Mood Disorder Questionnaire
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.
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
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?
If you checked YES to more than one of the above, have several of these ever happened during the same period of time?
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
Have any of your blood relatives (i.e., children, siblings, parents, grandparents, aunts, uncles) had manic-depressive illness or bipolar disorder?
Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?
For further information please contact:
Professor Christopher R. Stones (Clinical Psychologist and Behavioural Management Specialist)
Phone: 011-801-5616 (Reception) OR 083-222-9666
Alternatively send a booking request on: www.nhcltd.com
NHC Health Centre
Cnr Christiaan de Wet Road & Dolfyn Street
(opposite Eagle Canyon Auto)
 Derived from Hirschfeld, R. M. (2000). American Journal of Psychiatry, 157(11), 1873-5.