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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? (R)

        Yes
        No

2.   Has there ever been a period of time when you were not your usual self and you were so irritable that you shouted at people or started fights or arguments? (R)

        Yes
        No

3.   Has there ever been a period of time when you were not your usual self and you felt much more self-confident than usual? (R)

        Yes
        No

4.   Has there ever been a period of time when you were not your usual self and you got much less sleep than usual and found you didn't really miss it? (R)

        Yes
        No

5.   Has there ever been a period of time when you were not your usual self and you were much more talkative or spoke much faster than usual? (R)

        Yes
        No

6.   Has there ever been a period of time when you were not your usual self and thoughts raced through your head or you couldn't slow your mind down? (R)

        Yes
        No

7.   Has there ever been a period of time when you were not your usual self and you were so easily distracted by things around you that you had trouble concentrating or staying on track? (R)

        Yes
        No

8.   Has there ever been a period of time when you were not your usual self and you had much more energy than usual? (R)

        Yes
        No

9.   Has there ever been a period of time when you were not your usual self and you were much more active or did many more things than usual? (R)

        Yes
        No

10.   Has there ever been a period of time when you were not your usual self and you were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night? (R)

        Yes
        No

11.   Has there ever been a period of time when you were not your usual self and you were much more interested in sex than usual? (R)

        Yes
        No

12.   Has there ever been a period of time when you were not your usual self and you did things that were unusual for you or that other people might have thought were excessive, foolish or risky? (R)

        Yes
        No

13.   Has there ever been a period of time when you were not your usual self and spending money got you or your family into trouble? (R)

        Yes
        No

14.   If you said yes to more than one of the above, have several of these ever happened during the same period of time? (R)

        Yes
        No
        Unsure
        Does Not Apply To You

15.   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 and fights? (R)

        No Problem
        Minor Problem
        Moderate Problem
        Serious Problem
        Does Not Apply To You

16.   Specify moods by choosing one of the following based on the following definitions:

Depression - feel very sad, sometimes for long periods of time. May not want to get out of bed or eat and stop enjoying doing things you use to enjoy.

Mania - may start with a good feeling, almost like a "high". Or it may make a person feel very irritable and angry. Tend to do very risky things.

Hypomania - milder form of mania. Can make people feel good and they may think that they are getting more things done but hte "feel good" stage can change into mania or depression.

Mixed mood - this is when feelings of mania and depression go back and forth quickly, sometimes even in the same day. (R)

        One episode mania or mixed mood and often experience depression, too
        One episode of depression and at least one period of hypomania
        Back and forth between mild depression and slightly elevated mood, shorter and less severe
        Do not fit into the above choices
        Does not apply to you

17.   Please feel free to ask any questions or include any thoughts or comments in this area. This is not required. Note that all comments, thoughts and questions will be kept confidential. Also note that any questions submitted will be answered but if you submit the survey as ANONYMOUS I cannot answer your questions. Thank you for your time and consideration. J.D.

     

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