The modified SCID Hypomania Module (SCID-Hba): A detailed systematic phenomenologic probing

Abstract 

Diagnosing past hypomania is a difficult task. Current structured interviews (e.g. CIDI, SCID) limit the ability to probe for hypomania. A modified SCID Hypomania Module was published by us (Benazzi and Akiskal, J Affect Disord 2003; Akiskal and Benazzi, J Clin Psychiatry 2005) in order to overcome the limitations of structured interviewing. Our papers outlined the framework of the modified SCID. In response to requests from many readers of this journal and other clinicians and investigators, we are hereby providing a more explicit step-by-step phenomenologic probing interview. DSM-IV criteria have to be met, but the probing for hypomania is very different from that of the SCID. All past hypomanic symptoms are assessed. No negative meaning is given to symptoms, as hypomania often improves functioning and it is seen by patients as a state of well being. The first step is probing for overactivity (increase in goal-directed activity), because observable behaviors are easier to remember by patients and key informants. There is no gold-standard for overactivity: each person becomes his/her own standard to ‘measure’ a clear-cut departure form the usual behavior. Questions, correspondingly, can change from patient to patient. The emotions associated with behavioral change are easier to be remembered than asking them first, as in the structured interviews. Structured interviews have mood change (elation, irritability) as stem question (corresponding to the criterion A of DSM-IV, which postulates that it must always be present). However, apart from a likely recall bias of past emotions, the description of mood change appears more or less negative in structured interviews (to increase specificity but by much reducing sensitivity, i.e. the false-negatives). Presenting mood change as simply having been more elated/irritable than usual can easily be interpreted as normal mood fluctuations, while presenting mood change as much more than usual could be understood as a severe mental disorder. Both ways are likely to lead to a negative response, moving the interviewers to unipolar disorders (the skip-out instruction). Our modified SCID is a fully semi-structured interview: many questions are asked about each symptom to make the question understandable according to each patient, and, very importantly, examples of the ‘events’ are systematically asked to check understanding and clinical relevance. Our interview follows DSM-IV criteria (apart from the minimum duration, 2 days versus DSM-IV 4 days), i.e. mood change must always been present, but our probing detects more hypomanic episodes than the SCID.

Keywords: SCID, Hypomania, Diagnosis, Interview