Mood Disorder Questionnaire

Please answer each questions as best you can.
1. Has there ever been a period of time when you were not your usual self and...

...you felt so good or so hyper that you were not your normal self or you were so hyper that you got into trouble?

...you were so irritable that you shouted at people or started fights or arguments?

...you felt much more self-confident than usual?

...you got much less sleep than usual and found you didn't really miss it?

...you were much more talkative or spoke much faster than usual?

...thoughts raced through your head or you couldn't slow your mind down?

...you were so easily distracted by things around you that you had trouble concentrating or staying on track?

...you were much more active or did many more things than usual?

...you were much more social or outgoing than usual? For example, you telephoned friends in the middle of the night.

...you were much more interested in sex than usual?

...you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?

...spending money got you or your family into trouble?

2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time?

3. These have caused at least some problems - like being unable to work; having family, money or legal troubles; getting into arguments and fights.

4. Have any of your blood relatives (children, siblings, parents, grandparents, aunts, uncles) had manic-depressive illness or bipolar disorder?

5. Has a healthcare professional ever told you that you have manic-depressive illness or bipolar disorder?


If you scored 7 yes responses in Section 1, a yes in Section 2 and your behavior has caused some problems for you in life (Section 3), you might benefit from seeking a personal evaluation for BiPolar Disorder. Contact Elysse Beasley, SrPE at 615-542-6608. This questionnaire is from: Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr, Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J Am J Psych 157(11):1875 (appendix 1), November 2000