Bipolar Disorder

Bipolar disorder is a condition in which people go back and forth between periods of a very good or irritable mood and depression. The mood swings between mania and depression can be very quick. Each phase however, can last for weeks or months at a time. Between these mood episodes, a person with bipolar disorder may also experience normal moods.

It’s not fully understood what causes bipolar disorder however, studies have shown that it has a tendency to run in the family. Bipolar is a serious disorder and may cause dangerous behavior, even suicidal tendencies.

Northwest Clinical Research Center is conducting a clinical trial evaluating if a specific medication is safe and effective for bipolar disorder in adults 18-65. For more information about the research study, or to schedule an evaluation call our office at 877-453-0404 or complete the questionnaire and someone from our clinic will contact you.

Questionnaire:

Does anyone in your immediate family have… (Please check all that apply)

 Bipolar Schizophrenia Psychosis NONE

What symptoms are you experiencing?
 Being sad or discouraged Racing thoughts or talking excessively Feeling tired or having little energy Trouble concentrating or remembering Restlessness or irritability Changes in appetite or weight Overly excited or elated moods Not needing to sleep Psychosis Not enjoying activities that normally are enjoyable None of these

Gender?
 Male Female

How old are you?

Your Name (First and Last):

Phone:

Email Address:

How did you hear about us?
 TV Radio Referral Flyer/Brochure Internet Search Web Advertisement Facebook Previous Patient

Please enter any questions or comments in the space below.

Are you a resident of Washington State?

Zip Code:

What is the best time to contact you?

Your information will not be shared with or sold to anyone without your permission or except as required by law. See our Privacy Statement for details.

 I agree to the Privacy Statement

© 1999-2012 Northwest Clinical Research Center