How do you score the Mood Disorder Questionnaire (MDQ)?

Scoring the Mood Disorder Questionnaire (MDQ)

The Mood Disorder Questionnaire (MDQ) is scored using three criteria: a symptom count of 7 or more positive responses to the 13 core symptom questions, clustering of symptoms occurring at the same time period, and moderate to severe functional impairment caused by these symptoms.

Standard MDQ Scoring Method

The MDQ consists of three sections that must be evaluated sequentially:

1. Symptom Count (Section 1)

   • Contains 13 yes/no questions about manic/hypomanic symptoms
   • Score requirement: 7 or more "yes" responses 1
   • Each "yes" answer counts as 1 point

2. Symptom Clustering (Section 2)

   • Asks if the endorsed symptoms occurred during the same time period
   • Requirement: Answer must be "yes" for a positive screen

3. Functional Impairment (Section 3)

   • Assesses the degree of problem/impairment caused by symptoms
   • Requirement: Answer must indicate "moderate problem" or "serious problem"

Alternative Scoring Methods

Research has identified potential alternative scoring approaches that may improve sensitivity in certain populations:

• Modified threshold approach: Using a symptom count of 5 or more while maintaining the clustering and impairment criteria may increase sensitivity with minimal loss of specificity 2

• Reduced criteria approach: Using only the symptom count of 7 or more without requiring the impairment criterion increases sensitivity but decreases specificity 3

Interpretation of Results

• Positive screen: Meeting all three criteria indicates possible bipolar spectrum disorder and warrants further clinical evaluation
• Negative screen: Not meeting all criteria suggests bipolar disorder is less likely

Performance Characteristics

• Using the standard scoring method:

  • Sensitivity: 0.73 (ability to correctly identify those with bipolar disorder)
  • Specificity: 0.90 (ability to correctly identify those without bipolar disorder) 1

• Performance varies across different populations:

  • In general population samples, the MDQ shows lower sensitivity (as low as 0.50) 4
  • Cultural adaptations may affect performance metrics 5

Clinical Application

• A positive MDQ screen is not diagnostic but indicates the need for a comprehensive clinical assessment
• False positives may occur in patients with substance use disorders or other psychiatric conditions that share symptoms with bipolar disorder
• The MDQ should be used as one component of a broader diagnostic process

Common Pitfalls to Avoid

• Relying solely on the MDQ score without clinical correlation
• Failing to consider comorbid conditions that may elevate scores regardless of bipolar status 3
• Using the tool in isolation without considering other clinical indicators
• Not ensuring the patient understands the questions, particularly regarding the timeframe of symptom occurrence