Mood Assessment Questionnaire

Name		Date
Email		Phone

1. Has there ever been a period of time when you were not your usual self and...	Yes	No
...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?
..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 and/or spoke much faster than usual?
...thoughts raced through your head and/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 and/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?

	Yes	No
2. If you checked YES to more than one of the above, have you experienced several of these during the same period of time?

3. How much of a problem did any of these situations cause you (like being unable to work; having family, money, or legal problems; and/or getting into serious arguments or fights)?
No problem	Minor problem	Moderate problem	Serious problem

Two questions about yourself

These questions will ask you about current feelings of depression..	Yes	No
1. During the past month, have you often been bothered by feeling down, depressed or hopeless?
2. During the past month, have you often been bothered by little interest or pleasure in doing things?