logo Mood Disorder Questionnaire – NHC

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.
SCORING:
Question 1: 7 of the 13 answers must be positive (yes) responses
Plus:
Question 2: Answer must be a positive (yes) response
Plus:
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?
Yes No
.. you were so irritable that you shouted at people or started fights or arguments?
Yes No
… you felt much more self-confident than usual?
Yes No
… you got much less sleep than usual and found that you didn’t really miss it?
Yes No
… you were more talkative or spoke much faster than usual?
Yes No
… thoughts raced through your head or you couldn’t slow your mind down?
Yes No
… you were so easily distracted by things around you that you had trouble concentrating or staying on track?
Yes No
… you had much more energy than usual?
Yes No
… you were much more active or did many more things than usual?
Yes No
… you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?
Yes No
… you were much more interested in sex than usual?
Yes No
… you did things that were unusual for you or that other people might have thought were excessive, foolish or risky?
Yes No
… spending money got you or your family in trouble?
Yes No

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?
Yes No

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?
Yes No

Question 5:
Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?
Yes No

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)
Honeydew

 

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

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