Different patterns of manic/hypomanic symptoms in depression: A pilot modification of the hypomania checklist-32 to assess mixed depression

Miguel L. Prieto, Eric A. Youngstrom, Aysegul Ozerdem, Kursat Altinbas, Danilo Quiroz, Omer Aydemir, Nefize Yalin, Jennifer R. Geske, Scott E. Feeder, Jules Angst, Mark A. Frye*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Methods The study sample consisted of 188 patients with Structured Clinical Interview for DSM-IV-TR disorders (SCID) confirmed bipolar or major depressive disorder. We modified the Hypomania Checklist-32 (mHCL-32) to assess current instead of lifetime symptoms. An Exploratory Factor Analysis (EFA) was conducted to identify clusters of mHCL-32 items that were endorsed concurrently. A Latent Class Analysis (LCA) was carried out to identify groups of patients with similar mHCL-32 item endorsement patterns.

Background There are no self-report scales that assess manic/hypomanic symptoms in patients with depression. The aim of this study was to explore the use of a modified screening instrument for bipolar disorder to assess current manic/hypomanic symptoms in patients with a depressive episode.

Results The EFA identified 3 factors: factor #1 ("elation-disinhibition-increased goal directed activity"), factor #2 ("risk-taking-impulsivity-substance use") and factor #3 (distractibility-irritability). The LCA yielded 3 classes (2 showing manic/hypomanic features). While class #1 patients endorsed more items related to disinhibition and racing thoughts, class #2 patients recognized more items associated with irritability and substance use.

Limitations Lack of an adequate gold standard measure of mixed depression to compare to, the cross-sectional design and the lack of a validation sample.

Conclusions The mHCL-32 scale allowed a comprehensive and convergent delineation of hypomanic/manic symptoms in depression. Further validation of these findings is needed.

Original languageEnglish
Pages (from-to)355-360
Number of pages6
JournalJournal of Affective Disorders
StatePublished - 1 Feb 2015

Bibliographical note

Funding Information:
Dr. Frye has been a consultant (unpaid) for Allergan, Merck, Myriad, Sanofi-Aventis, Sunovion, Takeda Global Research, Teva Pharmaceuticals, and 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, and Sanofi-Aventis.

Funding Information:
Dr. Ozerdem has received honoraria from Astra Zeneca, BMS, Egis, GSK, Nobel, Pfizer, and Servier and travel grants from Lundbeck, Nobel, and 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, and Pharmavita, and has received scholarship support from the Government of Chile.1

Publisher Copyright:
© 2014 Elsevier B.V. All rights reserved.


  • Bipolar disorder
  • Manic/hypomanic
  • Mixed depression
  • mHCL-32 scale


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