The Rapid Mood Screener (RMS): a novel and pragmatic screener for bipolar I disorder

• Published in: Current medical research and opinion Vol. 37; no. 1; pp. 135 - 144
• Main Authors: McIntyre, Roger S., Patel, Mehul D., Masand, Prakash S., Harrington, Amanda, Gillard, Patrick, McElroy, Susan L., Sullivan, Kate, Montano, C. Brendan, Brown, T. Michelle, Nelson, Lauren, Jain, Rakesh
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02-01-2021
• Subjects: bipolar I disorder; major depressive disorder; misdiagnosis; Mood Disorder Questionnaire; Rapid Mood Screener; screening tool; Rapid Mood Screener; bipolar I disorder; screening tool; major depressive disorder; Mood Disorder Questionnaire; misdiagnosis
• ISSN: 0300-7995; 1473-4877
• DOI: 10.1080/03007995.2020.1860358

Depressive episodes and symptoms of bipolar I disorder are commonly misdiagnosed as major depressive disorder (MDD) in primary care. The novel and pragmatic Rapid Mood Screener (RMS) was developed to screen for manic symptoms and bipolar I disorder features (e.g. age of depression onset) to address this unmet clinical need.
A targeted literature search was conducted to select concepts thought to differentiate bipolar I from MDD and screener tool items were drafted. Items were tested and refined in cognitive debriefing interviews with individuals with self-reported bipolar I or MDD (n = 12). An observational study was conducted to evaluate predictive validity. Participants with clinical interview-confirmed bipolar I or MDD diagnoses (n = 139) completed a draft 10-item screening tool and other questionnaires. Data were analyzed to identify the smallest possible subset of items with optimized sensitivity and specificity.
Adults with confirmed bipolar I (n = 67) or MDD (n = 72) participated in the observational study. Ten draft screening tool items were reduced to 6 final RMS items based on the item-level analysis. When 4 or more items of the RMS were endorsed ("yes"), sensitivity was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties were an improvement over the Mood Disorder Questionnaire in the same analysis sample while using 60% fewer items.
The pragmatic 6-item RMS differentiates bipolar I disorder from MDD in patients with depressive symptoms, providing real-world guidance to primary care practitioners on whether a more comprehensive assessment for bipolar I disorder is warranted.