A lifetime screen for Bipolar symptoms. Answer based on any period where you felt unusual.
Part 1: Lifetime Experiences
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?
2. Has there ever been a period of time when you were not your usual self and you were so irritable that you shouted at people or started fights or arguments?
3. Has there ever been a period of time when you were not your usual self and you felt much more self-confident than usual?
4. Has there ever been a period of time when you were not your usual self and you got much less sleep than usual and found you didn’t really miss it?
5. Has there ever been a period of time when you were not your usual self and you were much more talkative or spoke much faster than usual?
6. Has there ever been a period of time when you were not your usual self and thoughts raced through your head or you couldn’t slow your mind down?
7. Has there ever been a period of time when you were not your usual self and you were so easily distracted by things around you that you had trouble concentrating or staying on track?
8. Has there ever been a period of time when you were not your usual self and you had much more energy than usual?
9. Has there ever been a period of time when you were not your usual self and you were much more active or did many more things than usual?
10. Has there ever been a period of time when you were not your usual self and you were much more social or outgoing than usual (e.g., calling friends in the middle of the night)?
11. Has there ever been a period of time when you were not your usual self and you were much more interested in sex than usual?
12. Has there ever been a period of time when you were not your usual self and you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?
13. Has there ever been a period of time when you were not your usual self and spending money got you or your family into trouble?
Part 2: Co-occurrence
If you checked "Yes" to more than one of the above, have several of these ever happened during the same period of time?
Part 3: Functional Impact
How much of a problem did any of these cause you (e.g., job issues, money/legal troubles, arguments)?
Screening for Bipolar Spectrum Disorder (Bipolar I, Bipolar II, and Bipolar NOS).
Differentiating Bipolar Disorder from Unipolar Depression in patients presenting with a depressive episode.
Initial assessment in primary care or psychiatric intake to guide diagnostic clinical interviews.
Educational tool for patients to identify lifetime patterns of mood elevation.
Section 2
Formula & Logic
Criteria for a Positive Screen
01
Symptom Count: At least 7 out of 13 behaviors in Part 1 must be checked "Yes".
02
Co-occurrence: Several symptoms must have occurred during the same period of time.
03
Impairment: Symptoms must have caused a "Moderate" or "Serious" problem.
Sensitivity & Specificity
Sensitivity (Bipolar I)
approx. 73%
Sensitivity (Bipolar II)
approx. 28-33%
Specificity
approx. 90% (general population)
Section 3
Pearls/Pitfalls
The Bipolar II Gap
The MDQ is significantly less sensitive for Bipolar II (hypomania) than Bipolar I (mania). A negative MDQ does NOT rule out a Bipolar II diagnosis.
Diagnostic Pearls
Consider the "Lifetime" perspective—patients in a depressive phase often under-report previous hypomanic episodes.
Screening is most effective when integrated with collateral information from family members.
Positive results require clinical exclusion of substance-induced mood states or hyperthyroidism.
Section 4
Next Steps
Clinical Pathways
01
Screen Positive: Proceed to a diagnostic interview (e.g., SCID or MINI) to confirm symptoms meet DSM-5 criteria for a manic or hypomanic episode.
02
Treatment Caution: If MDQ is positive, use caution when prescribing antidepressants (SSRIs/SNRIs) to avoid inducing mania or rapid cycling.
03
Monitoring: Use the Bipolarity Index to further quantify risk if the MDQ is borderline.
Section 5
Evidence Appraisal
Primary Reference
Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire
Hirschfeld RM et al. • The American Journal of Psychiatry. 2000;Vol 157, Issue 11. pp. 1873-1875. The foundational validatory study for the MDQ.
Section 6
Literature
Robert Hirschfeld
Developed by Dr. Robert Hirschfeld and colleagues. It was designed as a brief, easy-to-use tool to address the common delay in diagnosing Bipolar Disorder (often misdiagnosed as Unipolar Depression for many years).
