envisioned paper administration, patient completion before the office visit, and inclusion in the electronic health record.
-
Score the screener by counting yes responses
Count the number of endorsed yes items. Four or more yes responses constitute a positive screen for bipolar I disorder according to the article.
-
Interpret a positive screen as a trigger for diagnostic evaluation
Do not treat a positive RMS as a diagnosis. The article states that a positive screen should alert the clinician that a more thorough diagnostic evaluation for bipolar disorder is warranted.
-
Evaluate further even if suspicion remains below threshold
Proceed to complete diagnostic evaluation not only when the RMS is positive, but also when the result is subthreshold positive or other clinical suspicion remains. The authors explicitly state that comprehensive evaluation is warranted in these situations as well.
Clinical Considerations
- The RMS has been validated only for bipolar I disorder and not for bipolar II disorder.
- A positive RMS result does not confirm bipolar disorder and must be followed by complete diagnostic assessment.
- Although RMS operating characteristics are cited as 88% sensitivity and 80% specificity at a cutoff of 4 or more yes responses, the article states that real-world comparative advantage over other tools still requires further study.
Bottom Line
In depressed outpatients, use the brief 6-item RMS as a bipolar I case-finding tool and treat 4 or more yes responses as a clear prompt for full diagnostic evaluation.
