1. Do her symptoms seem to be that of Bipolar Disorder?
A. Yes, Bipolar I
B. Yes, Bipolar II
C. No, but a different diagnosis
D. No that I know of
2. Has your wife ever experienced thoughts of suicide or attempted suicide?
A. Perhaps, yes
B. Sometimes
C. No
D. I am not sure
3. Do your wife’s symptoms cause difficulty in her daily life functioning?
A. Sometimes
B. Many times
C. Rarely
D. I don't think so/I don't know
4. Does your wife experience periods of extreme happiness, decreased need for sleep, rapid speech, impulsivity, distractibility, or abnormally risky behaviors?
A. Yes
B. Sometimes
C. Rarely
D. No/I am not sure
5. Does your wife experience periods of extreme sadness, hopelessness, losing interest in activities, change in appetite, lack of energy, trouble concentrating/remembering things, or thoughts of harming herself?
A. Sometimes
B. Yes
C. Rarely
D. No/I am not sure
6. Does your wife experience major shifts in her mood or behavior that could escalate quickly and become out of control?
A. Yes
B. The depressive symptoms are more severe
C. Sometimes
D. Definitely mood swings, but it doesn’t become out of control
7. Are the shifts in your wife’s mood very different from her typical behavior?
A. Yes
B. Sometimes
C. Rarely
D. I am not sure
8. Do you notice manic episodes more prevalent than depressive episodes?
A. Yes
B. No, depressive episodes seem to be worse
C. They are both mild
D. I am not sure
9. Does your wife experience manic episodes nearly every day for at least a week at a time?
A. Yes
B. Maybe
C. I don't belive so
D. I am not sure
10. Does your wife have episodes of being severely depressed that last at least days or weeks at a time?
A. More than depression, she seems to have severe mood episodes
B. Yes
C. I believe so
D. I am not sure
