Hypomania/Mania Symptom Checklist (HCL-32)

　わが国の気分障害患者は増加の一途をたどっている。気分障害の中でも、躁病エピソードとうつ病エピソードを繰り返す双極性障害の診断・治療への関心は高い。治療に関しては、双極性障害の適応を有する薬剤が最近いくつか承認された背景もあり、日本うつ病学会は本年（2012年）3月末に双極性障害治療ガイドラインの改訂を行っている。一方、診断に関しては、躁症状や軽躁状態を把握することが難しく、うつ病と診断されるケースも少なくない。Perugi氏らは、双極性障害の診断ツールとして開発され、国際的にテストされているHCL-32（Hypomania Checklist-32）の有用性を検討し、Psychopathology誌オンライン版2012年8月7日号で報告した。

　対象として、DSM-IV基準により大うつ病と診断された571例（563例が適格）が継続的に登録され、多施設共同横断観察研究を行った。躁病エピソード（躁症状、軽躁状態）はHCL-32で評価し、うつ病エピソード（抑うつ症状、不安症状）はZungうつ病自己評価表にて評価した。

主な結果は以下のとおり。

・119例の患者は双極性障害（Ⅰ型またはⅡ型）と診断された。

・HCL-32トータルスコアおよび14のサブスコアにおいて、双極性障害患者の躁病エピソードの発生は大うつ病患者に比べ有意に高く、感度は0.85、特異性は0.78であった。

・若干の偽陽性がみられるものの、HCL-32は大うつ病患者における過去の軽躁病エピソードの把握に有用であると考えられる。

 

Hypomania/Mania Symptom Checklist (HCL-32)

(updated 4/2008)

The HCL-32 is a screening tool for researchers trying to find people with bipolar disorder. This is one of the better "complete but simple" lists of manic-side symptoms. It's a good "fine-tooth comb" when people want to inventory all possible hypomanic symptoms, usually in the context of asking "do I really have bipolar disorder?" (Download pdf of symptom list only; or  download an article pdf , which includes the scale as an appendix)

Remember, however, that this is not exactly the right question. As at the Harvard bipolar clinic, we should instead be asking "how much bipolarity might you have?"  In that clinic's Bipolarity Index, you'll note that hypomania or mania only account for up to 1/5th of the possible score; the other 4/5th's of the total 100 points possible come from other factors such as family history, age of onset of depression, course of the depressions since, and response to medications.

Thus you should not look at the HCL as a "yes or no" tool for detecting bipolar disorder. It's simply a handy way to check what should be checked when looking for hypomania or mania -- which is just one part of the story. Okay, with that reminder, here we go.

HCL-32

At different times in their life everyone experiences changes or swings in energy, activity and mood ("highs and lows" or "ups and downs"). The aim of this questionnaire is to assess the characteristics of the "high" periods.

1. First of all, how are you feeling today compared to your usual state?

Much worse than usual     Worse than usual     A little worse than usual     Neither better nor worse than usual

A little better than usual      Better than usual     Much better than usual

2. Compared to other people, my level of activity energy and mood:  (Not how you feel today, but how you are on average)

is always rather stable and even         is generally higher         is generally lower         repeatedly shows periods of ups and downs

3. Please try to remember a period when you were in a "high" state (while not using drugs or alcohol). In such a state:

I need less sleep

I feel more energetic and more active

I am more self-confident

I enjoy my work more

I am more sociable (make more phone calls, go out more)

I want to travel and/or do travel more

I tend to drive faster or take more risks when driving

I spend more money/too much money

I take more risks in my daily life (in my work and/or other activities)

I am physically more active (sport etc.)

I plan more activities or projects.

I have more ideas, I am more creative

I am less shy or inhibited

I wear more colourful and more extravagant clothes/make-up

I want to meet or actually do meet more people

I am more interested in sex, and/or have increased sexual desire

I am more flirtatious and/or am more sexually active

I talk more

I think faster

I make more jokes or puns when I am talking

I am more easily distracted

I engage in lots of new things

My thoughts jump from topic to topic

I do things more quickly and/or more easily

I am more impatient and/or get irritable more easily

I can be exhausting or irritating for others

I get into more quarrels

My mood is higher, more optimistic

I drink more coffee

I smoke more cigarettes

I drink more alcohol

I take more drugs (sedatives, anti-anxiety pills, stimulants)

In the official version of this tool, there are additional questions about how these "highs" affect your life (positively or negatively); other people's reactions to them; how long they last; whether you've had one recently; and how much of the last year has been spent in such a state. Here is that link to the original: Angst  and colleagues.