psychiatry & behavioral healthquestionnaire

Mood Disorder Questionnaire (MDQ)

The Mood Disorder Questionnaire is a brief screening tool for bipolar spectrum disorders. It assesses 13 symptoms of mania/hypomania, whether they occurred together, and their impact. A positive screen requires ≥7 symptoms + clustering + moderate-serious impairment.

questionnaire

✓ when to use

Use when bipolar disorder is suspected in patients presenting with depression, particularly before initiating antidepressant monotherapy (which can trigger mania in unrecognised bipolar disorder). Recommended in patients with recurrent depression, depression with atypical features, family history of bipolar disorder, or depression not responding to antidepressants.

✗ when not to use

The MDQ is a screening tool, not diagnostic. It has moderate sensitivity (~73%) and specificity (~90%) — false negatives occur. A negative MDQ does not exclude bipolar disorder if clinical suspicion is high. Not validated in children/adolescents. The MDQ is better at detecting bipolar I than bipolar II (which presents with hypomania rather than mania).

clinical pearls

  • A positive MDQ requires ALL THREE criteria: ≥7 of 13 symptoms, symptoms occurring during the same time period (clustering), and causing moderate or serious problems. Missing any criterion = negative screen.
  • The most important clinical application: screen before starting antidepressants in patients with depression. Antidepressant monotherapy in unrecognised bipolar disorder can trigger mania, mixed states, or rapid cycling.
  • The MDQ is better at detecting bipolar I (clear manic episodes) than bipolar II (hypomania, which is milder and often recalled as 'feeling great' rather than pathological). Clinical interview remains essential for bipolar II detection.
  • Patients with bipolar disorder often present during depressive episodes and may not spontaneously report prior manic/hypomanic episodes. The MDQ systematically asks about these experiences.
  • A positive MDQ should trigger psychiatric referral or a structured diagnostic interview (e.g., SCID), not immediate treatment change. Bipolar disorder diagnosis requires clinical confirmation.

related tools

phq-9Depression screening — screen for bipolar before treating depressiongad-7Anxiety screening — anxiety commonly co-occurs with bipolar disorder