Hypomania Checklist

The Hypomania Checklist (HCL-32) is a questionnaire developed by Dr. Jules Angst to identify hypomanic components in patients with major depressive disorder in order to help clinicians diagnose bipolar II disorder and other bipolar spectrum disorders^[1] presented in psychiatric and general medical practice. The development of a final and potentially shorter multi-lingual version with established cut-off scores for hypomania is a secondary goal.^[2]

Development and history

The HCL-32 was developed as a more useful method to test hypomania and essentially aid in epidemiological research. The test itself was made a self-assessment screening internment.

The Hypomania Checklist was developed because attempts to screen for bipolar focused on the identifying individuals at risk for developing mood disorders in non-clinical populations. The measures were specifically for personality and did not address the episodic nature of hypomania and potential negative consequences of any changes in behavior, affect and cognition.

The scale includes a checklist of possible symptoms of hypomania that can be rated either yes or no. The rating "yes" would mean the symptom is present or this trait is "typical of me" and "no" would mean the symptom is not present or this trait is "not typical of me" for the subject."^[3]

Scoring and interpretation

The HCL-32 is a checklist questionnaire that assesses the duration and impact of a participant’s “highs” on their life.^[4]

Scoring

The question breakdown of the HCL-32 is as follows:^[5]

• Question 1: this question assesses the participant’s current emotional state
• Question 2: this question assess the temperaments of the participant such as whether they have been constantly hyperthymic, depressed, or cyclothymic.
• Question 3: This is a list of 32 yes or no questions that contribute to the participant’s overall score on the measure
• Questions 4-7: These questions assess the “highs” of the participant over the last 12 months

Interpretation

The total score of the HCL-32 is mostly based on the answers to question 3. If there is a total score of 14 or more positive (“yes”) answers, then there is a high chance that the participant has bipolar disorder.^[5] However, subjects with less than a score of 14 may also test positive for bipolar disorder, so if there is a family history of bipolar or mood disorders, the participant is advised to see a clinicians for a full assessment.^[5]

Examples of items on the HCL-32 include: "I need less sleep", "I feel more energetic and more active", "I spend more/too much money", and "I have more ideas, I am more creative."^[6]

The HCL-32 is currently available in 20 different languages.^[7]

Limitations

The HCL suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can have an effect on the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey.^[1]

Similar reliability scores were found when only using 16 item assessments versus the traditional 32-item format of the HCL-32. A score of at least 8 items was found valid and reliable for distinguishing Bipolar Disorder and Major Depressive Disorder. In a study, 73% of patients who completed the HCL-32 R1 were true bipolar cases identified as potential bipolar cases. However, the HCL-32 R1 does not accurately differentiate between Bipolar I and Bipolar II.^[8] However, the 16-item HCL has not been tested as a standalone section in a hospital setting. In addition, while the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between bipolar I and bipolar-II disorders. The HCL-32 has not been compared with other commonly used screening tools for bipolar disorder, such as the Young Mania Rating Scale, Young Mania Rating Scale and the General Behavior Inventory. The online version of the HCL has been shown to be as reliable as the paper version.^[8]

See also

• Bipolar disorder
• Bipolar disorder in children
• AACAP practice parameter for depressive disorders
• AACAP practice parameter for bipolar disorder
• Effective Child Therapy regarding bipolar disorder
• Question Breakdown
• Cognitive Therapy (CT) for Bipolar Disorder
• Family Focused Therapy (FTT) for Bipolar Disorder
• Psychoeducation for Bipolar
• Systematic Care for Bipolar Disorder
• Interpersonal and Social Rhythm Therapy (ISRT) for Bipolar Disorder

References

1. Bowling A (2005). "Mode of questionnaire administration can have serious effects on data quality". Journal of Public Health 27 (3): 281–91. doi:10.1093/pubmed/fdi031. PMID 15870099.
2. Forty L, Kelly M, Jones L, Jones I, Barnes E, Caesar S, Fraser C, Gordon-Smith K, Griffiths E, Craddock N, Smith DJ (2010). "Reducing the Hypomania Checklist (HCL-32) to a 16-item version". Journal of Affective Disorders 124 (3): 351–6. doi:10.1016/j.jad.2010.01.004. PMID 20129673.
3. Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, Skeppar P, Vieta E, Scott J (2005). "The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients". Journal of Affective Disorders 88 (2): 217–33. doi:10.1016/j.jad.2005.05.011. PMID 16125784.
4. http://psycheducation.org/primary-care-provider-resource-center/moodcheck/hcl-32-questionnaire/|website=PsychEducation.org|accessdate=2 October 2015
5. Lakarhuset. "Hypomania Checklist Manual" (PDF). Retrieved 2 October 2015.
6. Angst, Jules (2005). "The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients". Journal of Affective Disorders. doi:10.1016/j.jad.2005.05.011.
7. http://www.lakarhuset.com/docs/HCL_32_R1_Manual.pdf
8. Angst. (PDF) http://www.lakarhuset.com/docs/HCL_32_R1_Manual.pdf. Retrieved 23 November 2015. Missing or empty |title= (help)