Mood Disorders Questionnaire Scoring

Mood disorders questionnaire scoring checks three answers on the Mood Disorder Questionnaire (MDQ), a self-report screen for bipolar disorder. A screen is positive when the patient answers “Yes” to 7 or more of 13 symptom items. Several of those symptoms must also have happened in the same period, and the patient must rate the resulting problems as moderate or serious. Missing any one of the three makes the screen negative.

Developed by psychiatrist Robert M.A. Hirschfeld and colleagues in 2000, the MDQ remains one of the most widely used bipolar screening tools in primary care and mental health settings. A positive screen doesn’t diagnose bipolar disorder. It prompts further evaluation, and it catches many patients who might otherwise be treated for depression alone.

Key takeaways

Mood disorders questionnaire scoring requires 7 or more of 13 symptom “Yes” responses, co-occurrence in the same time period, and moderate-to-serious functional impairment.

A positive MDQ screen identifies bipolar risk and triggers psychiatric evaluation. It does not diagnose bipolar disorder on its own.

MDQ had about 73% sensitivity for bipolar spectrum disorder in outpatient psychiatric samples, but lower sensitivity in primary care and for bipolar II. Use it alongside clinical interview and DSM-5 criteria.

Pabau, the practice software we build, has digital forms and clinical documentation features that help you capture and track MDQ results in the patient record.

What is the Mood Disorder Questionnaire?

The Mood Disorder Questionnaire is a self-report screening instrument designed to identify adult patients with bipolar I or II disorder in clinical settings. Patients complete the 13-item form by marking “Yes” or “No” to questions about manic and hypomanic symptoms. Those symptoms relate to distinct periods of elevated or expansive mood.

Unlike a diagnostic interview, the MDQ is a rapid, low-cost screening tool. It doesn’t replace a full psychiatric evaluation, but it efficiently identifies patients who warrant further assessment. Clinicians use positive screens to decide when to refer or adjust treatment. A positive screen can also prompt a closer look at a presenting depression for bipolar features.

Who uses the MDQ?

Primary care physicians, psychiatrists, nurse practitioners, physician assistants, therapists, and counselors all use the MDQ. It is particularly valuable in primary care, where bipolar disorder is often missed or misdiagnosed as unipolar depression, delaying appropriate treatment.

How to score the MDQ, step by step

Scoring the MDQ follows a three-step rule, and each step must be satisfied for a screen to be positive. The flow below shows how a single “no” ends scoring early, however high the symptom count.

Step 1: Count the “Yes” responses

The patient marks “Yes” or “No” to 13 items describing manic or hypomanic symptoms. Examples include needing less sleep, feeling unusually energetic, talking more than usual, racing thoughts, and excessive spending. Count the total number of “Yes” responses. If the count is 7 or higher, go to Step 2. If it is lower than 7, the screen is negative.

Step 2: Confirm symptom co-occurrence

Question 2 asks whether several of these symptoms happened during the same period of time. This confirms the symptoms cluster in one episode of elevated mood, rather than being scattered across years. A “Yes” confirms co-occurrence. A “No” makes the screen negative, whatever the symptom count.

Step 3: Assess functional impairment

Question 3 asks how much of a problem the symptoms caused: no problem, minor, moderate, or serious. Only “moderate” or “serious” produces a positive screen. Together, enough symptoms, co-occurrence, and functional impact separate clinically significant bipolar risk from subclinical mood variation.

What a positive screen requires

A positive MDQ result meets all three criteria at once. Knowing what each threshold means helps you explain results to patients and decide next steps.

Common scoring mistakes

The most frequent error is stopping at the symptom count. A patient who endorses nine items but rates the impact as a minor problem has a negative screen. Nine is well over the threshold, but the impairment gate still decides the result.

Two other slips are worth checking for:

• Treating a “No” on co-occurrence as optional. Symptoms spread across different years don’t make an episode, so the screen is negative.
• Recording only “positive” or “negative”. Write down the symptom count and the impairment rating too, so the next clinician can see how close a negative screen came.

How to interpret the results

A positive MDQ screen is a red flag for bipolar risk, not a diagnosis. Your next step depends on the patient’s presentation, history, and current symptoms.

Positive screen: What to do next

Conduct a structured psychiatric interview using DSM-5 bipolar disorder criteria to confirm or rule out bipolar I, bipolar II, or related conditions. Then work through these checks:

• Ask about the frequency, duration, and impact of manic or hypomanic episodes.
• Screen for substance use, medical conditions such as thyroid disease or sleep disorders, and medications that can mimic mania.
• Refer to psychiatry for diagnostic clarification and medication management if bipolar disorder appears likely.
• If the screen was a false positive, document your clinical reasoning and adjust the treatment plan. ADHD, personality disorder features, and substance-induced states are common causes.

Negative screen: Reassessment timing

If the MDQ is negative but the patient reports significant mood episodes or treatment resistance, consider rescreening in 6 to 12 months. Some bipolar II presentations are subtle and may not trigger a positive screen on first administration. A mood tracker kept between visits can surface episodes the patient forgets to mention. Document the screening result and the rationale for any follow-up evaluation.

Sensitivity and specificity of the MDQ

The MDQ’s diagnostic accuracy varies by setting and patient population. The original validation study was Hirschfeld et al., 2000, published in the American Journal of Psychiatry. It reported approximately 73% sensitivity and 90% specificity for bipolar spectrum disorder (bipolar I and II combined) in outpatient psychiatric samples.

Sensitivity is lower for bipolar II, because hypomanic episodes are subtler and often under-reported. In primary care settings, sensitivity drops further because patients may have less clear-cut manic episodes. Where bipolar II is still suspected, the Bipolar Spectrum Diagnostic Scale is another self-report screen to consider.

Bottom line: A positive screen warrants a full evaluation. A negative screen doesn’t rule out bipolar disorder, especially bipolar II, so clinical judgment should guide further workup.

How the MDQ items map to DSM-5 criteria

The MDQ symptom items map closely to DSM-5 manic and hypomanic episode criteria. Both require a distinct period of elevated or expansive mood. Both also look for additional symptoms such as reduced need for sleep, talkativeness, racing thoughts, distractibility, more goal-directed activity, and risky behavior.

The MDQ is a practical shortcut. A positive screen should prompt a full DSM-5 assessment to confirm the diagnosis. That assessment also separates bipolar I from bipolar II, based on episode duration and severity.

Limitations and false positives

The MDQ can produce false positives in patients with ADHD, borderline personality disorder features, substance use disorders, or anxiety disorders with activation. These patients may endorse racing thoughts, goal-directed activity, or decreased need for sleep without meeting criteria for mania or hypomania.

Always combine the MDQ with a thorough clinical interview, collateral history from family or previous records, and a review of medical and substance-use history. Only then conclude bipolar disorder. The MDQ is a starting point, not a finished diagnosis.

Using the MDQ in primary care and psychiatric settings

Primary care clinicians often use the MDQ during a depression workup, when a patient with depressive symptoms may have underlying bipolar disorder. It fits naturally alongside a depression screen such as the PHQ-9. Psychiatrists use it to confirm or rule out bipolar features in more complex presentations. Both settings benefit from a standardized, quick tool, though psychiatric settings allow deeper evaluation when a screen is positive.

How Pabau supports MDQ screening and follow-up

Many practices still hand patients a paper questionnaire, count the answers by hand, and type the result into the notes later. Each handoff adds a chance to miscount or misfile a positive screen.

In Pabau, that work moves into digital intake forms. You set up your licensed screening questionnaire once and send it before the appointment. The completed form lands in the patient record, ready to review alongside the clinician’s notes.

The outcome is a screening record your team can find and act on. A positive result, the referral decision, and the rescreening date sit in one place for the next appointment. Booking, notes, and billing run on the same software for therapy practices, so screening never lives in a separate system.

Streamline mental health screening with Pabau

Send your licensed screening questionnaire online and keep completed results and referral decisions in the patient record.

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Conclusion

Mood disorders questionnaire scoring is a practical, validated screening method that helps clinicians identify bipolar risk early. Apply all three criteria every time, and treat a positive screen as the start of a clinical assessment, not its end.

Record the number of Yes answers, the co-occurrence answer, the impairment rating, and the result in the patient’s notes. The free download is a general clinical documentation form rather than an MDQ scoring sheet, so pair it with your licensed copy of the MDQ.

Book a demo to see how Pabau can send your licensed screening questionnaire online and keep completed results and referral decisions in the patient record.

Continue your research

Need to document the patient’s full mental health history? Psychiatric Evaluation Template provides a complete structure for comprehensive mental health assessment and treatment planning.

Want to streamline your screening intake process? Pabau’s mental health EMR lets you send your licensed screening questionnaire online and keep completed results and referral decisions in the patient record.

Running a psychiatry practice? Psychiatry EMR software shows how Pabau handles psychiatric documentation, scheduling, and follow-up in one system.

Need to rate manic symptoms after a positive screen? Altman Self-Rating Mania Scale gives patients a short self-report measure of current manic symptom severity.

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