Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr,
Lewis L, McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS, Zajecka J
Am J Psych 157(11):1875 (appendix 1), November 2000.
This form is best viewed in landscape on phones.
| 1. | Has there ever been a period of time when you were not your usual self and (while not using drugs or alcohol) … | 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? (circle yes or no for each line please) | Yes
|
No
|
|
| …you were so irritable that you shouted at people or started fights or arguments? | Yes
|
No
|
|
| …you felt much more self-confident than usual? | Yes
|
No
|
|
| …you got much less sleep than usual and found you didn’t really miss it? | Yes
|
No
|
|
| …you were much more talkative or spoke faster than usual? | Yes
|
No
|
|
| …thoughts raced through your head or you couldn’t slow you mind down? | Yes
|
No
|
|
| …you were so easily distracted by things around you that you had trouble concentrating or staying on track? | Yes
|
No
|
|
| …you had much more energy than usual? | Yes
|
No
|
|
| …you were much more active or did many more things than usual? | Yes
|
No
|
|
| …you were much more social or outgoing than usual; for example, you telephoned friends in the middle of the night? | Yes
|
No
|
|
| …you were much more interested in sex than usual? | Yes
|
No
|
|
| …spending money got you or your family into trouble? | Yes
|
No
|
|
| Total number of “Yes” responses to question 1: | |||
| 2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time? | Yes | No |
| 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?
No Problem Minor Problem Moderate Problem Serious Problem |
Scoring:
An individual is considered positive for Bipolar Disorder if they answered:
1. “Yes” to at least 7 of the 13 items in question 1 AND
2. “Yes” to question number 2 AND
3. “Moderate” or “Serious” to question number 3.
All three of the criteria should be met. A positive screen indicates that the person should be evaluated for Bipolar Spectrum Disorder by a mental health professional.
Note: This questionnaire is provided for educational purposes only. It is not a substitute for consulting with a health professional. Even if an individual’s score on the questionnaire is “negative,” it is very important to consult with a primary care doctor or a mental health professional if there are concerns.
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September 13, 2019