Mood Assessment Questionnaire

The questions you are about to answer will help you assess your mood and assist your doctor in educating you about the need for additional evaluation. Please discuss the results of this questionnaire with your doctor.

Please answer all of the items listed below.

A response to each question is required.

Form 1

  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 in trouble?

  • ...you were so irritable that you shouted at people or started fights or arguments?

  • ...you felt much more self confident than usual?

  • ...you got much less sleep than usual and found you didn't really miss it?

  • ...you were much more talkative or spoke much faster than usual?

  • ...thoughts raced through your head or you couldn't slow your mind down?

  • ...you were so easily distracted by things around you that you had trouble concentrating or staying on track?

  • ...you had much more energy than usual?


  • ...you were much more active or did many more things than usual?

  • ...you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?

  • ...you were much more interested in sex than usual?

  • ...you 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 into trouble?