Mood Disorder Questionnaire/Bipolar Screening The Mood Disorder Questionnaire Date MM slash DD slash YYYY Name First Last Answer each of the following questions to the best of your ability. 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 or you wee so hyper that you got into trouble? Yes No 2) you were so irritable that you shouted at people or started fights or arguments? Yes No 3) you felt much more self-confident then usual? Yes No 4) you got much less sleep than usual AND found you didn't really miss it? Yes No 5) you were much more talkative or spoke much faster than usual? Yes No 6) thoughts raced through your head or you could not slow your mind down? Yes No 7) you were so easily distracted by things around you that you had trouble concentrating or staying on track? Yes No 8) you had much more energy than usual? Yes No 9) you were much more active or did many more things than usual? Yes No 10) you were much more social or outgoing than usual, for example, calling friends much later than usual, or doing things with others more impulsively, making more plans than usual? Yes No 11) you were much more interested in sex than usual? Yes No 12) you did things that were unusual for you or other people would have thought were excessive, foolish or risky? Yes No 13) spending money that got you or your family into trouble? Yes No If you checked YES to more than one of the above, have several of these ever happened during the same time? If yes, please describe:How much of a problem did any of these cause you - like being unable to work?, having family/money or legal troubles?, getting into arguments or fights? Please describe: Bipolar Disorder Screening Scale World Health Organization Date MM slash DD slash YYYY Name First Last Euphoria Question: Some people have periods lasting several days or longer when they feel much more excited and full of energy than usual. Their minds go too fast. They talk a lot. They are very restless and unable to sit still and they sometimes do things that are unusual for them, such as driving too fast or spending too much money. Have you ever had a period like this lasting several days or longer?*YesNoOnly onceMore than one timeIrritability Question: Have you ever had a period lasting several days or longer when most of the time you were so irritable or grouchy that you started arguments, shouted at people or hit people?*YesNoOnly onceMore than one timePeople who have episodes like this often have changes in their thinking or behavior at the same time, like being more talkative, needing very little sleep, being very restless, going on buying sprees and behaving in ways they would normally think inappropriate. Did you ever have any of these changes during your episodes of being excited and full of energy or very irritable and grouchy?*YesNoOnly onceMore than one timeThink of an episode when you had the largest number of changes like these at the same time. During that episode, which of the following changes did you experience? 1) Were you so irritable that you started arguments, shouted at people or hit people?YesNoNo, but I felt like I could lose control2) During these episodes did you become so restless or fidgety that you paced up or down and could not stand still?YesNo3) During these episodes did you do anything else that was not usual for you - like talking about things you would normally keep private or acting in ways that you would usually find embarassing?YesNo4) During these episodes did you try to do things that are impossible to do, like taking on large amounts of work?YesNo5) During these episodes did you constantly keep changing your plans or activities?YesNo6) During these episodes did you find it hard to keep your mind on what you were doing?YesNo7) During these episodes did your thoughts seem to jump from one thing or another or race through your head so fast that you could not keep track of them?YesNo8) During these episodes did you sleep far less than usual and still not get tired or sleepy?YesNo9) During these episodes did you spend so much more money than usual that it caused you to have financial trouble?YesNo