| RPT |
|Mood Disorder Questionnaire (MDQ)
| Gender: <.Patient_Gender.>
|
| Mood Disorder Questionnaire
| Possible Bipolar Disorder = <*Answer_7771*>
|
|
|Questions and Answers:
|
| 1. 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?
|
| <*Answer_9074*>
| 2. You were so irritable that you shouted at people or started fights or
| arguments?
| <*Answer_9075*>
| 3. You felt much more self-confident than usual?
| <*Answer_9076*>
| 4. You got much less sleep than usual and found that you didn't really
| miss it?
| <*Answer_9077*>
| 5. You were more talkative or spoke much faster than usual?
| Date Given: <.Date_Given.>
| <*Answer_9078*>
| 6. Thoughts raced through your head or you couldn't slow your mind down?
| <*Answer_9079*>
| 7. You were so easily distracted by things around you that you had trouble
| concentrating or staying on track?
| <*Answer_9080*>
| 8. You had more energy than usual?
| <*Answer_9081*>
| 9. Youwere much more active or did many more things than usual?
| <*Answer_9082*>
| Clinician: <.Staff_Ordered_By.>
| 10. You were much more social or outgoing than usual, for example, you
| telephoned friends in the middle of the night?
| <*Answer_9083*>
| 11. You were much more interested in sex than usual?
| <*Answer_9084*>
| 12. You did things that were unusual for you or that other people might
| have thought were excessive, foolish, or risky?
| <*Answer_9085*>
| 13. Spending money got you or your family in trouble?
| <*Answer_9086*>
| Location: <.Location.>
| 14. If you checked YES to more than one of the above, have several of
| these ever happened during the same period of time?
| <*Answer_9087*>
| 15. 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?
| <*Answer_9088*>
|
|Information contained in this note is based on a self-report assessment
|and is not sufficient to use alone for diagnostic purposes. Assessment
|
|results should be verified for accuracy and used in conjunction with
|other diagnostic activities.
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|
