Discriminative hypomania checklist-32 factors in unipolar and bipolar major depressive patients on behalf of come to me study group

Giulio Perugi, Michele Fornaro, Icro Maremmani, Pier Luigi Canonico, Paolo Carbonatto, Claudio Mencacci, Giovanni Muscettola, Luca Pani, Riccardo Torta, Claudio Vampini, Fabio Parazzini, Arina Dumitriu, Jules Angst

Research output: Contribution to journalArticlepeer-review


Background: Although manic or hypomanic episodes define bipolar disorder (BD), most patients show a predominance of depressive symptomatology, often associated with delayed or disregarded BD diagnosis. The Hypomania Checklist-32 (HCL-32) has therefore been developed and tested internationally to facilitate BD recognition. Sampling andMethods: Five hundred seventy-one (563 eligible) patients diagnosed with a major depressive episode according to DSM-IV criteria were consecutively enrolled in a cross-sectional, multicenter, observational study (Come To Me). Lifetime manic or hypomanic features were assessed by the HCL-32, and severity of depressive and anxious symptomatology was assessed using the Zung's self-report questionnaires for depression and anxiety. Results: Among the patients diagnosed with BD (n = 119), either type I or type II, the occurrence of (hypo)manic symptoms was significantly higher compared to major depressive disorder (MDD) symptoms according to HCL-32 total and subscale scores obtained using a score of 14, which ensured an optimal discrimination between BD and MDD with a sensitivity of 0.85 and a specificity of 0.78. Conclusions: Although some false positives might occur, the HCL-32 was confirmed to be a useful instrument in the detection of past hypomania in MDD patients, finally contributing to proper therapeutic choices.

Original languageEnglish
Pages (from-to)390-398
Number of pages9
Issue number6
Publication statusPublished - Oct 2012


  • Bipolar disorder
  • Depression
  • Hypomania Checklist-32

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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