Mood Disorder Questionnaire

Mood Disorder Questionnaire

Patient Name:      Date of Visit:

Please answer each question to the best of your ability.

1. Has there ever been a period of time when you were not your usual self and... felt so good or so hyper that other people thought you were not your normal self or your were so hyper that your got into trouble? were so irritable that you shouted at people or started fights or arguments? felt much more self-confident than usual? got much less sleep than usual and found that you didn't really miss it? were more talkative or spoke much faster than usual?

...thoughts race through your head or you couldn't slow your mind down? were so easily distracted by things around you that you had trouble concentrating or staying on track? had more energy than usual? were much more active or did many more things than usual? were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night? were much more interested in sex than usual? 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?

2. 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; getting into arguments or fights?

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Document name: Mood Disorder Questionnaire
lock iconUnique Document ID: f81037491679893d710cc3762ec85bda8da49d2c
Timestamp Audit
July 8, 2020 9:28 am PDTMood Disorder Questionnaire Uploaded by Do Not Reply - IP
July 24, 2020 10:59 am PDTCFD Main - added by Jason Dooley - as a CC'd Recipient Ip:
March 18, 2021 2:50 pm PDT Document owner has handed over this document to 2021-03-18 14:50:53 -
March 18, 2021 2:50 pm PDTCFD Main - added by Do Not Reply - as a CC'd Recipient Ip:
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