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Downloading the Primary Care MoodCheck
(revised 4/2008) 

You could do more harm than good, using this test, if you do not recall the effects of "prevalence" on the predictive value of a test result.   Below is a short review.  The longer version (written in regard to an earlier screening tool, the MDQ) describes why a negative bipolar screen comes close to "ruling out" bipolar disorder, whereas a positive screening test result must be interpreted in light of your educated hunch.  

Briefly: "predictive value" 
A test result is not a diagnosis, because tests are not perfect. Of course, neither are you. In most circumstances, however, you and the test are better than either alone. You don't need to remember how to calculate sensitivity,specificity or predictive values to understand that if a condition is very rare, most of the people you screen will not have the disease. If the test is not perfect, you will have many "false positives". Conversely, if the illness is common, then even with an imperfect test, a positive test result is much more likely to be a "true positive".

This logic also applies to your "clinical hunch". If you really don't think the patient could have bipolar disorder, a positive test result is more likely to be a false positive. And if you think "yes, this really could be bipolar", a positive test result is more likely to be a true positive.^{Phelps and Ghaemi, 2006}

Of course, your clinical hunch will depend on your understanding of "bipolarity".  When you have time, you should read about Bipolar II:  the more you understand, the better your hunch, and the more accurate your interpretation of the screening test you came here to download.

Anatomy of the instrument
MoodCheck 1: this depression screening tool simply assesses DSM depression symptoms, so that you can score it just by looking at it, and you can use it repeatedly, e.g. every time the patient comes in, to see if they're getting better.  (We used to use a tool called the PHQ-9 for this, but it's copyrighted now, though you can probably still find one if you like that better;  try this link if it still works or google PHQ-9). 

MoodCheck 2: this is the bipolar screener. 
Parts A/B:  the Bipolar Spectrum Diagnostic Scale, a validated bipolar screening tool.^{Miller et al}
Part C:  information you need before prescribing an antidepressant (family history; negative prior diagnosis; and one of the powerful predictors of suicide risk )
Part D:  non-manic bipolar markers (bipolar "soft signs") which are statistically associated with bipolar outcomes, and therefore will help you establish your clinical hunch

Scoring
You do not need to memorize the following numbers. All of the necessary cutoff values have been written into the test itself.  Most of your patients will be able to do the scoring for you using the instructions provided.

MoodCheck 1:  any checkmark in the shaded columns warrants attention. There is no cut-off for this instrument, which is made for simplicity and has not been validated as some other tools have. Contact me if you'd like a CES-D (a well-validated tool, similar to the Zung), adapted for use in this MoodCheck system, instead. 

MoodCheck 2:
Parts A/B: less than 10, significant bipolarity is unlikely; >13, bipolarity is likely.  Intermediate results require interpretation (see below).
Part C: a  family history of bipolar disorder, if the diagnosis is relatively secure, is a strong bipolar marker; more than 8 boxes checked is also significant (Youngstrom et al, in preparation).
Part D:  dark gray boxes carry more weight than light gray boxes, light gray greater than white --  but no cut-offs have been established.

What about a BSDS score between 10 and 13, or a low BSDS score but lots of "soft signs"? These are intermediate results that cannot be handled with a yes/no, black-or-white diagnostic system like the DSM-IV.  My usual approach is to send patients to learn more about Bipolar II and "soft" versions of bipolar disorder, as suggested on the test page. Note that the "bipolar spectrum" approach to diagnosis has been recommended by a task force of the International Society for Bipolar Disorders. ^{Phelps et al}

Download MoodCheck for primary care

You may also download the bipolar screener only (without the depression screener)