|
PHQ9
|
|
|
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
|
|
|
GAD-7
|
|
|
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
|
|
|
Total Sum of 1 - Several Days
|
|
|
Total Sum of 2 - More than half the days
|
|
|
Total Sum of 3 - Nearly every day
|
|
|
Transcranial Magnetic Stimulation Screening Questionnaire
|
|
|
1) Do you have epilepsy?
|
If yes, please specify
|
|
2) Have you ever had a convulsion or a seizure?
|
If yes, please specify
|
|
3) Does someone in your family have epilepsy?
|
If yes, how are you related to this person?
|
|
4) Have you ever lost consciousness without any known reason?
|
If yes, please describe when and how this occurred
|
|
5) Have you ever had a severe head trauma?
|
If yes, please specify
|
|
6) Have you ever had a stroke?
|
If yes, please specify
|
|
7) Have you ever undergone surgery to your head?
|
If yes, please specify
|
|
8) Do you have any deviations of the spinal cord, bone marrow, or the ventricular system (spaces in the brain filled with liquid
|
If yes, please specify
|
|
9) Do you have any hearing disabilities or ringing in your ears?
|
If yes, please specify
|
|
10) Have you ever (at present or in the past) suffered from a brain-related, neurological illness?
|
If yes, please specify
|
|
11) Do you suffer from frequent severe headaches?
|
If yes, please describe how often, and on which occasions
|
|
12) Are you pregnant, or is there a chance that you might be?
|
|
|
13) Have you ever undergone an MRI for clinical purposes?
|
|
|
If yes, did any problems occur during scanning?
|
If yes, please specify
|
|
14) Have you ever undergone TMS?
|
|
|
If yes, have you ever had an adverse reaction to TMS?
|
If yes, please specify
|
|
Self Reporting Vanderbilt
|
|
|
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?
|
|
|
Now add up the total for your answers in Part A using the number in parentheses next to each answer you selected.
|
|
|
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?
|
|
|
Now add up the total for your answers in Part B using the number in parentheses next to each answer you selected
|
|
|
Autism Screening Adult
|
|
|
The Adult Autism Spectrum Quotient (AQ) Ages 16+
|
|
|
If the result indicate that you have a diagnosis of autism
|
|
|
(including Asperger’s Syndrome which is know known as high functioning autism,
|
|
|
you will need to pay a fee for a formal face to face assessment with one of our psychologists to confirm the diagnosis.
|
|
|
How to fill out the questionnaire
|
|
|
Please read each statement very carefully and rate how strongly you agree or disagree with it by selecting your answer.
|
|
|
1. I prefer to do things with others rather than on my own.
• • •
|
|
|
2. I prefer to do things the same way over and over again.
• • •
|
|
|
3. If I try to imagine something, I find it very easy to create a picture in my mind.
• • •
|
|
|
4. I frequently get so strongly absorbed in one thing that I lose sight of other things.
• • •
|
|
|
5. I often notice small sounds when others do not.
• • •
|
|
|
6. I usually notice car number plates or similar strings of information.
• • •
|
|
|
7. Other people frequently tell me that what I’ve said is impolite, even though I think it is polite.
• • •
|
|
|
8. When I’m reading a story, I can easily imagine what the characters might look like.
• • •
|
|
|
9. I am fascinated by dates.
• • •
|
|
|
10. In a social group, I can easily keep track of several different people’s conversations.
• • •
|
|
|
11. I find social situations easy.
• • •
|
|
|
12. I tend to notice details that others do not.
• • •
|
|
|
13. I would rather go to a library than a party.
• • •
|
|
|
14. I find making up stories easy.
• • •
|
|
|
15. I find myself drawn more strongly to people than to things.
• • •
|
|
|
16. I tend to have very strong interests which I get upset about if I can’t pursue.
• • •
|
|
|
17. I enjoy social chit-chat.
• • •
|
|
|
18. When I talk, it isn’t always easy for others to get a word in edgeways.
• • •
|
|
|
19. I am fascinated by numbers.
• • •
|
|
|
20. When I’m reading a story, I find it difficult to work out the characters’ intentions.
• • •
|
|
|
21. I don’t particularly enjoy reading fiction.
• • •
|
|
|
22. I find it hard to make new friends.
• • •
|
|
|
23. I notice patterns in things all the time.
• • •
|
|
|
24. I would rather go to the theatre than a museum.
• • •
|
|
|
25. It does not upset me if my daily routine is disturbed.
• • •
|
|
|
26. I frequently find that I don’t know how to keep a conversation going.
• • •
|
|
|
27. I find it easy to “read between the lines” when someone is talking to me.
• • •
|
|
|
28. I usually concentrate more on the whole picture, rather than the small details.
• • •
|
|
|
29. I am not very good at remembering phone numbers.
• • •
|
|
|
30. I don’t usually notice small changes in a situation, or a person’s appearance.
• • •
|
|
|
31. I know how to tell if someone listening to me is getting bored.
• • •
|
|
|
32. I find it easy to do more than one thing at once
• • •
|
|
|
33. When I talk on the phone, I’m not sure when it’s my turn to speak.
• • •
|
|
|
34. I enjoy doing things spontaneously.
• • •
|
|
|
35. I am often the last to understand the point of a joke.
• • •
|
|
|
36. I find it easy to work out what someone is thinking or feeling just by looking at their face.
• • •
|
|
|
37. If there is an interruption, I can switch back to what I was doing very quickly.
• • •
|
|
|
38. I am good at social chit-chat.
• • •
|
|
|
39. People often tell me that I keep going on and on about the same thing.
• • •
|
|
|
40. When I was young, I used to enjoy playing games involving pretending with other children.
• • •
|
|
|
41. I like to collect information about categories of things (e.g. types of car, types of bird, types of train, types of plan, t
• • •
|
|
|
42. I find it difficult to imagine what it would be like to be someone else.
• • •
|
|
|
43. I like to plan any activities I participate in carefully.
• • •
|
|
|
44. I enjoy social occasions.
• • •
|
|
|
45. I find it difficult to work out people’s intentions.
• • •
|
|
|
46. New situations make me anxious.
• • •
|
|
|
47. I enjoy meeting new people.
• • •
|
|
|
48. I am a good diplomat.
• • •
|
|
|
49. I am not very good at remembering people’s date of birth.
• • •
|
|
|
50. I find it very easy to play games with children that involve pretending.
• • •
|
|
|
BSDS Self English V1
|
|
|
BSDS
|
|
|
Instructions
|
|
|
1. Please read through the entire passage below before answering.
|
|
|
Some individuals notice that their mood and/or energy levels shift drastically from time to time
|
|
|
These individuals notice that, at times, their mood and/or energy level is very low, and at other times, very high
|
|
|
During their ‘‘low’’ phases, these individuals often feel a lack of energy; a need to stay in bed or get extra sleep; and littl
|
|
|
They often put on weight during these periods
|
|
|
During their low phases, these individuals often feel ‘‘blue’’, sad all the time, or depressed
|
|
|
Sometimes, during these low phases, they feel hopeless or even suicidal
|
|
|
Their ability to function at work or socially is impaired
|
|
|
Typically, these low phases last for a few weeks, but sometimes they last only a few days
|
|
|
Individuals with this type of pattern may experience a period of ‘‘normal’’ mood in between mood swings, during which their mood
|
|
|
They may then notice a marked shift or ‘‘switch’’ in the way they feel
|
|
|
NewYesNoTheir energy increases above what is normal for them, and they often get many things done they would not ordinarily be a
|
|
|
Sometimes, during these ‘‘high’’ periods, these individuals feel as if they have too much energy or feel ‘‘hyper’’
|
|
|
Some individuals, during these high periods, may feel irritable, ‘‘on edge’’, or aggressive
|
|
|
Some individuals, during these high periods, take on too many activities at once
|
|
|
During these high periods, some individuals may spend money in ways that cause them trouble
|
|
|
They may be more talkative, outgoing, or sexual during these periods
|
|
|
Sometimes, their behavior during these high periods seems strange or annoying to others
|
|
|
Sometimes, these individuals get into difficulty with co-workers or the police, during these high periods
|
|
|
Sometimes, they increase their alcohol or non-prescription drug use during these high periods
|
|
|
2. Now that you have read this passage, please select one of the following options
|
|
|
3. Now please go back and select YES after each sentence that definitely describes you, otherwise select NO.
|
|
|
Each "YES" is worth one point.
|
|
|
Add 6 points for ‘‘fits me very well"
|
|
|
Add 4 points for ‘‘fits me fairly well’’
|
|
|
Add 2 points for ‘‘fits me to some degree’’
|
|
|
BSDS Score
|
|
|
Total score Likelihood of bipolar disorder
|
|
|
0 – 6 Highly unlikely
|
7 – 12 Low risk
|
|
13– 19 Moderate risk
|
20– 25 High risk
|
|
Optimum threshold for positive diagnosis: score of 13 or above.
|
|
|
Sensitivity to Bipolar I & II: .75
|
|
|
Specificity in unipolar depressed outpatients: .93
|
|
|
Diagnostic Likelihood for Positive (DLR+): 10.7
|
|
|
Diagnostic Likelihood for Positive (DLR+): .27
|
|
