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Mood Disorder Questionaire (MDQ)

Please answer each question as best you can.

Has there ever been a period of time when you were not your usual self and...

1 ...you felt so good or so hyper that other people thought you were not your normal self: *

Yes

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

Yes

3...you felt much more self-confident than usual: *

Yes

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

Yes

5...you were more talkative or spoke much faster than usual: *

Yes

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

Yes

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

Yes

8...you had much more energy than usual?: *

Yes

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

Yes

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

Yes

11... you were much more interested in sex than usual?: *

Yes

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

Yes

13...spending money got you or your family in trouble?: *

Yes

14 If you checked YES to one or more of the above questions (1-13), have several of these ever happened at the same period of time?: *

Yes

15. How much of a problem did any of these cause you - like being unable to work; having family, money, or legal trouble; getting into arguements or fights?: *

No problem

Minor problem

Moderate problem

Serious problem

Your Name: *

If privacy is a concern please use one of these formats: J. Smith , Joe S. etc

The Center For Behavioral Medicine

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All information © The Center For Behavioral Medicine. The information contained on this Web site is not intended as, and is not, a substitute for professional medical advice. All decisions about clinical care should be made in consultation with your treating physician. HR

Dr. Louis K. Hauber MD

Mood Disorder Questionaire