This study evaluated the use of the Mood Disorder Questionnaire (MDQ) to screen for bipolar disorder in a rural clinic serving predominantly Hispanic patients near the US-Mexico border. A review of 147 patient records found that 62% of those initially diagnosed with bipolar disorder had a negative MDQ score. Additionally, 29% of those initially diagnosed with anxiety and 28.8% initially diagnosed with depression had a positive MDQ. The results suggest the MDQ may be useful to prevent both under and overdiagnosis of bipolar disorder in this population and clinical setting.

1. Are we over-diagnosing Bipolar Disoder? The utility of the MDQ in a rural clinic by the US-Mexico
Border.
Jorge Gaspar, MD1; Alvaro Camacho, MD1,2; Bernardo Ng, MD1,2; Alan Simmons, PhD2;
Ipsit Vahia, MD1,2; Scott C Matthew, MD2; Mark A Frye, MD3.
1Sun Valley Behavioral and Research Center. Imperial, CA.
2Department of Psychiatry. University of California, San Diego
3Department of Psychiatry. Mayo Clinic. Rochester, MN.
Background: The Mood Disorder Questionnaire (MDQ) is a useful screening instrument for bipolar
spectrum disorders in the psychiatric outpatient population; a score of 7 or more items yields good
sensitivity (0.73) and very good specificity (0.9) (1). Recently the literature has raised concerns about
not only the under diagnosis but also the over diagnosis of Bipolar Disorder (2).
Objective: To demonstrate the usefulness of the MDQ as practical screening tool to prevent the over and
under diagnosis of Bipolar disorder a in a rural clinic in southern California.
Methods: A cross-sectional chart reviewed from January until December of 2009 done by an
independent researcher (JG), not involved in the treatment of patients. Basic demographics, initial
diagnosis and MDQ outcomes were extracted from patients’ charts.
Results: A total of 147 medical records were reviewed. The mean age was 38.1 (sd 1.1); 93 (45%) male
and 54 (26%) female. Seventy eight (37%) were Hispanic, 66 (32%) Caucasians, two African-American
and one Native-American. Of the 147 reviewed, 54 patients (26%) were diagnosed with a Bipolar
disorder (26%) , 51 (24%) with depression, and 24 (12%) with an anxiety disorder. Interestingly, the
MDQ was negative in 62% (34/55) of patients initially diagnosed with Bipolar Disorder. Conversely,
29% (7/24) of patient with an initial diagnosis of anxiety and 28.8% (15/52) with an initial diagnosis of
depression had a positive MDQ.
Discussion: Even though our findings showed only statistical trends, they are of clinical usefulness
because: a) In our sample, approximately 30% of patients continue to present with depression as the
initial manifestation of an underlying Bipolar disorder; b) Close to 1/3 of our sample presented with an
anxious diathesis that belonged to the Bipolar spectrum, which seems to be quite common in our
Hispanic sample; c) Near two thirds of patients who reported symptoms consistent with a Bipolar
disorder, were actually MDQ negative.
Conclusion This pilot data shows that the MDQ is useful not only for screening patients with
unsuspected bipolar disorder but also to corroborate possible over diagnosis of this condition. These
clinical observations from a busy rural clinic underscore the importance of implementing standardized
rating scales to operationalize different psychiatric symptoms.
Even thought this is a small sample, future studies might look at the association of the anxiety-bipolar
spectrum with standardized diagnostic tools, especially in rural community clinics with
predominantly Hispanic patients where these diagnoses tend to overlap.

2. References
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