What do these results, and having the RMS available as a tool, mean for practicing NPs? How does the RMS help with the appropriate screening of patients?
"The RMS provides a much-needed timely and useful screening tool to nurse practitioners for bipolar disorder assessment in busy clinical settings. In particular, it stands out in both its simplicity and ability to help identify bipolar patients with good specificity and sensitivity. In a time where every minute often counts, the RMS can offer both myself and my colleagues an evidence-based tool to help improve screening for bipolar disorder in psychiatry and primary care settings." – Kate Sullivan, NP, co-author
Depressive episodes and symptoms of bipolar I disorder can be commonly misdiagnosed as major depressive disorder (MDD) in primary care.1 The use of screening tools may assist clinicians as a holistic approach to diagnosing their patients appropriately.
Why was the research needed?
Delayed or missed diagnosis of bipolar disorder is common. One of the most common misdiagnoses of bipolar disorder is MDD.2 Treatment for each of these disorders varies, making early, accurate diagnosis a critically unmet need.
As many patients with bipolar disorder are treated by primary care providers, the authors determined that a short, easy-to-use, clinically validated screening tool for bipolar I disorder can be another option for healthcare providers.3
What did the researchers do?
The RMS tool was developed to help clinicians in a primary care setting identify patients with bipolar I disorder in 2 minutes, using easily understood terminology to screen for symptoms and risk factors.3 To develop the tool, the authors evaluated targeted literature search results identifying concepts that differentiated bipolar I disorder from MDD.3
A multidisciplinary group of mental health and psychometric experts then refined the concept list into a screening tool for evaluation. After 2 rounds of patient debriefing interviews, researchers selected 10 screening items that were relevant and easy for them to interpret and understand.3
Finally, researchers conducted an observational study to identify the smallest possible subset of items with optimized sensitivity and specificity.3
What were the main results of the study?
A total of 67 adults with confirmed bipolar I disorder and 72 adults with MDD participated in the observational study.3
The authors found that 6 final RMS items out of 10 draft screening tool questions provided the optimal balance of specificity and sensitivity to predict for bipolar I disorder versus MDD, while using 60% fewer items than the industry-used Mood Disorder Questionnaire.3
Of the 6 final RMS items, 3 were included that screen for factors related to depression; the other 3 screen for manic symptoms. The RMS tool requires an endorsement of 4 or more items to identify possible patients who have bipolar I disorder, with a sensitivity of 0.88 and specificity of 0.80.3
Why are these results potentially important?
Patients with bipolar disorder are often treated in a busy primary care setting.4 Having the new 6-item, patient-reported RMS tool available for clinicians to implement in practice may allow them to efficiently screen for bipolar I disorder and identify patients for further evaluation for bipolar I disorder. This tool may help improve patient care by decreasing the number of patients who are misdiagnosed with MDD and inappropriately treated with antidepressant therapies.3
The ability to generalize results to nonmedicated patients may be limited, as all participants were on medication.3 Another possible study limitation included the recruitment process from qualitative research facilities, which may limit generalizability to real-world samples.3 Additionally, the RMS tool was designed to identify patients with bipolar I disorder who may have been misdiagnosed with MDD, and it was not validated to screen for bipolar II/hypomania.3
Further validation studies in larger clinical samples and settings are warranted.3
This summary was prepared independently of the study’s authors. The content presented here is provided for educational purposes only. It is not intended as, nor is it a substitute for medical care or advice. Healthcare professionals should use their clinical judgment when reviewing educational resources on NP Psych Navigator.
The Rapid Mood Screener tool was developed with funding and input provided by AbbVie and external experts, who received financial support from AbbVie for research, honoraria and/or consulting services depending on the author.
Hirschfeld RM, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the national depressive and manic-depressive association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64(2):161–174.
Hirschfeld RM, Cass AR, Holt DC, Carlson CA. Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Fam Pract. 2005;18(4):233-239.
McIntyre RS, Patel MD, Masand PS, et al. The Rapid Mood Screener (RMS): a novel and pragmatic screener for bipolar I disorder. Curr Med Res Opin. 2021;37(1):135-144.
Kilbourne AM, Goodrich DE, O'Donnell AN, Miller CJ. Integrating bipolar disorder management in primary care. Curr Psychiatry Rep. 2012;14(6):687-695.