315 (315)    MH REPORT (601.93)

|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.>)