MDQ

Mood Disorder Questionnaire
Name
Today's Date

Month Day Year
Date
Instructions:

Click the answer that best applies to you . Please answer each question as best as you can.
1.Has there ever been a period of time where you were not your usual self and ...
...you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?

Yes No
...you were so irritable that you shouted at people or started fights or arguments

Yes No
... you felt much more self-confident than usual?

Yes No
... you got much less sleep than usual and found you didn't really miss it

Yes No
... you were much more talkative or spoke faster than usual?

Yes No
... thoughts raced through your head or you couldn't slow you mind down?

Yes No
... you were so easily distracted by things around you that you had trouble concentrating or staying on track?

Yes No
... you had much more energy than usual?

Yes No
... you were much more active or did many more things than usual?

Yes No
... you were much more social or outgoing than usual, for example you telephoned friends in the middle of the night?

Yes No
... you were much more interested in sex than usual?

Yes No
... you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?

Yes No
... spending money got you or your family in trouble?

Yes No
2. If you clicked YES to more than one of the above, have sever of these ever happened during the same period of time?

Yes No
3. How much of a problem did any of these cause you - like being able to work; having family, money, or legal troubles; getting into arguments or fights? Please check 1 response only.

No problem Minor problem Moderate problem Serious problem
4. Have any of your blood relatives (ie, children, siblings, parents, grandparents, aunts, uncles had manic-depressive illness or bipolar disorder?

Yes No
5. Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?

Yes No
This questionnaire should be used as a starting point. It is not a substitue for a full medical evlauation. Bipolar disorder is a compless illness, and an accurate, thorough diagnosis can only be made through personal evaluation by your doctor.
Should be Empty:

Mood Disorder Questionnaire

Instructions: