Mood Disorder Questionnaire (MDQ)

Foundational Context

Accurate identification of bipolar spectrum disorders is essential but challenging, especially because many individuals initially present with depression. Misdiagnosis can lead to inappropriate or destabilizing treatment, including antidepressant-induced mood elevation. The MDQ was developed to provide a rapid, structured way to screen for lifetime manic/hypomanic symptoms in general clinical practice.

Hirschfeld et al. (2000) validated the MDQ in both psychiatric and primary-care samples, demonstrating good sensitivity for bipolar I disorder. The tool captures a broad range of manic symptoms and incorporates functional impairment, helping clinicians identify when bipolar disorder—not just depression—should be considered.

What the Assessment Measures

The MDQ screens for lifetime manic and hypomanic symptoms, focusing on patterns typically associated with bipolar spectrum disorders.

The assessment measures:

• Elevated or irritable mood
• Increased energy
• Accelerated speech or thought processes
• Decreased need for sleep
• Increased goal-directed activity
• Risk-taking behaviors
• Distractibility and racing thoughts

In addition, it assesses:

• Whether symptoms occurred simultaneously, consistent with manic/hypomanic episodes
• Whether symptoms led to functional impairment, a key element of bipolar diagnosis

Interpretation Guidelines

The MDQ uses validated criteria to produce a positive or negative screen, rather than a numerical severity score.

A positive MDQ screen requires all three of the following:

1. Yes to 7 or more of the 13 lifetime manic/hypomanic symptoms
2. Confirmation that symptoms occurred during the same period
3. Symptoms caused moderate or serious functional impairment

Interpretation Notes:

• A positive MDQ screen suggests possible bipolar disorder, but is not diagnostic.
• False negatives may occur in bipolar II disorder, cyclothymia, or soft-spectrum presentations due to milder or shorter hypomanic episodes.
• False positives may occur in contexts such as ADHD, trauma-related hyperarousal, personality traits, or substance-induced activation.
• Clinicians should follow up with a structured diagnostic interview (e.g., SCID, MINI) for confirmation.
• The MDQ is most sensitive for bipolar I and less sensitive for bipolar II or atypical presentations.

Psychometric Properties

Reliability

• High internal consistency across manic symptom items
• Good test–retest reliability reported in validation studies

Validity

• Strong ability to differentiate bipolar I disorder from unipolar depression (Hirschfeld et al., 2000)
• Lower sensitivity for bipolar II and cyclothymia
• High specificity in psychiatric settings, with moderate sensitivity in primary care
• Widely validated across clinical and community samples

Administration Considerations

• Best administered when an individual is calm and able to reflect on lifetime patterns
• Useful early in assessment when depressive symptoms are present
• Should be paired with careful clinical questioning, especially for individuals with atypical or subthreshold presentations
• Clinician-assisted administration may help clarify symptom overlap with other conditions
• Particularly important before prescribing antidepressants, to reduce risk of treatment-induced mania

Limitations

• Screens for lifetime symptoms; not ideal for tracking current mood state or treatment response
• Lower sensitivity for bipolar II disorder and hypomania
• Self-report bias may influence recall of past symptoms
• Overlaps with symptoms seen in ADHD, trauma, anxiety, and personality disorders
• Requires clinician follow-up for diagnostic interpretation