logo Mood Disorder Questionnaire – NHC

If you think you (or a family member) may be suffering from a mood disorder, answer the questions below.
If most of the answers are Yes, consider consulting with a health care professional for a more in-depth assessment.

Use this ‘scoring key’ to assess the likelihood of your meeting the criteria for a Mood Disorder.
Question 1: 7 of the 13 answers must be positive (yes) responses
Question 2: Answer must be a positive (yes) response
Question 3: The answer must be a ‘moderate’ or ‘serious’ response
(All three of the above criteria must be met.)

INSTRUCTIONS: Please answer each question as best you can: Yes or No

Question 1:
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 your normal self or you were so hyper that you got into 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 or spoke much faster than usual?
  • … thoughts raced through your 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 thought were excessive, foolish or risky?
  • … spending money got you or your family in trouble?

Question 2:
If you checked YES to more than one of the above, have several of these ever happened during the same period of time?

Question 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?
No problem / Minor problem / Moderate problem / Serious problem

Question 4:
Have any of your blood relatives (i.e., children, siblings, parents, grandparents, aunts, uncles) had manic-depressive illness or bipolar disorder?

Question 5:
Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?

[1] Derived from Hirschfeld, R. M. (2000). American Journal of Psychiatry, 157(11), 1873-5.

For further information please contact:
Professor Christopher R. Stones (Clinical Psychologist and Behavioural Management Specialist)
Phone: 011-801-5616 (Reception)
Alternatively send a booking request.

NHC Health Centre
Cnr Christiaan de Wet Road & Dolfyn Street
(opposite Eagle Canyon Auto)

Proudly designed by Mad-Media

Proudly designed & developed by Mad-Media