|
PHQ9
|
|
|
PATIENT HEALTH QUESTIONNAIRE (PHQ)
|
|
|
Over the last 2 weeks, how often have you been bothered by
|
|
|
1. Little interest or pleasure doing things
|
|
|
2. Feeling down / depressed / hopeless
|
|
|
3. Trouble falling or staying asleep, or sleeping too much
|
|
|
4. Feeling tired and having little energy
|
|
|
5. Poor appetite or over eating
|
|
|
6. Feeling bad about yourself/feeling a failure/feeling you have let people down:
|
|
|
7. Trouble concentrating on things, such as reading the newspaper/watching television
|
|
|
8. Moving/Speaking so slow that other people could have noticed/the opposite
|
|
|
9. Thoughts that you would be better off dead or of hurting yourself in someway
|
|
|
10. Would you be interested in learning more about a safe, effective, non-drug treatment for depression?
|
|
|
PHQ-10 Score
|
|
|
GAD-8
|
|
|
Generalized Anxiety Disorder (GAD)
|
|
|
Over the last 2 weeks, how often have you been bothered by the following problems?
|
|
|
1. Feeling nervous, anxious or on edge
|
|
|
2. Not being able to stop or control worrying
|
|
|
3. Worrying too much about different things
|
|
|
4. Trouble relaxing
|
|
|
5. Being so restless that it is hard to sit still
|
|
|
6. Becoming easily annoyed or irritable
|
|
|
7. Feeling afraid as if something awful might happen
|
|
|
10. Would you be interested in learning more about a safe, effective, non-drug treatment for anxiety?
|
|
|
GAD-8 Score
|
|
|
Adult ADHD
|
|
|
Adult ADHD Evaluation (ASRSv1.1)
|
|
|
Part A
|
1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
|
|
2. How often do you have difficulty getting things in order when you have to do a task that requires organization?
|
3. How often do you have problems remembering appointments or obligations?
|
|
4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
|
5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
|
|
6. How often do you feel overly active and compelled to do things, like you were driven by a motor?
|
|
|
Score
|
|
|
Part B
|
7. How often do you make careless mistakes when you have to work on a boring or difficult project?
|
|
8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
|
9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
|
|
10. How often do you misplace or have difficulty finding things at home or at work?
|
11. How often are you distracted by activity or noise around you?
|
|
12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
|
13. How often do you feel restless or fidgety?
|
|
14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
|
15. How often do you find yourself talking too much when you are in social situations?
|
|
16. When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to?
|
17. How often do you have difficulty waiting your turn in situations when turn taking is required?
|
|
18. How often do you interrupt others when they are busy?
|
|
