How to Score the Mood Disorder Questionnaire (MDQ)
The MDQ is scored by counting the number of "yes" responses to 13 symptom items, with a positive screen defined as ≥7 "yes" responses PLUS endorsement that several symptoms occurred during the same time period PLUS at least moderate functional impairment. 1, 2
Standard Scoring Algorithm
The MDQ consists of three components that must all be evaluated:
Part 1: Symptom Count (13 items)
- Count the total number of "yes" responses to the 13 manic/hypomanic symptom items 1, 2
- These items cover all DSM-IV symptoms of mania/hypomania including racing thoughts, increased energy, increased social activity, irritability, decreased need for sleep, increased talkativeness, and risky behaviors 3
- A threshold of ≥7 "yes" responses is required for a positive screen 1, 2, 4
Part 2: Symptom Co-occurrence
- The patient must endorse that several of these symptoms occurred during the same time period 2, 4
- This item ensures symptoms cluster together rather than occurring in isolation across the lifespan 2
Part 3: Functional Impairment
- The patient must report that symptoms caused moderate or severe functional impairment 2, 4
- This distinguishes clinically significant episodes from normal mood variations 2
Performance Characteristics with Standard Scoring
Using the standard algorithm (≥7 symptoms + co-occurrence + moderate/severe impairment), the MDQ demonstrates:
- Sensitivity: 47-90% depending on the clinical population 5, 2, 4
- Specificity: 84-94% 5, 2, 4
- Better detection of Bipolar I (sensitivity 59-81%) than Bipolar II (sensitivity 19-23%) 5, 4
Modified Scoring for Increased Sensitivity
If higher sensitivity is needed (e.g., screening settings where missing cases is more problematic than false positives), remove the impairment requirement:
- Count ≥7 "yes" responses + symptom co-occurrence only 2
- This increases sensitivity from 63.5% to 75.0% 2
- Specificity decreases from 84.8% to 78.5%, but remains acceptable 2
For detecting Bipolar II specifically, further modifications may be considered:
- Lower the threshold to ≥3 "yes" responses and eliminate both co-occurrence and impairment items 4
- This improves Bipolar II sensitivity from 0.23 to 0.54 with specificity of 0.84 4
Critical Caveats
- The MDQ has inadequate sensitivity (63.5%) when used in psychiatric outpatient settings with standard scoring 2
- Self-reported euphoria is less sensitive than energized activity and irritability for detecting hypomania 3
- The MDQ performs significantly worse for Bipolar II than Bipolar I disorder 4
- Positive predictive value remains low (30-34%) even with modified scoring in clinical populations 2
- A positive MDQ screen requires confirmatory diagnostic evaluation with structured clinical interview 1, 2