Download structured clinical interview for dsm

PATIENT INITIALS:
VISIT DATE (MM/DD/YYYY):
PATIENT NUMBER:
RATER INITIALS:
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 BE,. 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.
Page 1 of 29
OVERVIEW
OCCUPATIONAL HISTORY
1
2
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?
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
8
After it started, what happened next? (Did
other things start to bother you?)
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?
Page 2 of 29
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?)
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?)
12
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:
Page 3 of 29
A. MOOD EPISODES
MAJOR DEPRESSIVE EPISODE
A1
A2
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.
In the past month…
(1) depressed mood most of
the day, nearly every day, as
…has there been a period of time
indicated by either subjective
when you were feeling depressed
report (e.g. feels sad or empty)
or down most of the day, nearly
or observation made by others
every day? (What was that like?)
(e.g. appears tearful).
IF YES: How long did it last? (As
long as 2 weeks?)
…what about losing interest or
(2) markedly diminished
pleasure in things you usually
interest or pleasure in all, or
enjoyed?
almost all, activities most of
the day, nearly every day (as
IF YES: Was it nearly every day?
indicated by either subjective
How long did it last? (As long as 2
account or observation made
weeks?)
by others).
PAST
MONTH
PAST 5
YEARS
? No* Yes
? No** Yes
? 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]…
(3) significant weight loss when not
dieting or weight gain (e.g. a change
…did you lose or gain any weight? (How
of more than 5% of body weight in a
much? Were you trying to lose weight?)
month), or decrease or increase in
IF NO: How was your appetite? (What
appetite nearly every day.
about compared with your usual appetite:
Did you have to force yourself to eat? Eat
[less/more] than usual? Was that nearly
every day?)
A4
…how were you sleeping? (Trouble falling (4) insomnia or hypersomnia nearly
asleep, waking frequently, trouble staying every day
asleep, waking too early, OR sleeping too
much? How many hours a night
compared with usual? Was that nearly
every night?)
? No Yes
? No Yes
Page 4 of 29
A5
A6
A7
…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?)
…what was your energy like? (Tired all
the time? Nearly every day?)
…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?)
A8
A9
…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?
…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?
(5) psychomotor agitation or
retardation nearly every day
(observable by others, not merely
subjective feelings of restlessness or
being slowed down)
? No Yes
(6) fatigue or loss of energy 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
(8) diminished ability to think or
concentrate, or indecisiveness, nearly
every day (either by objective account
or as observed by others)
? No Yes
(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
A. AT LEAST FIVE OF ITEMS A1-A9
ARE “Yes” AND AT LEAST ONE OF
THESE ITEMS IS A1 OR A2.
? No Yes
? No Yes
? No Yes
IF YES: Did you do anything to hurt
yourself?
A10
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
Page 5 of 29
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).
A14
A15
IF UNKNOWN: Have you had (SYMPTOMS
RATED “Yes” ABOVE) in the past month?
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]
CRITERIA A, C, D, AND E ARE
“Yes”
(MAKE A DIAGNOSIS OF MAJOR
DEPRESSION.)
MET CRITERIA FOR MAJOR
DEPRESSION IN PAST MONTH
Total number of Major Depressive
Episodes, including current (CODE
99 if too numerous or indistinct to
count).
No
Yes
No
Yes
___ ___
Page 6 of 29
MANIC EPISODE (Note: In order to rule out schizoaffective and bipolar disorder,
inquire for lifetime experience of manic symptoms. )
A16
A17
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?)
How long did that last? (As long as 1
week? Did you have to go into the
hospital?)
During [PERIOD OF WORST MANIC
SYMPTOMS]…
A18
A19
A20
A21
A22
A23
A24
…how did you feel about yourself?
(More self-confident than usual? Any
special powers or abilities?)
…did you need less sleep than usual?
IF YES: Did you still feel rested?
…were you more talkative than usual? (Did
people have trouble stopping you or
understanding you? Did people have
trouble getting a word in edgewise?)
…were your thoughts racing through your
head?
…were you so easily distracted by things
around you that you had trouble
concentrating or staying on one track?
…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?)
…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?)
A. A distinct period of abnormally
and persistently elevated,
expansive, or irritable mood…
? No Yes
⇓
B1
…lasting at least 1 week (or any
duration if hospitalization is
necessary)
? No Yes
⇓
A30
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:
(1) inflated self-esteem or
grandiosity
? No Yes
(2) decreased need for sleep (e.g.
feels rested after only 3 hours of
sleep)
(3) more talkative than usual or
pressure to keep talking
? No Yes
(4) flight of ideas or subjective
experience that thoughts are racing
(5) distractibility (i.e., attention too
easily drawn to unimportant or
irrelevant external stimuli)
(6) increase in goal-directed activity
(socially, at work or school, or
sexually) or psychomotor agitation
? No Yes
(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
? No Yes
? No Yes
? No Yes
Page 7 of 29
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.
Page 8 of 29
A28
A29
CRITERIA A, B, C, AND D ARE “Yes”
(MAKE A DIAGNOSIS OF MANIC EPISODE)
No
Yes
Yes
IF UNKNOWN ; Have you had
[SYMPTOMS RATED “Yes” ABOVE] in the
past month?
ARE MANIC SYMPTOMS
PRESENT IN THE PAST MONTH?
No
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
A31
A32
A33
A34
A35
A36
A37
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
…how did you feel about yourself?
(More self-confident than usual? Any
special powers or abilities?)
…did you need less sleep than usual?
IF YES: did you feel rested?
…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?)
…were your thoughts racing through your
head?
…were you so easily distracted by things
around you that you had trouble
concentrating or staying on one track?
…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)
…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?)
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
(1) inflated self-esteem or grandiosity
? No Yes
(2) decreased need for sleep (e.g.,
feels rested after only 3 hours of
sleep)
(3) more talkative than usual or
pressure to keep talking
? No Yes
(4) flight of ideas or subjective
experience that thoughts are racing
(5) distractibility (i.e., attention too
easily drawn to unimportant or
irrelevant external stimuli)
? No Yes
(6) increase in goal-directed activity
(either socially, at work or school, or
sexually) or psychomotor agitation
? No Yes
(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
? No Yes
? No Yes
Page 9 of 29
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).
Page 10 of 29
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?
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
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).
A43
A44
CRITERIA A, B, C, D, E, AND F
ARE “Yes”
(MAKE A DIAGNOSIS OF
HYPOMANIC EPISODE)
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)
No
Yes
___ ___
⇒ 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
? No Yes
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
Page 11 of 29
A46
A47
A48
A49
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.
D. The disturbance is not better accounted for by another mental disorder.
E. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
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
? No Yes
? No Yes
No Yes
Page 12 of 29
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
Delusion of reference; i.e., events,
? No Yes
experiences that people sometimes have.
objects, or other people in the
Has it ever seemed like people were talking individual’s environment have a
about you or taking special notice of you?
particular or unusual significance
that is clearly unwarranted.
(Has it ever seemed as if someone on the
radio, TV, or newspaper is sending you a
special message?)
B2
What about anyone going out of his or her
Persecutory delusion; i.e., the
? No Yes
way to give you a hard time, or trying to hurt individual (or his or her group) is
you?
being attacked, cheated, persecuted,
or conspired against.
B3
Did you ever feel that you were especially
Grandiose delusion; i.e., content
? No Yes
important in some way, or that you had
involves exaggerated power,
special powers to do things that other
knowledge, or importance, or a
people couldn’t do?
special relationship to a deity or
famous person.
(Do you have a special relationship with
someone who is famous? Do you have a
special relationship with God?)
B4
Did you ever feel that something was very
Somatic delusion; i.e., content
? No Yes
wrong with you physically even though your involves change or disturbance in
doctor said nothing was wrong…like you
body appearance of functioning.
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?)
Other delusions; i.e., religious,
B5
(Did you ever have any unusual religious
? No Yes
experiences?)
jealous, erotomanic, delusions of
guilt, delusions of being controlled,
Did you ever feel that…
thought broadcasting, thought
(…you had committed a crime or done
insertion, thought withdrawal.
something terrible for which you should be
(Check here if delusions are bizarre,
punished?)
i.e. that involve a phenomenon that
(…someone or something outside yourself
the person’s culture would regard as
was controlling your thoughts or actions
totally implausible.:___)
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?)
Page 13 of 29
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
Auditory hallucinations when fully
? No Yes
couldn’t hear, such as noises, or the voices
awake, heard either inside or outside
of people whispering or talking..
the head.
IF YES: What did you hear? How often did
(Check if voices give a running
you hear it?
commentary on patient’s thoughts
and behavior ___)
B7
Did you ever have visions or see things that Visual hallucinations.
? No Yes
other people couldn’t see? (Were you
awake at the time?)
B8
What about strange sensations in your body Tactile hallucinations, e.g.,
? No Yes
or on your skin?
electricity.
B9
What about smelling or tasting things that
Other hallucinations, e.g., gustatory,
? No Yes
other people couldn’t smell or taste?
olfactory.
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,
? No Yes
posturing, stereotyped movements, echolalia (senseless repeating or echoing the
words of another), echopraxia (senseless, uncontrolled imitation of the movements
of others).
B11 Grossly disorganized behavior; e.g., markedly disheveled appearance, grossly
? No Yes
inappropriate sexual behavior, unpredictable or untriggered agitation.
B12 Grossly inappropriate affect; e.g., smiling while discussing being persecuted.
? No Yes
B13 Disorganized speech; e.g., frequent derailment (loosening of associations) or
? No Yes
incoherence.
B14 Negative symptoms; i.e., affective flattening, alogia (poverty of thought, as indicated ? No Yes
by poverty in content or production of speech), avolition (inability to initiate or
sustain goal directed activities).
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?
____________________
__________________________
________ ________
________
____________________
__________________________
________ ________
________
____________________
__________________________
________ ________
________
____________________
__________________________
________ ________
________
____________________
__________________________
________ ________
________
Page 14 of 29
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
C3
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.
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?”
No Yes
⇓
C15
No Yes
⇓
C8
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.
Page 15 of 29
C4
C5
C6
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?
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).
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
⇓
C13
No
Yes
⇓
C15
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
No
⇓
C31
Yes
No
⇓
C31
Yes
No
⇓
C31
Yes
SCHIZOAFFECTIVE DISORDER CRITERIA
C8
C9
C10
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.
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]?
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
Page 16 of 29
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?
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.)
No
⇓
C26
Yes
Yes
⇓
D13
EXCLUSIONARY DIAGNOSES
SCHIZOPHRENIFORM DISORDER CRITERIA
C13
C14
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?
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
⇓
C21
No
⇓
C26
Yes
Yes
⇓
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
⇓
C21
Yes
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.
Yes
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.
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
⇓
C31
No
⇓
C31
No
⇓
C8
Yes
Yes
Page 17 of 29
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?
C20
CRITERIA A, B, C, AND E ARE MET (MAKE DIAGNOSIS OF DELUSIONAL
DISORDER).
No
⇓
C26
Yes
Yes
⇓
Excluded
END SCID
BRIEF PSYCHOTIC DISORDER
C21
C22
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
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.
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).
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.
No
⇓
C31
Yes
No
⇓
C31
No
⇓
D1
C8
C2
No
⇓
C26
Yes
Yes
Yes
Questions for clarification: Were you talking any drugs or medicines during this
time? Were you physically ill at this time?
C25
Yes
⇓
Excluded
END SCID
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)
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
⇓
D1
No
Yes
Yes
Page 18 of 29
C28
C29
C30
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.
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 nonsubstance-induced Psychotic Disorder (e.g., a history of recurrent nonsubstance related psychotic episodes).
CRITERIA A, B, AND C ARE MET
(MAKE A DIAGNOSIS OF SUBSTANCE INDUCED PSYCHOTIC DISORDER OR
DUE TO A GENERAL MEDICAL CONDITION.)
No
⇓
C31
Yes
No
Yes
Yes
⇓
Excluded
END SCID
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
Page 19 of 29
D. MOOD DISORDERS
BIPOLAR I DISORDER CRITERIA (BPAD)
If there have never been clinically significant mood symptoms, go to Module E.
D1
D2
D3
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.
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.
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
⇓
D4
Yes
No
⇓
D4
Yes
No
⇓
C2
Yes
⇓
BPAD
Excluded
END SCID
No
⇓
D8
No
⇓
D8
No
⇓
D8
No
Yes
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).
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).
D6
There have never been any Manic or Mixed Episodes.
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).
Yes
Yes
Yes
⇓
BPAD2
Excluded
END SCID
OTHER BIPOLAR DISORDER CRITERIA (CYCLOTHYMIC DISORDER)
(BIPOLAR DISORDER NOS)
D8
Clinically significant manic or hypomanic symptoms.
No Yes
⇓
D11
Page 20 of 29
D9
Not due to the direct physiological effects of a general medical condition or
substance (including somatic antidepressant treatment) use.
D10
If UNKNOWN: Have you had [MANIC OR DEPRESSIVE SYMPTOMS] in the past
month?
No
⇓
D11
No
⇓
D11
Yes
Yes
⇓
Excluded
END SCID
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)
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)
D12
There has never been a Manic Episode, a Mixed Episode, or a Hypomanic
Episode.
D13
No
⇓
D14
No
⇓
D14
Yes
No
⇓
D14
Yes
⇓
MDD*
Clinically significant depressive symptoms do not meet criteria for a specific
Depressive Disorder or Adjustment Disorder and are not better accounted for by
Bereavement.
Not due to the direct physiological effects of a general medical condition or
substance (including somatic antidepressant treatment) use.
No
Yes
No
Yes
Depressive Disorder Not Otherwise Specified
(Not scored on SCID/Psychiatric History source document.)
No
Yes
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.
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.
Yes
DEPRESSIVE DISORDER NOS CRITERIA
D14
D15
D16
Page 21 of 29
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?)
In the past five years, has had a period
of excessive drinking OR had evidence
of alcohol-related problems.
? No Yes
⇓
E15
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:
(3) alcohol is often taken in larger
amounts OR over a longer period than
was intended
? No Yes
(4) there is a persistent desire OR
unsuccessful efforts to cut down or
control substance use
? No Yes
(5) a great deal of time is spent in
activities necessary to obtain alcohol,
use alcohol, or recover from its effects
(6) important social, occupational, or
recreational activities are given up or
reduced because of alcohol use
? No Yes
(Currently/During that time…)
…(does/did) your drinking cause problems
for you?
…(does/did) anyone object to your drinking?
ALCOHOL DEPENDENCE CRITERIA
E2
E3
E4
E5
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?
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?)
Have you spent a lot of time drinking, being
high, or hung over?
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?
? No Yes
? No Yes
Page 22 of 29
E6
E7
E8
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?
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?
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?
(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
(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
(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
? No Yes
Page 23 of 29
E9
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 (E2E9) 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.)
ACTIVE IN PAST MONTH
No Yes
⇓
E10
No Yes
⇓
⇓
E15 E15
ALCOHOL ABUSE CRITERIA
Now I would like to ask you some more
questions about your drinking.
E10
E11
E12
E13
E14
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:
(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
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?)
In the past 5 years have you ever had a
(2) recurrent alcohol use in situation in
drink in a situation in which it might have
which it is physically hazardous (e.g.,
been dangerous to drink at all?
driving an automobile or operating a
(Did you ever drive while you were really too machine when impaired by alcohol
use)
drunk to drive?)
In the past 5 years did your drinking get you (3) recurrent alcohol-related legal
into trouble with the law? (Tell me more
problems (e.g., arrests for alcoholrelated disorderly conduct)
about that.)
IF YES: How many times?
IN NOT ALREADY KNOWN: In the past 5
(4) continued alcohol use despite
years did your drinking cause problems with having persistent or recurrent social or
other people, such as with family members, interpersonal problems caused or
friends, or people at work? (Have you ever
exacerbated by the effects of alcohol
gotten into physical fights when you were
(e.g., arguments with spouse about
drinking? What about having bad
consequences of intoxication, physical
arguments about your drinking?)
fights)
IF YES: Did you keep on drinking anyway?
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)
MET CRITERIA FOR ALCOHOL ABUSE IN PAST MONTH
? No Yes
? No Yes
? No Yes
? No Yes
No
Yes
No
Yes
Page 24 of 29
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.)
Which one caused you the most problems?
IF DENIES PROBLEMS: Which one did
you use the most?
B. In the past 5 years a maladaptive
? No Yes
pattern of substance use, leading to
⇓
clinically significant impairment or
F1
distress, as manifested by one (or
more) of the following occurring at any
time in the same 12-month period:
INDICATE DRUG CLASS WITH HEAVIEST
USE/MOST PROBLEMS:
NONALCOHOLIC SUBSTANCE DEPENDENCE
E16
E17
E18
E19
E20
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?
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?)
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?
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?
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?
(3) the substance is often taken in
larger amounts OR over a longer
period than was intended
? No Yes
(4) there is persistent desire OR
unsuccessful efforts to cut down or
control substance use
? No Yes
(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
(6) important social, occupational, or
recreational activities are given up or
reduced because of substance use
? No Yes
(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 cocaineinduced depression)
? No Yes
? No Yes
Page 25 of 29
E21
E22
E23
IF YES TO EITHER OF ABOVE: Did you
keep on using anyway?
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?
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?
IF UNKNOWN: When did [SYMPTOMS
RATED “Yes” ABOVE] occur? (Did they all
happen around the same time?)
(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
(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 (E16E22) ARE “Yes” AND OCCURRED
WITHIN THE SAME 12-MONTH
PERIOD.
(Score on SCID/Psychiatric History
source document)
No Yes
⇓
E24
? No Yes
IF YES, INDICATE SUBSTANCE(S):
___marijuana
___cocaine
___opiates
___PCP
___amphetamines
___other, specify:_________________
ACTIVE IN PAST MONTH
No
⇓
F1
Yes
⇓
F1
Page 26 of 29
NONALCOHOLIC SUBSTANCE ABUSE CRITERIA
E24
E25
E26
E27
E28
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]?
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?)
In the past five years has your use of
[DRUG] gotten you into trouble with the
law?
IF YES: How often? (When?)
IF YES: Did you keep on using [DRUG]
anyway?
(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
(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
(3) recurrent substance-related legal
problems (e.g., arrests for substancerelated disorderly conduct)
? No Yes
(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)
AT LEAST ONE ABUSE ITEM E24E27 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
ACTIVE IN PAST MONTH
NO YES
NO YES
Page 27 of 29
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
Page 28 of 29
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
Page 29 of 29