Mood Swings Rating Scale
BPRS
Date Of Exam:
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Year
Date
Hour Minutes
AM
PM
AM/PM Option
Patient Name:
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
When doing this form please think about:
Has there ever been a period of time when you were not your usual self and...
You felt so good or so hyper that other people thought you were not normal self or you were so hyper that you got into trouble?
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Yes
No
You were so irritable that you shouted at people or started fights or arguments?
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Yes
No
You felt much more self-confident than usual?
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Yes
No
you got much less sleep than usual and found you didn't really miss it?
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Yes
No
you were more talkative or spoke much faster than usual?
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Yes
No
thoughts raced through your head or you couldn't slow your mind down?
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Yes
No
you were much more active or did many more things than usual?
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Yes
No
you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?
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Yes
No
you were much more interested in sex than usual?
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Yes
No
you did things that were unusual, for you or that other people have thought were excessive foolish or risky?
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Yes
No
If you checked Yes to more than one of the above, have several of these happened ever happened during the same period of time?
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Yes
No
How much of a problem did any of these cause you-like being unable to work; having
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No Problem
Minor Problem
Moderate Problem
Serious Problem
Have any of your blood relatives had manic-depressive or bipolar disorder?
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Yes
No
Submit
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