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Hypomania interview guide (including hyperthymia): Retrospective assessment
version (HIGH-R)
Article in Depression and Anxiety · February 1999
DOI: 10.1002/(SICI)1520-6394(1999)9:23.0.CO;2-1 · Source: PubMed
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92 Williams et al. DEPRESSION AND ANXIETY 9:92–100 (1999)
Brief Report
HYPOMANIA INTERVIEW GUIDE (INCLUDING
HYPERTHYMIA): RETROSPECTIVE ASSESSMENT
VERSION (HIGH-R)
Janet B.W. Williams, D.S.W., Michael Terman, Ph.D.,* Martha J. Link, M.D., Leora Amira, Ph.D.,
and Norman E. Rosenthal, M.D.
INTRODUCTION tured interview and questionnaire formats, the pattern
and severity of symptoms that characterize mania, hy-
R esearch on seasonal affective disorder (SAD) has pomania, hyperthymia (hypomanic-like periods with-
mushroomed since the condition was first described in out associated impairment), and euthymia (absence of
the early 1980s [Rosenthal et al., 1984]. Numerous elevated or depressed mood symptoms). It can also be
evaluation instruments have been developed to char- used to provide a provisional DSM-IV diagnosis of
acterize the symptoms associated with SAD. Follow- Hypomanic Episode from consideration of a specified
ing the format of the Structured Interview Guide for the subset of the 15 scale items.
Hamilton Depression Rating Scale (SIGH-D) by Will- Even though the actual criterion symptoms are quite
iams [1988], an instrument was developed that added similar, the HIGH-R cannot be used to diagnose hypo-
eight items typical of seasonal (winter) depression to mania according to the Research Diagnostic Criteria
the original SIGH-D. This version, the Structured In- (RDC) [Spitzer et al., 1978], primarily because the symp-
terview Guide for the Hamilton Depression Rating Scale— tom duration thresholds in the RDC and DSM-IV dif-
Seasonal Affective Version (SIGH-SAD) [Williams et al., fer. “Probable” hypomania in the RDC requires only 2
1994], is widely used as a standard assessment tool in days of mood disturbance, while “definite” hypomanic
clinics assessing SAD throughout the world. disorder requires a week’s disturbance; in contrast, posi-
Some individuals who have winter depression also tive ratings are made in the HIGH-R only when symp-
experience elevated moods during the spring/summer toms have lasted at least 4 days.
months, and, as such, it has been necessary for re- The interview sequence in the HIGH-R begins by
search and clinical work to characterize these periods distinguishing “elevated, expansive” hypomanic mood
of elevated mood. Thus, the first version of the Hypo- from “irritable” hypomanic mood, and clarifies the
mania Interview Guide (Including Hyperthymia) for Sea- episode duration. The 13 questions that follow inter-
sonal Affective Disorder (HIGH-SAD) was developed sperse items which correspond to DSM-IV criteria for
[Williams et al., 1988). The HIGH-SAD was an inter- hypomania with other classic hypomanic symptoms
viewer-administered instrument based on the Hypoma- such as increased energy, increased social activity, and
nia Rating Scale by Norman E. Rosenthal, M.D., and sharpened and unusually clear thinking. (One earlier
Thomas A. Wehr, M.D. (National Institute of Mental item, insight, has been dropped from the HIGH-SAD
Health), and the Criteria for a Hyperthymic Episode by because it cannot be scaled for frequency or severity,
Richard A. Depue, Ph.D. (University of Minnesota).
The diagnostic items derive from the Diagnostic and
Statistical Manual for Mental Disorders, 3rd ed.—Revised
(DSM-III-R) [American Psychiatric Association, 1987)
and the Structured Clinical Interview for DSM-III-R Columbia University and New York State Psychiatric Insti-
[Spitzer et al., 1990]. tute, New York, New York
In 1994, the HIGH-SAD was expanded and re-
named the HIGH-R, for Retrospective Assessment Contract grant sponsor: Research Foundation for Mental Hy-
Version. The HIGH-R (see Appendix) contains all giene, Inc.; Contract grant number: 903-E795S; Contract grant
sponsor: National Institute of Mental Health; Contract grant num-
DSM-IV criterion features, adds a few new non-DSM-
ber: MH-42931.
IV features, and has a revised and more systematic rat-
ing scale. In addition, derivative versions focus on *Correspondence to: Michael Terman, New York State Psychiat-
current symptoms (HIGH-C), and self-ratings of cur- ric Institute, 1051 Riverside Drive, Unit 50, New York, NY 10032.
rent symptoms (HIGH-C-SR), the latter of which cor- E-mail:
[email protected]respond point-for-point with items in the HIGH-C.
The HIGH-R is designed to measure, using struc- Received for publication 9 October 1998; Accepted 9 October 1998
© 1999 WILEY-LISS, INC.
Brief Report: Hypomania Interview Guide 93
as all the other items, and it is not included in the Permission is granted for reproduction for use by re-
DSM-IV criteria for hypomania or mania.) searchers and clinicians. The instruments (HIGH-R,
All items are scored from 0 to 4. An item score of HIGH-C, and HIGH-C-SR), including instruction
“0” indicates absence of the symptom; “1” and “2” in- guides, are available from the Society for Light Treat-
dicate incremental levels of mild presentations short ment and Biological Rhythms, 842 Howard Avenue,
of hypomania (but typical of hyperthymia); “3” indi- New Haven, CT 06519, or from the Center for Envi-
cates moderate severity, persistent and uncharacteristic ronmental Therapeutics, POB 532, Georgetown, CO
for the patient, and in most cases, observable by others 80444 (ask for the SAD Assessment Tools Packet, which
(as is typical of hypomania); and “4” indicates a also includes SIGH-SAD and SIGH-SAD-SR forms).
marked or severe symptom (typical of mania). The
sum of points on all items constitutes the total HIGH-
R score. REFERENCES
Scoring algorithms are also provided for provisional American Psychiatric Association. 1987. Diagnostic and statistical
DSM-IV diagnoses of a Hypomanic Episode with ei- manual for mental disorders, 3rd ed., revised. (DSM-III-R).
ther elevated, expansive mood, or irritable mood. In Washington, DC: American Psychiatric Association.
addition, the HIGH-R assesses some of the DSM-IV Goel N, Terman M, Terman JS, Williams JBW. 1999. Summer
exclusion criteria that rule out a Hypomanic Episode, mood in winter depressives: validation of a structured interview.
i.e., need for hospitalization, presence of psychotic Depression and Anxiety 9:83–91.
Rosenthal NE, Sack DA, Gillin JC, Lewy AJ, Goodwin FK, Daven-
features, and marked functional impairment. The
port Y, Mueller PS, Newsome DA, Wehr TA.1984. Seasonal af-
HIGH-R is not designed to discriminate conclusively fective disorder. Arch Gen Psychiatry 41:72–80.
between Hypomanic and Manic Episodes within indi- Spitzer RL, Endicott J, Robins E. 1978. Research diagnostic crite-
viduals (although item scores of “4” are consistent ria: Rationale and reliability. Arch Gen Psychiatry 35:773–782.
with mania), but it is useful in discriminating hypoma- Spitzer RL, Williams JBW, Gibbon M, First MB. 1990. Structured
nia from mania on a group basis [Goel et al., 1999]. clinical interview for DSM-III-R. Washington, DC: American
The validity of the HIGH-R and its predecessor, the Psychiatric Press, Inc.
HIGH-SAD, has been tested, and is reported in a com- Williams JBW. 1988. A structured interview guide for the Hamilton
panion paper [Goel et al., 1999]. It is hoped that the Depression Rating Scale. Arch Gen Psychiatry 45:742–747.
HIGH-R will be useful for differential diagnosis in sea- Williams JBW, Link MJ, Rosenthal NE, Terman M. 1988. Hypo-
mania interview guide (including hyperthymia) for seasonal af-
sonal and nonseasonal clinical bipolar populations.
fective disorder (HIGH-SAD). New York: New York State
Acknowledgments. Development of the HIGH-R Psychiatric Institute.
was supported in part by Biomedical Research Sup- Williams JBW, Link MJ, Rosenthal NE, Amira L, Terman M.
port grant 903-E795S (J.B.W.W.) from the Research 1994. Structured interview guide for the Hamilton Depression
Foundation for Mental Hygiene, Inc., and National Rating Scale — Seasonal affective version (SIGH-SAD). New
Institute of Mental Health Grant MH-42931 (M.T.). York: New York State Psychiatric Institute.
94 Williams et al.
Brief Report: Hypomania Interview Guide 95
96 Williams et al.
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