This report is about 5 years old. It is contained in the books Soft Bipolar Suffering, Soft Bipolar Questions and Answers, and Blue Light Management for Bipolar Disorder. Watch in June for updates on this as we're revising it now. It is a self report which means it is not a scored test. However, it seems about the closest to describing symptoms. At the end is a Physician screening tool, which you should review also. Dr. Bunch
All materials are copyrighted, but if you have some reason to use or duplicate this for your purposes, simply contact us, state reasons, etc. Email to Dr.firstname.lastname@example.org. We give all Nami associations permission to use in Nami classes and to carry the evaluation copied in Nami offices, free, and without other permission.
Soft bipolar symptom self report
US Copyright, Charles Bunch, Ph.D., Sept 2004
Reproduction or transmission in whole or part prohibited by law.
Do you or any family members have any of the following?
· alcoholism, such as binge drinking, daily drinking, or drinking to alleviate other symptoms or life problems
· anxiety or panic attacks
· behavioral addictions or compulsions, such as shopping, gambling, cleaning, eating, internet surfing or chat rooms, or sexual
· child abuse or spousal abuse, including verbal attacks or throwing things
· chronic aches and pains, or Arthritic-like symptoms (fibromyalgia, chronic fatigue syndrome), digestive problems, or other frequent illnesses, which truly do exist (somatic illness)
· chronic headaches or migraines
· chronic Irritability, or not irritable at work but irritable at home
· mild legal problems such as getting speeding tickets or other “tests” of the law, or severe legal problems such as incarceration
· depression in childhood
· depression in the winter
· drug abuse or drug addiction, including use of marijuana
· eccentric or unusual behavior
· extreme worry, obsessiveness and compulsiveness
· frequent depression, in episodes, in the week, or even times of day
· hypersensitivity to light, noises, touch, crowds, etc.
· mood swings, shifts in energy
· if a woman, post-partum depression or post-partum psychosis
· religious addiction or religious compulsions
· sleep disorders, unable to sleep or extensive sleeping
· suicide or suicide threats, including severe feelings of hopelessness
· talking continually, talking fast
· unusual reactions to prescription medications, hypersensitivity to medications
· vivid and unusual fears, extreme childhood nightmares
· withdrawal or agoraphobic behaviors
· history of work, social, or relationship problems
· a prior diagnosis of bipolar disorder, borderline personality disorder, or a psychiatric hospitalization
· have two or more psychiatric diagnoses, such as panic, depression, or some other anxiety
· take antidepressants and felt odd immediately, or feel well immediately, or the antidepressants have a pattern of failing in benefit after a few months
· use various over-the-counter remedies to treat anxiety, sleep problems, mood problems, etc.
· seem bright, but not meeting potential
· get stuck on a thought, issue, or feeling and can’t move on
· have moods, emotions, or a lifestyle that seems different or more extreme than the average person
· known for some trait, such as being keyed up, withdrawn, a meddler, bubbly, hyperactive, energetic, irritable, or volatile
Do you have varying periods of:
· sharpened and creative thinking alternating with periods of mental confusion and apathy
· good mood versus times of low or irritable mood
· loss of interest or pleasure versus elevated and expansive mood
· decreased need for sleep versus too much need for sleep
· shaky self esteem and lack of self confidence versus naïve grandiose overconfidence
· unusual work hours with much done versus periods of down time and recuperation
· more uninhibited people seeking or social good times versus introverted self-absorption or withdrawal from others
· involvement in pleasurable activities versus restricted involvement in pleasurable actives and feelings of guilt over past activities
· optimism or exaggeration of past achievement versus pessimistic attitude toward the future or brooding about past events
· more talkative than usual with laughing, joking, and punning versus less talkative with tearfulness or crying
· financial extravagance versus periods of guilt and self punishment
· more sexual or impulsive versus over-constraint or held-back
· shopping, spending, and doing versus low activity
· feeling in slow motion versus feeling in fast motion.
· feeling serious or morbid versus happy
· feeling like your body is heavy or you feel old versus feeling light or energetic
· feeling aware of the outer world versus feeling introspective and that others are looking at you
· feeling resourceful and having ideas versus feeling stuck and limited
· having strong or increased body senses and sensations versus feeling everything is dull, tasteless, and boring
· feeling free to live in the world and society versus feeling you live in your head and are stuck with painful feelings, especially guilt and self-criticism
In the up feeling state, do you have any of these traits?
feel good physically
like noise and stimulation
do several things at once
others seen in slow motions
increased alcohol or tobacco use
controlled by the present fun or future ideas in harmful way
humorous, likes dating and comedy
may be the life of the party but scares others off
would rather talk
lose money, resources
has open boundaries with others
increased alcohol and caffeine intake, including rapid intake of same
inappropriate or loud laughter
reading or doing several projects at one time, multitasking
eat rapidly or forget to eat at all
engrossed in projects and may forget to drink water or go to bathroom
too much dreaming of the future, inventions, money making, lottery, etc.
disregard time or needs of others
vulnerable to other high risk behaviors
may anxiously take care of personal needs such as household needs or personal grooming
may be excessively helpful with neighbors, relatives, or strangers, whether they request help or not
do projects that are “off track” and may not support true goals or income needs
excessive punning, jokes, risky or vulgar language
On the down, depressed side, symptoms and behaviors can, but don’t always, include:
humorless, avoids comedy and dating
lethargic, feels drained
decreased verbal output
ruminative or stuck thoughts
skeptical or paranoid
lack of interests
may feel ill or sick
overwhelmed by stimulus
vivid dark images
go to a dark place
heavy heart, burdened
foggy, feels like a mist, inability to focus
Feels heavy, leaden arms or legs
sore, tired, may have many illnesses (somatic illness)
suicidal or hopeless thoughts
paranoid or fearful of others
fault finding of others
may worry about others or start codependency patterns
rumination on past, flood of melancholy feelings
avoid responding to phone messages, email, and responsibilities
feel there are no options, stuck, trapped
feel left alone by others, alone in life, different than others
time is lost and not productive, free time is often not utilized well
has sudden and almost complete loss of goals, direction, focus, and self esteem
overwhelmed by responsibility, paperwork, bills, etc.
want left alone, feels need to back out of prior commitments
feel personally empty, bankrupt, that personal needs are not and will not be met
feel others have unfair advantage and are not “broken” like you
vulnerable to others, is pushed over by others
may escape for hours or days in television, an old hobby, books, or other pastime that is solitary
may not take care of self, household, personal needs
may give up on social projects or obligations to help others or family
prone to eat fatty or other foods known to be bulky or not nutritious (less carb craving, more fat craving)
feel rejected by others, overly sensitive, feelings on shoulders
abrupt and sharp with others, may not realize it until later
discouraging toward own self
NOTE: were are changing this section soon. For many soft bipolars, a mixed state is not a mood shift, it is life in perpetual vivid thought. We will explain that further, but this is described in all Soft Bipolar Books.
feeling something is going to happen
feeling tired, but may need to pace
dysphoria, not feeling good, which is just the opposite of a feeling of euphoria, and this can be pretty bad for the mixed-states, including going on for weeks or years
can’t sleep, tired during the day
lack of flexibility
may perseverate (hyper-focus) on some issue because of internal anxiety and fear: can’t get off a topic
intense responses to any perceived or biological stressor
rigid responses or needs
distractible, seems like has attention deficit hyperactive disorder
may be more prone to impulsive or addictive behaviors during this time
edgy, may even fidget or pace
may seem bothersome or irritate spouse or relatives
obsessive and compulsive
Unable to sustain projects or does them out of fear and anxiety
Abrupt mood shifts
Need to self medicate: drugs or alcohol
A few soft bipolars may experience extreme thought, fears, depression, or anxiety. Here are some other characteristics of psychosis:
Feeling on the edge
Extreme obsessiveness or compulsiveness
Intrusive bizarre thought that cannot be stopped
This is an invalidated mood disorder report. In my practice I find that persons with 40% or more positive answers often qualify for a mild mood disorder and benefit from appropriate treatment.
Bipolar ll Self Report, Copyright Charles K. Bunch, Ph.D., September 2004
Use and copies are allowed for personal use. Any professional use requires written permission of the author.
For family physicians, gynecologists, nurses, counselors, and social workers
One percent of the population suffers from severe bipolar mood disorder (manic-depressive disorder). However, up to another three percent of the population suffers from other forms of the mood disorders. Approximately one-fourth of those with unipolar depression actually have unipolar-bipolar depression, and one-fifth of women who experience depressive or psychotic post-partum depression are experiencing the opening of bipolar mood disorder.
The Mood Disorder Screening Tool (MDST) is based on new insights on the whole spectrum of mood disorders present in the population, including milder form, soft bipolar. New classifications of mood disorders have been suggested that do not fit the understanding of typical manic and depressive cycles. Those suggested types are:
· type l mania and depression.
· type 2 hypomania (milder mania) and Depression.
· type 3 cyclothymia (mild mania followed by mild depression, with mood shifts often caused by life events, there is no spontaneous hypomania).
· type 4 hypomania or mania precipitated by medication (particularly antidepressants and illicit drugs).
· type 5 depressed patients with bipolar relatives or depressed patients with alcoholic parents.
· type 6 mania without depression.
· hyperthymia (florid thoughts, fears, emotions, nightmares, vivid daydreams, often with “happy and social” mood).
· hyperthymic depression (florid thoughts, fears, emotions, with “pained,” depressed mood).
· (types 1-4 from Gerald Klerman, MD, 1987; another list calls bipolar 3 depression without hypomania with Hyperthymia Akiskal, 1983)
The Mood Disorder Screening Tool is not a complete diagnostic tool, but quickly screens individuals are at risk of misdiagnosis or harm from inappropriate medications. Positive responses should be followed by further diagnostic exploration. The MDST is especially useful in screening all patients prior to prescribing antidepressants, because they may be related to:
· manic or hypomanic responses to the SSRI antidepressants.
· patient switching from a stable bipolar disorder to more severe.
· actual scarring of brain tissue, exacerbating the mood disorder for life.
· decrease in long term compliance with treatment due to bad medication responses.
See “SSRI Induced Mania/Rapid Cycling Research, Articles, and Links” www.neurotransmitter.net/admania.html.
Remember: 40 percent of bipolar patients attempt suicide and 20 percent complete their attempt.
Please check off in the right-hand columns if any of these characteristics apply. In the first column, place a mark if it applies to you. In the second column, place a mark if it applies to any blood-relative of yours. Place a check in the question column if you are uncertain for any reason that the question might possibly apply to you or your relative.
Please do not rush through the questions. You should complete this in a place where you are not distracted because your responses are important. If you do not understand any question or need help on any part, feel free to ask for assistance from the person who gave you this form.
The estimated time it will take you to complete this is less than 10 minutes.
1. Is there a prior diagnosis of Bipolar Disorder, mood disorder, psychosis, schizophrenia, borderline personality, a hospitalization for any of these, or depression or anxiety?
2. Have you ever been prescribed mood stabilizers or antipsychotic medication (such as lithium, Depakote, Gabatril, Trileptal, Neurontin, Haldol, Risperidal, Zyprexa, or others)?
3. Have you ever been told you have various psychiatric disorders (such as depression, general anxiety, panic, obsessive-compulsive disorder, borderline personality, psychotic disorder, schizophrenia, Bipolar Disorder, etc.), or that you have had several of these at different periods of time?
4. Have you had depression or anxiety and needed more than one medication at a time?
5. If you ever took an antidepressant, did you: initially feel odd, unreal or anxious or agitated, have an almost immediate improvement, stop the medication from some odd reaction, or take antidepressants and find that they stopped working after a while?
6. Did you have a pattern of childhood depression, fears, or anxiety?
7. Women only: did you have a reaction after the birth of a child that was termed post-partum depression or post-partum psychosis?
8. Have you ever had suicidal thoughts or feelings, or attempted suicide?
9. Have you ever had periods of elation, euphoria, extreme energy, risk-taking, lessened need for sleep, racing thoughts, or starting many projects at the same time?
10. Have you ever had periods of depression, lethargy, lack of interest, hopelessness, inability to think or solve problems, or slowed physical motions (sluggish and uncoordinated)?
11. Have you or others noted that you have mood swings?
12. Have you ever been depressed and felt anxious or agitated at the same time?
13. Have you had periods where you have had problems with impulsiveness, overeating, gambling, shopping, or any other compulsive behavior?
14. Have you had periods of extreme interest in sex or periods with lack of interest in sex?
15. Have you had in childhood or adulthood vivid fears, vivid emotions, realistic nightmares, or realistic “daytime dreams”?
16. Do you have vivid physical or emotional pain, heightened sensitivity to sensations such as noise or light, which may cause you pain or to withdraw from others or the world?
17. Do you have ongoing or repeated work, social, or family problems?
18. Do you use regularly or binge on alcohol, use marijuana or other illicit drugs, or use over-the-counter medications to treat emotional or sleep problems?
19. Are you known as irritable or reactive and often criticize yourself or others, start arguments, have fights, or throw things during an emotional upset?
20. Are you concerned that your bad thoughts and feelings are not normal, could be harmful, or could get worse?
10-point physician bipolar disorder quick screen
Before you prescribe an antidepressant
(Antidepressants prescribed for bipolar depression can backfire, causing mania in the short term and worsening of the Bipolar 1llness in the long term (see www.neurotransmitter.net/admania.html). This is a liability issue and should be taken seriously.
Does the patient have:
A prior history of Bipolar Disorder l, ll or lll?
A family history of Bipolar Disorder?
A history of childhood depression?
A history of these reactions to prior antidepressant treatment: immediate “brightening,” immediate recovery, bizarre or manic reactions?
A history of prior antidepressant treatment where the medication stops efficacy after a few months and the patient is again depressed on the antidepressant?
Untreatable adult depression?
Mood or energy cycles (low mood versus elevated mood [hypomanic: gregarious and energetic, or typical manic])?
Multiple psychiatric diagnoses, such as depression, phobias, anxiety disorders, personality disorders, etc.?
Post-partum depression or psychosis?
Addictions, compulsions, obsessions, eating disorders?
US Copyright August 25, 2004. Reproduction or Transmission is Prohibited. To register for clinical use go to: www.boisebipolarcenter.com