Shore To Shore Psychiatric Scales

Psychiatric Scales

These questionnaires will give your medical provider insight into your condition and possible diagnosis.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Patient Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
1. PHQ-9; Patient Health Questionaire

PHQ-9; Over the last 2 weeks, how often have you been bothered by the following symptoms?

Rows	Not At All	Several Days	More Than Half The Days	Nearly Every Day
1. Little Interest or Pleasure in Doing Things
2. Feeling Down, Depressed or Hopeless
3. Trouble Falling or Staying Asleep or Sleeping Too Much
4. Feeling Tired or Having Little Energy
5. Poor Appetite or Overeating
6. Feeling bad about Yourself, or that you are a failure and have let your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or Speaking so Slowly that other people have noticed. Or the Opposite, being so figety or Restless that you have been Moving Around Alot more than Usual.
9. Thoughts that you would be better off dead, or killing yourself.

2. GAD-7 - Generalized Anxiety Disorder Scale

GAD-7; Over the last 2 weeks, how often have you been bothered by the following symptoms?

Rows	Not At All	Several Days	More Than Half The Days	Nearly Every Day
Feeling Nervous
Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. being so restless it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen

3. MDQ - Mood Disorder Questionairre

MDQ; Please answer each question to the best of your ability. Has there ever been a period of time when you were not you usual self and:

Rows	Yes	No
You felt so good or so hyper that other people thought you were not normal self or you were so hyper that you got into trouble?
You were so irritable that you shouted at people or started fights or arguments?
You felt much more self-confident than usual?
You got much less sleep than usual and found you didn't really miss it?
You were more talkative or spoke much faster than usual?
Thoughts raced through your head or you couldn't slow your mind down?
You were much more active or did many more things than usual?
You were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?
You were much more interested in sex than usual?
You did things that were unusual, for you or that other people have thought were excessive foolish or risky?
How much of a problem did any of these cause you - like being able to work; having family, money, or legal troubles; getting into arguments or fights?

4. Adult Health Self-Report Scale(ASRS-v1.1) Symptoms Checklist ADHD Self-Reporting Test

ADHD; Please answer each question to the best of your ability. Base your answers off of how you have been feeling over the past 6 months.

Rows	Never	Rarely	Sometimes	Often	Very Often
How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
How often do you have difficulty getting things in order when you have to do a task that requires organization?
How often do you have problems remembering appointments or obligations?
When you have a task that requires a lot of thought, how often do you avoid of delay getting started?
How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
How often do you feel overly active and compelled to do things, like you were driven by a motor?
How often do you make careless mistakes when you have to work on a boring or difficult project?
How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
How often do you misplace or have difficulty finding things at home or at work?
How often are you distracted by activity or noise around you?
How so much of a problem did any of these cause you-like being unable to work
How often do you leave your seat in meetings or other situations in whic you are expected to remain seated?
How often do you feel reckless or fidgety?
How often do you have difficulty unwinding and relaxing when you have time to yourself?
How often do you find yourself talking too much when you are in social situations
When you're in conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish themselves?
How often do you have difficulty waiting your turn in situations when turn taking is required?
How often do you interrupt others when they are busy?

Should be Empty: