w-385d01

1
_____ A. Anxiety about being in places or in situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of a panic attack or other panic symptoms. Some people have very strong fears of being in certain places or situations. Do any of the following make you feel very fearful, anxious, or nervous? Being away from home alone ................................................ 69a Being in crowded places, like a movie theater, supermarket, shopping mall, church, or restaurant ......... 69b Standing in long lines .............................................................. 69c Being on a bridge or in a tunnel ........................................... 69d Traveling in a bus, train, or plane ......................................... 69e Driving or riding in a car .......................................................... 69f Being home alone ..................................................................... 69g Being in wide-open spaces, like a park ............................... 69h IF YES TO ANY: I know it may be difficult to describe, but what is it about [PHOBIA] that worries you? What do you think might happen to you? What are you afraid of ? _____ B. The situations are avoided or else require the presence of a companion or are endured with distress or with anxiety about having a panic attack. To what degree do you avoid [PHOBIA]? IF NO AVOIDANCE: So what do you do—how do you cope? Does having someone with you help? Do you [PHOBIA] only when you’re with someone? Do you [PHOBIA] alone? IF YES: How bad does the anxiety get? What are you anxious about? Exclusion Criteria EXCLUDE the diagnosis if the anxiety or phobia is better accounted for by another mental disorder. Make an effort to differentiate, for example, Agoraphobia from Specific Phobia or Social Phobia. Consider the diagnosis of Specific Phobia if the avoidance is limited to one of only a few specific situations, or Social Phobia if the avoidance is limited to social situations. W-385D(1) Copyright © 2002 by Mark Zimmerman, M.D. Not to be reproduced in whole or in part without written permission of Western Psychological Services. All rights reserved. 1 2 3 4 5 6 7 8 9 Printed in U.S.A. PDSQ Follow-up Interview Guide Publishers and Distributors wps ® 12031 Wilshire Boulevard Los Angeles, CA 90025-1251 Published by WESTERN PSYCHOLOGICAL SERVICES AGORAPHOBIA The PDSQ item numbers relevant to the Agoraphobia subscale are printed in italics in the right margin. Circle the item numbers to which a yes response was given. You should begin your follow-up inquiry by asking about these items, and proceed to cover all of the DSM-IV criteria for this syndrome. This guideline may be used to help you with your follow-up interview. Note: Agoraphobia (covered by PDSQ Items 68 through 71) is not a separate disorder. Follow-up inquiry should focus on assessing the duration and extent of symptoms and identifying the appropriate associated mental disorder (usually Panic Disorder). The follow-up should also help determine whether symptoms can be accounted for by a medication or general medical condition. Mark Zimmerman, M.D. INCLUSION: A, B EXCLUSION: One Commonly co-occurring syndromes: Mood Disorder, Anxiety Disorder, Substance Use Disorder, Posttraumatic Stress Disorder, Panic Disorder, Obsessive-Compulsive Disorder

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Page 1: W-385D01

_____ A. Anxiety about being in places or in situations from

which escape might be difficult (or embarrassing) or

in which help may not be available in the event of

a panic attack or other panic symptoms.

Some people have very strong fears of being in certain

places or situations. Do any of the following make you feel

very fearful, anxious, or nervous?

Being away from home alone ................................................ 69a

Being in crowded places, like a movie theater,

supermarket, shopping mall, church, or restaurant ......... 69b

Standing in long lines .............................................................. 69c

Being on a bridge or in a tunnel ........................................... 69d

Traveling in a bus, train, or plane ......................................... 69e

Driving or riding in a car .......................................................... 69f

Being home alone ..................................................................... 69g

Being in wide-open spaces, like a park ............................... 69h

IF YES TO ANY:

I know it may be difficult to describe,

but what is it about [PHOBIA] that worries you?

What do you think might happen to you?

What are you afraid of ?

_____ B. The situations are avoided or else require the presence

of a companion or are endured with distress or with

anxiety about having a panic attack.

To what degree do you avoid [PHOBIA]?

IF NO AVOIDANCE:

So what do you do—how do you cope?

Does having someone with you help?

Do you [PHOBIA] only when you’re with someone?

Do you [PHOBIA] alone?

IF YES:

How bad does the anxiety get?

What are you anxious about?

Exclusion Criteria

EXCLUDE the diagnosis if the anxiety or phobia is

better accounted for by another mental disorder.

Make an effort to differentiate, for example,

Agoraphobia from Specific Phobia or Social Phobia.

Consider the diagnosis of Specific Phobia if the

avoidance is limited to one of only a few specific

situations, or Social Phobia if the avoidance is

limited to social situations.

W-385D(1)

Copyright © 2002 by Mark Zimmerman, M.D.Not to be reproduced in whole or in part without written permission of Western Psychological Services.All rights reserved. 1 2 3 4 5 6 7 8 9 Printed in U.S.A.

PDSQ

Follow-up Interview Guide

Publishers and Distributorswps®

12031 Wi lsh i re Bou levardLos Angeles, CA 90025-1251

Published byWESTERN PSYCHOLOGICAL SERVICES

AGORAPHOBIA

The PDSQ item numbers relevant to the Agoraphobia subscale are printed in italics in the right margin.

Circle the item numbers to which a yes response was given. You should begin your follow-up inquiry by

asking about these items, and proceed to cover all of the DSM-IV criteria for this syndrome. This guideline

may be used to help you with your follow-up interview.

Note: Agoraphobia (covered by PDSQ Items 68 through 71) is not a separate disorder. Follow-up inquiry

should focus on assessing the duration and extent of symptoms and identifying the appropriate associated

mental disorder (usually Panic Disorder). The follow-up should also help determine whether symptoms can

be accounted for by a medication or general medical condition.

Mark Zimmerman, M.D.INCLUSION: A, B

EXCLUSION: One

Commonly co-occurring syndromes: Mood Disorder, Anxiety Disorder,

Substance Use Disorder, Posttraumatic Stress Disorder, Panic Disorder, Obsessive-Compulsive Disorder