Mood Disorder Questionnaire 940 E. El Camino Real Sunnyvale, CA 94087 harminder@homeopathicvibes.com www.homeopathicvibes.com Office Phone (408)737-7100 Office Fax (408)737-7102 Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *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 to trouble?YesNoSome whatYou were so irritable that you shouted at people or started fights or arguments?YesNoQuite a lotYou felt much more confident than usual?YesNo I have a quick temper... a short fuseNot at allJust a littleSome whatModeratelyQuite a lotVery much I am irritable, and get upset by minor annoyancesNot at allJust a littleSome whatModeratelyQuite a lotVery muchYou got less sleep than usual and found you do not really miss it? YesNoYou are much more talkative or speak faster than usual?YesNoYour thoughts raced through your head and you can not slow down my mind?YesNoDo you get distracted easily by things around you and you have trouble concentrating or staying on track?YesNoYou had much more energy than usual?YesNoWere you much more active and did many things than usual? YesNoYou were much more social and out going than usual, for example phone a friend in middle of night? Spending you own money or time to help someone you knew little? YesNoYou are much more interested in sex than usual? YesNoYou did things that were unusual for you or other people might have though were excessive, foolish or risky? YesNoSpending money got you or your family into trouble? YesNoIf you checked Yes to more than one have several of these happened at same period of time?YesNo 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? Not at allJust a littleSome whatModeratelyQuite a lotVery muchDid any body in the family: parents, grand parents, siblings, aunts, uncles had manic- depressive illness or bipolar disorder?YesNo Have any health professional told you have manic-depressive illness or bi-polar disorder. YesNoWebsiteSubmit