> ## Documentation Index > Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt > Use this file to discover all available pages before exploring further. # MDQ — Mood Disorder Questionnaire > The standard brief bipolar-spectrum screen. 13 symptom items plus a co-occurrence question and an impairment question, with a three-part positive-screen rule. The MDQ is the brief screen for bipolar-spectrum history. It's the one to reach for when a client presents as depressed and you want to know whether there has ever been a hypomanic or manic period before you treat the depression as unipolar. ## What it measures Lifetime manic and hypomanic experience, in three parts. **Q1** — thirteen yes/no symptom items, all under the stem "Has there ever been a period of time when you were not your usual self and …": elevated or hyper mood, irritability, inflated self-confidence, reduced need for sleep, pressured speech, racing thoughts, distractibility, increased energy, increased activity, increased sociability, increased sexual interest, risky or excessive behaviour, and spending that caused trouble. **Q2** — one yes/no question about whether several of those symptoms ever happened during the same period of time. **Q3** — one four-option question about how much of a problem the symptoms caused: work, family, money, legal trouble, arguments, fights. The frame is lifetime, not the last two weeks. That's the point — the client sitting in front of you is depressed now; the question is what happened three years ago. ## When to use it * **Before treating a depression as unipolar.** Especially where an antidepressant is on the table or already prescribed by someone else. * **When a depression hasn't responded as expected.** Treatment-resistant depression is one of the presentations where an unrecognized bipolar-spectrum history turns up. * **Family history of bipolar disorder.** * **Alongside the [PHQ-9](/clinical-templates/screening/phq-9) at intake** when the history includes periods the client describes as unusually good, productive, or "not myself." * **Before a psychiatry referral,** so the referral letter carries the screen rather than an impression. ## How clients fill it Two to three minutes — most of it is yes/no. The thirteen Q1 items all carry the same two options: * No * Yes Q2 reads: "If you checked YES to more than one of the above, have several of these ever happened during the same period of time?" — also No or Yes. Q3 reads: "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?" — four options: * No problem * Minor problem * Moderate problem * Serious problem ## How Rivet scores it Each Q1 item scores 1 for Yes and 0 for No, and the score Rivet shows you is the count of Yes answers across the thirteen symptom items. Range: 0–13. Q2 and Q3 carry no score. They're captured with the response and shown with it, but they aren't summed into anything. ## The positive screen A positive MDQ screen requires **all three** of the following: 1. Seven or more Yes answers among the thirteen Q1 symptom items 2. Q2 answered Yes — several of the symptoms co-occurred 3. Q3 answered "Moderate problem" or "Serious problem" Rivet surfaces the first of those three automatically. The Q1 count and its band appear live in your scoring pill: | Q1 count | Band | | -------- | --------------------------------------------------------------------------------------- | | 0–6 | Below MDQ symptom threshold | | 7–13 | At or above MDQ symptom criterion — inspect Q2 and Q3 for full positive-screen criteria | Q2 and Q3 are yours to read. A Q1 of 9 with Q2 answered No, or with Q3 at "Minor problem," is not a positive screen — the symptoms were scattered across the client's life or didn't cost them anything. Read all three before you call it. Hirschfeld 2000 reported sensitivity of 73% and specificity of 90% in a psychiatric outpatient sample. ## Clinical change The MDQ isn't a change measure. It asks about lifetime history, so re-administering it a month later measures nothing new. Administer it once, record the result, and track the depression with a depression measure. ## When NOT to use it * **As a diagnostic instrument.** A positive screen means the clinical interview needs to cover bipolar-spectrum history properly, and usually means a psychiatry consult. It is not a diagnosis. * **To rule out bipolar disorder.** A specificity of 90% is good; a sensitivity of 73% means roughly a quarter of true cases screen negative. A negative MDQ in a client with a strong family history and an odd treatment response doesn't settle the question. * **As a repeat outcome measure.** See above — the frame is lifetime. * **When the client can't recall or report the period reliably.** Collateral history often does more than the questionnaire here. ## MDQ vs YMRS The MDQ is a self-report screen about the client's history — has there ever been a period like this. The [YMRS](/clinical-templates/clinician-administered/ymrs) is rated by you about the client's state right now, and it measures how severe a current manic episode is. That makes them sequential rather than alternative. The MDQ belongs at intake, particularly before treating what looks like unipolar depression, because a missed bipolar history changes the treatment plan. The YMRS belongs after, when there is a manic or hypomanic presentation to track. One caution about the MDQ specifically: it produces more false positives in clients with borderline features or co-occurring substance use. A positive screen is a reason for a clinical interview, never a diagnosis on its own. ## Is it free to use? **Yes.** Hirschfeld's 2000 publication grants free reproduction without permission. ## Citation Hirschfeld, Williams, Spitzer, Calabrese, Flynn, Keck, Lewis, McElroy, Post, Rapport, Russell, Sachs & Zajecka (2000). *American Journal of Psychiatry,* 157: 1873–1875. The MDQ carries an explicit free-reproduction licence from that publication: "this material may be reproduced without permission." Rivet preserves the canonical item wording verbatim. ## Related articles The depression measure the MDQ most often accompanies at intake. The clinician-rated mania severity scale, for when the question moves past screening. When to screen and picking between overlapping measures.