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 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? | ||
2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? | ||
3. 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? Please circle one response only. | ||
No problem Minor problem Moderate problem Serious problem | ||
4. Have any of your blood relatives (ie, children, siblings, parents, grandparents, aunts, uncles) had manic depressive illness or bipolar disorder? | ||
5. Has a health professional ever told you that you have manic-depressive illness or bipolar disorder? |
Courtesy of The University of Texas Medical Branch. This instrument is designed for screening purposes only and is not to be used as a diagnostic tool.