Mood Disorder Questionnaire
Sharing all your symptoms with your healthcare provider is the first step to finding out if it could be more than depression. Answer these questions and discuss the responses with your provider. This is not meant to be for self-diagnosis.
1. Has there ever been a period of time when you were not your usual self and ...
YES
NO
... you felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got in 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 that you didn't really miss it?
... you were more talkative of spoke much faster than usual?
... thoughts raced through yoru 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 had much more energy than usual?
... 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 though were excessive, foolish, or risky?
... spending money got you or you rfamily 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?
YES
NO
If you checked yes to more than one of the above, have several of these ever happened during the same period of time?
3. How much of a problem did any of these cause you? (like being unable to work; having family, money, or legal troubles; and/or getting into arguments or fights)
No Problem
Minor Problem
Moderate problem
Serious problem
How much of a problem did any of these cause you? (like being unable to work; having family, money, or legal troubles; and/or getting into arguments or fights)
Calculation
Submit
Should be Empty: