The 33-item Hypomania Checklist (HCL-33): A new self-completed screening instrument for bipolar disorder.

BACKGROUND: Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD). This study tested the psychometric properties and the accuracy of the Chinese version of the 33-item Hypomania Checklist (HCL-33) to identify BD in Chinese clinical settings. METHODS: A total of 350 depressed patients were consecutively interviewed in a major psychiatric hospital in China. The patients' socio-demographic and clinical characteristics were recorded using standardized protocol and data collection procedures. The HCL-33 was completed by patients to detect symptoms characteristic of mania and hypomania. DSM-IV diagnoses were established using the Mini International Neuropsychiatric Interview (MINI). RESULTS: The HCL-33 showed high internal consistency with two-factorial dimensions. The optimal cut-off point on the HCL-33 to differentiate BD from MDD was 15, while cut-off points of 14 and 13 differentiated BD-I and BD-II from MDD, respectively. The maximum sensitivity was 0.62, 0.67 and 0.72 for differentiating BD, BD-I and BD-II from MDD, respectively. CONCLUSIONS: The HCL-33 is a useful tool for screening for BD in Chinese depressed patients. The routine clinical use of the HCL-33 as a screening instrument for BD in Chinese patients is recommended.

Prescription patterns of psychotropic medications and use of electroconvulsive therapy in Chinese patients with dementia.

BACKGROUND: Little is known about psychiatric pharmacotherapy and somatic treatments in dementia in China. This study examined the prescription patterns of psychotropic medications and use of electroconvulsive therapy (ECT) in dementia patients hospitalized in a psychiatric institution in Beijing, China. METHODS: This was a retrospective chart review of 401 patients with dementia treated over a period of 7 years (2007 - 2013) in a university-affiliated psychiatric institution in Beijing. Socio-demographic and clinical data were collected from the electronic chart management system (ECMS) for discharged patients. RESULTS: Nearly all patients (96.8%) received psychotropic medications in order of frequency: second-generation antipsychotics (83.0%), benzodiazepines (77.8%), first generation antipsychotics (39.7%), antidepressants (29.7%), and mood stabilizers (24.7%). The rate of polypharmacy and ECT use was 82.0% and 3.7%, respectively. Prescription of mood stabilizers was associated with longer length of hospitalization. CONCLUSIONS: In a major psychiatric hospital in China, ECT was sporadically used in patients with dementia, while the vast majority of patients received at least one type of psychotropic medication. Factors contributing to the high use of psychopharmacological interventions in this population warrant further investigations.

Validation of Self-administrated Questionnaire for Psychiatric Disorders in Patients with Functional Dyspepsia.

INTRODUCTION: Psychiatric comorbidity is common in patients with functional dyspepsia (FD) but a good screening tool for psychiatric disorders in gastrointestinal clinical practice is lacking. AIMS: 1) Evaluate the performance and optimal cut-off of 12-item General Health Questionnaire (GHQ-12) as a screening tool for psychiatric disorders in FD patients; 2) Compare health-related quality of life (HRQoL) in FD patients with and without psychiatric comorbidities. METHODS: Consecutive patients fulfilling Rome III criteria for FD without medical co-morbidities and gastroesophageal reflux disease were recruited in a gastroenterology clinic. The followings were conducted at 4 weeks after index oesophagogastroduodenoscopy: self-administrated questionnaires on socio-demographics, dyspeptic symptom severity (4-point Likert scale), GHQ-12, and 36-item short-form health survey (SF-36). Psychiatric disorders were diagnosed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by a trained psychiatrist, which served as reference standard. RESULTS: 55 patients underwent psychiatrist-conducted interview and questionnaire assessment. 27 (49.1%) had current psychiatric disorders as determined by SCID (anxiety disorders: 38.2%, depressive disorders: 16.4%). Receiver operating characteristic curve analysis of GHQ-12 revealed an area under curve of 0.825 (95%CI: 0.698-0.914). Cut-off of GHQ-12 at >/=3 gave a sensitivity of 63.0% (95%CI = 42.4-80.6%) and specificity of 92.9% (95%CI = 76.5%-98.9%). Subjects with co-existing psychiatric disorders scored significantly lower in multiple domains of SF-36 (mental component summary, general health, vitality and mental health). By multivariate linear regression analysis, current psychiatric morbidities (Beta = -0.396, p = 0.002) and family history of psychiatric illness (Beta = -0.299, p = 0.015) were independent risk factors for poorer mental component summary in SF-36, while dyspepsia severity was the only independent risk factor for poorer physical component summary (Beta = -0.332, p = 0.027). CONCLUSIONS: Concomitant psychiatric disorders adversely affect HRQoL in FD patients. The use of GHQ-12 as a reliable screening tool for psychiatric disorders allows early intervention and may improve clinical outcomes of these patients.