MDQ for Me and You

If you have been to a psychiatrist in the last 18 or so years, odds are your experience was very similar to mine: The front desk hands you a form and a clipboard and a pen. Then the terror of self-reflection begins.

The Mood Disorder Questionnaire, or MDQ, is a non-diagnostic screening tool for the identification of Bipolar Disorder. Dr. Robert M.A. Hirschfeld, MD Et al. published the questionnaire in 2000, based on DSM-IV criteria in an effort to identify those most likely to have Bipolar Disorder.

According to his research:

“…the depressed mood typically associated with the depressive phase of these disorders is often misdiagnosed as depression. Consequently, bipolar disorder may go unrecognized for 7 to 10 years. Furthermore, many patients with bipolar disorder undergo 3 or more professional evaluations before receiving correct diagnosis and treatment.” (Source)

Before the publication of the MDQ, studies revealed that Bipolar was severely under diagnosed. One 1999 study even estimated that 40% of Bipolar cases were being misdiagnosed as Unipolar Depression. (Source). The MDQ was developed to aid in lowering this percentage.

Play Along with the MDQ

The MDQ consists of 15 self-reported questions designed to determine the likelihood of a Bipolar Diagnosis. It is broken up into three sections:

Section 1 consists of 13 yes or no questions about the patient’s moods. It is used to determine such criteria as energy levels, focus, self-esteem, and irritability, among others. It is comprised of the following questions:

1. Has there ever been a period of time when you were not your usual self and…

…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?

…you were so irritable that you shouted at people or started fights or arguments?

…you felt much more self-confident than usual?

…you got much less sleep than usual and found you didn’t really miss it?

…you were much more talkative or spoke much faster than usual?

…thoughts raced through your head or you couldn’t slow your mind down?

…you were so easily distracted by things around you that you had trouble concentrating or staying on track?

…you had much more energy than usual?

…you were much more active or did many more things than usual?

…you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?

…you were much more interested in sex than usual?

…you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?

…spending money got you or your family into trouble?

Sections 2 and 3 are a single question each:

2. If you checked YES to more than one of the above, have several of these ever happened during the same period of time?

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? Please circle one response only.

No Problem Minor Problem Moderate Problem Serious Problem

According to the screening standards set by the MDQ, if a patient has answered “yes” to 7 or more of questions in section 1, “yes” to section 2, and “Moderate” or “Serious” to section 3, they are possibly experiencing symptoms of Bipolar Disorder (source)

Note: It’s important to remember that this is not intended as a diagnostic tool. You should always consult a qualified mental health professional for diagnosis and treatment.

What the MDQ Tells Us (and What It Doesn’t)

The MDQ is designed specifically as a pre-screening tool. It tells mental health professionals how to proceed. If you’re like me and “aced” it, that indicates that a clinical investigation for Bipolar is warranted.

If section 2 is a “No” response, that may indicate a uni-polar disorder such as Depression, but the test is not designed to screen for these. (source)

Taking this at home is a good start, and in my case, was the deciding factor in seeking treatment. That said, if you’ve checked every yes to every question that does not mean you have Bipolar Disorder. The MDQ points out warning signs such as depression, hyperactivity, anxiety, insomnia, irritability, fatigue, paranoia, relationship issues and others. All of these signs are indicative of Bipolar, but in proper control, they’re also signs of being human.

What to Believe

When I first took the MDQ, I was in denial. It was 15 questions and took significantly fewer minutes. It seemed impossible to me that it could reveal all that in such a short time–It had taken me more time to heat up a gas station burrito for breakfast (a move that I still regret to this day).

There seems to be consensus on the efficacy of the MDQ. In his article,
Hirschfeld suggests that the test can identify 70% of all Bipolar individuals, and screen out 90% of Non-Bipolar individuals. A 2017 study revealed similar performance with a documented sensitivity of .73 (ability to positively detect Bipolar diagnoses) and a specificity of .90 (ability to correctly screen out non-Bipolar diagnoses). A 2009 study suggests .75 and .97, respectively. (source)

The MDQ does have some limitations, however:

  • The MDQ may be too culturally specific

In a 2014 study comparing the MDQ results of patients from Italy with those from China and Korea. Results suggested that cultural differences had a significant effect on their respective answers, and consequently, on the applicability of those answers to the diagnosis of Bipolar Disorder. (source)

  • The MDQ may be less sensitive to Bipolar II and Bipolar NOS. (source)
  • Bipolar II is characterized by a milder hypomania, which the MDQ my mistake as Unipolar Depression, resulting in a false negative.
  • The MDQ is self-reported.

This is a drawback that I personally experienced that first time I took the MDQ a few years ago. The day I went in to the Psychiatrist’s office I was given that clipboard and checklist, and told to answer as honestly as I could.

The problem with Bipolar is that your brain lies. A lot. The day I was in the office, I was in a depression (unexpectedly, it was the only thing that got me there). When I answered the first 13 questions, my self-esteem, energy level, and focus were all Iow and I had to conclude that I’d never felt energetic, that I never felt good or happy or even OK. After I ticked No after No, I was diagnosed: “Depressed”.

The Takeaway

From reading this, you might glean that I’m against the use of the MDQ. This isn’t the case at all. In a world where 73% of Bipolar individuals go undiagnosed, and 83% of diagnosed individuals have serious life impairments as a result I’m for anything which starts the conversation. (source)

The MDQ is not perfect, but I and many others believe it is a good jumping off point, and for what it’s worth, it eventually did work for me.

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