A multinational study to pilot the modified Hypomania Checklist (mHCL) in the assessment of mixed depression

Kursat Altinbas, Aysegul Ozerdem, Miguel L. Prieto, Manuel E. Fuentes, Nefize Yalin, Zeliha Ersoy, Omer Aydemir, Danilo Quiroz, Signem Oztekin, Jennifer R. Geske, Scott E. Feeder, Jules Angst, Mark A. Frye*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background Mixed depression is a common, dimensional phenomenon that is increasingly recognized in unipolar and bipolar disorders. We piloted a modified version of the Hypomania Checklist (mHCL-32) to assess the prevalence and clinical correlates of concurrent manic (hypo) symptoms in depressed patients. Methods The mHCL-32, Young Mania Rating Scale (YMRS) and Hamilton Rating Scale for Depression (HAMD-24) were utilized in the assessment of unipolar (UP=61) and bipolar (BP=44) patients with an index major depressive episode confirmed by the Structured Clinical Interview for DSM-IV (SCID). Differential mHLC-32 item endorsement was compared between UP and BP. Correlation analyses assessed the association of symptom dimensions measured by mHCL-32, YMRS and HAMD-24. Results There was no significant difference between mood groups in the mean mHCL-32 and YMRS scores. Individual mHLC-32 items of increased libido, quarrels, and caffeine intake were endorsed more in BP vs. UP patients. The mHCL-32 active-elevated subscale score was positively correlated with the YMRS in BP patients and negatively correlated with HAMD-24 in UP patients. Conversely, the mHCL-32 irritable-risk taking subscale score was positively correlated with HAMD-24 in BP and with YMRS in UP patients. Limitations Small sample size and cross-sectional design. Conclusion Modifying the HCL to screen for (hypo) manic symptoms in major depression may have utility in identifying mixed symptoms in both bipolar vs. unipolar depression. Further research is encouraged to quantify mixed symptoms with standardized assessments.

Original languageEnglish
Pages (from-to)478-482
Number of pages5
JournalJournal of Affective Disorders
Issue number1
StatePublished - Jan 2014

Bibliographical note

Funding Information:
Dr. Frye has been a consultant (unpaid) for Allergan, Merck, Myriad, Sanofi-Aventis, Sunovion, Takeda Global Research, Teva Pharmaceuticals, United Biosource Corporation, has received grant support from Myriad, Pfizer, National Alliance for Schizophrenia and Depression (NARSAD), National Institute of Mental Health (NIMH), National Institute of Alcohol Abuse and Alcoholism (NIAAA), Mayo Foundation and has received travel support from Chilean Society of Neurology, Psychiatry and Neurosurgery (Sociedad de Neurologia, Psiquiatria y Neurocirugia), Advanced Health Media, GlaxoSmithKline, Colombian Society of Neuropsychopharmacology, AstraZeneca, Bristol-Myers-Squib, Otsuka, Sanofi-Aventis.

Funding Information:
Dr. Ozerdem has received honoraria from Astra Zeneca, BMS, Egis, GSK, Nobel, Pfizer, Servier and travel grants from Lundbeck, Nobel, Abdi İbrahim.

Funding Information:
Dr. Prieto has received honoraria for speaker activities and development of educational presentations from GlaxoSmithKline, has received travel support from GlaxoSmithKline, Lilly, Lundbeck, Pharmavita, and has received scholarship support from the Government of Chile.


  • Bipolar
  • Depression
  • Modified hypomania checklist
  • Unipolar


Dive into the research topics of 'A multinational study to pilot the modified Hypomania Checklist (mHCL) in the assessment of mixed depression'. Together they form a unique fingerprint.

Cite this