Mood Disorder Questionnaire PDF

• 1. Has there ever been a period of time when you were not your usual self and…
• You felt so good or hyper that other people thought you were not your normal self or 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 much faster than usual?
  • YES
  • NO
• Thoughts raced through your head or you couldn’t slow your 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 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 into trouble?
  • YES
  • NO
• 2. If you checked YES to more than one of the above, have several 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 unable to work; having family, money or legal troubles; getting into arguments or fights?
  • NO PROBLEM
  • MINOR PROBLEM
  • MODERATE PROBLEM
  • SERIOUS PROBLEM
• 4. Have any of your blood relatives had manic-depressive illness or bipolar disorder?
  i.e. Children, siblings, parents, grandparents, aunts, and uncles.
  • YES
  • NO
• 5. Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?
  • YES
  • NO

   

You can download Mood Disorder Questionnaire PDF by clicking on the following download button.