Psychiatric History

Subject #: «SUBJECT_ID»

Attachment 16

Psychiatric History: Structured Clinical Interview for the DSM-IV Scoring Sheet

STRUCTURED CLINICAL INTERVIEW FOR DSM-IV-TR AXIS I DISORDERS Non-patient Edition (November 2002) S C I D - I / NP Michael B. First, M.D.; Robert L. Spitzer, M.D.; Miriam Gibbon, M.S.W.; and Janet B.W. Williams, D.S.W.
Survey of Chronic Fatigue Syndrome and Chronic Unwellness in Georgia Subject ID No.: __ __ __ __ __ __ __ __ __ Rater: __________________________________ Rater No.: __ __ __ Date of Interview: __ __ / __ __ / __ __ __ __ Mo. Day Year					ABTID
Edited and checked by: __________________________________ Date: _______________
The development of the SCID was supported in part by NIMH Contract #278-83-0007(DB) and NIMH Grant #1 R01 MH40511. DSM-IV-TR criteria are reprinted with permission of the American Psychiatric Association. For citation: First, Michael B., Spitzer, Robert L., Gibbon, Miriam, and Williams, Janet B.W.: "Structured Clinical Interview for DSM-IV-TR Axis I Disorders – Non-patient Edition (SCID-I/NP, 11/2002 revision)” Biometrics Research Department New York State Psychiatric Institute 1051 Riverside Drive - Unit 60 New York, New York 10032 Web page: http://www.scid4.org © 2002 Biometrics Research Department

DX code	Diagnosis				Lifetime Prevalence													Meets Symptomatic Dx. Crit. past Month
						Inade­quate info.			Absent		Sub-Thresh­­old		Thresh­old						Absent		Present
	MOOD DISORDERS
01	Bipolar I Disorder (D. 1)						?			1		2		3						1		3		NP8 NP9
								Single Manic Episode Recurrent						1 2		1 2 3 4 5		Current episode: manic mixed hypomanic major depressive unspecified						NP10 NP11 NP12
								Without Rapid Cycling With Rapid Cycling W/O Seasonal Pattern With Seasonal Pattern						0 1 0 1				Neither Melancholic, Atypical, Nor catatonic Melancholic Atypical Catatonic					0 1 2 3	NP13 NP14
								(only if not current): In Partial Remission In Full Remission						6 7		1 2 3 4 5		Current severity: mild moderate severe, without psychotic features with mood-congruent psychotic features with mood-incongruent psychotic features						NP15 NP16
02	Bipolar II Disorder (D. 2)						?			1		2		3						1		3		NP17 NP18
																1 2		Current episode: hypomanic major depressive						NP19
								Without Rapid Cycling With Rapid Cycling W/O Seasonal Pattern With Seasonal Pattern						0 1 0 1				Neither Melancholic, Atypical, Nor catatonic Melancholic Atypical Catatonic					0 1 2 3	NP20 NP21 NP22
								(only if not current): In Partial Remission In Full Remission						6 7		1 2 3 4 5		Current severity: mild moderate severe, without psychotic features with mood-congruent psychotic features with mood-incongruent psychotic features						NP23 NP24
03	Other Bipolar Disorder (D. 5)						?			1		2		3						1		3		NP25 NP26
		1 2 3 4 5	Cyclothymic Disorder Intermittent hypomanic episodes Manic or hypomanic episode superimposed on Psychotic Disorder Bipolar Disorder NOS with subthreshold manic episodes Other																					NP27

DX code	Diagnosis				Lifetime Prevalence													Meets Symptomatic Dx. Crit. past Month
						Inade­quate info.			Absent		Sub-Thresh­­old		Thresh­old						Absent		Present
MOOD DISORDERS (continued)
04	Major Depressive Disorder (D. 6)						?			1		2		3						1		3	NP28 NP29
								Single Episode Recurrent						1 2		0 1 2 3		Type of current episode: Neither Melancholic, Atypical, Nor catatonic Melancholic Atypical Catatonic					NP30 NP31 NP32
								W/O Seasonal Pattern With Seasonal Pattern						0 1
								(only if not current): In Partial Remission In Full Remission						6 7		1 2 3 4 5		Current severity: mild moderate severe, without psychotic features with mood-congruent psychotic features with mood-incongruent psychotic features					NP33 NP34
05	Dysthymic Disorder (current only) (A. 41)						?			1		2		3									NP35
		1 2 0 1	Early onset Late onset Without Atypical Features With Atypical Features																				NP36 NP37
06	Depressive Disorder Not Otherwise Specified (D. 9)						?			1				3						1		3	NP38 NP39
		1 2 3 4 5 6	Postpsychotic Depressive Disorder of Schizophrenia Major Depressive Episode superimposed on a Psychotic Disorder Premenstrual dysphoric disorder Minor depressive disorder Recurrent brief depressive disorder Other																				NP40
07	Mood Disorder Due to A General Medical Condition (A. 44) Specify GMC:_________						?			1				3						1		3	NP41 NP42 NP42SP
		1 2 3 4	With major depressive-like episode With depressive features With manic features With mixed features																				NP43
08	Substance-Induced Mood Disorder (A. 46) Specify Substance:______						?			1				3						1		3	NP44 NP45 NP45SP
		1 2 3	With depressive features With manic features With mixed features																				NP46
	PSYCHOTIC SYMPTOMS
09	Primary Psychotic Symptoms (not part of Mood Disorder) (B/C. 4)						?			1		2		3						1		3	NP47 NP48

DX code	Diagnosis		Lifetime Prevalence												Meets Symptomatic Dx. Crit. past Month
				Inade­quate info.		Absent		Abuse		Depen- dence						Absent		Present
SUBSTANCE USE DISORDERS (Abuse/Dependence)
17	Alcohol (E. 3/E. 6)				?		1		2		3						1		3	NP49 NP50
18	Substance (non-alcohol) (E. 12/E. 15)				?		1		2		3						1		3	NP51 NP52

DX code	Diagnosis				Lifetime Prevalence												Meets Symptomatic Dx. Crit. past Month
						Inade­quate info.		Absent		Sub-Thresh­­old		Thresh­old						Absent		Present
ANXIETY DISORDERS
26	Panic Disorder (F. 3)						?		1		2		3						1		3	NP67 NP68
		1 2	without Agoraphobia with Agoraphobia																			NP69
27	Agoraphobia without History of Panic Disorder (AWOPD) (F. 9)						?		1		2		3						1		3	NP70 NP71
28	Social Phobia (F. 14)						?		1		2		3						1		3	NP72 NP73
29	Specific Phobia (F. 18)						?		1		2		3						1		3	NP74 NP75
30	Obsessive Compulsive (F. 23)						?		1		2		3						1		3	NP76 NP77
31	Posttraumatic Stress (F. 29)						?		1		2		3						1		3	NP78 NP79
32	Generalized Anxiety (current only) (F. 34)						?		1		2		3									NP80
33	Anxiety Disorder Due To a General Medical Condition (F. 37) Specify GMC:_________						?		1				3						1		3	NP81 NP82 NP82SP
		1 2 3	With Generalized Anxiety With Panic Attacks With Obsessive-Compulsive Symptoms																			NP83
34	Substance-Induced Anxiety Disorder (F. 39) Specify Substance______						?		1				3						1		3	NP84 NP85 NP85SP
		1 2 3 4	With Generalized Anxiety With Panic Attacks With Obsessive-Compulsive Symptoms With Phobic Symptoms																			NP86
35	Anxiety Disorder NOS (F. 40)						?		1				3						1		3	NP87 NP88

DX code	Diagnosis		Lifetime Prevalence												Meets Symptomatic Dx. Crit. past Month
				Inade­quate info.		Absent		Sub-Thresh­­old		Thresh­old						Absent		Present
SOMATOFORM DISORDERS
39	Hypochondriasis (current only) (G. 9)				?		1		2		3									NP92
EATING DISORDERS
41	Anorexia Nervosa (H. 2)				?		1		2		3						1		3	NP94 NP95
42	Bulimia Nervosa (H. 5)				?		1		2		3						1		3	NP96 NP97
43	Binge Eating Disorder (H. 7)				?		1		2		3						1		3	NP98 NP99
44	ADJUSTMENT DISORDER (current only) (I. 2)				?		1		2		3									NP100
45	OTHER DSM-IV AXIS I DISORDER: Specify: ___________________				?		1		2		3						1		3	NP101 NP102 NP102SP

PRINCIPAL AXIS I DIAGNOSIS (i.e., the disorder that is [or should be] the main focus of current clinical attention). Enter Dx Code number from scoresheet for principal diagnosis: __ __ Note: Code 00 if no current Axis I disorder. Code 99 if unknown. INTERVIEWER’S DIAGNOSES, IF DIFFERENT FROM SCID DIAGNOSES: ____________________ ____________________ __________________

NP103

DSM-IV Axis IV: Psychosocial and Environmental Problems Check: ___ Problems with primary support group (childhood, adult, parent-child). Specify: ________________________ ___ Problems related to the social environment. Specify:____________________________________ ___Educational problems. Specify:__________________ ___Occupational problems. Specify:_________________ ___Housing problems. Specify:_____________________ ___Economic problems. Specify:____________________ ___Problems with access to health care services. Specify:____________________________________ ___Problems related to interaction with the legal system/crime. Specify:________________________________ ___Other psychosocial problems. Specify:____________

NP104 NP104SP NP104a NP104ASP NP104b NP104bSP NP104c NP104cSP NP104d NP104dSP NP104e NP104eSP NP104f NP104fSP NP104g NP104gSP NP104h NP104hSP

INTERVIEWER COMMENTS INTCOM

DSM-IV Axis V: Global Assessment of Functioning Scale

Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical (or environmental) limitations CODE (Note: Use intermediate codes when appropriate, e.g., 45, 68, 72).		__ __ __		NP105
100 | 91	Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his many positive qualities. No symptoms.
90 | | 81	Absent or minimal symptoms (e.g., mild anxiety before an exam); good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).
80 | | 71	If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in school work).
70 | | 61	Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.
60 | 51	Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or coworkers).
50 | 41	Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).
40 | | | 31	Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).
30 | | 21	Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).
20 | | 11	Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death, frequently violent, manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).
10 | 1	Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.
0	Inadequate information.