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10 Cards in this Set
- Front
- Back
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ID Questions
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How old are you?
Are you married (If no, ever?) Do you have any children? Who do you live with? What kind of work do you do? (For women: do you work outside of the home) Have you always done that kind of work? (If no, what other kids of work) Has there ever been a time when you were unable to go to work (school, if yes When and Why) How far did you go in school? When did you come to (current place)? Have you been here before? |
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CC
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What concerns or problems have brought your here?
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HPI Section?
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1. Pre-Morbid Function: When were you last well? What was life like then?
2. Onset dWhen did your problems start? 3. Course: Then what, then what End 4. Stressors: Did anything happen just before your problems started? When were your problems at their worst? What seemed to make your problems worse? 5. Alleviators: What have you found helpful in reducing these problems? What have you tried so far? 6. FIFE: Fxn: Overall, how much have these problems interfered with your life? How so /Ideas: What do you think is the cause of your problems: Feel/Future?:What is your concern now, What do you think will happen in the future? How does the future look? Where do you think things are going? Expectations: What are you hoping your team is going to do with you? |
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Psych ROS: Mood
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Since your problems began:
1. Mood: Have you had a period of time where you felt down or depressed nearly every day? What was it like? How long did that last? 2. How is your mood now (scale 1/ to 10). Expand on scale (What would be normal for you? What stops it from being a lower number? What would it take to get you higher? 3. During that period, did you notice a change in your interests or (Has there been a period where you noticed your interest in things change? What was that like? How long did that last? MISGECAPS 4. During this time, how was you sleep? How did it change? (Trouble falling asleep, staying asleep, waking too early, too much sleep)? How long did that last? During this time did you feel guilty about things? Was it there every day? How did you feel about yourself (did you feel worthless?) What was your energy like? (were you tired all the time?, every day?) Did you have trouble thinking or concentrating? Was it there every day? Did you appetite change? How? How long did that last? Eat more, less? Any change in weight? During this time did you feel fidgety/restless? Would I or others have noticed that? Was that there everyday? What about the opposite, talking or moving more slowly than usual? Would others have noticed? How long did that last? During this time, did you ever think things were so bad that you would be better off dead or have thoughts about hurting yourself? Did you do anything to hurt yourself? Rule out organic: Just before this began, were you physically ill? Start any medicine, herbs, supplements, substances? |
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Psych ROS: Mania
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DIGFAST (3 or more for a week)
In the past month, have you had a period of time when you felt so good or hyper than you were not your usual self or so hyper than you got into trouble? Did anyone notice? What was that like? How about being so irritable that you would shout at people or start fights and arguements? How long did that period last? Distractable: During this time, were you easily distracted, unable to stay on track Indiscrete: Did you do anything that caused trouble for you? Shopping Sex? Reckless driving? Grandiose: How did you feel about youself? Did you feel more confident? What was that like? Did you feel you had any special abilities or powers? Flight of ideas: Were your thoughts racing through your head? What was that like? How long did that last? Activity increases: Were you so active that other people noticed? Did you feel restless? Sleep deficit: Did you need less less that you usual? Did you still feel rested? Talkative: During this time, were you more talkative? What was that like? Did people have trouble understanding you or getting a word in? |
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Organic Factor rule out?
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Just before this period began were you sick?
How about start any new medications, herbs, supplements, substances, alcohol? |
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Psychosis ROS
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Now, I'm going to ask you about experiences that people sometimes have. (or I'm going to ask you more about what you mentioned)
Paranoia: Did it ever seem people were talking about you or following you? Reference: How about feel like you were getting special messages from people or from different objects like TV, Newspaper, radio? Grandiosity: Did it ever feel like you were extra important or had special abilities? Did it feel like any of your body parts had stopped working? Did you have any beliefs that was hard to get other people to believe? Did it ever feel like someone outside of you was controlling your thoughts/actions against your will Did it ever feel like your thoughts were not your own or being put into you head? Did you ever feel that thoughts were being taken out of your heads Did it ever feel like your thoughts were being broadcast out loud so other people could hear them? Did you ever hear things that other people coudn't hear like noises or voices? What did you hear? How often did you hear that? What did the voices talk about? Did you ever have visions or see things other people couldn't? Strange body sensations? Smells? |
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Substance review?
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How much caffeine do you have?
How often do you smoke cigarettes? Do you have a drink every now and then? How often do you use other substances? What are those substances? CAGE WILD/ADDICTeD |
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Anxiety ROS:
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PANIC
PHOBIAS GAD OCD PTSD |
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Adjustment Ds Screen?
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Adjustment DisordeR:
IT’S BAD: Impairment of fxn, Three months or less from stressor to sx onset Six months or less of symptoms (from ending of stressor) Bereavement excluded, Another Axis I excluded, Distress is greater than expected |
