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Mood Disorder Questionnaire

Please answer each question to the best of your ability 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?* were so irritable that you shouted at people or started fights or arguments?* felt much more self-confident than usual?* got much less sleep than usual and found you didn’t really miss it?* were much more talkative or spoke faster than usual?*
...thoughts raced through your head or you couldn’t slow your mind down?* were so easily distracted by things around you that you had trouble concentrating or staying on track?* had much more energy than usual?* were much more active or did many more things than usual?* were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?* were much more interested in sex than usual?* 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 in 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? Please check 1 response only.*
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.*
4. Have any of your blood relatives (ie, children, siblings, parents, grandparents, aunts, uncles) had manic-depressive illness or bipolar disorder?*
5. Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?*
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This questionnaire should be used as a starting point. It is not a substitute for a full medical evaluation. Bipolar disorder is a complex illness, and an accurate, thorough diagnosis can only be made through a personal evaluation by your doctor.