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Psychologist Form

Mood Disorder Questionnaire

A downloadable Psychologist form for healthcare professionals.
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Specialty

Psychologist

Downloads

21 times

Type

Form

Last edited

24/7/2026

Created by

Heidi Team

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About this form

This form is to identify symptoms associated with conditions such as bipolar disorder and to support clinical decision-making during initial assessments and ongoing care. It includes key information such as patient-reported mood patterns, symptom frequency, behavioural changes, and the impact on daily functioning, offering a consistent approach to assessing mental health status. The form also helps facilitate communication between clinicians and supports continuity of care across services. Completing this form in Heidi facilitates clearer submissions and reduces the risk of omissions, resulting in more efficient decision-making and stronger compliance outcomes.

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Frequently asked questions

What is the purpose of the Mood Disorder Questionnaire PDF?

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The purpose of the Mood Disorder Questionnaire PDF is to screen for bipolar spectrum disorders in a US clinical setting. Developed by a team of researchers, this 13-item self-report instrument helps identify patients who may have undiagnosed bipolar disorder. This is particularly important when you are considering antidepressant monotherapy for what appears to be unipolar depression, as this treatment can precipitate mania in patients with an undiagnosed bipolar condition. The form provides a consistent approach to assessing a patient’s mental health status during initial assessments and ongoing care.

Who uses the Mood Disorder Questionnaire PDF?

Patients self-complete the initial sections of this questionnaire, including 13 yes/no items about symptoms, questions on co-occurrence and functional impairment, and their family and diagnostic history. You, or another member of your team like a nurse or medical staff assistant, then score the form. As the clinician, you are responsible for interpreting the final score within the full clinical context to support your decision-making. The form also helps facilitate communication and continuity of care across different services.

What is included in a Mood Disorder Questionnaire PDF?

A Mood Disorder Questionnaire PDF includes patient details, a 13-item symptom checklist, and questions about symptom co-occurrence, functional impairment, and history.

  • Patient name and date
  • A 13-item checklist of lifetime manic or hypomanic symptoms
  • A question on the co-occurrence of multiple symptoms during the same period
  • A scale to rate the level of functional impairment caused by symptoms
  • A question about any blood relatives with a bipolar or manic-depressive disorder diagnosis
  • A question about any prior diagnosis from a health professional

Common Problems of Completing Mood Disorder Questionnaire PDFs

The Scoring Rule Is Frequently Miscalibrated

The full scoring rule for a positive screen requires satisfying three specific criteria: at least seven "yes" answers for symptoms, a "yes" for symptom co-occurrence, and a "moderate" or "serious" rating for functional impairment. A common error is to focus only on the symptom count and misinterpret the result as positive. This over-calling of positive results can lead to incorrect initial conclusions, requiring you to carefully re-evaluate the raw responses against the complete three-part rule to ensure an accurate interpretation.

Patient Self-Report Can Obscure Hypomania

The sensitivity of this instrument is moderate, particularly for Bipolar II, and a negative result does not definitively rule out a bipolar spectrum disorder. This is partly because patients often minimize or fail to recognize periods of hypomania. They may have experienced these episodes as positive or productive periods of high energy and confidence, not as problematic symptoms. This lack of self-recognition can lead to under-reporting on the form, making your clinical judgment essential to contextualize the patient's answers.

Documenting the Clinical Decision Is Separate Work

The questionnaire itself does not include a section for you to document how the result influenced your clinical reasoning or treatment plan. The real value is in connecting the screening result to a specific action, especially the decision to prescribe or withhold an antidepressant. This means you must create separate documentation to link the questionnaire's findings to your clinical decision, adding an extra step to finalize the patient's record and justify the chosen care pathway.

Benefits of Using Heidi to Auto-Fill Mood Disorder Questionnaire PDFs

Accurate Scoring Applied to Every Form

You do not have to manually check for the three-part positivity rule. Heidi applies the complete scoring logic, requiring the 7+ symptom count, co-occurrence, and moderate-to-serious impairment, rather than relying on just the symptom-count threshold. Heidi also flags inconsistencies if a patient denies co-occurrence but has endorsed multiple symptoms in the checklist. This gives you a correctly scored instrument as a starting point for your clinical interpretation.

Qualifying Details Captured From Conversation

Patients often share important context about their symptoms that a simple checkbox cannot capture, especially when they view hypomanic periods as productive. If you administer the questionnaire conversationally, Heidi transcribes the patient's full responses. This includes the qualifying details and nuances that help you interpret their answers and assess for minimized symptoms. You can review this transcribed context alongside the structured form data.

Clinical Reasoning Connected to the Result

The key step is linking the screening result to your treatment plan, especially around antidepressant prescribing. Heidi structures the clinical reasoning that connects the questionnaire’s outcome to your final decision. By transcribing your in-visit explanation of the treatment plan, Heidi drafts the note that documents exactly how the screening tool informed your actions, which you then review and confirm before it enters the record.

How to use this form

1

Auto-fill with Heidi

Click "Auto-fill Form with Heidi" to open the form in Heidi and complete the fields straight from your note, no copying and pasting.

2

Review and edit

Check the pre-filled details and make any changes before finalising the form.

3

Download or save

Download the completed form or save it directly into your patient records and workflows.

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