Different Diseases Symptoms Report

Depression Screener Questions:

• Have you ever gone through a 2 year period of feeling sad most of the time?
• Mood on scale of 0-10?

Reports...

Depression
Report
Deny
Note
1. depressed mood most of the day, nearly every day for at least 2 weeks
2. markedly diminished interest in activities
3. sleep issues
4. excessive guilt/shame or remorse
5. feelings of worthlessness
6. hopelessness
7. low self-esteem, feelings of inadequacy
8. lack of energy
9. struggles with concentration or indecisiveness, brain fog
10. issues with appetite
11. psychomotor symptoms
12. thoughts of death
13. suicidal ideation
14. experiencing current depressive symptoms for
15. Aggravating factors include:
16. Protective factors include:



Anxiety Screener Questions:

• Do you have any special fears, such as fear of insects or of flying? (for specific phobia)
• Are you a worrier?
• Anxiety 0-10/10?

Reports...

Anxiety
Report
Deny
Note
1. excessive worry about a variety of topics that is difficult to control and is present more days than not for at least 6 months
2. muscle tension
3. fatigue
4. irritability
5. feeling on edge, restless or keyed up
6. concentration difficulty
7. sleep disturbance



Mania Screener Questions:

• Have you ever had a period of a week or so when you felt so happy and energetic that your friends said that you were talking too fast or that you were behaving differently and strangely?
• Has there been a time when you felt just the opposite of depressed, so that for a week or so you felt as if you were on an adrenaline high?
• Has anyone ever said that you were manic or that you had bipolar disorder?

Reports...

Notes:

• Distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week, or such a mood of any duration if hospitalization is necessary. Persistence of three or more symptoms(four if the mood is only irritable) during the period of the mood disturbance:

• 20% of people presenting with depression go one to develop bipolar disorder

• Hypomania: at least 4 days, the episode is not severe enough to cause “marked impairment in social or occupational functioning.”

Mania
Report
Deny
Note
1. mood change
2. reduced need for sleep
3. impulsivity, indiscretion
4. increased activity
5. grandiosity
6. distractibility
7. flight of ideas or racing thoughts
8. talkativity
10. First episode was
11. Last episode was
12. Episode lasts



Panic
Report
Deny
Note
1. recurrent, unexpected, abrupt surge of intense fear or discomfort reaching peak w/i minutes
2. 1+ month worry about further issues and/or maladaptive changes
3. fear of dying/losing control
4. cardio symptoms
5. sweating
6. sob
7. gi distress
8. feeling dizzy/lightheaded
9. aberrant sensorimotor symptoms
10. derealization/depersonalization



OCD
Report
Deny
Note
1. dysfunctional drive to engage in a behavior repetitively
2. symptoms result in clinically significant time consumption/distress/dysfunction
3. recurrent and persistent intrusive thoughts, urges, or images
4. attempts to ignore or suppress these thoughts
5. attempts to neutralize these thoughts with either another thought or action
6. thoughts/behaviors with anxiety-neutralizing intent are not connected to the focus of distress in a realistic manner



Psychosis
Report
Deny
Note
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic bx
5. negative symptoms
6. symptoms lasting for 2wk
7. symptoms lasting for 1 month
8. overall disturbance lasting for 6 months
9. symptoms occur in context of mood disturbance



Trauma
Report
Deny
Note
1. direct exposure to traumatic event
2. witnessing traumatic event
3. learning that a traumatic event occurred to someone close
4. experiencing repeated or extreme exposure to aversive details of the traumatic event
5. recurrent intrusive thoughts r/t traumatic event
6. recurrent trauma-related nightmares
7. re-experiencing of event
8. intense distress in response to event cues
9. marked physical reaction to cues
10. persistent avoidance of associated stimuli
11. inability to remember an important aspect of the event
12. persistent exaggerated negative beliefs about self/others/world
13. distorted cognition leading to self blame
14. persistent negative emotional state, diminished positive emotionality, or detachment
15. hypervigilance
16. irritability
17. impulsivity/recklessness



ADHD
Report
Deny
Note
1. difficulty with follow through
2. difficulty organizing tasks/priorities
3. being forgetful
4. avoiding sustained attention tasks
5. being physically restless
6. restlessness
7. careless mistakes
8. struggles with sustaining attention
9. often zoning out when spoken to
10. losings things
11. being easily distracted
12. difficulty sitting still
13. excessive talkativity
14. often blurts out
15. difficulty waiting
16. interrupts/intrudes on others
17. frequent difficulty engaging in quiet activity



Depersonalization/derealization disorder
Report
Deny
Note
1. unreality/detachment r/t self (depersonalization)
2. unreality/detachment r/t surroundings (derealization)
3. during depersonalization/derealization reality testing remains intact



Eating d/o
Report
Deny
Note
1. binge eating
2. recurrent inappropriate compensatory behaviors in order to prevent weight gain
3. occurring at least 1x/wk for 3 months
4. self-evaluation dysfunctionally influenced by body shape/weight
5. weight is less than minimally normal/expected





Agoraphobia
Report
Deny
Note
1. marked fear/anxiety about public transportation
2. marked fear/anxiety about being in open spaces
3. marked fear/anxiety about being in enclosed places
4. marked fear/anxiety about standing in line or being in a crowd
5. marked fear/anxiety about being outside of the home
6. fear/anxiety r/t thoughts that escape might be difficult or help might be unavailable in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms
7. specific situation almost always provokes fear/anxiety
8. specific situation actively avoided, requires companion, or endured with intense distress
9. distress is out of proportion to actual threat




ASD
Report
Deny
Note
1. deficits in social-emotional reciprocity
2. deficits in nonverbal communicative behaviors used for social interaction
3. deficits in developing, maintaining, and understanding relationships
4. stereotypies
5. repetitive behavior/speech
6. atypical use of objects
7. rigidity
8. restricted/unusual interests
9. unusual sensory experience
10. unusual interest in specific sensory experience




BPD
Report
Deny
Note
1. excessive fear/avoidance of real or perceived abandonment
2. pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3.
4. significant and longstanding self-image or sense of self that is unstable
5. impulsivity in at least two areas
6. recurrent suicidal/self-harming behavior, gestures, or threats
7. affective instability due to marked reactivity of mood
8. chronic feelings of emptiness
9. inappropriate, intense anger or difficulty controlling anger
10. transient stress-related paranoid ideation
11. dissociative symptoms




Body Dysmorphic D/O
Report
Deny
Note
1. preoccupation with minimal or imagined issue with physical appearance
2. repetitive thoughts/actions r/t appearance




Conduct d/o
Report
Deny
Note
1. often bullies, threatens, or intimidates others
2. often initiates physical fights
3. use of weapon causing physical harm to others
4. physical cruelty to people
5. physical cruelty to animals
6. aggressive stealing
7. non-aggressive stealing items of non-trivial value
8. forcing someone into sexual activity
9. deliberate fire setting with intent to cause damage
10. deliberate destruction of property
11. forced entry to building or car
12. often lies to obtain goods/favors or avoid obligations
13. frequent non-compliance with parental rules
14. truancy




Conversion disorder
Report
Deny
Note
1. symptoms of altered sensorimotor function
2. symptomology not recognized condition




DMDD
Report
Deny
Note
1. severe recurrent temper outbursts manifested verbally and/or behaviorally that are grossly out of proportion in intensity or duration to the situation or provocation
2. outbursts developmentally inappropriate
3. outbursts occur, on average 3+X/wk
4. mood between outbursts is persistently irritable or angry most of day, nearly every day, and is observable by others
5. sx 12+ months and has not had period of 3+ months where all symptoms are not met
6. present in 2 separate settings
7. age of onset before 10y




Gender Dysphoria
Report
Deny
Note
1. 6+ months incongruence between experienced/expressed and assigned gender
2. strong desire to identify as non-assigned gender
3. strong preference for cross-dressing
4. strong desire for change in primary/secondary sex characteristics




IED
Report
Deny
Note
1. non-injurious verbal or physical aggression occurring twice weekly, on average, for 3 months
2. 3 injurious or property damaging outbursts w/i 12month period
3. Aggression grossly disproportionate to any provocationa
4. outbursts are not premeditated




Insomnia
Report
Deny
Note
1. difficulty initiating sleep
2. dificulty maintaining sleep
3. issues occur 3+/wk
4. issue present 3+/months




ODD
Report
Deny
Note
1. often angry/irritated
2. often argues with authority figures
3. often defies authority figures
4. often deliberately annoys others
5. often blames others for their mistakes
6. spiteful/vindictive 2+ w/i past 6m with 1+ behavior/wk
7. sx present with 1+ non-sibling
8. sx present for 6m




Reactive attachment disorder
Report
Deny
Note
1. emotionally withdrawn from caregivers
2. child minimally seeks or responds to comfort when distress
3. minimal social/emotional responsiveness
4. limited positive affect
5. unexplained irritability/sadness/fearfulness
6. markedly insufficient social/emotional care
7. situations severely limiting development of stable attachments




Separation anxiety disorder
Report
Deny
Note
1. disturbance evident before age 5
2. developmentally inappropriate and excessive fear/anxiety concerning separation from those to whom the individual is attached
3. recurrent excessive distress when anticipating or experiencing separation from major attachment figure (or home)
4. persistent and excessive worry about losing major attachment figures or about possible harm to them
5. persistent and excessive worry about experiencing an event that causes separation
6. persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear or separation
7. persistent and excessive fear of or reluctance about being alone or without major attachment figure
8. persistent reluctance or refusal to sleep away from home or to go to sleep without being near major attachment figure
9. repeated nightmares involving theme of separation
10. repeated complaints of physical symptoms when separation from major attachment figures occurs or is anticipated




Social anxiety disorder (Social Phobia)
Report
Deny
Note
1. marked distress about social situation in which individual fears they may be exposed to possible judgement or negative evaluation by others
2. social situations almost always provoke fear or anxiety
3. social situation are avoided or endured with intense fear or anxiety




Specific phobia
Report
Deny
Note
1. marked fear/anxiety about specific object/situation
2. object of fear almost always provokes immediate fear/anxiety
3. object of fear actively avoided or endured with intense fear/anxiety
4. fear/anxiety is out of proportion to threat