How to Use the Mood Disorder Questionnaire (MDQ)
The MDQ is a self-report screening tool for bipolar spectrum disorders that should be administered to patients with depression when you suspect underlying manic or hypomanic symptoms, though its clinical utility remains limited by poor positive predictive value.
Administration
Have the patient complete the MDQ as a self-report questionnaire. The tool consists of 13 yes/no questions asking about lifetime manic or hypomanic symptoms (such as feeling unusually happy, irritable, increased energy, decreased need for sleep, racing thoughts, increased activity, or risky behavior) 1.
The questionnaire also includes two critical follow-up questions:
- Whether several symptoms occurred during the same time period
- The level of functional impairment caused by these symptoms
Scoring and Interpretation
The original scoring method requires all three criteria to screen positive:
- ≥7 "yes" responses to the 13 symptom questions
- Symptoms occurred simultaneously during the same period
- At least moderate functional impairment 1
Using this standard threshold yields:
- Sensitivity: 63-73%
- Specificity: 85-90%
- Positive predictive value: only 29-34% in psychiatric outpatients 2, 3
Consider lowering the threshold to improve detection: A cutoff of ≥5 symptoms (rather than 7) increases sensitivity to 91% with only modest reduction in specificity to 67% 4, 5. This may be more appropriate in high-risk populations or when bipolar disorder suspicion is elevated.
Critical Limitations and Caveats
The MDQ has significant limitations that restrict its clinical utility:
- Poor positive predictive value: Only 29-34% of positive screens actually have bipolar disorder in psychiatric settings 3
- Better for bipolar I than bipolar II: Sensitivity is 66% for bipolar I but only 39% for bipolar II disorder 2
- May capture general distress: Recent genetic studies suggest the MDQ may measure general psychopathology or distress rather than specific manic symptoms, with stronger correlations to PTSD, ADHD, and insomnia than to bipolar disorder 6
- Setting-dependent performance: Much lower sensitivity and positive predictive value in general population versus psychiatric outpatients 2
Clinical Application
Use the MDQ as a screening tool only, never for diagnosis. All positive screens require comprehensive diagnostic evaluation using DSM criteria through structured clinical interview 1, 2.
Best clinical scenarios for MDQ use:
- Patients with treatment-resistant depression
- Depression with atypical features (hypersomnia, hyperphagia, mood reactivity)
- Family history of bipolar disorder
- History of antidepressant-induced activation or mood switching
Do not use the MDQ routinely in all depressed patients given the high false-positive rate and absence of evidence that screening improves clinical outcomes 2. The potential harms of overdiagnosis and inappropriate treatment may outweigh benefits of improved detection.
For your patient currently treated for depression, administer the MDQ only if clinical features suggest possible bipolar spectrum disorder, interpret positive results cautiously, and always confirm with comprehensive diagnostic assessment before changing treatment.