DEPRESSION

IN THE LAST TWO WEEKS:

N

O

N

E

S

O

M

E

O

F

T

E

N

Almost

A

L

W

A

Y

S

Have you been feeling sad?

Do things look hopeless?

Are you lacking in interest for things that usually interest you?

Have you been resentful and angry?

Do you feel overwhelmed and have to push yourself hard?

Do you have trouble making up your mind?

Do you think about killing yourself?

Do you have problems (too much or too little) with sleep?

Is your appetite poor?

Do you eat when you aren't hungry?

Have you lost interest in sex?

Do you have trouble with concentration and memory?

 ANXIETY, PANIC, PARANOIA, HALLUCINATIONS

IN THE LAST TWO WEEKS:

how much have you had these symptoms:

N

O

N

E

S

O

M

E

O

F

T

E

N

Almost

A

L

W

A

Y

S

Anxiety, nervousness, worry, or fear

Sudden, unexpected panic spells (extreme fear, etc)

Feeling tense, stressed, or on edge

Racing thoughts or mind jumps from one thing to the next

Fears of physical illness such as heart attack or dying

Concern about looking foolish/inadequate in front of others

Skipping, racing, pounding of heart

Tingling or numbness in toes or fingers             

Butterflies or discomfort in the stomach

A lump in the throat, Trembling or shaking,

Feeling dizzy, lightheaded, or off balance?

Headaches or pains in the neck or back

Voices heard even when no one else is around?

Concerned about someone wanting to follow or harm you?

MANIA   (You might let your “Significant other” or relative review this: sometimes their memory or impression is helpful)

 Consider the following about an occurrence THAT LASTED FOR A FEW DAYS, now or any time in the past.

N

O

N

E

S

O

M

E

O

F

T

E

N

Almost

A

L

W

A

Y

S

I felt that my mind had never been sharper

I felt I needed less sleep than usual.

I had so many plans and new ideas that it was hard for me to work.

I felt a pressure to talk and talk.

I felt particularly happy.

I was more active than usual.

I talked so fast that people had a hard time keeping up with me

I was irritable.

I felt like "the life of the party."

I was full of energy.

I thought a lot about sex

I felt particularly playful.

I had special plans for the world

I spent too much money.

My attention jumped from one idea to another

I found it hard to slow down and stay in one place

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