patient initials: visit date (mm/dd/yyyy): · pdf filepage 1 of 29 camp selected sections* of...

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CAMP

SELECTED SECTIONS* OF THE

STRUCTURED CLINICAL INTERVIEW FOR DSM-IV AXIS I DISORDERS

CLINICIAN VERSION SCID-I

Michael B. First, M.D. Robert L. Spitzer, M.D. Miriam Gibbon, M.S.W. Janet B. W. Williams, D.S.W. *Modified and used with the permission of the authors. Selected modules were modified to examine disorders that have occurred during the past 5 years, and to give instructions specific to the CAMP project. The modules used include: Module A (Mood Episodes, modified to include the sections that cover Major Depressive, Manic, and Hypomanic Episodes, and Mood Disorder Due to a General Medical Condition or Substance Use), and Module B-E,. The E module was modified to have Substance Dependence Disorders screened first, followed by Substance Abuse Disorders. The B module was modified by the addition of 3 optional questions to item B5 to inquire for other delusions common in schizophrenia.

Instructions: Complete the Demographics source document and items 13-17 from the SCID/Psychiatric History source document to collect basic demographic and treatment information for the study subject. Also, review the Medical History source document and Physical Exam source document to rule out psychiatric disorder due to a general medical condition. Use the results of the SCID interview to score items 1-12 of the SCID/Psychiatric History source document. PLEASE NOTE THAT YOU SHOULD RECORD DSM IV DISORDERS THAT HAVE BEEN ACTIVE DURING THE PAST 5 YEARS. Disorders that occurred more than 5 years ago and have not been active during the past 5 years are not recorded on the SCID/Psychiatry History source document.

PATIENT INITIALS: VISIT DATE (MM/DD/YYYY):

PATIENT NUMBER: RATER INITIALS:

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OVERVIEW OCCUPATIONAL HISTORY 1 What kind of work do you do? Are you

working now? IF YES: How long have you worked there? (IF LESS THAN 6 MONTHS: Why did you leave your last job?) Have you always done that kind of work? IF NO: Why is that? What kind of work have you done before? How are you supporting yourself now?

2 IF UNKNOWN: Has there ever been a period of time when you were unable to work or go to school? IF YES: When? Why was that?

CHIEF COMPLAINT AND DESCRIPTION OF PROBLEM 3 What led to your coming here (this time)?

(What is the major problem you are having trouble with?) IF DOES NOT GIVE DETAILS OF PRESENTING PROBLEM: Tell me more about that. (What do you mean by…?)

ONSET OF PRESENT ILLNESS OR EXACERBATION 4 When did this begin? (When did you first

notice that something was wrong?) When were you last feeling OK (Your usual self)?

NEW SYMPTOMS OR RECURRENCE 5 If this something new or a return of

something you had before? (What made you come for help now?)

ENVIRONMENTAL CONTEXT AND POSSIBLE PRECIPITANTS 6 Did anything happen or change just before

this all started? (Do you think this had anything to do with your [PRESENT ILLNESS])? What other kinds of problems were you having when this began?

COURSE OF PRESENT ILLNESS OR EXACERBATION 7 After it started, what happened next? (Did

other things start to bother you?)

8 Since this began, when have you felt the worst? IF MORE THAN A YEAR AGO: In the last year, when have you felt the worst?

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OTHER CURRENT PROBLEMS 9 Have you had any other problems in the

past month?

10 What has your mood been like?

11 Do you take any medications, herbal treatments, or vitamins (other than those you have already told me about)? IF YES: How much and how often do you take [MEDICATION]? (Has there been any change in the amount you have been taking?)

12 How much have you been drinking [alcohol] [in the past month]? Have you been taking any drugs [in the past month]? (What about marijuana, cocaine, other street drugs?)

CURRENT SOCIAL FUNCTIONING P13 How have you been spending your free

time? Whom do you spend time with?

OVERVIEW DIAGNOSES P25 MOST LIKELY CURRENT DIAGNOSES:

P26 DIAGNOSES THAT NEED TO BE RULED OUT:

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A. MOOD EPISODES MAJOR DEPRESSIVE EPISODE CRITERIA FOR MAJOR DEPRESSIVE EPISODE: A. Five (or

more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

PAST MONTH

PAST 5 YEARS

A1 In the past month… …has there been a period of time when you were feeling depressed or down most of the day, nearly every day? (What was that like?) IF YES: How long did it last? (As long as 2 weeks?)

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g. feels sad or empty) or observation made by others (e.g. appears tearful).

? No* Yes ? No** Yes

A2 …what about losing interest or pleasure in things you usually enjoyed? IF YES: Was it nearly every day? How long did it last? (As long as 2 weeks?)

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).

? No* Yes ? No** Yes

*If neither A1 nor A2 is “Yes” during the current month, check for Major Depressive Episode in the past 5 years by asking questions A1 and A2 again, beginning with “In the past 5 years has there been…” IF AT LEAST ONE PAST DEPRESSED PERIOD: In the past 5 years have you had more than one time like that? Which one was the worst? **If neither A1 nor A2 has been “Yes” in the past 5 years go to A16 (Manic Episode). FOR THE FOLLOWING QUESTIONS, FOCUS ON THE WORST 2-WEEK PERIOD: A3 During [2-week period]…

…did you lose or gain any weight? (How much? Were you trying to lose weight?) IF NO: How was your appetite? (What about compared with your usual appetite: Did you have to force yourself to eat? Eat [less/more] than usual? Was that nearly every day?)

(3) significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.

? No Yes

A4 …how were you sleeping? (Trouble falling asleep, waking frequently, trouble staying asleep, waking too early, OR sleeping too much? How many hours a night compared with usual? Was that nearly every night?)

(4) insomnia or hypersomnia nearly every day

? No Yes

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A5 …were you so fidgety or restless that you

were unable to sit still? (Was it so bad that other people noticed it? What did they notice? Was that nearly every day?) IF NO: What about the opposite- talking or moving more slowly than is normal for you? (Was it so bad that other people noticed it? What did they notice? Was that nearly every day?)

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

? No Yes

A6 …what was your energy like? (Tired all the time? Nearly every day?)

(6) fatigue or loss of energy nearly every day

? No Yes

A7 …how did you feel about yourself? (Worthless? Nearly every day?) IF NO: What about feeling guilty about things you had done or not done? (Nearly every day?)

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) NOTE: CODE “NO“ IF ONLY LOW SELF- ESTEEM

? No Yes

A8 …did you have trouble thinking or concentrating? (What kinds of things did it interfere with? Nearly every day?) IF NO: Was it hard to make decisions about everyday things?

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by objective account or as observed by others)

? No Yes

A9 …were things so bad that you were thinking a lot about death or that you would be better off dead? What about thinking of hurting yourself? IF YES: Did you do anything to hurt yourself?

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without specific plan, or a suicide attempt or a specific plan for committing suicide.

? No Yes

A10 A. AT LEAST FIVE OF ITEMS A1-A9 ARE “Yes” AND AT LEAST ONE OF THESE ITEMS IS A1 OR A2.

? No Yes

If A10 above is “No“ (i.e., fewer than five are “Yes”), ask the following if unknown: “In the past 5 years have there been any other times when you’ve been depressed and had even more of the symptoms that we’ve just talked about”? If “yes” go back to A1 and ask about that episode. If “no” go to A16 (Manic Episode). A11 IF UNCLEAR: Has [the depression/OWN

WORDS] made it hard for you to do your work, take care of things at home, or get along with other people?

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

? No Yes ⇓ A16

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A12 Just before this began, were you

physically ill? Just before this began, were you taking any medications? IF YES: Any change in the amount that you were taking? Just before this began, were you drinking or using any street drugs?

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition.

? No Yes ⇓ *A16

Etiological general medical conditions include degenerative neurological illnesses (e.g. Parkinson’s disease, cerebrovascular disease (e.g. stroke), metabolic conditions (e.g. vitamin B12 deficiency), endocrine conditions (e.g. hyper- and hypothyroidism), viral or other infections (e.g. hepatitis), and certain cancers (e.g. carcinoma of the pancreas). Etiological substances include alcohol, amphetamines, cocaine, hallucinogens, inhalants, opioids, phencyclidine, sedatives, hypnotics, anxiolytics. Medications include antihypertensives, oral contraceptives, corticosteroids, anabolic steroids, anticancer agents, analgesics, anticholinergics, cardiac medications.

*If A12 above is “No“ (i.e., mood is due to substance or general medical condition), ask the following: Have there been any other times when you’ve been depressed and it was not because of [GENERAL MEDICAL CONDITION/SUBSTANCE USE]? If “yes” go back to A1 and ask about that episode. If “no” go to A16. A13 IF UNKNOWN: Did this begin soon after

someone close to you died?

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss [death] of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

? No Yes ⇓ *A16

*If A13 above is “No“ (i.e., the depressed mood is better accounted for by Bereavement), ask the following: “Have there been any other times when you’ve been depressed and it was not because of a loss of a loved one?” If “yes” go back to A1 and ask about that episode. If “no” go to A16 (Manic Episode).

CRITERIA A, C, D, AND E ARE “Yes” (MAKE A DIAGNOSIS OF MAJOR DEPRESSION.)

No Yes A14

IF UNKNOWN: Have you had (SYMPTOMS RATED “Yes” ABOVE) in the past month?

MET CRITERIA FOR MAJOR DEPRESSION IN PAST MONTH

No Yes

A15 How many separate times have you been [depressed/OWN WORDS] nearly every day for at least 2 weeks and had several of the symptoms that you just described, such as [SYMPTOMS OF WORST EPISODE]

Total number of Major Depressive Episodes, including current (CODE 99 if too numerous or indistinct to count).

___ ___

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MANIC EPISODE (Note: In order to rule out schizoaffective and bipolar disorder, inquire for lifetime experience of manic symptoms. ) A16 Have you ever had a period of time when

you were feeling so good, high, excited, or hyper that other people thought you were not your normal self or you got into trouble? (Did anyone say you were manic? Was that more than just feeling good?) What was that like? IF NO: What about a period of time when you were so irritable that you found yourself shouting at people or starting fights or arguments? (Did you find yourself yelling at people you didn’t really know?)

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood…

? No Yes ⇓ B1

A17 How long did that last? (As long as 1 week? Did you have to go into the hospital?)

…lasting at least 1 week (or any duration if hospitalization is necessary)

? No Yes ⇓ A30

During [PERIOD OF WORST MANIC SYMPTOMS]…

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

A18 …how did you feel about yourself? (More self-confident than usual? Any special powers or abilities?)

(1) inflated self-esteem or grandiosity

? No Yes

A19 …did you need less sleep than usual? IF YES: Did you still feel rested?

(2) decreased need for sleep (e.g. feels rested after only 3 hours of sleep)

? No Yes

A20 …were you more talkative than usual? (Did people have trouble stopping you or understanding you? Did people have trouble getting a word in edgewise?)

(3) more talkative than usual or pressure to keep talking

? No Yes

A21 …were your thoughts racing through your head?

(4) flight of ideas or subjective experience that thoughts are racing

? No Yes

A22 …were you so easily distracted by things around you that you had trouble concentrating or staying on one track?

(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

? No Yes

A23 …how did you spend your time? (Work, friends, hobbies? Were you so active that your friends or family were concerned about you?) IF NO INCREASED ACTIVITY: Were you physically restless? (How bad was it?)

(6) increase in goal-directed activity (socially, at work or school, or sexually) or psychomotor agitation

? No Yes

A24 …did you do anything that could have caused trouble for you or your family? (Buying things you didn’t need? Anything sexual that was unusual for you? Reckless driving?)

(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

? No Yes

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A25 B. AT LEAST THREE OF ITEMS A18-A24 ARE “Yes” (OR FOUR IF MOOD IS IRRITABLE AND NOT ELEVATED)

? No Yes ⇓ *B1

*If A25 above is “No“ (i.e., fewer than three are “Yes”) ask the following: “Have there been any other times when you were [high/irritable/OWN WORDS] and had even more of the symptoms that we’ve just talked about?” If “yes,” go back to A16 and ask about that episode. If “no” go to B1 (Psychotic and Associated Symptoms). A26 IF NOT KNOWN; At that time, did you have

serious problems at home or at work (school) because you were [SYMPTOMS] or did you have to go into a hospital?

C. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

? No* Yes

*If A26 above is “No“ (i.e., not sufficiently severe) ask the following: Have there been any other times when you were [high/irritable/OWN WORDS] and you got into trouble with people or were hospitalized? If “yes,” go back to A16 and ask about that episode. If “no” go to A39 (Criterion C for Hypomanic Episode).

A27 Just before this began, were you physically

ill? Just before this began, were you taking any medications? IF YES: Any change in the amount that you were taking? Just before this began, were you drinking or using any street drugs?

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition*.

? No* Yes

*If A27 above is “No“ (i.e., the mania is due to a substance or general medical condition) ask the following: “Have there been any other times when you were [high/irritable/OWN WORDS] and you were not [physically ill/taking medication/using SUBSTANCE]?” If “yes,” go back to A16 and ask about that episode. If “no” go to A39 (Criterion C for Hypomanic Episode).

*Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g. medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder but are considered Substance-Induced Mood Disorders. Etiological general medical conditions include degenerative neurological illnesses (e.g. Huntington’s Disease, Multiple Sclerosis), cerebrovascular disease (e.g. stroke), metabolic conditions (e.g. vitamin B12 deficiency, Wilson’s disease), endocrine conditions (e.g., hyperthyroidism), viral or other infections, and certain cancers (e.g., cerebral neoplasms). Etiological substances include alcohol, amphetamines, cocaine, hallucinogens, inhalants, opioids, phencyclidine, sedatives, hypnotics, and anxiolytics. Medications include psychotropic medications (e.g. antidepressants), antihypertensives, oral contraceptives, corticosteroids, anabolic steroids, isoniazid, antiparkinson medication (e.g. levodopa), and sympathomimetics/decongestants.

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CRITERIA A, B, C, AND D ARE “Yes” (MAKE A DIAGNOSIS OF MANIC EPISODE)

No Yes A28

IF UNKNOWN ; Have you had [SYMPTOMS RATED “Yes” ABOVE] in the past month?

ARE MANIC SYMPTOMS PRESENT IN THE PAST MONTH?

No Yes

A29 How many separate times were you [HIGH/OWN WORDS] and had [ACKNOWLEDGED MANIC SYPTOMS] for at least a week (or were hospitalized)?

Total number of Manic Episodes, including current (CODE 99 if too indistinct or numerous to count)

___ ___ GO TO B1

HYPOMANIC EPISODE (Only inquire if suspect hypomania.) A30 IF UNKNOWN: When you were

[high/irritable/OWN WORDS], did it last for at least 4 days? Have you had more than one time like that” (Which time were you the most [high/irritable/OWN WORDS]?) FOR ITEMS A31-A37 FOCUS ON THE MOST EXTREME EPISODE

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.

? No Yes ⇓ B1

A31 …how did you feel about yourself? (More self-confident than usual? Any special powers or abilities?)

(1) inflated self-esteem or grandiosity ? No Yes

A32 …did you need less sleep than usual? IF YES: did you feel rested?

(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

? No Yes

A33 …were you much more talkative than usual? (Did people have trouble stopping you or understanding you? Did people have trouble getting a word in edgewise?)

(3) more talkative than usual or pressure to keep talking

? No Yes

A34 …were your thoughts racing through your head?

(4) flight of ideas or subjective experience that thoughts are racing

? No Yes

A35 …were you so easily distracted by things around you that you had trouble concentrating or staying on one track?

(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

? No Yes

A36 …how did you spend your time? (Work,

friends, hobbies? Were you so active that your friends or family were concerned about you?) IF NO INCREASED ACTIVITY: Were you physically restless? (How bad was it)

(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

? No Yes

A37 …did you do anything that could have caused trouble for you or your family? (Buying things you didn’t need? Anything sexual that was unusual for you? Reckless driving?)

(7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

? No Yes

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A38 B. AT LEAST THREE OF A(31)-A(37) ARE “Yes” (OR FOUR IF MOOD IS IRRITABLE AND NOT ELEVATED)

? No Yes ⇓ B1

If A38 is “No“ (i.e., fewer than three are “Yes”), ask the following: Have there been any other times when you were [high/irritable/OWN WORDS] and had even more of the symptoms that we’ve just talked about? If “yes”, go back to A30 and ask about that episode. If “no” go to B1 (Psychotic Disorder). A39 IF UNKNOWN; Is this very different from the

way you usually are? (How were you different? At work? With friends?

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

? No Yes ⇓ B1

If A39 is “No“ (i.e., characteristically “hypomanic”) ask the following: Have there been any other times when you were [high/irritable/OWN WORDS] and you were really different from the way you usually are? If “yes” go back to A30 and ask about that episode. If “no” go to B1 (Psychotic Disorder). A40 IF UNKNOWN: Did other people notice the

change in you? (What did they say?) D. The disturbance in mood and the change in functioning are observable by others.

? No Yes ⇓ B1

If A40 “No“ (i.e., not observable by others). Have there been any other times when you were [high/irritable/OWN WORDS] and other people did notice the change in the way you were acting? If “yes” go back to A30 and ask about that episode. If “no” go to B1 (Psychotic Disorder).

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A41 IF UNKNOWN: At the time, did you have

serious problems at home or at work (school) because you were [SYMPTOMS] or did you have to go into a hospital

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

? No Yes ⇓ A26

If A41 is “No“ (i.e., severe enough to cause marked impairment), go back to A26, code “Yes” for that item, and continue with A27.

A42 Just before this began, were you physically

ill? Just before this began, were you taking any medications? IF YES: Any change in the amount you were taking? Just before this began, were you drinking or using any street drugs? Is there is any indication that the hypomania may be secondary (i.e., a direct physiological consequence of general medical condition or substance).

F. The symptoms are not due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication) or a general medical condition.

? No Yes ⇓ A45

A43 CRITERIA A, B, C, D, E, AND F ARE “Yes” (MAKE A DIAGNOSIS OF HYPOMANIC EPISODE)

No Yes

A44 How many separate times were you [high /irritable/OWN WORDS] and had [ACKNOWLEDEMENT HYPOMANIC SYMPTOMS] for a period of time?

Total number Hypomanic Episodes (CODE 99 if too indistinct or numerous to count)

___ ___ ⇒ B1

MOOD DISORDER DUE TO A GENERAL MEDICAL CONDITION OR SUBSTANCE USE (ONLY INQUIRE IF SUSPECT THIS DIAGNOSIS) A45 A. A prominent and persistent disturbance in mood predominant in the clinical

picture and by either (or both) of the following: (1) depressed mood or markedly diminished interest or pleasure in all, or almost

all, activities (2) elevated, expansive, or irritable mood

? No Yes

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A46 B. Either: There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition, Or There is evidence from the history, physical examination, or laboratory findings of either (1) or (2): (1) the symptoms in criterion A developed during, or within a month of, substance

intoxication or withdrawal (2) medication use is etiologically related to the disturbance.

? No Yes

A47 D. The disturbance is not better accounted for by another mental disorder. ? No Yes A48 E. The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning. ? No Yes

A49 CRITERIA A, B, C, AND E ARE “YES” (MAKE A DIAGNOSIS OF MOOD DISORDER DUE TO A GENERAL MEDICAL CONDITION OR SUBSTANCE USE) (This diagnosis is not scored on SCID/Psychiatric History source document.)

No Yes

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B. PSYCHOTIC AND ASSOCIATED SYMPTOMS DELUSIONS: False personal beliefs based on incorrect inference about external reality and firmly sustained in spite of what almost everyone else believes and in spite of what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture. Do not consider as delusions unreasonable and sustained beliefs that are maintained with less than delusional intensity (‘’overvalued ideas”). B1 Now I am going to ask you about unusual

experiences that people sometimes have. Has it ever seemed like people were talking about you or taking special notice of you? (Has it ever seemed as if someone on the radio, TV, or newspaper is sending you a special message?)

Delusion of reference; i.e., events, objects, or other people in the individual’s environment have a particular or unusual significance that is clearly unwarranted.

? No Yes

B2 What about anyone going out of his or her way to give you a hard time, or trying to hurt you?

Persecutory delusion; i.e., the individual (or his or her group) is being attacked, cheated, persecuted, or conspired against.

? No Yes

B3 Did you ever feel that you were especially important in some way, or that you had special powers to do things that other people couldn’t do? (Do you have a special relationship with someone who is famous? Do you have a special relationship with God?)

Grandiose delusion; i.e., content involves exaggerated power, knowledge, or importance, or a special relationship to a deity or famous person.

? No Yes

B4 Did you ever feel that something was very wrong with you physically even though your doctor said nothing was wrong…like you had cancer or some terrible disease? Have you ever been convinced that something was very wrong with the way a part or parts of you body looked? (Did you ever feel that something strange was happening to parts of your body?)

Somatic delusion; i.e., content involves change or disturbance in body appearance of functioning.

? No Yes

B5 (Did you ever have any unusual religious experiences?) Did you ever feel that… (…you had committed a crime or done something terrible for which you should be punished?) (…someone or something outside yourself was controlling your thoughts or actions against your will?) (…someone could read your mind? …you could read someone else’s mind?) (…certain thoughts that were not your own were put into your head? What about taken out of your head? How about that your thoughts were broadcast out loud so that other people could hear them?) (Do you have any other beliefs that most people would consider unusual?)

Other delusions; i.e., religious, jealous, erotomanic, delusions of guilt, delusions of being controlled, thought broadcasting, thought insertion, thought withdrawal. (Check here if delusions are bizarre, i.e. that involve a phenomenon that the person’s culture would regard as totally implausible.:___)

? No Yes

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HALLUCINATIONS: A sensory perception that has the compelling sense of reality of a true perception but occurs without external stimulation or the relevant sensory organ. B6 Did you hear things that other people

couldn’t hear, such as noises, or the voices of people whispering or talking.. IF YES: What did you hear? How often did you hear it?

Auditory hallucinations when fully awake, heard either inside or outside the head. (Check if voices give a running commentary on patient’s thoughts and behavior ___)

? No Yes

B7 Did you ever have visions or see things that other people couldn’t see? (Were you awake at the time?)

Visual hallucinations. ? No Yes

B8 What about strange sensations in your body or on your skin?

Tactile hallucinations, e.g., electricity.

? No Yes

B9 What about smelling or tasting things that other people couldn’t smell or taste?

Other hallucinations, e.g., gustatory, olfactory.

? No Yes

THE REMAINDER OF THE ITEMS IN THIS SECTION ARE OBSERVATIONAL OR BY HISTORY Let me stop for a minute

while I make a few notes.

B10 Catatonia; e.g., catalepsy, stupor, catatonic agitation, negativism, mutism, posturing, stereotyped movements, echolalia (senseless repeating or echoing the words of another), echopraxia (senseless, uncontrolled imitation of the movements of others).

? No Yes

B11 Grossly disorganized behavior; e.g., markedly disheveled appearance, grossly inappropriate sexual behavior, unpredictable or untriggered agitation.

? No Yes

B12 Grossly inappropriate affect; e.g., smiling while discussing being persecuted. ? No Yes B13 Disorganized speech; e.g., frequent derailment (loosening of associations) or

incoherence. ? No Yes

B14 Negative symptoms; i.e., affective flattening, alogia (poverty of thought, as indicated by poverty in content or production of speech), avolition (inability to initiate or sustain goal directed activities).

? No Yes

CHRONOLOGY OF PSYCHOTIC SYMPTOMS If any delusions or hallucinations, note type, course, onset and offset dates, and whether present during past month (e.g., “bizarre delusions of being controlled by aliens, present intermittently, onset 1969, offset June 1993”) Type of symptoms Course Onset Offset Present during past month? ____________________ __________________________ ________ ________ ________ ____________________ __________________________ ________ ________ ________ ____________________ __________________________ ________ ________ ________ ____________________ __________________________ ________ ________ ________ ____________________ __________________________ ________ ________ ________

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C. DIFFERENTIAL DIAGNOSIS OF PSYCHOTIC DISORDERS C1 Psychotic symptoms occur at times other than during Major Depressive,

Manic, and Mixed Episodes. The following question may be asked for clarification: IF MAJOR DEPRESSIVE, MANIC, OR MIXED EPISODE HAS EVER BEEN PRESENT; “Has there ever been a time when you had [PSYCHOTIC SYMPTOMS] and you were not [DEPRESSED/MANIC]?”

No Yes ⇓ ⇓ D1 C2

SCHIZOPHRENIA CRITERIA C2 A. Two (or more) of the following, (only one symptom required if delusions are

bizarre* or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other), each present for a significant portion of time during a 1-month period (or less if successfully treated).

(1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior (5) negative symptoms i.e., affective flattening, alogia, or avolition *Bizarre delusions involve a phenomenon that the person’s culture would regard as totally implausible. For example, a bizarre delusion would be that the patient’s mother has been replaced by an exact double, or that the patient’s internal organs are all removed. A non-bizarre delusion would be that the patient is under surveillance, or that someone is poisoning him/her.

No Yes ⇓ C15

C3 D. Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out because either: (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with

the active-phase symptoms (i.e., the “A” symptoms listed in C2). The following question may be asked for clarification: Has there ever been a time when you had [PSYCHOTIC SYMPTOMS] at the same time that you were depressed/high/irritable/OWN WORDS]? (2) If mood episodes have occurred concurrently during active-phase symptoms,

their total duration has been brief relative to the duration of the active and residual periods.

Question for clarification: How much of the time that you have had [SYMPTOMS FROM ACTIVE AND RESIDUAL PHASES] would you say you have also been depressed/high/irritable/OWN WORDS?”

NOTE: Answer “yes” if …: 1. …there have never been any Major Depressive, Manic, or Mixed Episodes, 2. …if all such episodes occurred during the prodromal or residual phase, 3. …or if episodes overlap with psychotic symptoms AND the mood symptoms are

NOT a significant part of the total disturbance.

No Yes ⇓ C8

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C4 C. Continuous signs of the disturbance persist for at least 6 MONTHS. This 6-month period must include at least one month of symptoms (or less if successfully treated that meet criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms (i.e., affective flattening, alogia, avolition) or two or more symptoms listed in criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Question for clarification: Between [MULTIPLE EPISODES], were you back to your normal self? How long did each episode last?

No Yes ⇓ C13

C5 B. For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood, or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

No Yes ⇓ C15

C6 E. The disturbance is not due to the direct physiological effects of a substance* (e.g., a drug abuse, a medication) or general medical condition*.

Questions for clarification: Were you taking any drugs or medicines during this time? Were you physically ill at this time?

No Yes ⇓ C26

?If C6 “No“ (i.e., psychotic symptoms likely due to the direct effects of a substance or medical condition), go back to C2 and determine whether there are psychotic symptoms that are not due to a substance or general medical condition. Otherwise, go to C32. *Etiological general medical conditions include neurological conditions (e.g., neoplasms, cerebrovascular disease, Huntington’s Disease, epilepsy, auditory nerve injury, deafness, migraine, central nervous system infections), endocrine conditions (e.g., hyper-and hypothyroidism, hyper-or hypoparathyroidism, hypocortisolism), metabolic conditions, (e.g., hypoxia, hypercarbia, hypoglycemia), fluid or electrolyte imbalances, hepatic or renal diseases, and autoimmune disorders with central nervous involvement (e.g., systemic lupus erythematosis). Etiological substance include alcohol, amphetamine, cannabis, cocaine, hallucinogens, inhalants, opioids (meperidine), phencyclidine, sedatives, hypnotics, anxiolytics, and other or unknown substances. C7 CRITERIA A,B,C,D, AND E ARE MET:

PATIENT MEETS DIAGNOSTIC CRITERIA FOR SCHIZOPHRENIA, AND THUS MEETS DIAGNOSTIC CRITERIA FOR THE CAMP TRIAL. (Score on SCID/Psychiatric History source document.)

No Yes ⇓ D13

SCHIZOAFFECTIVE DISORDER CRITERIA C8 A. An uninterrupted period of illness during which, at some time, there is either a

Major Depressive Episode (which must include A(1) (depressed mood), a Manic, or a Mixed Episode concurrent with symptoms that meet criterion A for schizophrenia.

No Yes ⇓ C31

C9 B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

Question for clarification: Have there been any times when you had [PSYCHOTIC SYMPTOMS] when you were not [MANIC OR DEPRESSED]?

No Yes ⇓ C31

C10 C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the duration of the active and residual periods of the illness

No Yes ⇓ C31

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C11 D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medial condition. NOTE: Refer to list of general medical questions and substances in items C6.

Questions for clarification: Were you taking any drugs or medicines during this time? Were you physically ill at this time?

No Yes ⇓ C26

C12 CRITERIA A, B, C, AND D ARE MET PATIENT MEETS DIAGNOSTIC CRITERIA FOR SCHIZOAFFECTIVE DISORDER, AND THUS MEETS DIAGNOSTIC CRITERIA FOR THE CAMP TRIAL. (Score on SCID/Psychiatric History source document.)

Yes ⇓ D13

EXCLUSIONARY DIAGNOSES

SCHIZOPHRENIFORM DISORDER CRITERIA C13 A. An episode of the disorder (including prodromal, active, residual phase) lasts at

least 1 month but less than 6 months. Question for clarification: How long did [PSYCHOTIC SYMPTOMS] last?

No Yes ⇓ C21

C14 B. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug abuse, a medication) or a general medical condition. Questions for clarification: Were you taking any drugs or medicines during this time? Were you physically ill at this time? Refer to list of general medical conditions and substances in item C6. (IF YES: MAKE A DIAGNOSIS OF SCHIZOPHRENIFORM DISORDER).

No Yes ⇓ ⇓ C26 Excluded END SCID

DELUSIONAL DISORDER C15 A. Nonbizzare delusions (i.e., involving situations that occur in real life, such as

being followed, poisoned, infected, loved at a distance, or deceived by a spouse or lover, or having a disease) of at least 1 month’s duration.

No Yes ⇓ C21

C16 B. Criterion A for Schizophrenia has never been met. NOTE: Tactile and olfactory hallucinations may be present in Delusional Disorder if they are related to the delusional theme.

No Yes ⇓ C31

C17 C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.

No Yes ⇓ C31

C18 D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.

Questions for clarification: Has there ever been a time when you have believed [DELUSIONS] at the same time you were [depressed/high/irritable/OWN WORDS]? How much of the time that you have believed [DELUSIONS]. Would you say you have also been [depressed/high/irritable/OWN WORDS]? NOTE: Answer “yes” if 1) there have never been any mood episodes at all, 2) mood episodes occurred at times other than during delusional periods, or 3) mood episodes were brief relative to total duration of the delusional periods. Answer “no” if symptoms meeting criteria for mood episodes have been present for a substantial portion of the total duration of the disturbance.

No Yes ⇓ C8

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C19 E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. NOTE: Refer to list of general medical conditions and substances in item C6, page 31.

Questions for clarification: Were you taking any drugs or medicines during this time? Were you physically ill at the time?

No Yes ⇓ C26

C20 CRITERIA A, B, C, AND E ARE MET (MAKE DIAGNOSIS OF DELUSIONAL DISORDER).

Yes ⇓ Excluded END SCID

BRIEF PSYCHOTIC DISORDER C21 A. Presence of one (or more) of the following symptoms:

(1) Delusions (2) Hallucinations (3) Disorganized speech (e.g., frequent derailment or incoherence) (4) Grossly disorganized or catatonic behavior

No Yes ⇓ C31

C22 B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with an eventual full return to premorbid level of functioning.

No Yes ⇓ C31

C23 C (1) The disturbance is not better accounted for by a Mood Disorder With Psychotic Features (see D1), Schizoaffective Disorder (see C8), or Schizophrenia (see C2).

No Yes ⇓ D1 C8 C2

C24 C (2) The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or the direct physiological consequence of a general medical condition. NOTE: Refer to list of general medical conditions and substances in item C6.

Questions for clarification: Were you talking any drugs or medicines during this time? Were you physically ill at this time?

No Yes ⇓ C26

C25 CRITERIA A, B, AND C ARE MET (MAKE A DIAGNOSIS OF BRIEF PSYCHOTIC DISORDER).


PSYCHOTIC DISORDER DUE TO A GENERAL MEDICAL CONDITION OR SUBSTANCE USE C26 A. Prominent hallucinations or delusions.

(CODE BASED ON INFORMATION ALREADY OBTAINED) No Yes ⇓ D1

C27 B (1). There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition, and the disturbance is not better accounted for by another mental disorder.

No Yes

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C28 B (2). There is evidence from the history, physical examination, or laboratory findings of either: 1. the symptoms in criterion A developed during, or within a month of,

Substance Intoxication or Withdrawal, or 2. medication use is etiologically related to the disturbance.

No Yes ⇓ C31

C29 C. The disturbance is not better accounted for by a Psychotic Disorder that is not substance induced or due to a general medical conditon. If the disturbance is better accounted for by a non-substance-induced psychotic disorder, return to the disorder being evaluated. Evidence that the symptoms are better accounted for by a Psychotic Disorder that is not substance induced include: (1) the psychotic symptoms precede the onset of the substance or medication

use or the general medical condition (2) the psychotic symptoms persist for a substantial period of time (e.g., about a

month) after the cessation of acute withdrawal or severe intoxication. (3) the psychotic symptoms are substantially in excess of what would be

expected given the type or amount of the substance used or the duration of use.

(4)there is other evidence that suggests the existence of an independent non-substance-induced Psychotic Disorder (e.g., a history of recurrent non-substance related psychotic episodes).

No Yes

C30 CRITERIA A, B, AND C ARE MET (MAKE A DIAGNOSIS OF SUBSTANCE INDUCED PSYCHOTIC DISORDER OR DUE TO A GENERAL MEDICAL CONDITION.)


PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED C31 This category should be used to diagnose psychotic symptomatology (i.e.,

delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) about which there is inadequate information to make a specific diagnosis or about which there is contradictory information, or disorders with psychotic symptoms that do not meet the criteria for any specific Psychotic Disorder defined above.

No Yes ⇓ ⇓ D1 Excluded END SCID

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D. MOOD DISORDERS BIPOLAR I DISORDER CRITERIA (BPAD) If there have never been clinically significant mood symptoms, go to Module E. D1 History of one or more Manic or Mixed Episodes (see A28)

NOTE: In a Mixed Episode, the criteria are met for both a Manic Episode and a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

No Yes ⇓ D4

D2 At least one Manic or Mixed Episode is not due to the direct physiological effects of a general medical condition or substance use. NOTE: Manic-Like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

No Yes ⇓ D4

D3 At least one Manic or Mixed Episode is not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

No Yes ⇓ ⇓ C2 BPAD Excluded END SCID

BIPOLAR II DISORDER CRITERIA (BPAD2) D4 At least one Hypomanic Episode is not due to the direct physiological effects of a

general medical condition or substance use (including somatic antidepressant treatment) (see A42).

No Yes ⇓ D8

D5 At least on Major Depressive Episode is not due to the direct physiological effects of a general medical condition or substance use (see A14).

No Yes ⇓ D8

D6 There have never been any Manic or Mixed Episodes. No Yes ⇓ D8

D7 The mood symptoms are not better accounted for by Schizoaffective Disorder (16) and are not superimposed on Schizophrenia (C2), Schizophreniform Disorder (C13), Delusional Disorder (C21), or Psychotic Disorder Not Otherwise Specified (C39).

No Yes ⇓ BPAD2 Excluded END SCID

OTHER BIPOLAR DISORDER CRITERIA (CYCLOTHYMIC DISORDER) (BIPOLAR DISORDER NOS) D8 Clinically significant manic or hypomanic symptoms. No Yes

⇓ D11

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D9 Not due to the direct physiological effects of a general medical condition or

substance (including somatic antidepressant treatment) use.

No Yes ⇓ D11

D10 If UNKNOWN: Have you had [MANIC OR DEPRESSIVE SYMPTOMS] in the past month? Cyclothymic Disorder (must meet all three of the following criteria): A. For at least 2 years, the presence of numerous periods with hypomanic

symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.

B. During the above 2-year period, the person has not been without the symptoms in criterion A for more than 2 months at a time.

C. No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.

Bipolar Disorder Not Otherwise Specified (for disorders with bipolar features that do not meet criteria for any specific Bipolar Disorder)

No Yes ⇓ ⇓ D11 Excluded END SCID

MAJOR DEPRESSIVE DISORDER CRITERIA (MDD) D11 At least one Major Depressive Episode is not due to the direct physiological

effects of a general medical condition or substance use (see A14) No Yes ⇓ D14

D12 There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode. NOTE: In a Mixed Episode, the criteria are met for both a Manic Episode and a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

No Yes ⇓ D14

D13 Patient has met diagnostic criteria for Major Depressive Disorder in past 5 years. *If MDD is co-morbid with schizophrenia, score on SCID/Psychiatric History source document. If current MDD with psychotic features, exclude from CAMP.

No Yes ⇓ ⇓ D14 MDD*

DEPRESSIVE DISORDER NOS CRITERIA D14 Clinically significant depressive symptoms do not meet criteria for a specific

Depressive Disorder or Adjustment Disorder and are not better accounted for by Bereavement.

No Yes

D15 Not due to the direct physiological effects of a general medical condition or substance (including somatic antidepressant treatment) use.

No Yes

D16 Depressive Disorder Not Otherwise Specified (Not scored on SCID/Psychiatric History source document.)

No Yes

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E. ALCOHOL AND OTHER SUBSTANCE USE DISORDERS E1 What are your drinking habits like? (How

much do you drink?) (How often?) (What do you drink?) IF NOT CURRENTLY DRINKING HEAVILY: In the past 5 years has there been a time when you were drinking a lot more? (How often were you drinking) (What were you drinking? How much? How long did that period last?) (Currently/During that time…) …(does/did) your drinking cause problems

for you? …(does/did) anyone object to your drinking?

In the past five years, has had a period of excessive drinking OR had evidence of alcohol-related problems.

? No Yes ⇓ E15

ALCOHOL DEPENDENCE CRITERIA A. In the past 5 years a maladaptive

pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following occurring at any time in the same 12-month period:

? No Yes

E2 Let me ask you a few more questions about [TIME WHEN DRINKING MOST/TIME WITH MOST PROBLEMS]. During that time… Have you often found that when you started drinking you ended up drinking much more than you were planning to? IF NO: What about drinking over a much longer period of time than you were planning to?

(3) alcohol is often taken in larger amounts OR over a longer period than was intended

? No Yes

E3 Have you tried to cut down or stop drinking alcohol? IF YES: Did you ever actually stop drinking altogether? (How many times did you try to cut down or stop altogether?)

(4) there is a persistent desire OR unsuccessful efforts to cut down or control substance use

? No Yes

E4 Have you spent a lot of time drinking, being high, or hung over?

(5) a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects

? No Yes

E5 Have you had times when you would drink so often that you started to drink instead of working, spending time with your family or friends, or engaging in other important activities, such as sports, gardening, or playing music?

(6) important social, occupational, or recreational activities are given up or reduced because of alcohol use

? No Yes

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E6 IF NOT ALREADY KNOWN: Has your

drinking ever caused any psychological problems such as making you depressed or anxious, making it hard to sleep, or causing “blackouts” IF NOT ALREADY KNOWN: Has your drinking ever caused significant physical problems or made a physical problem worse? IF YES TO EITHER OF ABOVE: Did you keep on drinking anyway?

(7) alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption)

? No Yes

E7 Have you found that you needed to drink a lot more in order to get the feeling you wanted than you did when you first started drinking? IF YES: How much more? IF NO: What about finding that when you drank the same amount, it had much less effect than before?

(1) tolerance, as defined by either of the following:

(a) a need for markedly increased amounts of alcohol to achieve intoxication or desired effect

(b) markedly diminished effect with the continued use of the same amount of alcohol

? No Yes

E8 Have you had any withdrawal symptoms when you cut down or stopped drinking such as…. …sweating or racing heart? …hand shakes? …trouble sleeping? …feeling nauseated or vomiting? …feeling agitated? …or feeling anxious? (How about having a seizure or seeing, feeling, or hearing things that weren’t really there?) IF NO: have you ever started the day with a drink, or did you often drink or take some other drug or medication to keep yourself from getting the shakes or becoming sick?

(2) withdrawal, as manifested by either (a) or (b): (a) at least two of the following

developing within several hours to a few days after cessation of (or reduction in) heavy and prolonged alcohol use:

-automatic hyperactivity (e.g., sweating or pulse rate greater than 100) -increased hand tremor -insomnia -nausea or vomiting -psychomotor agitation -anxiety -grand mal seizures -transient visual, tactile, or auditory hallucinations or illusions (b) alcohol (or a substance from the sedative/hypnotic/anxiolytic class) taken to relieve or avoid withdrawal symptoms

? No Yes

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IF UNKNOWN: When did [SYMPTOMS RATED “Yes” ABOVE] occur? (Did they all happen around the same time?)

IN THE PAST 5 YEARS, AT LEAST THREE DEPENDENCE ITEMS (E2-E9) ARE “Yes” AND OCCURRED WITHIN THE SAME 12-MONTH PERIOD Patient has met diagnostic criteria for Alcohol Dependence in past 5 years. (Score on SCID/Psychiatric History source document.)

No Yes ⇓ E10

E9

ACTIVE IN PAST MONTH No Yes ⇓ ⇓ E15 E15

ALCOHOL ABUSE CRITERIA Now I would like to ask you some more

questions about your drinking. A. In the past five years, a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by one (or more) of the following occurring within a 12-month period:

E10 In the past 5 years have you ever missed work or school because you were intoxicated, high, or very hung over? (How often? What about doing a bad job at work or failing courses at school because of your drinking?) IF NO: What about not keeping your house clean or not taking proper care of your children because of your drinking? (How often?)

(1) recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home (e.g. repeated absences or poor work performances

? No Yes

E11 In the past 5 years have you ever had a drink in a situation in which it might have been dangerous to drink at all? (Did you ever drive while you were really too drunk to drive?)

(2) recurrent alcohol use in situation in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by alcohol use)

? No Yes

E12 In the past 5 years did your drinking get you into trouble with the law? (Tell me more about that.) IF YES: How many times?

(3) recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct)

? No Yes

E13 IN NOT ALREADY KNOWN: In the past 5 years did your drinking cause problems with other people, such as with family members, friends, or people at work? (Have you ever gotten into physical fights when you were drinking? What about having bad arguments about your drinking?) IF YES: Did you keep on drinking anyway?

(4) continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol (e.g., arguments with spouse about consequences of intoxication, physical fights)

? No Yes

IN THE PAST 5 YEARS, AT LEAST ONE ABUSE ITEM (E10-E13) IS “Yes” Patient has met diagnostic criteria for Alcohol Abuse in past 5 years. (Score on SCID/Psychiatric History source document)

No Yes E14

MET CRITERIA FOR ALCOHOL ABUSE IN PAST MONTH No Yes

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NONALCOHOLIC SUBSTANCE USE DISORDERS E15 In the past five years have you taken any of

these to get high, to sleep better, to lose weight, or to change your mood? (SHOW DRUG LIST TO PATIENT AND RECORD INFORMATION ON SCORESHEET.)

B. In the past 5 years a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by one (or more) of the following occurring at any time in the same 12-month period:

? No Yes ⇓ F1

Which one caused you the most problems? IF DENIES PROBLEMS: Which one did you use the most?

INDICATE DRUG CLASS WITH HEAVIEST USE/MOST PROBLEMS:

NONALCOHOLIC SUBSTANCE DEPENDENCE E16 I would now like to ask you some questions

about your use of [DRUG]. Have you often found that when you started using [DRUG] you ended up using much more than you were planning to? IF NO: What about using it for a much longer period of time than you were planning to?

(3) the substance is often taken in larger amounts OR over a longer period than was intended

? No Yes

E17 Have you tried to cut down or stop using [DRUG]? IF YES: Did you ever actually stop using [DRUG] altogether? How many times did you try to cut down or stop altogether?) IF NO: Did you want to stop or cut down? (Is this something you kept worrying about?)

(4) there is persistent desire OR unsuccessful efforts to cut down or control substance use

? No Yes

E18 Have you spent a lot of time using [DRUG] or doing whatever you had to do to get it? Did it take you a long time to get back to normal?

(5) a great deal of time is spent in activities necessary to obtain the substance (e.g., visiting multiple doctors or driving long distances), use the substance, or recover from its effects

? No Yes

E19 Have you had times when you would use [DRUG] so often that you started to use [DRUG] instead of working, spending time with your family or friends, or engaging in other important activities, such as sports, gardening, or playing music?

(6) important social, occupational, or recreational activities are given up or reduced because of substance use

? No Yes

E20 IF NOT ALREADY KNOWN: Has your drug use ever caused any psychological problems such as making you depressed or anxious, making it difficult to sleep, or causing “blackouts”? IF NOT ALREADY KNOWN: Has your drug use ever caused significant physical problems or made a physical problem worse?

(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., current cocaine use despite recognition of cocaine-induced depression)

? No Yes

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IF YES TO EITHER OF ABOVE: Did you keep on using anyway?

E21 Have you found that you needed to use a lot more [DRUG] in order to get the feeling you wanted than you did when you first started using it? IF YES: How much more? IF NO: What about finding that when you used the same amount, it had much less effect than before?

(1) Tolerance, as defined by either of the following:

(a) a need for markedly increased amounts of the substance to achieve intoxication or desired effect

(b) markedly diminished effect with continued use of the same amount of the substance

? No Yes

E22 THE FOLLOWING MAY NOT APPLY TO CANNABIS, HALLUCINOGENS, AND PHENCYCLIDINE. Have you ever had any withdrawal symptoms, that is, felt sick when you cut down or stopped using [DRUG]? IF YES: What symptoms did you have? [REFER TO LIST OF WITHDRAWAL SYMPTOMS ON PAGE 28]. IF HAD WITHDRAWAL SYMPTOMS: After not using [DRUG] for a few hours or more, have you often used it to keep yourself from getting sick with [WITHDRAWAL SYMPTOMS]? What about using [DRUG IN SAME CLASS] when you were feeling sick with [WITHDRAWAL SYMPTOMS] so that you would feel better?

(2) withdrawal, as manifested by either (a) or (b):

(a) the characteristic withdrawal syndrome for the substance (see next page for descriptions)

(b) the same (or closely related) substance is taken to relieve or avoid withdrawal symptoms

? No Yes

IN THE PAST 5 YEARS AT LEAST THREE DEPENDENCE ITEMS (E16-E22) ARE “Yes” AND OCCURRED WITHIN THE SAME 12-MONTH PERIOD. (Score on SCID/Psychiatric History source document) IF YES, INDICATE SUBSTANCE(S): ___marijuana ___cocaine ___opiates ___PCP ___amphetamines ___other, specify:_________________

No Yes ⇓ E24

E23 IF UNKNOWN: When did [SYMPTOMS RATED “Yes” ABOVE] occur? (Did they all happen around the same time?)

ACTIVE IN PAST MONTH No Yes ⇓ ⇓ F1 F1

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NONALCOHOLIC SUBSTANCE ABUSE CRITERIA E24 Now I’d like to ask you some more

questions about your use of [DRUG USED THE MOST OR CAUSED THE MOST PROBLEMS]. In the past five years have you missed work or school because you were high or very hung over? (How often?) (What about doing a bad job at work or failing courses at school because you used [Drug]?

(1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household).

? No Yes

E25 In the past five years have you used [DRUG] in a situation in which it might have been dangerous? (have you ever driven when you were really too high to drive?) IF YES: How often? (When?)

(2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)

? No Yes

E26 In the past five years has your use of [DRUG] gotten you into trouble with the law? IF YES: How often? (When?)

(3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct)

? No Yes

E27 IF YES: Did you keep on using [DRUG] anyway?

(4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about the consequences of intoxication, physical fights)

? No Yes

AT LEAST ONE ABUSE ITEM E24-E27 IS “Yes” (MAKE A DIAGNOSIS OF SUBSTANCE ABUSE DISORDER) (Score on SCID/Psychiatric History source document) IF YES, INDICATE SUBSTANCE(S): ___marijuana ___cocaine ___opiates ___PCP ___amphetamines ___other, specify:_________________

NO YES E28

ACTIVE IN PAST MONTH NO YES

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LIST OF WITHDRAWAL SYMPTOMS (FROM DSM-IV CRITERIA)

Listed below are the characteristic withdrawal symptoms for those classes of substances for which a withdrawal syndrome has been identified. (NOTE: A specific withdrawal syndrome has not been identified for cannabis and hallucinogens/PCP.) Withdrawal symptoms may occur following the cessation of prolonged moderate or heavy use of a substance or a reduction in the amount used. SEDATIVES, HYPNOTICS, AND ANXIOLYTICS: Two (or more) of the following, developing within several hours to a few days after cessation (or reduction) of sedative, hypnotic, or anxiolytic use, that has been heavy and prolonged: 1. autonomic hyperactivity (e.g. sweating or pulse rate greater than 100) 2. increased hand tremor 3. insomnia 4. nausea or vomiting 5. transient visual, tactile, or auditory hallucinations or illusions 6. psychomotor agitation 7. anxiety 8. grand mal seizures STIMULANTS/COCAINE: Dysphoric mood AND two (or more) of the following physiological changes, developing within a few hours to several days after cessation (or reduction of stimulant or cocaine use that has been heavy and prolonged): 1. fatigue 2. vivid, unpleasant dreams 3. insomnia or hypersomnia 4. increased appetite 5. psychomotor retardation or agitation OPIOIDS: Three (or more) of the following, developing within minutes to several days after cessation (or reduction) of opioid use that has been heavy and prolonged (several weeks or longer) or after administration of an opioid antagonist (after a period of opioid use): 1. dysphoric mood 2. nausea or vomiting 3. muscle aches 4. lacrimation or rhinorrhea 5. pupillary dilation, piloerection, or sweating 6. diarrhea 7. yawning 8. fever 9. insomnia

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DRUG LIST Sedatives-hypnotics-anxiolytics (“downers”) Quaalude (“ludes”), Seconal (“reds”), Valium, Xanax, Librium, barbituates, Miltown, Ativan, Dalmane, Halcion, Restoril Cannabis Marijuana, hashish (“hash”), THC, “pot,” “grass,” “weed,” “reefer” Stimulants (“uppers”) Amphetamine, “speed,” crystal meth, dexadrine, Ritalin, diet pills, “ice” Opioids Heroin, morphine, opium, Methadone, Darvon, codeine, Percodan, Demerol, Dilaudid Cocaine Snorting, IV, freebase, crack, “speedball” Hallucinogens (“psychedelics”) LSD (“acid”), mescaline, peyote, psilocybin, STP, mushrooms, Extasy, MDMA PCP (phencyclidine) “angel dust,” Special K (ketamine) Other Steroids, “glue,” ethyl chloride, paint, inhalants, nitrous oxide (“laughing gas”), amyl or butyl nitrate (poppers), nonprescription sleep or diet pills

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