Attachment V

PDF 11 - Attachment V.pdf

2012 National Survey on Drug Use and Health (NSDUH)

Attachment V

OMB: 0930-0110

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0930-0110 can be found here:

2024-04-09 - No material or nonsubstantive change to a currently approved collection
2023-10-24 - No material or nonsubstantive change to a currently approved collection

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Attachment V
Follow-up SCID Interview Content

OMB # 0930-0110
Expiration Date: 01-31-12
V.6, 3/4/11

STRUCTURED CLINICAL INTERVIEW FOR
DSM-IV AXIS I DISORDERS (SCID-I)
By
Michael B. First, M.D.; Miriam Gibbon, M.S.W.;
Robert L. Spitzer, M.D.; and Janet B. W. Williams, D.S.W.
MODIFIED BY RTI INTERNATIONAL
FOR

2011 NATIONAL SURVEY ON DRUG USE AND
HEALTH
MENTAL HEALTH SURVEILLANCE STUDY
SCID Transmittal Record
Interviewer ID:

QuestID:
Date of Interview:

Date
Shipped to
______/ _______/ ______
RTI:
MM
DD
YY
Clinical QC
by:

Edited by:

______/ _______/ ______
MM
DD
YY

Date Received
at RTI: ______/ _______/ ______
MM
DD
YY
Date of Clinical ______/ _______/ ______
DD
YY
QC: MM

Date Edited:

______/ _______/ ______
MM
DD
YY

Public reporting burden for this collection of information is estimated to 60 minutes per
response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any aspect of this collection of
information, including suggestions for reducing this burden to SAMHSA Reports Clearance
Officer; Paperwork Reduction Project (0930-0110); Room 7-1045, 1 Choke Cherry Road,
Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 0930-0110.

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Introduction Page 1

Introduction to Clinical Interview
Before you call, be prepared:
• Review the assignment information provided including the respondent name, telephone number,
as well as the date of the initial interview.
• Have your schedule available (in case you need to schedule an appointment).
• Have all interviewing materials available.
VERIFY NUMBER AND LOCATE RESPONDENT
Hi, my name is _______________ and I’m calling on behalf of the U.S. Public Health Service. Is
this [PHONE NUMBER]?
YES: PROCEED BELOW
NO: I apologize. I need to double check my records. Thank you for your time. END CALL.
I’m trying to reach [FIRST NAME] who agreed to take part in a telephone interview we’re
conducting. May I speak to [FIRST NAME]?
IF R NOT HOME OR UNAVAILABLE
When would be a good time to call again? ENTER CODE 51 AND DETAILS IN CMS.
Thank you for your time. END CALL.
IF R AVAILABLE
(Hi, my name is _______________.)
You recently completed an interview in your home with an interviewer working on the National
Survey on Drug Use and Health. I am the interviewer you were told would contact you for a followup telephone interview. Do you recall completing the first interview?
YES: PROCEED BELOW.
NO: VERIFY FIRST NAME OF PERSON YOU ARE SPEAKING TO.
IF NOT SPEAKING TO CORRECT RESPONDENT, ASK TO SPEAK TO RESPONDENT.
IF NAME IS CORRECT AND RESPONDENT DOESN’T RECALL INITIAL INTERVIEW,
REMIND OF DATE OF INITIAL INTERVIEW.
IF CORRECT RESPONDENT STILL NOT FOUND: I apologize. I need to double check my
records. Thank you for your time. END CALL. ENTER CODE 59 AND INVESTIGATE.
Are you in a place where you can safely talk on the phone and answer my questions?
YES: PROCEED
NO: Are you able to move to a place where you can safely talk?
YES: PAUSE, THEN CONTINUE
NO: When would be a good time to call again? ENTER CODE 50 AND DETAILS IN
CMS. Thank you for your time. END CALL.
Is now a good time to complete this interview?
YES: PROCEED. BE SURE TO READ VERBATIM.
NO:
When would be a good time to call again? ENTER CODE 50 AND DETAILS IN CMS.
Thank you for your time. END CALL.

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Introduction Page 2

PRIVACY
Because you may not want others to hear the responses to some of our questions, I’d like to be
sure you’re in a private area. Where are you right now? Are you at home, at work, or somewhere
else? Are you in an area where you can answer these questions privately?
YES: PROCEED
NO: Please consider moving to a more private area. Do you need more time?
YES: PAUSE, THEN CONTINUE
NO: CONTINUE
INFORMED CONSENT
Before we begin, I would like to remind you of the study details. This study, sponsored by the
United States Public Health Service, asks questions about various mental health issues such as
depression, anxiety, post traumatic stress disorder, and substance dependence. Although there is
no benefit to you personally, knowledge gained from this study will improve our ability to describe
and understand mental health issues in the United States. While the interview has some personal
questions, federal law keeps your answers private. The only exception to this promise of
confidentiality is if you tell me that you intend to seriously harm yourself or someone else; in this
situation I may need to notify a mental health professional or other authorities.
Your participation is voluntary. You may consider some of the questions to be sensitive in nature
and some of the questions may also make you feel certain emotions, such as sadness. Remember
that you can refuse to answer any questions that you do not want to answer, and you can stop the
interview at any time. If you become upset at any time during the interview and wish to speak to a
mental health professional about how you are feeling, I will provide you with the toll-free hotline
numbers that are printed on your payment receipt from the first interview. It is important for you to
keep in mind that I will not be providing you with a psychological diagnosis or any mental health
advice or counseling. The information we are collecting today is only for research purposes.
These study details are also included on the Follow-up Study Description you received from the
interviewer who met with you in your home. Do you have any questions before we begin?
ANSWER ANY RESPONDENT QUESTIONS.
Is it OK to continue with the interview?
YES: PROCEED TO NEXT PAGE
NO: BASED ON CONVERSATION:
What sort of concerns do you have about participating?
OR
Are there other questions that I could answer for you?
IF R STILL UNWILLING TO PARTICIPATE: Thank you for your time. END CALL.

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Introduction Page 3

RECORDING PERMISSION
In order to ensure that I am conducting this interview accurately and properly, I would like to make
an electronic audio recording of this interview. This is done strictly for quality control purposes. The
recording will only be listened to by staff members on the project who have signed confidentiality
pledges. The recording will be stored in a secure manner and will not contain your name—only a
random number that will be assigned to this case. To help maintain confidentiality, we ask that you
not give your name or any other identifying information, such as an address or place of business,
during the interview. All recordings will be permanently destroyed within eighteen months after the
end of the data collection period. You can still do the interview if you do not want me to record it.
Do you agree to allow me to record the interview?
YES: I will now begin recording. START RECORDING AND SAY: “This is [YOUR FIRST AND
LAST NAME] conducting telephone interview [QUEST ID] on [DATE].”
NO: DON’T RECORD
Ok, let’s get started.
CI NOTES:
IF ASKED AT ANY TIME BY A RESPONDENT WHETHER THE INTERVIEWER IS A DOCTOR,
PSYCHIATRIST, PSYCHOLOGIST, SOCIAL WORKER, OR OTHER MENTAL HEALTH
PROFESSIONAL, YOU MAY DISCLOSE THAT YOU HAVE MEDICAL OR PSYCHOLOGICAL
TRAINING THAT ALLOWS YOU TO FULLY UNDERSTAND THE SURVEY.
HOWEVER, YOU SHOULD EXPLAIN THAT YOUR INVOLVEMENT IN THIS STUDY IS FOR
RESEARCH PURPOSES ONLY AND IN NO WAY CONSTITUTES MEDICAL OR
PSYCHOLOGICAL ADVICE, TREATMENT, OR DIAGNOSIS. EXPLAIN THAT THIS IS NOT THE
NATURE OF THIS EFFORT.
IF RESPONDENT REQUESTS PSYCHOLOGICAL COUNSELING OR ADVICE OF ANY KIND,
REFER HIM/HER TO THE NATIONAL LIFELINE. IF RESPONDENT IS INTERESTED IN
CONTACTING THE LIFELINE, OFFER TO STAY ON THE PHONE AND CONNECT THEM VIA A
THREE-WAY CALL.

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

This page has been intentionally left blank.

Introduction Page 4

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Overview i

(March 2011)

OVERVIEW
Interview Start Time: ___ ___ : ___ ___ AM/PM
I’m going to be asking you about problems or
difficulties you may have had, and I’ll be
making some notes as we go along.
DEMOGRAPHIC DATA
SEX:
What’s your date of birth?

Are you married?
IF NO: Have you ever been married?
Do you have any children?
IF YES: How many?
(What are their ages?)
Where do you live?
(That is, do you live in a house, an
apartment, or do you have some other living
arrangement?)

1 male
2 female

DOB:

MARITAL STATUS 1
(most recent):
2
3
4
5

OV1

______/ _______/ ______
mm
dd
yyyy

OV2

married or living with
someone as if married
widowed
divorced or annulled
separated
never married

OV3

__________________________________________
__________________________________________
__________________________________________

Who do you live with?
(Do you live with family, friends, or
roommates?)
EDUCATION AND WORK HISTORY
What’s the highest grade or year of school
you have completed?

EDUCATION:

1
2
3
4
5
6
7
8

IF FAILED TO COMPLETE A
PROGRAM IN WHICH THEY WERE
ENROLLED: Why did you decide to
leave school?
What kind of work do you do?
(Do you work outside of your home?)

grade 6 or less
grade 7 to 12 (without
graduating high school)
graduated high school or high
school equivalent
part college
graduated 2 year college
graduated 4 year college
part graduate/professional
school
completed graduate/
professional school

__________________________________________
__________________________________________
__________________________________________
__________________________________________

OV4

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Overview ii

(March 2011)

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? How long has it been
since you worked outside the
home? What kind of work have
you done?
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: Why was that?

_________________________________________
_________________________________________
_________________________________________
_________________________________________

PAST PERIODS OF PSYCHOPATHOLOGY
(THE LIFE CHART ON PAGE VIII OF OVERVIEW MAY BE USED TO SUMMARIZE A
COMPLICATED HISTORY OF PSYCHOPATHOLOGY AND TREATMENT.)
Have you ever seen anybody for emotional or
psychiatric problems?
IF YES: What was that for? (What
treatment(s) did you get? Any
medications?)
IF NO: Was there ever a time when you
received medication to help your
mood, calm your nerves, or to help
you sleep?
IF NO: Was there ever a time when you, or
someone else, thought you should
see someone because of the way
you were feeling or acting?
IF NOT ALREADY KNOWN:
Did you receive any of the treatment you just
mentioned in the past 12 months, that is since
(this date), 2010?

What about treatment for drugs or alcohol?

Treatment for emotional problems with a
physician or mental health professional

1 NO OV5
3 YES
If OV5=

_________________________________________ 1, SKIP
OV5a

_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
Most recent mental health
treatment

1 Lifetime MH
Treatment (not Past
Year)
2 Past Year –
Counseling Alone
3 Past Year - Meds
alone
4 Past Year –
Counseling and
meds

_________________________________________

OV5a

NOTE:
IF OV5a
= 3 or 4,
medications
should
be listed
at OV7a
or OV7b

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Overview iii

(March 2011)

Have you ever been a patient in a psychiatric
hospital?
IF YES: What was that for? (How many
times?)
IF GIVES AN INADEQUATE ANSWER,
CHALLENGE GENTLY: e.g., Wasn't there
something else? People don't usually go
to psychiatric hospitals just because they
are tired or nervous.

OV6
0
1
2
3
IF OV6
_____________________________________
= 0,
4
SKIP
5
(or
_____________________________________
more) OV6a
and
OV6b
_____________________________________

Number of previous hospitalizations (Do not
include transfers)

_____________________________________
Timing of most recent
psychiatric hospitalization

OV6a

1 Lifetime Psychiatric
Hospitalizations (not IF OV6a
= 1,
Past Year)
SKIP

2 Past Year Psychiatric OV6b
Hospitalizations
Reasons for hospitalization in the past year
__________________________________________
__________________________________________
__________________________________________

Have you ever been in a hospital for treatment
of a medical problem?

__________________________________________
__________________________________________

IF YES: What was that for?
Thinking back over your whole life, when were
you the most upset?

__________________________________________
__________________________________________

(Why? What was that like? How were you
feeling?)

__________________________________________
__________________________________________
__________________________________________

When were you feeling the best you have ever
felt?

__________________________________________
__________________________________________

OV6b

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Overview iv

PSYCHOPATHOLOGY DURING PAST YEAR
Now I would like to ask you about the past
year, that is since (CURRENT DATE) 2010.
How have things been going for you?

__________________________________________

Has anything happened that has been
especially hard for you?

__________________________________________

What about difficulties at work or with your
family?

__________________________________________

How has your mood been?
How has your physical health been? (Have
you had any medical problems?) (USE THIS
INFORMATION TO CODE AXIS III)

__________________________________________

__________________________________________
__________________________________________
__________________________________________
__________________________________________

Thinking back over the past year, when were
you the most upset?

__________________________________________
__________________________________________
__________________________________________

(IF UNKNOWN:) Are you currently in a
relationship?
IF YES: Tell me a little about that.
IF NO: How long has it been since you
were in a relationship?

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)
Do you take any medications or vitamins?
IF YES: How much and how often do you
take (MEDICATION)? (What is that
medication for?) (Has there been any
change in the amount you have been
taking?)
Are there any medications that you have
taken in the past year that you are not
currently taking?

(March 2011)

Overview v

____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Psychotropic medications taken in the past year (but
not currently)

OV7a

____________________________________________
____________________________________________
____________________________________________

Psychotropic medications taken currently
____________________________________________
____________________________________________
____________________________________________

OV7b

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Overview vi

__________________________________________
How much have you been drinking (alcohol) (in
the past year)?

__________________________________________
__________________________________________

Have you been taking any drugs (in the past
year)? (What about marijuana, cocaine, other
street drugs?)

__________________________________________
__________________________________________
__________________________________________

Have you (in the past year) gotten “hooked” on
a prescribed medicine or taken a lot more of it
than you were supposed to?

__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Overview vii

CURRENT SOCIAL FUNCTIONING
How have you been spending your free time?

__________________________________________

Who do you spend time with?
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
MOST LIKELY CURRENT DIAGNOSES:

DIAGNOSES THAT NEED TO BE RULED
OUT:

__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Overview viii

(March 2011)
LIFE CHART

Age
(or date)

Description (symptoms, triggering events)

Treatment

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

______

___________________________________________________

______________

RETURN TO OVERVIEW PAGE iv, PSYCHOPATHOLOGY DURING PAST YEAR.

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Screening – Page 1

Screening Questions

SCID SCREENING MODULE
Now I want to ask you some more specific questions about problems you may have
had. We’ll go into more detail about them later.
RESPOND TO POSITIVE RESPONSES WITH: We’ll talk more about that later.
1. In the past year, that is since (CURRENT DATE) 2010, have you had
any panic attacks, when you suddenly felt frightened or anxious or
suddenly developed a lot of physical symptoms?

1
CIRCLE “1”
ON PAGE
E.9

2. In the past year, have you been afraid of going out of the house alone,
being alone, being in a crowd, standing in a line, or traveling on buses
or trains?

1
CIRCLE “1”
ON PAGE
E.15

3. During the past year, has there been anything that you have been
afraid to do or felt uncomfortable doing in front of other people, like
speaking, eating, or writing?

4. In the past year have there been any other things that you’ve been
especially afraid of, like flying, seeing blood, getting a shot, heights,
closed places, or certain kinds of animals or insects?
5. In the past year have you been bothered by thoughts that didn’t make
any sense and kept coming back to you even when you tried not to
have them?
IF NOT SURE WHAT IS MEANT: Thoughts like hurting someone
even though you really didn’t want to or being contaminated by germs
or dirt.

1
CIRCLE “1”
ON PAGE
E.19

1
CIRCLE “1”
ON PAGE
E.23

1
CIRCLE “1”
ON PAGE
E.27

1
6. In the past year has there been anything that you had to do over and
over again and couldn’t resist doing, like washing your hands again
and again, counting up to a certain number, or checking something
several times to make sure that you’d done it right?

1=not present

2=unsure or equivocal

CIRCLE “1”
ON PAGE
E.29

CIRCLE
“3” ON PAGE
E.9

CIRCLE
“3” ON
PAGE E.15

2
CIRCLE “3”
ON PAGE
E.19

CIRCLE “3”
ON PAGE
E.23

CIRCLE
“3” ON PAGE

E.27

CIRCLE
“3” ON PAGE

E.29

3=present

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

(March 2011)

Screening – Page 2

Screening Questions

1
7. In the past year, have you had times when you have been particularly
nervous or anxious?

8. During the past year, have you had a time when you weighed much
less than other people thought you ought to weigh?

CIRCLE “1”
ON PAGE
E.33

1
CIRCLE “1”
ON PAGE
F.1

9. In the past year, have you often had times when your eating was out
of control?

1
CIRCLE “1”
ON PAGE
F.3

1=not present

2=unsure or equivocal

CIRCLE
“3” ON PAGE

E.33

CIRCLE
“3” ON PAGE

F.1

CIRCLE
“3” ON PAGE

F.3

3=present

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year MDE

(March 2011)

Mood Episodes A.1

A. MOOD EPISODES
*PAST YEAR MAJOR DEPRESSIVE
EPISODE*

MDE CRITERIA

In the past year, that is since
(CURRENT DATE) 2010, 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?)

A. Five (or more) of the following
symptoms have been present during the
same two-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.

IF YES: When was that? How long
did it last? (As long as two weeks?)
________________________________
________________________________
________________________________
________________________________
IF DEPRESSED MOOD: During that
time did you lose interest or pleasure
in things you usually enjoyed?
IF NO DEPRESSED MOOD: What
about a time in the last year when you
lost interest or pleasure in things you
usually enjoyed? (What was that like?)
IF YES: When was that? Was it
nearly every day? How long did it
last? (As long as two weeks?)
Have you had more than one time in the
past year like that? (Which time was the
worst?)
________________________________
________________________________

(1) depressed mood most of the
day, nearly every day, as
indicated either by subjective
report (e.g., feels sad or empty)
or observation made by others
(e.g., appears tearful). Note: in
children or adolescents, can be
irritable mood.

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

IF NEITHER
ITEM (1) NOR
ITEM (2) IS
CODED “3,” GO
TO *LIFETIME
MDE,* A.7

NOTE: IF MORE THAN ONE
PAST EPISODE IS LIKELY,
SELECT THE “WORST” ONE FOR
YOUR INQUIRY ABOUT A
MAJOR DEPRESSIVE EPISODE.
NOTE: WHEN RATING THE FOLLOWING ITEMS, CODE “1”
IF CLEARLY DUE TO A GENERAL MEDICAL CONDITION,
OR TO MOOD-INCONGRUENT DELUSIONS OR
HALLUCINATIONS

________________________________
________________________________
________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year MDE

(March 2011)

Mood Episodes A.2

FOR THE FOLLOWING QUESTIONS,
FOCUS ON THE WORST TWO WEEKS
OF THE MAJOR DEPRESSIVE
EPISODE THAT YOU ARE INQUIRING
ABOUT
During that (TWO WEEK PERIOD) . . .
. . . how was your appetite? (What
about compared to your usual appetite?)
(Did you have to force yourself to eat?)
(Eat [less/more] than usual?) (Was that
nearly every day?) (Did you lose or gain
any weight) (How much?) (Were you
trying to [lose/gain] weight?)

(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. Note: in children,
consider failure to make
expected weight gains.

(4) insomnia or hypersomnia nearly
every day

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

(6) fatigue or loss of energy nearly
every day

________________________________
________________________________
. . . 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 to usual? Was that
nearly every night?)
________________________________
________________________________
. . . 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?)
________________________________
________________________________
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year MDE

Mood Episodes A.3

(March 2011)

During this time . . .
. . .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?)
________________________________
________________________________

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

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

(7) feelings of worthlessness or
excessive or inappropriate guilt
(which may be delusional) nearly
every day (not merely selfreproach or guilt about being
sick)
NOTE: CODE “1” OR “2” IF ONLY
LOW SELF-ESTEEM

________________________________
________________________________
. . .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?
(Nearly every day?)
________________________________
________________________________
. . .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?
________________________________
________________________________

NOTE: CODE “1” FOR SELFMUTILATION W/O SUICIDAL
INTENT

________________________________
________________________________
________________________________
________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

MDE Past Year

(March 2011)

AT LEAST FIVE OF THE ABOVE SXS
[A(1-9)] ARE CODED “3” AND AT
LEAST ONE OF THESE IS ITEM (1)
OR (2)

Mood Episodes A.4

IF NOT ALREADY ASKED: Has there
been any other time in the past year
when you were (depressed/OWN
WORDS) and had even more of the
symptoms that I just asked you about?

A10

CONTINUE
WITH NEXT
ITEM, CRITERION C,
MIDDLE OF
PAGE

IF YES: RETURN TO * PAST
YEAR MDE,* A.1, AND CHECK
WHETHER THERE HAVE BEEN
ANY OTHER MAJOR
DEPRESSIVE EPISODES IN THE
PAST 12 MONTHS THAT WERE
MORE SEVERE AND/OR
CAUSED MORE SYMPTOMS. IF
SO, ASK ABOUT THAT
EPISODE.
IF NO: GO TO *LIFETIME MDE*
A.7.
IF UNCLEAR: Did (depressive
episode/OWN WORDS) make it hard
for you to do your work, take care of
things at home, or get along with other
people?

NOTE: DSM-IV criterion B (i.e., does not
meet criteria for a mixed episode) has
been omitted from the SCID.
C. The symptoms cause clinically
significant distress or impairment in
social, occupational or other
important areas of functioning.

IF NOT ALREADY ASKED: Has there
been any other time in the past year
when you were (depressed/OWN
WORDS) and it caused even more
problems than the time I just asked
you about?

A11

CONTINUE
ON NEXT
PAGE

IF YES: RETURN TO *PAST
YEAR MDE*, A. 1, AND CHECK
WHETHER THERE HAVE BEEN
ANY OTHER MAJOR
DEPRESSIVE EPISODES IN THE
PAST 12 MONTHS THAT WERE
MORE SEVERE AND/OR
CAUSED MORE SYMPTOMS. IF
SO, ASK ABOUT THAT EPISODE
IF NO: GO TO *LIFETIME MDE*,
A.7.
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

MDE Past Year

In what month (and what year) did this
(PAST YEAR MAJOR DEPRESSIVE
EPISODE) start?

(March 2011)

Mood Episodes A.5

PAST YEAR MAJOR DEPRESSIVE
EPISODE STARTED:

A12
A13

Month/Yr: ___ ___/___ ___ ___ ___
Just before this began, were you
physically ill?
IF YES: What did the doctor say?
________________________________
Just before this began, were you using
any medications?
IF YES: Was there any change in
the amount you were taking at that
time?
________________________________
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 to a general medical
condition
IF THERE IS ANY INDICATION
THAT THE DEPRESSION MAY
BE SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL
CONSEQUENCE OF A GMC OR
SUBSTANCE), GO TO *MOOD
EPISODES DUE TO
GMC/SUBSTANCE* IN THE
BACK OF THIS BOOKLET, AND
RETURN HERE TO MAKE A
RATING OF “1” OR “3.”

A14

DUE TO SUBSTANCE USE OR
GMC

PRIMARY
MOOD
EPISODE

________________________________
IF UNKNOWN: Has there been any
other time when you were (depressed /
OWN WORDS) like this but were not
(using SUBSTANCE / ill with GMC)?
IF YES: RETURN TO *PAST YEAR
MDE*, A.1, AND CHECK
WHETHER THERE HAVE BEEN
ANY OTHER MAJOR DEPRESSIVE
EPISODES IN THE PAST 12
MONTHS THAT WERE MORE
SEVERE AND/OR CAUSED MORE
SYMPTOMS. IF SO, ASK ABOUT
THAT EPISODE
IF NO: GO TO *LIFETIME MDE*,
A.7.

?=inadequate information

Etiological general medical conditions
include: degenerative neurological
illnesses (e.g., Parkinson’s disease),
cerebrovascular disease (e.g., stroke),
metabolic conditions (e.g., Vitamin B-12
deficiency), endocrine conditions (e.g.,
hyper- and hypothyroidism, hyper- and
hypoadrenocorticism); viral or other
infections (e.g., hepatitis,
mononucleosis, HIV), 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.

1=absent or false

2=subthreshold

CONTINUE
ON NEXT
PAGE

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year MDE

Mood Episodes A.6

(March 2011)

1
E. The symptoms are not better
accounted for by [Simple]
Bereavement, i.e., after the loss
SIMPLE
of a loved one, the symptoms
BEREAVEpersist for longer than 2 months MENT
or are characterized by marked
functional impairment, morbid
preoccupation with
worthlessness, suicidal ideation,
psychotic symptoms or
psychomotor retardation.

Did this begin soon after someone
close to you died?

A15

3
AT
LEAST
ONE
EPISODE
NOT
SIMPLE
BEREAVEMENT

NOTE: CODE “3” IF EITHER
NOT FOLLOWING THE LOSS
OF LOVED ONE OR IF
BEREAVEMENT IS
COMPLICATED BY MAJOR
DEPRESSIVE EPISODE. CODE
“1” IF SIMPLE BEREAVEMENT
IF UNKNOWN: Has there been any
other time in the past year when you
were (depressed / OWN WORDS) like
this that did not occur after someone
close to you died?
IF YES: GO TO *PAST YEAR
MDE *, A. 1 AND CHECK
WHETHER THERE HAS BEEN
ANY OTHER MAJOR
DEPRESSIVE EPISODE IN THE
PAST 12 MONTHS THAT WAS
NOT BETTER ACCOUNTED FOR
BY BEREAVEMENT. IF SO, ASK
ABOUT THAT EPISODE.
IF NO: GO TO *LIFETIME MDE*,
A.7.
______________________________
______________________________

CONTINUE
BELOW

MAJOR DEPRESSIVE EPISODE
CRITERIA A, C, D, AND E ARE
CODED “3”
GO TO
*LIFETIME
MDE*, A.7

______________________________
How many separate times in your life
have you been (depressed/ OWN
WORDS) nearly every day for at least
two weeks and had several of the
symptoms that you described like
(SXS OF WORST EPISODE)

?=inadequate information

Total number of Major Depressive
Episodes (CODE 98 IF TOO
NUMEROUS OR INDISTINCT TO
COUNT)

1=absent or false

A16

PAST YEAR
MAJOR
DEPRESSIVE
EPISODE

____ ____

A17

GO TO *PAST
YEAR MANIC
EPISODE*, A.13

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime MDE

*LIFETIME MAJOR DEPRESSIVE
EPISODE*

MDE CRITERIA

Looking back before the past year,
have you ever had a period when
you were feeling depressed or down
most of the day nearly every day?
(What was that like?)

IF YES: When was that? How
long did it last? (As long as two
weeks?)
______________________________
______________________________

IF PAST DEPRESSED MOOD:
During that time, did you lose
interest or pleasure in things you
usually enjoyed? (What was that
like?)

(March 2011)

Mood Episodes A.7

A. Five or more of the following
symptoms have been present during
the same two-week period and
represent a change from previous
functioning; at least one of the
symptoms was either (1) depressed
mood or (2) loss of interest or
pleasure.
(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). Note: in
children and adolescents, can
be irritable mood.
(2) markedly diminished interest or
pleasure in all, or almost all,
activities most of the day, nearly
every day (as indicated either
by subjective account or
observation made by others).

IF NO PAST DEPRESSED
MOOD: Looking back before the
past year, did you ever have a
time when you lost interest or
pleasure in things you usually
enjoyed? (What was that like?)

A18

A19

IF NEITHER
ITEM (1)
NOR (2) IS
CODED “3”,
GO TO
*PAST YEAR
MANIC
EPISODE*
A.13

IF YES: When was that? Was it
nearly every day? How long did it
last? (As long as two weeks?)
______________________________
______________________________
______________________________

NOTE: IF MORE THAN ONE
PAST EPISODE IS LIKELY,
SELECT THE “WORST” ONE FOR
YOUR INQUIRY ABOUT A
MAJOR DEPRESSIVE EPISODE.

______________________________
______________________________
Have you had more than one time like
that? (Which time was the worst?)

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime MDE

(March 2011)

Mood Episodes A.8

FOR THE FOLLOWING QUESTIONS,
FOCUS ON THE WORST TWO
WEEKS OF THE MAJOR
DEPRESSIVE EPISODE THAT YOU
ARE INQUIRING ABOUT

NOTE: WHEN RATING THE FOLLOWING ITEMS, CODE
“1” IF CLEARLY DIRECTLY DUE TO A GENERAL
MEDICAL CONDITION, OR TO MOOD-INCONGRUENT
DELUSIONS OR HALLUCINATIONS

During that (TWO WEEK PERIOD) . . .
. . . how was your appetite? (What
about compared to your usual
appetite?) (Did you have to force
yourself to eat?) (Eat [less/more] than
usual?) (Was that nearly every day?)
(Did you lose or gain any weight?)
(How much?) (Were you trying to
[lose/gain] weight?)

(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.

A20

(4) insomnia or hypersomnia nearly
every day

A21

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

A22

(6) fatigue or loss of energy nearly
every day

A23

______________________________
______________________________
______________________________

. . .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 to
usual? Was that nearly every night?
______________________________
______________________________

. . . 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 it
nearly every day?)
. . . what was your energy like? (Tired
all the time? Nearly every day?)
______________________________
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime MDE

(March 2011)

Mood Episodes A.9

During that time . . .
. . . 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?)

A24

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

A25

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

A26

(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 “1” OR “2” FOR
LOW SELF-ESTEEM BUT NOT
WORTHLESSNESS

______________________________
______________________________
. . . 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?
(Nearly every day?)
______________________________
______________________________
. . .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?
______________________________
______________________________
______________________________

NOTE: CODE “1” FOR SELFMUTILATION W/O SUICIDAL
INTENT

IF YES: Did you do anything to
hurt yourself?
______________________________
______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime MDE

(March 2011)

AT LEAST FIVE OF THE ABOVE SXS
[A(1-9)] ARE CODED “3” AND AT
LEAST ONE OF THESE IS ITEM (1)
OR (2)

Mood Episodes A.10

IF NOT ALREADY ASKED: Has there
been any other time when you were
(depressed/OWN WORDS) and had
even more of the symptoms that I just
asked you about?

A27

CONTINUE
WITH NEXT
ITEM, CRITERION C,
MIDDLE OF
PAGE

IF YES: RETURN TO *LIFETIME
MDE*, A.7, AND CHECK
WHETHER THERE HAVE BEEN
ANY OTHER MAJOR
DEPRESSIVE EPISODES THAT
WERE MORE SEVERE AND/OR
CAUSED MORE SYMPTOMS. IF
SO, ASK ABOUT THAT
EPISODE.
NOTE: DSM-IV criterion B (i.e., does not
meet criteria for a mixed episode) has
been omitted from the SCID.

IF NO: GO TO *PAST YEAR
MANIC EPISODE*, A.13.

IF UNCLEAR: Did (depressive
episode/OWN WORDS) make 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.

IF NOT ALREADY ASKED: Has there
been any other time when you were
(depressed/OWN WORDS) and it
caused even more problems than the
time I just asked you about?

A28

CONTINUE
ON NEXT
PAGE

IF YES: RETURN TO *LIFETIME
MDE*, A. 7, AND CHECK
WHETHER THERE HAVE BEEN
ANY OTHER MAJOR
DEPRESSIVE EPISODES THAT
WERE MORE SEVERE AND/OR
CAUSED MORE SYMPTOMS. IF
SO, ASK ABOUT THAT EPISODE
IF NO: GO TO *PAST YEAR
MANIC EPISODE*, A.13.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime MDE

(March 2011)

How old were you when this
(LIFETIME MAJOR DEPRESSIVE
EPISODE) started?

LIFETIME MAJOR DEPRESSIVE
EPISODE STARTED:

Mood Episodes A.11

A29

AGE: ___ ___
Just before this began, were you
physically ill?
IF YES: What did the doctor say
______________________________
Just before this began, were you using
any medications?
IF YES: Was there any change in
the amount you were taking at
that time?
______________________________
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 to a general medical
condition (e.g., hypothyroidism)

A30

DUE TO
SUBSTANCE
USE OR GMC

IF THERE IS ANY INDICATION THAT THE
DEPRESSION MAY BE SECONDARY (I.E.,
A DIRECT PHYSIOLOGICAL
CONSEQUENCE OF A GMC OR
SUBSTANCE), GO TO *MOOD EPISODE

DUE TO GMC/SUBSTANCE* IN THE
BACK OF THIS BOOKLET, AND
RETURN HERE TO MAKE A RATING OF
“1” OR “3.”

REFER TO LIST OF GENERAL
MEDICAL CONDITIONS AND
SUBSTANCES, A.5.
PRIMARY
MOOD
EPISODE

IF UNKNOWN: Has there been any
other time when you were (depressed
/ OWN WORDS) like this but were not
(using SUBSTANCE / ill with GMC)?
IF YES: GO TO *LIFETIME
MDE*, A.7 AND CHECK
WHETHER THERE HAS BEEN
ANY OTHER MAJOR
DEPRESSIVE EPISODE NOT
DUE TO A SUBSTANCE OR
GENERAL MEDICAL
CONDITION. IF SO, ASK
ABOUT THAT EPISODE.
IF NO: GO TO *PAST YEAR
MANIC EPISODE*, A.13

?=inadequate information

CONTINUE
ON NEXT
PAGE

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime MDE

Did this begin soon after someone
close to you died?
______________________________
______________________________

(March 2011)

Mood Episodes A.12

E. The symptoms are not better
1
accounted for by [Simple]
Bereavement, i.e., after the loss
SIMPLE
of a loved one, the symptoms
BEREAVEpersist for longer than 2 months MENT
or are characterized by marked
functional impairment, morbid
preoccupation with
worthlessness, suicidal ideation,
psychotic symptoms or
psychomotor retardation.

A31

3
AT
LEAST
ONE
EPISODE
NOT
SIMPLE
BEREAVEMENT

NOTE: CODE “3” IF EITHER
NOT FOLLOWING THE LOSS
OF LOVED ONE OR IF
BEREAVEMENT IS
COMPLICATED BY MAJOR
DEPRESSIVE EPISODE. CODE
“1” IF SIMPLE BEREAVEMENT
IF UNKNOWN: Has there been any
other time when you were (depressed
/ OWN WORDS) like this that did not
occur after someone close to you
died?
IF YES: GO TO *LIFETIME MDE*,
A.7 AND CHECK WHETHER
THERE HAS BEEN ANY OTHER
MAJOR DEPRESSIVE EPISODE
THAT WAS NOT BETTER
ACCOUNTED FOR BY
BEREAVEMENT. IF SO, ASK
ABOUT THAT EPISODE.
IF NO: GO TO *PAST YEAR
MANIC EPISODE*, A.13.

CONTINUE
BELOW

MAJOR DEPRESSIVE EPISODE
CRITERIA A, C, D, AND E ARE
CODED “3”

How many separate times in your life
have you been (depressed/OWN
WORDS) nearly every day for at least
two weeks and had several of the
symptoms that you described like
(SXS OF WORST EPISODE)

?=inadequate information

1
GO TO
*PAST YEAR
MANIC
EPISODE*,
A.13

Total number of Major Depressive
Episodes (CODE 98 IF TOO
NUMEROUS OR INDISTINCT TO
COUNT)

1=absent or false

2=subthreshold

A32

LIFETIME
MAJOR
DEPRESSIVE
EPISODE

____ ____

A34

GO TO *PAST
YEAR MANIC
EPISODE*, A.13

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year Mania

*PAST YEAR MANIC EPISODE*

(March 2011)

Mood Episodes A.13

MANIC EPISODE CRITERIA

In the past year has there been 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 were so hyper
that you got into trouble?
IF YES: What was it like? (Did
anyone say you were manic?)
(Was that more than just feeling
good?)
IF NO: In the past year, have you
had a period of time when you
were feeling irritable or angry
every day for at least several
days?

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

What was it like? (Did you find
yourself often starting fights or
arguments?)
______________________________

A35

A36

GO TO
*LIFETIME
MANIC
EPISODE*,
A. 19

______________________________
______________________________
______________________________
How long did that last? (As long as
one week?) (Did you have to go into a
hospital?)
______________________________
______________________________
______________________________

. . . lasting at least one week (or any
?
duration if hospitalization is necessary)
NOTE: IF ELEVATED MOOD LASTS
LESS THAN ONE WEEK, CHECK
WHETHER IRRITABLE MOOD LASTS
AT LEAST ONE WEEK BEFORE
SKIPPING TO A.19.

GO TO
*LIFETIME
MANIC
EPISODE*,
A. 19

______________________________
______________________________
______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year Mania

FOCUS ON THE WORST PERIOD
OF THE EPISODE THAT YOU ARE
INQUIRING ABOUT.
IF UNCLEAR: During (EPISODE),
when were you the most (OWN
WORDS FOR MANIA)?

(March 2011)

Mood Episodes A.14

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:

During that time . . .
. . how did you feel about yourself?

(1) inflated self-esteem or
grandiosity

A37

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

A38

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

A39

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

A40

(More self-confident than usual?)
(Any special powers or abilities?)
______________________________
______________________________
. . did you need less sleep than usual?
(How much sleep did you get?)
IF YES: Did you still 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? (What was that like?)
______________________________
______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year Mania

(March 2011)

Mood Episodes A.15

During that time . . .
. . .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)

A41

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

A42

A43

(Give me an example of that.)
______________________________
______________________________
. . .how did you spend your time?
(Work, friends, hobbies?) (Were you
especially productive or busy during
that time?) (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?)
______________________________

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

______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year Mania

(March 2011)

AT LEAST THREE “B” SXS ARE
CODED “3” (FOUR IF MOOD ONLY
IRRITABLE)

Mood Episodes A.16
1

A44

A44a

IF NOT ALREADY ASKED: Has there
been any other times in the past year
when you were (high/irritable/OWN
WORDS) and had even more of the
symptoms that I just asked you about?
IF YES: RETURN TO *PAST
YEAR MANIC EPISODE*, A. 13,
AND INQUIRE ABOUT WORST
EPISODE.
IF NO: GO TO *LIFETIME MANIC
EPISODE*, A19.

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?

IF NOT ALREADY ASKED: Have
there been any other times in the past
year when you were
(high/irritable/OWN WORDS) and had
(ACKNOWLEDGED MANIC
SYMPTOMS) and you got into trouble
with people or were hospitalized?

NOTE: DSM-IV criterion C (i.e., does
not meet criteria for a Mixed Episode)
has been omitted from the SCID.

D. 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.

A45

DESCRIBE:

IF YES: RETURN TO *PAST YEAR MANIC EPISODE*, A.13 AND
INQUIRE ABOUT THAT EPISODE
IF NO: GO TO *LIFETIME MANIC EPISODE*, A.19.

?=inadequate information

CONTINUE
BELOW

1=absent or false

2=subthreshold

CONTINUE
ON NEXT
PAGE

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year Mania

In what month (and what year) did this
(PAST YEAR MANIC EPISODE)
start?

(March 2011)

Mood Episodes A.17

PAST YEAR MANIC EPISODE
STARTED:

A46
A47

Month/Yr: ___ ___/___ ___ ___ ___
Just before this began, were you
physically ill?
IF YES: What did the doctor say?
Just before this began, were you
taking any medications?

E. The symptoms are not due to the
?
1
direct physiological effects of a
substance (e.g., a drug of abuse,
DUE TO
medication) or to a general medical SUBSTANCE
condition
USE OR

A48

GMC

IF YES: Was there any change
in the amount you were taking at
that time?
Just before this began, were you
drinking or using any street drugs?
NOTE: MANIC-LIKE EPISODES
THAT ARE CLEARLY CAUSED BY
SOMATIC ANTIDEPRESSANT
TREATMENT (E.G., MEDICATION,
ECT, LIGHT THERAPY) SHOULD
NOT COUNT TOWARD A
DIAGNOSIS OF BIPOLAR I
DISORDER BUT ARE CONSIDERED
SUBSTANCE-INDUCED MOOD
DISORDERS.

IF THERE IS ANY INDICATION THAT
THE MANIA MAY BE SECONDARY
(I.E., A DIRECT PHYSIOLOGICAL
CONSEQUENCE OF A GMC OR
SUBSTANCE), GO TO *MOOD
EPISODE DUE TO GMC/SUBSTANCE*
IN THE BACK OF THIS BOOKLET, AND
RETURN HERE TO MAKE A RATING
OF “1” OR “3.”

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 B-12
deficiency, Wilson’s disease), endocrine
conditions (e.g., hyperthyroidism), viral
or other infections, and certain cancers
(e.g., cerebral neoplasms).
PRIMARY
MOOD
EPISODE

IF UNKNOWN: Has there been any
other times in the past year when you
were (high / irritable / OWN WORDS)
and were not (using SUBSTANCE / ill
with GMC)?

Etiological substances include: alcohol,
amphetamines, cocaine, hallucinogens,
inhalants, opioids, phencyclidine,
sedatives, hypnotics, and anxiolytics.
Medications include psychotropic
medications (e.g., anti-depressants),
corticosteroids, anabolic steroids,
isoniazid, antiparkinson medication
(e.g., levadopa), and
sympathomimetics/decongestants
IF YES: RETURN TO *PAST YEAR MANIC EPISODE*, A.13, AND
INQUIRE ABOUT OTHER EPISODE.
IF NO: GO TO *LIFETIME MANIC EPISODE*, A.19.
1

MANIC EPISODE CRITERIA
A, B, D AND E ARE CODED “3”
GO TO
*LIFETIME
MANIC
EPISODE*,
A.19

?=inadequate information

1=absent or false

2=subthreshold

A49

MANIC
EPISODE
PAST YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Past Year Mania

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

(March 2011)

Number of Manic Episodes, including
past year (CODE 98 IF TOO
INDISTINCT OR NUMEROUS TO
COUNT)

Mood Episodes A.18
____ ____

A50

GO TO *PSYCHOTIC
SCREEN*, B/C.1

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime Mania

*LIFETIME MANIC EPISODE*

(March 2011)

Mood Episodes A.19

MANIC EPISODE CRITERIA

Looking back before the past year, did
you ever have 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 were so hyper that you got into
trouble?
IF YES: What was it like? (Did
anyone say you were manic?)
(Was that more than just feeling
good?)

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

A51

A52

GO TO
*DYSTHYMIC
DISORDER*,
A.25

IF NO: Looking back before the
past year, did you ever have a
period of time when you were
feeling irritable or angry every day
for at least several days?
What was it like? (Did you find
yourself often starting fights or
arguments?)
______________________________
______________________________
When was that?
______________________________

How long did that last? (as long as
one week?) (Did you need to go to the
hospital?)
______________________________
______________________________

Have you had more than one time like
that? (Which time was the most
extreme?)
______________________________

GO TO
*DYSTHYMIC
DISORDER*,
A.25

NOTE: IF THERE IS EVIDENCE FOR
MORE THAN ONE PAST EPISODE,
SELECT THE “WORST” ONE FOR
YOUR INQUIRY ABOUT PAST MANIC
EPISODE.

______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime Mania

FOCUS ON THE WORST PERIOD
OF THE EPISODE THAT YOU ARE
INQUIRING ABOUT.
IF UNCLEAR: During (EPISODE),
when were you the most (OWN
WORDS FOR MANIA)?

(March 2011)

Mood Episodes A.20

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:

During that time . . .
. . .how did you feel about yourself?
(More self-confident than usual?)
(Any special powers or abilities?)
______________________________

(1) inflated self-esteem or grandiosity ?

A53

. . did you need less sleep than usual?
(How much sleep did you get?)

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

A54

. . .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

A55

. . .were your thoughts racing through
your head? (What was that like?)
______________________________

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

A56

. . .were you so easily distracted by
things around you that you had trouble
concentrating or staying on one track?
(Give me an example of that.)
______________________________

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

A57

. . .how did you spend your time?
(Work, friends, hobbies?) (Were you
especially productive or busy during
that time?) (Were you so active that
your friends or family were concerned
about you?)
______________________________

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

A58

IF YES: Did you still feel rested?
_____________________________

______________________________
IF NO INCREASED ACTIVITY:
Were you physically restless?
(How bad was it?)
______________________________
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime Mania

(March 2011)

Mood Episodes A.21

During that time . . .
. . .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 which have
a high potential for painful
consequences (e.g., engaging in
unrestrained buying sprees,
sexual indiscretions, or foolish
business investments)

A59

A60

______________________________
AT LEAST THREE “B” SXS ARE
CODED “3” (FOUR IF MOOD ONLY
IRRITABLE)

A60a

IF NOT ALREADY ASKED: Has there
been any other time when you were
(high/irritable/OWN WORDS) and had
even more of the symptoms that I just
asked you about?
IF YES: RETURN TO *LIFETIME
MANIC EPISODE*, A.19, AND
INQUIRE ABOUT WORST
EPISODE.
IF NO: GO TO *DYSTHYMIC
DISORDER*, A.25.

NOTE: DSM-IV criterion C (i.e., does
not meet criteria for a Mixed Episode)
has been omitted from the SCID.

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?
______________________________

D. 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.

CONTINUE
BELOW

A61

IF NOT ALREADY ASKED: Has there DESCRIBE:
been any other time when you were
(high/irritable/OWN WORDS) and had
(ACKNOWLEDGED MANIC
SYMPTOMS) and you got into trouble
with people or were hospitalized?
IF YES: RETURN TO *LIFETIME MANIC EPISODE”, A.19 AND INQUIRE
ABOUT THAT EPISODE
IF NO: GO TO *DYSTHYMIC DISORDER*, A.25.
?=inadequate information

1=absent or false

2=subthreshold

CONTINUE
ON NEXT
PAGE

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime Mania

How old were you when this
(LIFETIME MANIC EPISODE)
started?

(March 2011)

Mood Episodes A.22

LIFETIME MANIC EPISODE STARTED:
A62

AGE: ___ ___

Just before this began, were you
physically ill?
IF YES: What did the doctor say?
______________________________

E The symptoms are not due to the
?
1
direct physiological effects of a
substance (e.g., a drug of abuse,
DUE TO
medication) or to a general medical SUBSTANCE
condition
USE OR

A63

GMC

Just before this began, were you
taking any medications?
IF YES: Was there any change
in the amount you were taking at
that time?
______________________________
Just before this began, were you
drinking or using any street drugs?
______________________________
______________________________
______________________________
______________________________

NOTE: MANIC-LIKE EPISODES THAT
ARE CLEARLY CAUSED BY SOMATIC
ANTIDEPRESSANT TREATMENT
(E.G., MEDICATION, ECT, LIGHT
THERAPY) SHOULD NOT COUNT
TOWARD A DIAGNOSIS OF BIPOLAR
I DISORDER BUT ARE CONSIDERED
SUBSTANCE-INDUCED MOOD
DISORDERS.
REFER TO LIST OF GENERAL
MEDICAL CONDITIONS AND
SUBSTANCES, A.17
PRIMARY
MOOD
EPISODE

IF UNKNOWN: Has there been any
other time when you were (high /
irritable / OWN WORDS) and were not
(using SUBSTANCE / ill with GMC)?
IF YES: RETURN TO *LIFETIME MANIC EPISODE*,
A.19, AND INQUIRE ABOUT OTHER EPISODE.

CONTINUE
ON NEXT
PAGE

IF NO: GO TO *DYSTHYMIC DISORDER*, A.25.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime Mania

(March 2011)

Mood Episodes A.23

MANIC EPISODE CRITERIA
A, B, D AND E ARE CODED “3”

1
GO TO
*DYSTHYMIC
DISORDER*,
A.25

How many separate times in your life
were you (HIGH / OWN WORDS) and
had [ACKNOWLEDGED MANIC
SYMPTOMS] for a period of time (or
were hospitalized)?

Number of Manic Episodes (CODE 98
IF TOO INDISTINCT OR NUMEROUS
TO COUNT)

A64

LIFETIME
MANIC
EPISODE

____ ____

A65

GO TO
*PSYCHOTIC
SCREEN*,
B/C.1

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Lifetime Mania

(March 2011)

Mood Episodes A.24

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Dysthymic Disorder

*DYSTHYMIC DISORDER*
(PAST YEAR)

(March 2011)

Mood Episodes A.25

DYSTHYMIC DISORDER CRITERIA

For the past couple of years, have
you been bothered by depressed
mood most of the day, more days
than not? (More than half of the
time?)
IF YES: What was that like?

A. Depressed mood for most of the
?
day, for more days than not, as
indicated either by subjective
account or observation made by
others, for at least two years. Note:
in children and adolescents, mood
can be irritable and duration must be
at least 1 year.

A66

GO TO
*PSYCHOTIC
SCREEN*, B/C.1

______________________________

During these periods of (OWN
WORDS FOR CHRONIC
DEPRESSION) do you often . . .

B Presence, while depressed, of two
(or more) of the following:

. . . lose your appetite? (What about
overeating?)
______________________________

(1) poor appetite or overeating

A67

(2) insomnia or hypersomnia

A68

(3) low energy or fatigue

A69

(4) low self-esteem

A70

(5) poor concentration or difficulty
making decisions

A71

______________________________
. . . have trouble sleeping or sleep too
much?
______________________________
______________________________
. . . have little energy to do things or
feel tired a lot?
______________________________
______________________________
. . . feel down on yourself? (Feel
worthless, or a failure?)
______________________________
______________________________
. . . have trouble concentrating or
making decisions?
______________________________
______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Dysthymic Disorder

. . . feel hopeless?
______________________________

(March 2011)

(6) feelings of hopelessness

Mood Episodes A.26
?

A72

A73

______________________________
AT LEAST TWO “B”
SYMPTOMS CODED “3”

GO TO
*PSYCHOTIC
SCREEN*, B/C.1

What is the longest period of time,
during this period of long-lasting
depression, that you felt OK? (NO
DYSTHYMIC SYMPTOMS)

C. During the two year period of the
disturbance, the person has never
been without the symptoms in
criteria A and B for more than two
months at a time.

A74

GO TO
*PSYCHOTIC
SCREEN*,
B/C.1

NOTE: CODE “1” IF NORMAL MOOD
FOR AT LEAST TWO MONTHS AT A
TIME

How long have you been feeling this
way? (When did this begin?)
COMPARE ONSET OF DYSTHYMIC
SXS WITH DATES OF PAST MAJOR
DEPRESSIVE EPISODES TO
DETERMINE IF THERE WERE ANY
MAJOR DEPRESSIVE EPISODES IN
FIRST TWO YEARS OF DYSTHYMIC
DISORDER.
IF A MAJOR DEPRESSIVE EPISODE
PRECEDED DYSTHYMIC SXS: Now
I want to know whether you got
completely back to your usual self
after that (MAJOR DEPRESSIVE
EPISODE) you had (DATE), before
this long period of being mildly
depressed? (Were you back to your
usual self for at least two months?)

?=inadequate information

D. No Major Depressive Episode has
been present during the first 2 years
of the disturbance (1 year for
children and adolescents): i.e., not
better accounted for by chronic
Major depressive Disorder or Major
Depression in partial remission.
Age at onset of current Dysthymic
Disorder (CODE 98 IF UNKNOWN)

A75

____ ____

A76

1
GO TO
*PSYCHOTIC
SCREEN*,
B/C.1

Note: There may have been a previous
Major Depressive Episode provided
there was a full remission (no significant
signs or symptoms for 2 months) before
development of the Dysthymic Disorder.
In addition, after the initial 2 years (1
year for children or adolescents) of
Dysthymic Disorder, there may be
superimposed episodes of Major
Depressive Disorder, in which case both
diagnoses may be given when criteria
are met for a Major Depressive Episode.

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Dysthymic Disorder

(March 2011)

Mood Episodes A.27

NOTE: CODE “3” IF NO PAST MAJOR
DEPRESSIVE EPISODES OR IF
MAJOR DEPRESSIVE EPISODES
WERE NOT PRESENT DURING THE
FIRST TWO YEARS OR IF THERE
WAS AT LEAST A TWO-MONTH
PERIOD WITHOUT SYMPTOMS
PRECEDING THE ONSET.
E. NOTE: RULE OUT FOR MIXED
EPISPODE AND HYPOMANIC
EPISODE AND CYCLOTHYMIC
DISORDER ARE NOT ASSESSED
HERE.
IF NOT ALREADY CLEAR: RETURN
TO THIS ITEM AFTER COMPLETING
THE PSYCHOTIC SYMPTOMS
SECTION.

F. The disturbance does not occur
exclusively during the course of a
1
chronic psychotic disorder, such as
Schizophrenia or Delusional
GO TO
Disorder.
*PSYCHOTIC
NOTE: CODE “3” IF NO CHRONIC
PSYCHOTIC DISORDER OR IF NOT
SUPERIMPOSED ON A CHRONIC
PSYCHOTIC DISORDER

?=inadequate information

1=absent or false

2=subthreshold

SCREEN*,
B/C.1

A77

NOT
SUPERIMPOSED
CONTINUE

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Dysthymic Disorder

Just before this began, were you
physically ill?
IF YES: What did the doctor say?
Just before this began, were you using
any medications?
IF YES: Was there any change in
the amount you were taking at that
time?
______________________________
______________________________
Just before this began, were you
drinking or using any street drugs?

(March 2011)

Mood Episodes A.28

G. Not due to the direct physiological ?
1
effects of a substance (e.g., a drug
of abuse, medication) or to a
DUE TO SUBgeneral medical condition
STANCE USE OR
IF THERE IS ANY INDICATION
THAT THE DYSTHMIA MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL CONSEQUENCE
OF A GMC OR SUBSTANCE), GO
TO *MOOD EPISODE DUE TO
GMC/SUBSTANCE* IN THE BACK
OF THIS BOOKLET AND RETURN
HERE TO MAKE A RATING OF “1”
OR “3.”

A78

GMC
GO TO
*PSYCHOTIC
SCREEN*, B/C.1

PRIMARY
MOOD
DISORDER

Etiological general medical conditions
include: degenerative neurological
illnesses (e.g., Parkinson’s disease,
Huntington’s disease, cerebrovascular
disease, metabolic and endocrine
conditions (e.g., B-12 deficiency,
hypothyroidism, autoimmune conditions
(e.g., systemic lupus erythematosis),
viral or other infections (e.g., hepatitis,
mononucleosis, HIV), 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, anti-cholinergics, and
cardiac medications.

IF UNCLEAR: How much do your
depressed feelings interfere with your
life?

CONTINUE
BELOW

H. The symptoms cause clinically
?
1
2
significant distress or impairment
GO TO
in social, occupational, or other
*PSYCHOTIC
important areas of functioning
SCREEN*, B/C.1
DYSTHYMIC DISORDER
CRITERIA A, B, C, D, F, G, AND GO TO
H ARE CODED “3.”
*PSYCHOTIC
SCREEN*,
B/C.1

?=inadequate information

1=absent or false

2=subthreshold

A79

A80

DYSTHYMIC
DISORDER

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Psychotic Symptoms Past Year (March 2011)

B/C.1

B/C PSYCHOTIC SCREENING MODULE
THIS MODULE IS FOR CODING PSYCHOTIC AND ASSOCIATED SXS THAT HAVE BEEN
PRESENT AT ANY POINT IN THE PAST YEAR.
FOR EACH PSYCHOTIC SYMPTOM CODED "3," DESCRIBE THE ACTUAL CONTENT AND
INDICATE THE PERIOD OF TIME DURING WHICH THE SYMPTOM WAS PRESENT.
FOR ANY DELUSIONS OR HALLUCINATIONS CODED “3”, DETERMINE WHETHER THE
SYMPTOM IS DEFINITELY “PRIMARY” OR WHETHER THERE IS A POSSIBLE OR DEFINITE
ETIOLOGIC SUBSTANCE (INCLUDING MEDICATIONS) OR GENERAL MEDICAL CONDITION.
THE FOLLOWING QUESTIONS MAY BE USEFUL IF THE OVERVIEW HAS NOT ALREADY
PROVIDED THE INFORMATION:
Just before (PSYCHOTIC SXS) began, were you using drugs? ...on any medications? ...did you
drink much more than usual or stop drinking after you had been drinking a lot for a while? ...were
you physically ill?
IF YES TO ANY: Has there been a time when you had (PSYCHOTIC SXS) and were not (USING
DRUGS/TAKING MEDICATION/CHANGING YOUR DRINKING HABITS/ILL)?
Now I am going to ask you about unusual
experiences that people sometimes have.

In the past year, that is since (CURRENT
DATE) 2010…

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. Code overvalued ideas (unreasonable and
sustained beliefs that are maintained with less than
delusional intensity) as "2."

? 1 2 3
…did it ever seem like people were talking Delusion of reference, i.e., events,
about you or taking special notice of you? objects, or other people in the
individual's immediate environment have
1
3
a particular or unusual significance.
IF YES: Were you convinced they
POSS/DEF PRIwere talking about you or did you think
SUBST/
MARY
it might have been your imagination?
GMC

BC1

BC2

…what about receiving special messages
from the TV, radio, or newspaper, or from
the way things were arranged around
you?
DESCRIBE:
_________________________________
_________________________________
_________________________________
_________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Psychotic Symptoms Past Year (March 2011)

In the past year…
…have you felt that someone was going
out of their way to give you a hard time, or
trying to hurt you?

B/C.2

Persecutory delusion, i.e., the individual ? 1 2 3
(or his or her group) is being attacked,
harassed, cheated, persecuted, or
1
3
conspired against.
POSS/DEF PRISUBST/
GMC

DESCRIBE:
_________________________________

BC3

BC4

MARY

_________________________________
_________________________________
…have you felt that you were especially
important in some way, or that you had
special powers to do things that other
people couldn't do?

Grandiose delusion, i.e., content
? 1 2 3
involves exaggerated power, knowledge
or importance, or a special relationship
1
3
to a deity or famous person.
POSS/DEF PRISUBST/
GMC

DESCRIBE:
_________________________________

BC5

BC6

MARY

_________________________________
_________________________________
In the past year have you felt that
something was very wrong with you
physically even though your doctor said
nothing was wrong...like you had cancer
or some other terrible disease?

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

1
1

BC7

BC8

POSS/DEF PRISUBST/
MARY
GMC

… have you been convinced that
something was very wrong with the way a
part or parts of your body looked?
…have you felt that something strange
was happening to parts of your body?
DESCRIBE:
_________________________________
_________________________________
_________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Psychotic Symptoms Past Year (March 2011)

In the past year…

Other delusions

B/C.3
?

…have you had any unusual religious
experiences?

1
1

BC9

BC10

POSS/DEF PRISUBST/
MARY
GMC

…have you felt that you had committed a
crime or done something terrible for which
you should be punished?
…have you been convinced that your
spouse or partner was being unfaithful to
you?
IF YES: How did you know they were
being unfaithful?
…did you feel you had a special, secret
relationship with someone famous, or
someone you didn't know very well?
DESCRIBE:
_________________________________
_________________________________
_________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Psychotic Symptoms Past Year (March 2011)

B/C.4

HALLUCINATIONS (PSYCHOTIC):
A sensory perception that has the
compelling sense of reality of a true
perception but occurs without external
stimulation of the relevant sensory
organ. (CODE "2" FOR
HALLUCINATIONS THAT ARE SO
TRANSIENT AS TO BE WITHOUT
DIAGNOSTIC SIGNIFICANCE)
In the past year…
…have you heard things that other people
couldn't hear, such as noises, or the
voices of people whispering or talking?
(Were you awake at the time?)

Auditory hallucinations when fully
awake, heard either inside or outside of
head

BC11

BC12

POSS/DEF PRISUBST/
MARY
GMC

IF YES: What did you hear? How
often did you hear it?
DESCRIBE:
______________________________
______________________________
______________________________
IF VOICES: Did they comment on
what you were doing or thinking?

A voice keeping up a running
commentary on the individual's
behavior or thoughts as they occur

BC13

How many voices did you hear? Were
they talking to each other?

Two or more voices conversing with
each other

BC14

BC15

BC16

How about having visions or seeing things Visual hallucinations
that other people couldn't see? (Were you
awake at the time?)

POSS/DEF PRISUBST/
MARY
GMC

NOTE: DISTINGUISH FROM AN
ILLUSION, I.E., A MISPERCEPTION OF
A REAL EXTERNAL STIMULUS.
DESCRIBE:
______________________________
______________________________
______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Psychotic Symptoms Past Year (March 2011)

…what about strange sensations in your
body or on your skin?

B/C.5

Tactile hallucinations, e.g., electricity

1
DESCRIBE:

BC17

BC18

POSS/DEF PRISUBST/
MARY
GMC

______________________________
______________________________
______________________________
(What about smelling or tasting things that Other hallucinations, e.g., gustatory,
other people couldn't smell or taste?)
olfactory

1
1

DESCRIBE:

BC19

BC20

POSS/DEF PRISUBST/
MARY
GMC

______________________________
______________________________
______________________________
ANY ITEM CODED "3" IN "PRIMARY"
SECTION

GO TO *MOOD
DISORDERS*,
D.1

BC21

A PRIMARY
PSYCHOTIC SX
HAS
BEEN
PRESENT

EXPLORE DETAILS AND DESCRIBE DIAGNOSTIC SIGNIFICANCE:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Psychotic Symptoms Past Year (March 2011)

B/C.6

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Bipolar I

(March 2011)

Mood Differential

D.1

D. MOOD DISORDERS
IF THERE HAVE NEVER BEEN ANY CLINICALLY SIGNIFICANT MOOD
SYMPTOMS, CIRCLE 1 AND GO TO *PTSD,* E.1.

IF THERE HAVE BEEN ANY CLINICALLY SIGNIFICANT MOOD SYMPTOMS,
CIRCLE 3 AND CONTINUE.
BIPOLAR I DISORDER CRITERIA
CODE BASED ON RATINGS OF
MANIC EPISODE PAST YEAR
(A49) AND MANIC EPISODE
LIFETIME (A64)

History of one or more Manic or Mixed
Episodes

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

GO TO *MAJOR
DEPRESSIVE
DISORDER*, D. 2

1
GO TO *MAJOR
DEPRESSIVE
DISORDER*, D.2

Note: Manic-like Episodes that are
clearly caused by somatic
antidepressant treatment (e.g.,
medication, ECT, 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 NOS

1
GO TO *MAJOR
DEPRESSIVE
DISORDER*, D. 2

BIPOLAR I
DISORDER
Indicate time frame of manic episode:
1 – Manic episode in past 12 months
2 – Manic episode lifetime (i.e., prior to past 12 months)

GO TO *PTSD*, E.1

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Mood Chronology (March 2011)

Mood Differential

D.2

*MAJOR DEPRESSIVE DISORDER* MAJOR DEPRESSIVE DISORDER CRITERIA
CODE BASED ON RATINGS OF
PAST YEAR MAJOR DEPRESSIVE
EPISODE (A16) AND LIFETIME
MAJOR DEPRESSIVE DISODER
(A32)

At least one Major Depressive Episode
that is not due to the direct
physiological effects of a general
medical condition or substance use

GO TO
*PTSD*, E.1

At least one Major Depressive Episode
that is not better accounted for by
Schizoaffective Disorder and is not
superimposed on Schizophrenia,
Schizophreniform Disorder, Delusional
Disorder, or Psychotic Disorder Not
Otherwise Specified

1
GO TO *
*PTSD*, E.1

Has never had any Manic, Mixed, or
unequivocal Hypomanic Episodes

1
GO TO *PTSD*, E.1

MAJOR
DEPRESSIVE
DISORDER

Indicate type:
D9

1 - Single Episode
2 - Recurrent (i.e., to be considered separate episodes, there
must be an interval of at least two months in which criteria
are not met for a Major Depressive Episode)

GO TO *PTSD*, E.1

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

(March 2011)

Anxiety Disorders

E.1

E. ANXIETY DISORDERS
*POSTTRAUMATIC STRESS DISORDER*
Sometimes things happen to people that are extremely upsetting--things like being in a life threatening
situation like a major disaster, very serious accident or fire; being physically assaulted or raped; seeing
another person killed or dead, or badly hurt, or hearing about something horrible that has happened to
someone you are close to. At any time during your life, have any of these kinds of things happened to
you?
IF NO: Have you ever been in any serious car accidents or have you ever been a victim of a crime?
(Tell me about that.)
IF NO SUCH EVENTS, CIRCLE 1 AND GO TO *PANIC DISORDER* ON PAGE E.9.
TRAUMATIC EVENT(S)
IF ONE OR MORE SUCH EVENTS, CIRCLE 3 AND CONTINUE:
NO
1

YES
3

Traumatic Events List
Brief Description

Date (Month/Yr)

Age

_______________________________________________

____/____

___

_______________________________________________

____/____

___

_______________________________________________

____/____

___

_______________________________________________

____/____

___

_______________________________________________

____/____

___

_______________________________________________

____/____

___

_______________________________________________

____/____

___

IF ANY EVENTS LISTED: Sometimes traumatic experiences like (TRAUMAS LISTED ABOVE) keep
coming back in nightmares, flashbacks, or thoughts that you can’t get rid of. Has that ever happened to
you?
IF NO: What about being very upset when you were in a situation that reminded you of one
of these terrible things?
IF NO TO BOTH OF THE ABOVE, CIRCLE 1 AND GO TO *PANIC
DISORDER* ON PAGE E.9.

IF YES TO EITHER OR BOTH OF THE ABOVE, CIRCLE 3 AND CONTINUE:

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

(March 2011)

Anxiety Disorders

E.2

POSTTRAUMATIC STRESS DISORDER
CRITERIA
FOR FOLLOWING QUESTIONS,
FOCUS ON TRAUMATIC EVENT(S)
MENTIONED IN SCREENING
QUESTION ABOVE.

A. The person has been exposed to
a traumatic event in which both of
the following were present:

IF MORE THAN ONE TRAUMA IS
REPORTED: Which of these do you
think affected you the most?

(1) the person experienced,
witnessed, or was
confronted with an event or
events that involved actual
or threatened death or
serious injury, or a threat to
the physical integrity of self
or others

(2) the person’s response
involved intense fear,
helplessness or horror.

_______________________________
_______________________________

GO TO
*Panic*,
E.9

_______________________________
IF UNCLEAR: How did you react when
(TRAUMA) happened? (Were you very
afraid or did you feel helpless or
horrified?)

1
GO TO
*Panic*,
E.9

_______________________________
_______________________________
Now I’d like to ask a few questions
about specific ways that it may have
affected you in the past year.

B. The traumatic event is
persistently re-experienced in one
(or more) of the following ways:

For example, in the past year . . .
. . . did you think about
(TRAUMA) when you didn’t want
to or did thoughts about
(TRAUMA) come to you suddenly
when you didn’t want them to?

(1) recurrent and intrusive
distressing recollections of
the event, including images,
thoughts or perceptions

(2) recurrent distressing dreams
of the event

_______________________________
_______________________________
. . . what about having dreams
about (TRAUMA)?
______________________________
______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

. . . what about finding yourself
acting or feeling as if you were
back in the situation?
_______________________________
_______________________________
_______________________________
. . . what about getting very upset
when something reminded you of
(TRAUMA)?
______________________________
______________________________

(March 2011)

Anxiety Disorders

E.3

(3) acting or feeling as if the
traumatic event were
recurring (includes a sense
of reliving the experience,
illusions, hallucinations and
dissociative flashback
episodes, including those
that occur on awakening or
when intoxicated)

(4) intense psychological
distress at exposure to
internal or external cues that
symbolize or resemble an
aspect of the traumatic
event

(5) physiological reactivity on
exposure to internal or
external cues that symbolize
or resemble an aspect of
the traumatic event

E10

______________________________
. . . what about having physical
symptoms--like breaking out in a
sweat, breathing heavily or
irregularly, or your heart pounding
or racing, when something
reminded you of (TRAUMA)?
_______________________________
_______________________________
_______________________________
AT LEAST ONE “B” SX IS CODED “3”

1
GO TO
*Panic*, E.9

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

(March 2011)

Anxiety Disorders

E.4

C. Persistent avoidance of stimuli
associated with the trauma and
numbing of general
responsiveness (not present
before the trauma), as indicated
by three (or more) of the
following:
IF TRAUMA HAS OCCURRED IN THE
PAST YEAR: Since (THE TRAUMA) ...
IF TRAUMA OCCURRED PRIOR TO
PAST YEAR: In the past year, that is
since (CURRENT DATE) 2010
. . have you made a special
effort to avoid thinking or talking
about what happened?

(1) efforts to avoid thoughts,
feelings, or conversations
associated with the trauma

E11

E12

(3) inability to recall an
important aspect of the
trauma

E13

(4) markedly diminished interest
or participation in significant
activities

E14

_______________________________
_______________________________

. . . have you stayed away from
things or people that reminded
you of (TRAUMA)?
_______________________________

(2) efforts to avoid activities,
places, or people that
arouse recollections of the
trauma

_______________________________

. . . have you been unable to
remember some important part of
what happened?
_______________________________
_______________________________

. . . have you been less interested
in doing things that used to be
important to you, like seeing
friends, reading books or
watching TV?
_______________________________
_______________________________
_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

. . . have you felt distant or cut off
from others?

(March 2011)

(5) feeling of detachment or
estrangement from others

Anxiety Disorders

E.5

E15

E16

E17

E18

_______________________________
_______________________________

. . . have you felt “numb” or like
you no longer had strong feelings
about anything or loving feelings
for anyone?

(6) restricted range of affect,
(e.g., unable to have loving
feelings)

_______________________________
_______________________________
. . . did you notice a change in the
way you think about or plan for the
future?
_______________________________

(7) sense of a foreshortened
future (e.g., does not expect
to have a career, marriage,
children, or a normal life
span)

_______________________________
1
AT LEAST 3 “C” SXS ARE
CODED “3”

?=inadequate information

1=absent or false

2=subthreshold

GO TO
*Panic*,
E.9

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

IF TRAUMA HAS OCCURRED IN THE
PAST YEAR: Since (THE TRAUMA). . .
IF TRAUMA OCCURRED PRIOR TO
PAST YEAR: In the past year…
. . . have you had trouble
sleeping? (What kind of trouble?)

(March 2011)

Anxiety Disorders

E.6

D. Persistent symptoms of increased
arousal (not present before the
trauma) as indicated by two (or
more) of the following:
(1) difficulty falling or staying
asleep

E19

E20

E21

E22

E23

E24

______________________________
______________________________
. . . have you been unusually
irritable? What about outbursts of
anger?

(2) irritability or outbursts of
anger

_______________________________
_______________________________
. . . have you had trouble
concentrating?

(3) difficulty concentrating

_______________________________
_______________________________

. . . have you been watchful or on
guard even when there was no
reason to be?

(4) hypervigilance

_______________________________
_______________________________

. . . have you been jumpy or
easily startled, like by sudden
noises?

(5) exaggerated startle
response

_______________________________
_______________________________
AT LEAST TWO “D” SXS ARE
CODED “3”

1
GO TO
*Panic*,
E.9

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

About how long did these problems-(CITE POSITIVE PTSD SYMPTOMS)-last?

(March 2011)

Anxiety Disorders

E. Duration of the disturbance
?
(symptoms in criteria B, C, and D)
is more than one month

_______________________________

E.7

E25

E26

E27

GO TO
*Panic*,
E. 9

_______________________________
_______________________________
_______________________________

F. The disturbance causes clinically
significant distress or impairment
in social, occupational, or other
important areas of functioning

1
GO TO
*Panic*,
E.9

POSTTRAUMATIC STRESS
1
DISORDER CRITERIA A, B, C, D, E,
AND F ARE CODED “3” AND
GO TO
PRESENT IN THE PAST YEAR
*PANIC*,
E.9

?=inadequate information

1=absent or false

2=subthreshold

POSTTRAUMATIC
STRESS
DISORDER
IN THE
PAST YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

PTSD Past Year

(March 2011)

Anxiety Disorders

E.8

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Panic Past Year

(March 2011)

Anxiety Disorders

E.9

PANIC DISORDER
PANIC DISORDER CRITERIA
E28

IF SCREENING QUESTION #1 EQUALS 1, CIRCLE 1 AND GO TO *AWOPD*,
ON PAGE E.15
SCREEN Q#1
NO
YES
1
3

IF SCREENING QUESTION #1 EQUALS 2 OR 3,
CIRCLE 3 AND CONTINUE:
You’ve said that in the past year you have
had a panic attack, when you suddenly felt
frightened, or anxious or suddenly
developed a lot of physical symptoms . . .

Have these attacks ever come
on completely out of the blue--in
situations where you didn’t
expect to be nervous or
uncomfortable?

A. (1) recurrent unexpected panic
attacks.

E29

E30

GO TO
*AWOPD*,
E.15

IF UNCLEAR: How many of
these kinds of attacks have
you had? (At least two?)
(2) at least one of the attacks
has been followed by a
month (or more) of one of
the following:

After any of these attacks . . .

Did you worry that there might be
something terribly wrong with you, like
you were having a heart attack or were
going crazy? (How long did you
worry?) (At least a month?)
_______________________________
_______________________________
IF NO: Did you worry a lot about
having another one? (How long
did you worry?) (At least a
month?)

(b)

1
GO TO
*AWOPD*,
E.15

worry about the
implications of the attack or
its consequences (e.g.,
losing control, having a heart
attack, “going crazy”);

(a) persistent concern about
having additional attacks;

_______________________________
IF NO: Did you do anything
differently because of the attacks
(like avoiding certain places or not
going out alone?) (What about
avoiding certain activities like
exercise?) (What about things like
always making sure you’re near a
bathroom or exit?)
_______________________________
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Panic Past Year

(March 2011)

Anxiety Disorders

E.10

NOW CHECK TO SEE IF CRITERIA
ARE MET FOR A PANIC ATTACK.
When was the last bad one?
What was the first thing you
noticed? Then what?
_______________________________
IF UNKNOWN: Did the symptoms
come on all of a sudden?

The panic attack symptoms
developed abruptly and reached a
peak within ten minutes

(1) palpitations, pounding heart,
or accelerated heart rate

(2) sweating

E31

E32

E33

E34

(4) sensations of shortness of
breath or smothering

E35

(5) feeling of choking

E36

(6) chest pain or discomfort

E37

(7) nausea or abdominal
distress

E38

GO TO
*AWOPD*,
E.15

IF YES: How long did it take
from when it began to when it got
really bad? (Less than ten
minutes?)
_______________________________
During that attack . . .
. . did your heart race, pound or skip?
_______________________________
. . did you sweat?
_______________________________
(3) trembling or shaking

. . did you tremble or shake?
_______________________________
. . were you short of breath? (Did you
have trouble catching your breath?)
_______________________________
. . did you feel as if you were choking?
_______________________________
. . did you have chest pain or pressure?
_______________________________
. . did you have nausea or upset
stomach or the feeling that you were
going to have diarrhea?
_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Panic Past Year

(March 2011)

Anxiety Disorders

E.11

. . did you feel dizzy, unsteady, or like
you might faint?

(8) feeling dizzy, unsteady,
light-headed or faint

E39

(9) derealization (feelings of unreality) or depersonalization
(being detached from
oneself)

E40

(10) fear of losing control or
going crazy

E41

E42

(12) paresthesias (numbness or
tingling sensations)

E43

(13) chills or hot flushes

E44

E45

_______________________________
. . did things around you seem unreal or
did you feel detached from things
around you or detached from part of
your body?
_______________________________
. . were you afraid you were going
crazy or might lose control?
_______________________________
. . were you afraid that you might die?

(11) fear of dying

_______________________________
. . did you have tingling or numbness in
parts of your body?
_______________________________
. . did you have flushes (hot flashes) or
chills?
_______________________________
AT LEAST FOUR ITEMS CODED
“3” AND REACHED A PEAK
WITHIN 10 MINUTES (E31
CODED “3”)

?=inadequate information

1=absent or false

GO TO *AWOPD*, E.15

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Panic Past Year

Just before you began having panic
attacks, were you taking any drugs,
caffeine, diet pills, or other medicines?

1
C. Not due to the direct physiological ?
effects of a substance (e.g., a
drug of abuse, medication) or to a
DUE TO
general medical condition
SUBSTANCE

(How much coffee, tea, or caffeinated
soda do you drink a day?)
Just before the attacks, were you
physically ill?
IF YES: What did the doctor
say?

(March 2011)

Anxiety Disorders

E.12
3

E46

USE OR GMC

IF THERE IS ANY INDICATION
THAT PANIC ATTACKS MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL
CONSEQUENCE OF A GMC OR
SUBSTANCE), GO TO *ANXIETY
DUE TO GMC/SUBSTANCE* IN
THE BACK OF THIS BOOKLET
AND RETURN HERE TO MAKE A
RATING OF “1” OR “3”

GO TO
*AWOPD*,
E.15
PRIMARY
ANXIETY
DISORDER

Etiological general medical
conditions include: hyperthyroidism,
hyperparathyroidism, pheochromocytoma, vestibular dysfunctions,
seizure disorders, and cardiac
conditions (e.g., arrhythmias,
supraventricular tachycardia).
Etiological substances include:
intoxication with central nervous
stimulants (e.g., cocaine,
amphetamines, caffeine) or cannabis
or withdrawal from central nervous
system depressants (e.g., alcohol,
barbiturates) or from cocaine.

CONTINUE

D. The panic attacks are not better
?
accounted for by another mental
disorder, such as Social Phobia
(e.g., occurring on exposure to
feared social situations), Specific
Phobia, Obsessive-Compulsive
Disorder (e.g., on exposure to dirt
in someone with an obsession
about contamination),
Posttraumatic Stress Disorder, or
Separation Anxiety Disorder.
A, C, AND D coded “3”

E47

E47a

GO TO
*AWOPD*,
E.15

?=inadequate information

1=absent or false

2=subthreshold

PANIC
DISORDER

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Panic Past Year

(March 2011)

Anxiety Disorders

E.13

PANIC DISORDER WITH AGORAPHOBIA
IF NOT OBVIOUS FROM OVERVIEW:
Are there situations that make you
nervous because you are afraid that
you might have a panic attack?
Tell me about that.
IF CANNOT GIVE SPECIFICS:
What about . . .
. . being uncomfortable if you’re
more than a certain distance
from home?
. . being in a crowded place like a
busy store, movie theatre, or
restaurant?
. . standing in a line?
. . being on a bridge?
. . using public transportation-like a bus, train, or subway--or
driving a car?

B. The presence of Agoraphobia:

(1) Anxiety about being in
places or situations from
which escape might be
difficult (or embarrassing) or
in which help may not be
available in the event of
having an unexpected or
situationally predisposed
Panic Attack or panic-like
symptoms. Agoraphobic
fears typically involve
characteristic clusters of
situations that include being
outside the home alone;
being in a crowd or standing
in a line; being on a bridge;
and traveling in a bus, train
or automobile.

E48

E49

PANIC
DISORDER
WITHOUT
AGORAPHOBIA
GO TO
*SOCIAL
PHOBIA*,
E.19

______________________________
______________________________
______________________________

Do you avoid these situations?
IF NO: When you are in one of these
situations, do you feel very
uncomfortable or like you might have a
panic attack?
(Can you go into one of these situations
only if you are with someone you
know?)

(2) Agoraphobic situations are
avoided (e.g., travel is
restricted), or else endured
with marked distress or with
anxiety about having a
panic attack or panic-like
symptoms, or require the
presence of a companion.

1
PANIC
DISORDER
WITHOUT
AGORAPHOBIA
GO TO
*SOCIAL
PHOBIA*,
E.19

_______________________________
_______________________________
_______________________________
_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Panic Past Year

(March 2011)

(3) The anxiety or phobic
avoidance is not better
accounted for by another
mental disorder, such as
Social Phobia (e.g.,
avoidance limited to social
situations because of fear of
embarrassment), Specific
Phobia (e.g., avoidance
limited to a single situation
like elevators), ObsessiveCompulsive Disorder (e.g.,
avoidance of dirt in
someone with an obsession
about contamination),
Posttraumatic Stress
Disorder (e.g., avoidance of
stimuli associated with a
severe stressor), or
Separation Anxiety Disorder
(e.g., avoidance of leaving
home or relatives).

Anxiety Disorders

E.14
3

E50

E51

PANIC
DISORDER
WITHOUT
AGORAPHOBIA IN
PAST YEAR

PANIC
DISORDER
WITH
AGORAPHOBIA IN
PAST YEAR

1
PANIC
DISORDER
WITHOUT
AGORAPHOBIA
GO TO
*SOCIAL
PHOBIA*,
E.19

NOTE: CONSIDER SPECIFIC
PHOBIA IF FEAR IS LIMITED TO
ONE OR ONLY A FEW SPECIFIC
SITUATIONS OR SOCIAL PHOBIA
IF FEAR IS LIMITED TO SOCIAL
SITUATIONS
B(1), B(2), B(3) ALL CODED “3”

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Agoraphobia w/o Panic Disorder

(March 2011)

Anxiety Disorders

E.15

*AGORAPHOBIA WITHOUT HISTORY AGORAPHOBIA WITHOUT HISTORY OF
OF PANIC DISORDER (AWOPD)*
PANIC DISORDER (AWOPD) CRITERIA
IF MET PAST YEAR CRITERIA FOR PANIC DISORDER,
CIRCLE 3 AND GO TO *SOCIAL PHOBIA* ON PAGE E.19.

PANIC DISORDER
YES
NO
1
3

E52

SCREEN Q#2
YES
NO
1
3

E53

IF CRITERIA FOR PAST YEAR PANIC DISORDER NOT MET,
CIRCLE 1 AND CONTINUE:

IF SCREENING QUESTION #2 EQUALS 1, CIRCLE 1 AND GO TO *SOCIAL
PHOBIA* ON PAGE E.19.
IF SCREENING QUESTION #2 EQUALS 2 or 3, CIRCLE 3 AND CONTINUE:
You’ve said that in the past
year you have been afraid of
going out of the house alone, being
in crowds, standing in a line, or
traveling on buses or trains . . .

What were you afraid could happen?
_______________________________
_______________________________
_______________________________
_______________________________

A. The presence of Agoraphobia:
(1) anxiety about being in places or
situations from which escape
might be difficult (or
embarrassing) or in which help
may not be available in the event
of having panic-like symptoms
(e.g., dizziness or diarrhea).
Agoraphobic fears typically
involve characteristic clusters of ?
situations that include being
outside the home alone; being in
a crowd or standing in a line;
being on a bridge; and traveling
in a bus, train, or car.

_______________________________

E54

GO TO
*SOCIAL
PHOBIA*,
E. 19

INDICATE FEARED SYMPTOM:

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Agoraphobia w/o Panic Disorder

(March 2011)

Anxiety Disorders

(2) Agoraphobic situations are
avoided (e.g., travel is
restricted), or else endured
with marked distress or with
anxiety about having paniclike symptoms, or require
the presence of a
companion.

(3) The anxiety or phobic
avoidance is not better
accounted for by another
mental disorder, such as
Social Phobia (e.g.,
avoidance limited to social
situations because of fear of
embarrassment), Specific
Phobia (e.g., avoidance
limited to single situations
like elevators), ObsessiveCompulsive Disorder (e.g.,
avoidance of dirt in
someone with an obsession
about contamination),
Posttraumatic Stress
Disorder (e.g., avoidance of
stimuli associated with a
severe stressor), Separation
Anxiety Disorder (e.g.,
avoidance of leaving home
or relatives).

E.16
3

E55

E56

GO TO
*SOCIAL
PHOBIA*,
E. 19

_______________________________
1
GO TO
*SOCIAL
PHOBIA*,
E.19

NOTE: CONSIDER SPECIFIC
PHOBIA IF FEAR IS LIMITED TO
ONE OR ONLY A FEW SPECIFIC
SITUATIONS, OR SOCIAL PHOBIA
IF FEAR IS LIMITED TO SOCIAL
SITUATIONS
E57

A(1), A(2), A(3) ALL CODED “3”

GO TO
*SOCIAL
PHOBIA*,
E.19

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Agoraphobia w/o Panic Disorder

Just before you began having these
fears, were you taking any drugs,
caffeine, diet pills, or other medicines?
(How much coffee, tea, or caffeinated
soda do you drink a day?)
Just before the fears began, were you
physically ill?
IF YES: What did the doctor
say?
______________________________
______________________________

(March 2011)

Anxiety Disorders

C. Not due to the direct physiological ?
1
effects of a substance (e.g., a
drug of abuse, medication) or to a
DUE TO
general medical condition
IF THERE IS ANY INDICATION
THAT THE ANXIETY MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL CONSEQUENCE OF A GMC OR SUBSTANCE), GO TO *ANXIETY
DUE TO GMC/SUBSTANCE*
IN THE BACK OF THIS
BOOKLET, ND RETURN HERE
TO MAKE A RATING OF “1”
OR “3.”

E.17
3

E58

SUBSTANCE
USE OR GMC
GO TO
*SOCIAL
PHOBIA*, E.19

PRIMARY
ANXIETY
DISORDER

Etiological general medical conditions
include hyper- and hypo-thyroidism,
hypoglycemia, hyper-parathyroidism,
pheochromocytoma, congestive heart
failure, arrhythmias, pulmonary
embolism, chronic obstructive
pulmonary disease, pneumonia,
hyperventilation, B-12 deficiency,
porphyria, CNS neoplasms,
vestibular dysfunction, encephalitis.
Etiological substances include
intoxication with central nervous
stimulants (e.g., cocaine,
amphetamines, caffeine) or cannabis,
hallucinogens, PCP, or alcohol, or
withdrawal from central nervous
system depressants (e.g., alcohol,
sedatives, hypnotics) or from
cocaine.
D. If an associated general medical
condition is present, the fear
described in criterion A is clearly
in excess of that usually
associated with the condition.

?=inadequate information

1=absent or false

2=subthreshold

CONTINUE

1
GO TO
*SOCIAL
PHOBIA*,
E. 19

E59

AWOPD
IN
PAST
YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Agoraphobia w/o Panic Disorder

(March 2011)

Anxiety Disorders

E.18

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Social Phobia Past Year (March 2011)

*SOCIAL PHOBIA*

Anxiety Disorders

E.19

SOCIAL PHOBIA CRITERIA

IF SCREENING QUESTION #3 EQUALS 1, CIRCLE 1 AND GO TO
*SPECIFIC PHOBIA*, ON PAGE E.23.

E60

SCREEN Q#3
NO
YES
1
3

IF SCREENING QUESTION #3 EQUALS 2 OR 3, CIRCLE 3 AND
CONTINUE:
You’ve said that during the
past year there have been things
that you are afraid to do in front of
other people, like speaking, eating,
or writing . . .
Tell me about it.
What are you afraid would happen
when ________________?
IF PUBLIC SPEAKING ONLY: (Do you
think that you are more uncomfortable
than most people are in that situation?)
_______________________________

A. A marked and persistent fear of
?
1
2
one or more social or
performance situations in which
GO TO
the person is exposed to
*SPECIFIC
unfamiliar people or to possible
PHOBIA*,
E.23
scrutiny by others. The individual
fears that he or she will act in a
way (or show anxiety symptoms)
that will be humiliating or
embarrassing.

E61

E62

_______________________________
_______________________________
_______________________________
_______________________________
Note: In adolescents, there must be
evidence of capacity for ageappropriate relationships with familiar
people and the anxiety must occur in
peer settings, not just in interactions
with adults.
Have you always felt anxious when you
(CONFRONTED PHOBIC
STIMULUS)?
_______________________________

B. Exposure to the feared social
?
1
2
situation almost invariably
provokes anxiety, which may take
GO TO
the form of a situationally bound
*SPECIFIC
or situationally predisposed panic
PHOBIA*,
attack.
E.23

_______________________________
_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Social Phobia Past Year (March 2011)

Did you think that you are more afraid
of (PHOBIC ACTIVITY) than you
should have been (or than made
sense)?

Anxiety Disorders
2

E63

D. The feared social or performance ?
1
2
situations are avoided, or else
endured with intense anxiety or
GO TO
distress.
*SPECIFIC

E64

E65

C. The person recognizes that the
fear is excessive or
unreasonable. Note: in children,
this feature may be absent.

_______________________________
IF NOT OBVIOUS: Do you go out of
your way to avoid _____________?
IF NO: How hard was it for you
to ________________?

E.20

1
GO TO
*SPECIFIC
PHOBIA*,
E.23

PHOBIA*,
E.23

______________________________
______________________________
IF UNCLEAR WHETHER FEAR WAS
CLINICALLY SIGNIFICANT: How
much does ________ interfere with
your life?
IF DOES NOT INTERFERE
WITH LIFE: How much has the
fact that you have this fear
bothered you?

E. The avoidance, anxious
?
1
2
anticipation, or distress in the
feared social or performance
GO TO
situation(s) interferes significantly
*SPECIFIC
with the person’s normal routine,
PHOBIA*,
E.23
occupational (academic)
functioning, or social activities or
relationships, or there is marked
distress about having the phobia.

______________________________
______________________________
F. NOTE: CRITERION F HAS BEEN
OMITTED FROM THIS VERSION
OF THE SCID.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Social Phobia Past Year (March 2011)

Just before you began having these
fears, were you taking any drugs,
caffeine, diet pills, or other medicines?
(How much coffee, tea, or caffeinated
soda did you drink a day?)
Just before the fears began, were you
physically ill?
IF YES: What did the doctor
say?

G. The fear or avoidance is not due
to the direct physiological effects
of a substance (e.g., a drug of
abuse, a medication) or a general
medical condition.
IF THERE IS ANY INDICATION
THAT THE ANXIETY MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL CONSEQUENCE OF THE GMC OR
SUBSTANCE), GO TO *ANXIETY
DUE TO GMC/SUBSTANCE* IN
THE BACK OF THIS BOOKLET,
AND RETURN HERE TO MAKE A
RATING OF “1” OR “3.”

Anxiety Disorders
?

E.21
3

E66

DUE TO
SUBSTANCE
USE OR GMC
GO TO
*SPECIFIC
PHOBIA*, E.23
PRIMARY
ANXIETY
DISORDER

Etiological general medical conditions
include: hyper- and hypo-thyroidism,
hypoglycemia, hyper-parathyroidism,
pheochromocytoma, congestive heart
failure, arrhythmias, pulmonary
embolism, chronic obstructive
pulmonary disease, pneumonia,
hyperventilation, B-12 deficiency,
porphyria, CNS neoplasms,
vestibular dysfunction, encephalitis.
Etiological substances include:
intoxication with central nervous
stimulants (e.g., cocaine, amphetamines, caffeine) or cannabis, hallucinogens, PCP, or alcohol, or
withdrawal from central nervous
system depressants (e.g., alcohol,
sedatives, hypnotics) or from
cocaine.

CONTINUE

. . . and is not better accounted for by ?
1
2
another mental disorder (e.g., Panic
Disorder Without Agoraphobia,
GO TO
Separation Anxiety Disorder, Body
*SPECIFIC
Dysmorphic Disorder, a Pervasive
PHOBIA*,
Developmental Disorder, or Schizoid
E.23
Personality Disorder).

?=inadequate information

1=absent or false

2=subthreshold

E67

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Social Phobia Past Year (March 2011)

IF NOT ALREADY CLEAR: RETURN
TO THIS ITEM AFTER COMPLETING
INTERVIEW.

Anxiety Disorders

?
1
2
H. If a general medical condition or
other mental disorder is present,
the fear in A is unrelated to it,
GO TO
e.g., the fear is not of stuttering,
*SPECIFIC
trembling (in Parkinson’s disease)
PHOBIA*,
E.23
or exhibiting abnormal eating
behavior (in Anorexia Nervosa or
Bulimia Nervosa).

SOCIAL PHOBIA CRITERIA A, B, C,
D, E, G, AND H ARE CODED “3”

1
GO TO
*SPECIFIC
PHOBIA*,
E.23

?=inadequate information

1=absent or false

2=subthreshold

E.22
3

E68

E69

SOCIAL
PHOBIA
IN PAST
YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Specific Phobia Past Year (March 2011)

*SPECIFIC PHOBIA*

Anxiety Disorders

E.23

SPECIFIC PHOBIA CRITERIA

IF SCREENING QUESTION #4 EQUALS 1, CICLE 1 AND GO TO
*OCD/OBSESSIONS* ON PAGE E.27

SCREEN Q#4
NO
YES
1
3

IF SCREENING QUESTION #4 EQUALS 2 OR 3, CIRCLE 3 AND CONTINUE:

E70

You’ve said that in the past year
there have been other things that
you’ve been especially afraid of, like
flying, seeing blood, getting a shot,
heights, closed places, or certain
kinds of animals or insects . . .
Tell me about that.
What are you afraid would happen
when (CONFRONTED WITH PHOBIC
STIMULUS)?
_______________________________

A. Marked and persistent fear that
?
1
2
is excessive or unreasonable,
cued by the presence or
GO TO *OCD/
anticipation of a specific object or
OBSESSION*,
situation (e.g., flying, heights,
E.27
animals, receiving an injection,
seeing blood).

E71

B. Exposure to the phobic stimulus
?
1
2
almost invariably provokes an
immediate anxiety response,
GO TO * OCD/
which may take the form of a
situationally bound or situationally OBSESSION*,
E.27
predisposed Panic Attack.

E72

C. The person recognizes that the
fear is excessive or
unreasonable.

E73

_______________________________
_______________________________
_______________________________
Have you always felt frightened when
you (CONFRONTED PHOBIC
STIMULUS)?
_______________________________
_______________________________
_______________________________
Did you think that you are more afraid
of (PHOBIC STIMULUS) than you
should have been (or than made
sense)?

GO TO *OCD/
OBSESSION*,
E.27

_______________________________
_______________________________
_______________________________
_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Specific Phobia Past Year (March 2011)

Do you go out of your way to avoid
(PHOBIC STIMULUS)?

D. The phobic situation(s) is
avoided, or else endured with
intense anxiety or distress.

Anxiety Disorders
?

(Are there things you don’t do because
of this fear that you would otherwise
have done?)

E.24
3

E74

E75

GO TO
*OCD/
OBSESSION*,
E.27

IF NO: How hard is it for
you to (CONFRONT PHOBIC
STIMULUS)?
_______________________________
_______________________________
_______________________________
IF UNCLEAR WHETHER FEAR WAS
CLINICALLY SIGNIFICANT: How
much does (PHOBIA) interfere with
your life?
(Is there anything you’ve avoided
because of being afraid of [PHOBIC
STIMULUS])?

E. The avoidance, anxious
?
1
2
anticipation, or distress in the
feared situation(s) interferes
GO TO *OCD/
significantly with the person’s
OBSESSION*,
normal routine, occupational (or
E.27
academic) functioning, or social
activities or relationships, or there
is marked distress about having
the phobia.

IF DOES NOT INTERFERE
WITH LIFE: How much has the
fact that you were afraid of
(PHOBIC STIMULUS) bothered
you?
_______________________________
_______________________________
_______________________________
_______________________________

NOTE: CRITERION F HAS BEEN
OMITTED FROM THIS VERSION
OF THE SCID.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Specific Phobia Past Year (March 2011)

IF NOT ALREADY CLEAR:
RETURN TO THIS ITEM AFTER
COMPLETING SECTION ON PTSD
AND OBSESSIVE-COMPULSIVE
DISORDER.

Anxiety Disorders

G. The anxiety, panic attacks, or
?
1
phobic avoidance associated with
the specific object or situation are
GO TO *
not better accounted for by
OCD/
another mental disorder, such as
OBSESSION*,
Obsessive-Compulsive Disorder
E.27
(e.g., fear of dirt in someone with
an obsession about
contamination), Posttraumatic
Stress Disorder (e.g. avoidance
of stimuli associated with a
severe stressor), Separation
Anxiety Disorder (e. g., avoidance
of school), Social Phobia (e.g.,
avoidance of social situations
because of fear of
embarrassment), Panic Disorder
With Agoraphobia, or
Agoraphobia Without History of
Panic Disorder.

E76

E77

GO TO * OCD/
OBSESSION*, E.27

SPECIFIC
PHOBIA
PAST
YEAR

SPECIFIC PHOBIA CRITERIA A, B,
C, D, E, AND G ARE CODED “3.”

?=inadequate information

1=absent or false

E.25

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Specific Phobia Past Year (March 2011)

Anxiety Disorders

E.26

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

OCD Past Year

*OBSESSIVE COMPULSIVE DISORDER*

(March 2011)

Anxiety Disorders

E.27

OBSESSIVE COMPULSIVE DISORDER
CRITERIA
SCREEN Q#5
YES
NO
1
3

IF SCREENING QUESTION #5 EQUALS 1, CIRCLE 1 AND GO TO
*COMPULSIONS* ON PAGE E.29

E78

IF SCREENING QUESTION #5 EQUALS 2 OR 3, CIRCLE 3 AND
CONTINUE: You’ve said that in the past year that you have had
thoughts that didn’t make any sense and kept
coming back to you even when you tried not to have them . . .
A. Either obsessions or
compulsions:
(What were they?)
Obsessions as defined by (1), (2),
(3) and (4)
IF SUBJECT NOT SURE WHAT
IS MEANT: . . . Thoughts like
hurting someone, even though
you really didn’t want to or being
contaminated by germs or dirt?
______________________________
______________________________
______________________________

(1) recurrent and persistent
thoughts, impulses, or images
that are experienced, at some
time during the disturbance,
as intrusive and inappropriate,
and that cause marked
anxiety or distress

E79

(2) the thoughts, impulses, or
images are not simply
excessive worries about
real-life problems.

E80

(3) the person attempts to
ignore or suppress such
thoughts, impulses, or
images, or to neutralize
them with some other
thought or action.

E81

E82

______________________________
When you had these thoughts, did you
try hard to get them out of your head?
(What would you try to do?)
______________________________
______________________________
IF UNCLEAR: Where did you think
these thoughts were coming from?
____________________________

(4) the person recognizes that
?
1
the obsessional thoughts,
impulses, or images are a
product of his or her own
mind (not imposed from
without as in thought
insertion)
NO OBSESSIONS GO

OBSESSIONS

TO *COMPULSIONS*,
E.29

DESCRIBE CONTENT OF OBSESSIONS:
__________________________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

OCD Past Year

(March 2011)

Anxiety Disorders

E.28

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

OCD Past Year

(March 2011)

Anxiety Disorders

E.29

*COMPULSIONS*
SCREEN Q#6
NO
YES
1
3

IF SCREENING QUESTION #6 EQUALS 1, CIRCLE 1 AND GO TO
*CHECK FOR OBSESSIONS/COMPULSIONS* ON PAGE E.30 (TOP OF
NEXT PAGE)

E83

IF SCREENING QUESTION #6 EQUALS 2 OR 3, CIRCLE 3 AND
CONTINUE:
You’ve said that in that past year there were things that you had to do
over and over again and couldn’t resist doing, like washing your hands
again and again, counting up to a certain number or checking something
several times to make sure that you had done it right . . .
Compulsions as defined by
(1) and (2)

(What did you have to do?)
______________________________
______________________________
______________________________
______________________________

IF UNCLEAR: Why did you have to do
(COMPULSIVE ACT?) What would
happen if you didn’t do it?
IF UNCLEAR: How many times would
you do (COMPULSIVE ACT)? How
much time a day would you spend
doing it?
_______________________________

(1) repetitive behaviors (e. g.,
handwashing, ordering,
checking) or mental acts
(e.g., praying, counting,
repeating words silently)
that the person feels driven
to perform in response to an
obsession, or according to
rules that must be applied
rigidly

E84

(2) the behaviors or mental acts
are aimed at preventing or
reducing distress or
preventing some dreaded
event or situation; however
these behaviors or mental
acts either are not
connected in a realistic way
with what they are designed
to neutralize or prevent, or
are clearly excessive

E85

COMPULSIONS

_______________________________

GO TO *CHECK FOR OBSESSIONS /
COMPULSIONS*, E.30 (TOP OF
NEXT PAGE)

DESCRIBE CONTENT OF COMPULSION(S)
_________________________________________________
_________________________________________________
_________________________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

OCD Past Year

(March 2011)

Anxiety Disorders

E.30

*CHECK FOR OBSESSIONS/COMPULSIONS*
IF NEITHER OBSESSIONS NOR COMPULSIONS, CIRCLE 1 AND GO TO
*GENERALIZED ANXIETY* ON PAGE E.33

OBSESSIONS/
COMPULSIONS
YES
NO
1
3
E86

IF EITHER OBSESSIONS, OR COMPULSIONS, OR BOTH, CIRCLE 3 AND
CONTINUE:
Do you (think about [OBSESSIVE
THOUGHTS]/do [COMPULSIVE
ACTS]) more than you should have (or
than makes sense)?
IF NO: How about when you first
started having this problem?
______________________________
______________________________
______________________________
What effect has this (OBSESSION OR
COMPULSION) had on your life? (Did
[OBSESSION OR COMPULSION]
bother you a lot?)
_______________________________
_______________________________

B. At some point during the course
?
1
of the disorder, the person has
recognized that the obsessions or
GO TO
compulsions are excessive or
*GAD*,
unreasonable. Note: this does
E.33
not apply to children.

E87

E88

Check here ___ if With Poor Insight:
i.e., for most of the time during the
current episode, the person does not
recognize that the obsessions and
compulsions are excessive or
unreasonable.
C. The obsessions or compulsions
?
1
cause marked distress, are timeconsuming (take more than an
GO TO
hour a day), or significantly
*GAD*,
E.33
interfere with the person’s normal
routine, occupational functioning,
or usual social activities or
relationships.

E89

(How much time have you spent on
[OBSESSION OR COMPULSION])?
_______________________________
_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

OCD Past Year

(March 2011)

Anxiety Disorders

E.31

IF NOT ALREADY CLEAR: RETURN
TO THIS ITEM AFTER COMPLETING
INTERVIEW

D. If another Axis I disorder is
?
1
present, the content of the
obsessions or compulsions is not
GO TO
restricted to it (e.g., preoccupation
*GAD*,
E.33
with food in the presence of an
Eating Disorder; hair pulling in the
presence of Trichotillomania;
concern with appearance in the
presence of Body Dysmorphic
Disorder; preoccupation with
drugs in the presence of a
Substance Use Disorder;
preoccupation with having a
serious illness in the presence of
Hypochondriasis; preoccupation
with sexual urges or fantasies in
the presence of a Paraphilia, or
guilty ruminations in the presence
of Major Depressive Disorder).

E90

Just before you began having
(OBSESSIONS OR COMPULSIONS)
were you taking any drugs or
medicines?

1
E. Not due to the direct physiological ?
effects of a substance (e.g., a
drug of abuse, medication) or to a
DUE TO
general medical condition

E91

Just before the (OBSESSIONS OR
COMPULSIONS) started, were you
physically ill? (What did the doctor
say?)

IF THERE IS ANY INDICATION THAT
THE OBSESSIONS OR
COMPULSIONS MAY BE SECONDARY (I.E., A DIRECT PHYSIOLOGICAL CONSEQUENCE OF A
GMC OR SUBSTANCE), GO TO
*ANXIETY DUE TO
GMC/SUBSTANCE,* IN THE BACK
OF THIS BOOKLET, AND RETURN
HERE TO MAKE A RATING OF “1”
OR “3.”

SUBSTANCE
USE OR A
GMC
GO TO
*GAD*, E.33

PRIMARY
ANXIETY
DISORDER

Etiological general medical conditions
include: certain CNS neoplasms.
Etiological substances include:
intoxication with central nervous
system stimulants (e.g., cocaine,
amphetamines)

CONTINUE

1
OBSESSIVE COMPULSIVE
DISORDER CRITERIA A, B, C, D,
AND E ARE CODED “3”

?=inadequate information

1=absent or false

GO TO
*GAD*,
E. 33

2=subthreshold

E92

OBSESSIVE
COMPULSIVE
DISORDER IN
PAST YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

OCD Past Year

(March 2011)

Anxiety Disorders

E.32

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

GAD Past Year

(March 2011) Anxiety Disorders

E.33

*GENERALIZED ANXIETY DISORDER* GENERALIZED ANXIETY
DISORDER CRITERIA
IF SCREENING QUESTION #7 EQUALS 1, CIRCLE 1 AND GO TO
*ANOREXIA* ON PAGE F.1.

E93

SCREEN Q#7
NO
YES
1
3

IF SCRENING QUESTION #7 EQUALS 2 OR 3, CIRCLE 3 AND CONTINUE:
You’ve said that in the last year there have been times you’ve been particularly nervous or anxious . . .

Do you also worry a lot about bad things
that might happen?
IF YES: What do you worry
about? (How much do you worry
about [EVENTS OR
ACTIVITIES]?)

A. Excessive anxiety and worry
(apprehensive expectation),
occurring more days than not for
at least six months, about a
number of events or activities
(such as work or school
performance)

B. The person finds it difficult to
control the worry.

E94

E95

E96

GO TO
*ANOREXIA*,
F.1

Has there been a six month period
of time in the past year when you
were worrying for more days than
not?
________________________________
________________________________
________________________________

When you’re worrying this way, do you
find that it’s hard to stop yourself?

GO TO
*ANOREXIA*,
F.1

________________________________
________________________________
F(2). Does not occur exclusively
When did this anxiety start?
COMPARE ANSWER WITH ONSET OF during the course of a Mood
Disorder, Psychotic Disorder, or a
MOOD OR PSYCHOTIC DISORDER.
Pervasive Developmental Disorder
________________________________

1
GO TO
*ANOREXIA*,
F.1

________________________________
________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

GAD Past Year

Now I am going to ask you some
questions about symptoms that often
go along with being nervous.
Thinking about those periods in the
past year when you’re feeling nervous
or anxious . . .

(March 2011) Anxiety Disorders

E.34

C. The anxiety and worry are
associated with three (or more) of
the following six symptoms (with
at least some symptoms present
for more days than not for the
past six months):

_______________________________
_______________________________
. . . do you often feel physically
restless--can’t sit still?

(1) restlessness or feeling
keyed up or on edge

E97

E98

E99

E100

E101

_______________________________
_______________________________
. . . do you often feel keyed up or
on edge?
_______________________________
_______________________________

. . . do you often tire easily?

(2) being easily fatigued

_______________________________
_______________________________
. . . do you have trouble
concentrating or does your mind
go blank?

(3) difficulty concentrating or
mind going blank

_______________________________
_______________________________

. . . are you often irritable?

(4) irritability

_______________________________
_______________________________
. . . are your muscles often tense?

(5) muscle tension

_______________________________
_______________________________
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

GAD Past Year

. . . do you often have trouble
falling or staying asleep?
_______________________________

(March 2011) Anxiety Disorders

(6) sleep disturbance (difficulty
falling or staying asleep, or
restless unsatisfying sleep)

E.35

E102

E103

_______________________________
AT LEAST THREE “C” SXS ARE
CODED “3”

GO TO
*ANOREXIA*,
F.1

CODE BASED ON PREVIOUS
INFORMATION

D. The focus of the anxiety and
?
1
worry is not confined to the
features of another Axis I
GO TO
Disorder, e.g., the anxiety or
*ANOREXIA*,
worry is not about having a panic
F.1
attack (as in Panic Disorder),
being embarrassed in public (as
in Social Phobia), being
contaminated (as in Obsessive
Compulsive Disorder), being
away from home or close
relatives (as in Separation Anxiety
Disorder), gaining weight (as in
Anorexia Nervosa), having
multiple physical complaints (as in
Somatization Disorder), or having
a serious illness (as in
Hypochondriasis), and the anxiety
or worry do not occur exclusively
during Posttraumatic Stress
Disorder.

E104

IF UNCLEAR: What effect has the
anxiety, worry, or (PHYSICAL
SYMPTOMS) had on your life? (Has it
made it hard for you to do your work or
be with your friends?)

E. The anxiety, worry, or physical
symptoms cause clinically
significant distress or impairment
in social, occupational, or other
important areas of functioning

E105

GO TO
*ANOREXIA*,
F.1

_______________________________
_______________________________
_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

GAD Past Year

Just before you began having this
anxiety, were you taking any drugs,
caffeine, diet pills, or other medicines?
(How much coffee, tea, or caffeinated
soda do you drink a day?)
Just before these problems began,
were you physically ill?
IF YES: What did the doctor say?

(March 2011) Anxiety Disorders

1
F. Not due to the direct physiological ?
effects of a substance (e.g., a
drug of abuse, medication) or to a
DUE TO SUBgeneral medical condition

E.36
E106

STANCE USE
OR A GMC

IF THERE IS ANY INDICATION
THAT THE ANXIETY MAY BE
SECONDARY (I.E., A DIRECT
PHYSIOLOGICAL CONSEQUENCE OF A GMC OR SUBSTANCE), GO TO *ANXIETY DUE
TO GMC/SUBSTANCE* IN THE
BACK OF THIS BOOKLET, AND
RETURN HERE TO MAKE A
RATING OF “1” OR “3.”

GO TO
*ANOREXIA*,
F.1

PRIMARY
ANXIETY
DISORDER

Etiological general medical conditions
include: hyper- and hypo-thyroidism,
hypoglycemia, hyper-parathyroidism,
pheochromocytoma, congestive heart
failure, arrhythmias, pulmonary
embolism, chronic obstructive
pulmonary disease, pneumonia,
hyperventilation, B-12 deficiency,
porphyria, CNS neoplasms,
vestibular dysfunction, encephalitis.
Etiological substances include:
intoxication with central nervous
stimulants (e.g., cocaine, amphetamines, caffeine) or cannabis, hallucinogens, PCP, or alcohol or
withdrawal from central nervous
system depressants (e.g., alcohol,
sedatives, hypnotics) or from
cocaine.
CONTINUE

GENERALIZED ANXIETY CRITERIA
A, B, C, D, E AND F ARE CODED “3”

?=inadequate information

1=absent or false

GO TO
*ANOREXIA*,
F.1

GENERALIZED
ANXIETY
DISORDER

2=subthreshold

E107

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Anorexia Nervosa Past Year (March 2011)

Eating Disorders

F.1

F. EATING DISORDERS
*ANOREXIA NERVOSA*

ANOREXIA NERVOSA CRITERIA

IF SCREENING QUESTION #8 EQUALS 1, CIRCLE 1 AND GO TO *BULIMIA*
ON PAGE F.3
IF SCREENING QUESTION #8 EQUALS 2 OR 3, CIRCLE 3 AND CONTINUE:
You’ve said that there was a time in the past year
When you weighed much less than other people
thought you ought to weigh . . .

Why was that? How much did you
weigh? How tall are you?
_________________________________
_________________________________
_________________________________

At that time, were you very afraid that you
could become fat?

A. Refusal to maintain body weight at
or above a minimally normal weight
for age and height (e.g., weight loss
leading to maintenance of body
weight less than 85% of that
expected; or failure to make
expected weight gain during period
of growth, leading to body weight
less than 85% of that expected)

B. Intense fear of gaining weight or
becoming fat, even though
underweight.

_________________________________

SCREEN Q#8
NO
YES
1
3

GO TO
*BULIMIA*,
F.3

_________________________________
At your lowest weight, did you still feel too
fat or that part of your body was too fat?
IF NO: Did you need to be very
thin in order to feel good about
yourself?

C. Disturbance in the way in which
one’s body weight or shape is
experienced; undue influence of
body weight or shape on selfevaluation, or denial of the
seriousness of the current low body
weight

GO TO
*BULIMIA*,
F.3

IF NO AND LOW WEIGHT IS
MEDICALLY SERIOUS: When
you were that thin, did anybody tell
you it could be dangerous to your
health to be that thin? (What did
you think?)
_________________________________
_________________________________
_________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Anorexia Nervosa Past Year (March 2011)

FOR FEMALES: Before this time, were
you having your periods? Did they stop?
(For how long?)
_________________________________
_________________________________

Eating Disorders

D. In postmenarchal females,
? 1 2
amenorrhea, i.e., the absence of at
least three consecutive menstrual
GO TO
cycles. (A woman is still considered
*BULIMIA*,
to have amenorrhea if her periods
F.3
occur only following hormone, e.g.,
estrogen, administration)

F.2
3

_________________________________
ANOREXIA NERVOSA CRITERIA A, B,
C, AND D ARE CODED “3”
GO TO
*BULIMIA*,
F.3

?=inadequate information

1=absent or false

2=subthreshold

ANOREXIA
NERVOSA
PAST
YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Bulimia Nervosa Past Year (March 2011)

*BULIMIA NERVOSA*
BULIMIA NERVOSA CRITERIA
IF CRITERIA MET FOR ANOREXIA NERVOSA, CIRCLE 3 AND
GO TO *IED* ON PAGE G.1.
IF CRITERIA NOT MET FOR ANOREXIA NERVOSA, CIRCLE 1 AND
CONTINUE.

Eating Disorders

ANOREXIA NERVOSA
NO
YES
1
3

IF SCREENING QUESTION #9 EQUALS 1, CIRCLE 1 AND GO TO *IED* ON
PAGE G.1.

SCREEN Q#9
NO
YES
1
3

IF QUESTION #9 EQUALS 2 OR 3, CIRCLE 3 AND CONTINUE:
You’ve said that in the past year, you’ve often had times when your eating was
out of control. Tell me about those times.
_________________________________
_________________________________

_________________________________

IF UNCLEAR: During these times, do you
often eat within any two hour period what
most people would regard as an unusual
amount of food? Tell me about that.
_________________________________

A. Recurrent episodes of binge eating.
An episode of binge eating is
characterized by BOTH of the
following:
?

_________________________________

F.3

(2) a sense of lack of control over
eating during the episode
(e.g., a feeling that one cannot
stop eating or control what or
how much one is eating)
(1) eating, in a discrete period of
time (e.g., within any two hour
period), an amount of food that
is definitely larger than most
people would eat during a
similar period of time and
under similar circumstances.

F10

F11

GO TO
*IED*, G.1

_________________________________
Did you do anything to counteract the
effects of eating that much? (Like making
yourself vomit, taking laxatives, enemas
or water pills, strict dieting or fasting, or
exercising a lot?)
_________________________________

B. Recurrent inappropriate
? 1 2
compensatory behavior in order to
prevent weight gain, such as: selfGO TO
*IED*, G.1
induced vomiting; misuse of
laxatives, diuretics, enemas, or other
medications; fasting; or excessive
exercise.

_________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Bulimia Nervosa Past Year (March 2011)

How often were you eating that much
(AND COMPENSATORY BEHAVIOR)?
(At least twice a week for at least three
months?)

Eating Disorders

F.4

C. The binge eating and inappropriate ? 1 2
compensatory behaviors both occur,
on average, at least twice a week for
GO TO
three months.
*IED*, G.1

F12

D. Self-evaluation is unduly influenced
by body shape and weight.

F13

F14

F15

_________________________________
_________________________________
_________________________________
_________________________________
Were your body shape and weight among
the most important things that affected
how you felt about yourself?

GO TO
*IED*, G.1

_________________________________
_________________________________
E. The disturbance does not occur
exclusively during episodes of
Anorexia Nervosa

GO TO
*IED*, G.1

BULIMIA NERVOSA CRITERIA A, B, C,
D AND E ARE CODED “3”

1
GO TO
*IED*,
G.1

?=inadequate information

1=absent or false

2=subthreshold

BULIMIA
NERVOSA
PAST
YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

IED Past Year

G. INTERMITTENT EXPLOSIVE
DISORDER

In the past year, that is since
(CURRENT DATE) 2010, have you
had times when you lost control of your
anger, resulting in your hitting or
seriously threatening someone or
damaging things?

(March 2011)

Impulse Control Disorders

G.1

INTERMITTENT EXPLOSIVE
DISORDER CRITERIA

A. Several discrete episodes of
failure to resist aggressive
impulses that result in serious
assaultive acts or destruction of
property.

B. The degree of aggressiveness
expressed during the episodes is
grossly out of proportion to any
precipitating psychosocial
stressors.

GO TO
*ALCOHOL
USE
DISORDERS*,
H.1

IF YES: What did you do?
When did you do it? How often
did it happen?
DESCRIBE ASSAULTIVE ACTS:
______________________________
______________________________
What happened that set you off? (Do
you think your reaction was much
stronger than it should have been
given the circumstances?) (Has
anyone told you that your reaction was
way off-base given the situation?)

GO TO
*ALCOHOL
USE
DISORDERS*,
H.1

______________________________
______________________________
Did this happen only when you were
drinking or using drugs?
Did this happen only when you were
sick with a medical illness?
IF HX OF MANIA OR PSYCHOSIS:
Did this happen only when you were
feeling excited or irritable or only when
you were (PSYCHOTIC SXS)?

C. The aggressive episodes are not ?
better accounted for by Antisocial
Personality Disorder, Borderline
Personality Disorder, a psychotic
disorder, a Manic Episode,
Conduct Disorder, or AttentionDeficit/ Hyperactivity Disorder and
are not due to the physiological
effects of a substance or a
general medical condition.

GO TO
*ALCOHOL
USE
DISORDERS*,
H.1

(Did you do [ASSAULTIVE ACTS]
because you were hearing voices or
because your thinking was confused?)
(Did you do [ASSAULTIVE ACTS] on
purpose or was it really beyond your
control?)
_______________________________
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

IED Past Year

(March 2011)

Impulse Control Disorders

ITEMS A, B, AND C ARE CODED “3”
GO TO
*ALCOHOL
USE
DISORDERS*,
H.1

?=inadequate information

1=absent or false

2=subthreshold

G.2
G4

INTERMITTENT
EXPLOSIVE
DISORDER
PAST YEAR

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)

H. SUBSTANCE USE DISORDERS
*ALCOHOL USE DISORDERS (PAST
YEAR)*

SUDs

H.1

RECORD TYPICAL WEEKLY PATTERN OF
USE:
______________________________________

______________________________________
Next I’d like to ask about your use of alcohol.
What have your drinking habits been like in ______________________________________
the past year?
(How much do you drink?) (Have there been ______________________________________
any times in the past year when you had five
or more drinks on one occasion?)
______________________________________
When in the past year were you drinking
the most? (How long did that period last?)

RECORD DATE OF HEAVIEST USE AND
DESCRIBE PATTERN
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________

During that time . . .

______________________________________

how often were you drinking?

______________________________________

what were you drinking? how much?

______________________________________

During that time . . .

______________________________________

did your drinking cause problems for
you?
did anyone object to your drinking?

IF R HAS NOT DRUNK AT LEAST 6 DRINKS IN THE PAST YEAR, CIRCLE THE 1 AND
1
SKIP TO *NON-ALCOHOL SUBSTANCE USE DISORDERS*, H. 9

IF R HAS DRUNK AT LEAST 6 DRINKS IN THE PAST YEAR, CIRCLE THE 3 AND
CONTINUE TO NEXT PAGE.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)

SUDs

ALCOHOL DEPENDENCE

ALCOHOL DEPENDENCE CRITERIA

I’d now like to ask you some more
questions about (TIME IN PAST YEAR
WHEN DRINKING THE MOST OR TIME
WHEN DRINKING CAUSED MOST
PROBLEMS).

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 twelve month
period:

During that time…

H.2

NOTE: CRITERIA FOR
ALCOHOL DEPENDENCE ARE
NOT IN DSM-IV-TR ORDER
…did you often find that when you started
drinking you ended up drinking much more
than you were planning to? (Tell me about
that.)

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

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

IF NO: What about drinking for a
much longer period of time than
you were planning to?
_________________________________
_________________________________
_________________________________
…did you try to cut down or stop drinking
alcohol?
IF YES: Did you actually stop drinking
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?)
__________________________________
__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)

…did you spend a lot of time drinking,
being high, or hung over? (How much
time?)
__________________________________

SUDs

H.3

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

(6)

__________________________________
__________________________________
…did you have times when you would
drink so often that you started to drink
instead of working or spending time at
hobbies or with your family or friends, or
engaging in other important activities, such
as sports, gardening, or playing music?

important social,
occupational, or
recreational activities given
up or reduced because of
alcohol use

__________________________________
__________________________________
__________________________________

IF NOT ALREADY KNOWN: During that
time did your drinking cause any
psychological problems like making you
depressed or anxious, making it difficult to
sleep, or causing “blackouts?”
IF NOT ALREADY KNOWN: Did your
drinking cause 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)

__________________________________
__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)

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:

SUDs

H.4

(a) a need for markedly
increased amounts of alcohol
to achieve intoxication or
desired effect
(b) markedly diminished effect
with continued use of the
same amount of alcohol

__________________________________
__________________________________
During the past year have you had any
withdrawal symptoms when you cut down
or stopped drinking like . . .

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

(a) at least TWO of the
following:
. . . 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?)

- - autonomic 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

__________________________________
__________________________________
IF NO: During the past year, 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?

(b) alcohol (or a substance
from the sedative / hypnotic /
anxiolytic class) taken to
relieve or avoid withdrawal
symptoms

__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)
AT LEAST THREE
DEPENDENCE ITEMS CODED
“3” AND ITEMS OCCURRED IN
THE PAST YEAR

SUDs
1

H.5
3

ALCOHOL
DEPENDENCE
GO TO
*ALCOHOL
ABUSE*, H.6

GO TO *ALCOHOL
ABUSE*, H.6

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)

*PAST YEAR ALCOHOL ABUSE*
Let me ask you a few more questions
about (TIME IN PAST YEAR WHEN
DRINKING THE MOST OR TIME WHEN
DRINKING CAUSED MOST PROBLEMS).
During that time…

…did you miss work or school because you
were intoxicated, high, or very hung over?
(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 [IF CHILDREN: or not
taking proper care of your children]
because of your drinking?

SUDs

H.6

ALCOHOL ABUSE CRITERIA
A. A maladaptive pattern of
alcohol use, leading to
clinically significant
impairment or distress, as
manifested by one (or more)
of the following occurring
within a twelve 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 performance
related to alcohol use;
alcohol-related absences,
suspensions, or expulsions
from school; neglect of
children or household).

H10

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

H11

IF YES TO EITHER: How often?
(Over what period of time?)
__________________________________
__________________________________
__________________________________
__________________________________
…did you drink in a situation in which it
might have been dangerous to drink at all?
(In the past year have you driven while you
were really too drunk to drive?)
IF YES AND UNKNOWN: How many
times? (When?)

__________________________________
__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)

During the past year has your drinking
gotten you into trouble with the law?
IF YES AND UNKNOWN: How often?
(Over what period of time?)

SUDs

H.7

H12

(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
consequences of
intoxication, physical fights)

H13

H14

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

_________________________________
_________________________________
_________________________________
IF NOT ALREADY KNOWN: Did your
drinking cause problems with other people,
such as with family members, friends, or
people at work? Did you get into physical
fights when you were drinking? What
about having bad arguments about what
happens when you drink too much?)
IF YES: Did you keep on drinking
anyway? (Over what period of time?)
_________________________________
_________________________________
_________________________________
AT LEAST ONE “A” ITEM
CODED “3”

GO TO *NONALCOHOL
SUBSTANCE USE
DISORDERS*, H.9

ALCOHOL
ABUSE
GO TO *NONALCOHOL
SUBSTANCE
USE
DISORDERS*,
H.9

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Alcohol Use Disorders Past Year (March 2011)

SUDs

H.8

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

SUDs

H.9

*NON-ALCOHOL SUBSTANCE USE DISORDERS*
(PAST YEAR DEPENDENCE AND ABUSE)
Now I am going to ask you about your use of
drugs or medicines in the past 12 months.
CIRCLE THE NAME OF EACH DRUG USED IN
THE PAST YEAR (OR WRITE IN NAME IF
"OTHER")

RECORD PATTERN OF USUAL USE AND INDICATE
PAST
PERIOD/PATTERN OF HEAVIEST USE
YEAR USE
(INCLUDING DATE AND DURATION)
LEVEL*
1

H15

Stimulants:
How about stimulants or “uppers”, like speed,
1
methamphetamine, crystal meth, “crank”, Ritalin, ___________________________________
dexadrine, Adderall or prescription diet pills?
___________________________________

H16

H17

H18

In the past 12 months have you taken any pills to
Sedatives-hypnotics-anxiolytics:
calm you down or mellow you out or to help you
__________________________________
sleep - drugs like Valium, Xanax, Ativan, Klonopin,
Rohypnol or “roofies”, Ambien, Sonata, Lunesta,
__________________________________
Halcion, or Restoril?
__________________________________

___________________________________
How about prescription pain relievers like
morphine, codeine, Darvocet, Darvon, Tylenol
with Codeine, Percocet, Percodan, Tylox,
Vicodin, Lortab, Lorcet, OxyContin, or any other
prescription pain reliever?

Opioids:
1
___________________________________
___________________________________
___________________________________

How about marijuana (pot, grass, weed) or
hashish?

Cannabis:
____________________________________
____________________________________

How about heroin?

Heroin:
___________________________________

H19

How about cocaine, “crack”, or freebase?

Cocaine:
__________________________________

H20

How about LSD, “acid”, PCP, peyote, mescaline, Hallucinogens/PCP
__________________________________
psilocybin, Ecstasy, Ketamine or other
hallucinogens?

H21

1
Inhalants:
___________________________________

H22

How about sniffing glue, paint, correction fluid,
“poppers,” gasoline, laughing gas or other
inhalants to get high?

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

SUDs

H.10

*FOR ANY DRUG CLASS USED NONMEDICALLY MORE THAN ONCE (FOR CANNABIS,
THRESHOLD IS AT LEAST 6 TIMES) IN THE PAST YEAR, CIRCLE 3 FOR USE LEVEL.
FOR ALL OTHERS, CIRCLE 1.
*FOR PRESCRIBED MEDICATIONS, CIRCLE 3 IF SUBJECT REPORTS BEING
DEPENDENT ON A PRESCRIBED DRUG OR USING MORE THAN WAS PRESCRIBED.

IF NO DRUG CLASSES HAVE A 3 CIRCLED FOR PAST YEAR USE
LEVEL, CIRCLE 1 AND GO TO *ADJUSTMENT DISORDER*, J.1.

H23

IF ANY DRUG CLASS HAS A 3 CIRCLED FOR LEVEL OF USE, CIRCLE
3 AND CONTINUE.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

SUDs

*SUBSTANCE DEPENDENCE*

SUBSTANCE DEPENDENCE CRITERIA

I'd now like to ask you some more
questions about (TIME IN THE PAST
YEAR WHEN YOU WERE USING THE
MOST DRUG[S] / YOUR USE OF
DRUG[S] DURING THE PAST 12
MONTHS).

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

H.11

During that time...
NOTE: CRITERIA FOR
SUBSTANCE DEPENDENCE
ARE NOT IN DSM-IV-TR ORDER
?

H24

STIM ?

H25

OPI

H26

CAN

H27

HER

H28

COC

H29

HAL

H30

INH

H31

SED

H32

STIM ?

H33

OPI

H34

CAN

H35

HER

H36

IF NO: Did you want to stop or cut
down? (Is this something you kept
worrying about?)

COC

H37

HAL

H38

__________________________________

INH

H39

…did you often find that when you started
using (DRUG[S]) you ended up using much
more of it than you were planning to? (Tell
me about it.)

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

IF NO: What about using it over a much
longer period of time than you were
planning to?

SED

__________________________________
__________________________________
__________________________________

…did you try to cut down or stop using
(DRUG[S])?
IF YES: In the past year, did you ever
actually stop using (DRUG[S])
altogether?

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

(How many times did you try to cut
down or stop altogether?)

__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

…did you spend a lot of time using
(DRUG[S]) or doing whatever you had to
do to get it? Did it take you a long time to
get back to normal? (How much time?)
__________________________________

SUDs

H.12

(5) a great deal of time is
SED
spent in activities
necessary to obtain the
STIM
substance, use the
substance, or recover from OPI
its effects
CAN

H40

H41

H42

H43

HER

H44

COC

H45

HAL

H46

INH

H47

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

H48

H49

H50

CAN

H51

HER

H52

COC

H53

HAL

H54

INH

H55

SED

H56

STIM

H57

OPI

H58

CAN

H59

HER

H60

COC

H61

HAL

H62

INH

H63

__________________________________
__________________________________

…did you often have times when you would
use (DRUG[S]) so often that you used
(DRUG[S]) instead of working or spending
time with your family or friends or engaging
in other important activities, such as sports,
gardening, or playing music?
__________________________________
__________________________________
__________________________________

IF NOT ALREADY KNOWN: Did
[DRUG(S)] cause any psychological
problems like making you depressed,
agitated, or paranoid?
IF NOT ALREADY KNOWN: Did
[DRUG(S)] cause any significant physical
problems or make a physical problem
worse?
IF YES TO EITHER OF ABOVE: Did
you keep on using (DRUG[S]) anyway?

(7) 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.,
recurrent cocaine use
despite recognition of
cocaine-related
depression)

__________________________________
__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

Have you found that you needed to use a
lot more (DRUG[S]) 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?
__________________________________

SUDs

H.13

SED

H64

STIM

H65

OPI

H66

CAN

H67

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

H68

H69

H70

INH

H71

SED

H72

STIM

H73

OPI

H74

CAN

H75

H76

H77

HAL

H78

INH

H79

(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

__________________________________
__________________________________
In the past year, have you had any
withdrawal symptoms, that is, felt sick
when you cut down or stopped using
(DRUG[S])?
IF YES: What symptoms did you have?
REFER TO LIST OF WITHDRAWAL
SYMPTOMS ON H.18
IF NO: After not using (DRUG[S]) for a
few hours or more, did you sometimes
use it to keep yourself from getting sick
with (WITHDRAWAL SYMPTOMS)?

(2) withdrawal, as manifested
by either of the following:
(a) the characteristic
withdrawal syndrome for the
substance

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

__________________________________
__________________________________
_________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

IF UNKNOWN: When did (SXS CODED
"3" ABOVE) occur? (Did they all happen
around the same time?)

SUDs

H.14

SED
AT LEAST THREE
DEPENDENCE ITEMS CODED
STIM
"3" AND ITEMS OCCURRED
WITHIN THE SAME TWELVE
OPI
MONTH PERIOD

H80

H81

H82

CAN

H83

HER

H84

COC

H85

HAL

H86

INH

H87

Substance
Dependence

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

*NON-ALCOHOL SUBSTANCE ABUSE
PAST YEAR*
Now I'd like to ask you some questions
about (TIME IN THE PAST YEAR WHEN
USED DRUG[S] THE MOST / YOUR USE
OF DRUG[S] DURING THE PAST 12
MONTHS).
During that time...
…did you miss work or school because you
were very high or very hung over? (What
about doing a bad job at work or failing
courses at school because you used
[DRUG(S)]?)
IF NO: What about not keeping your
house clean [IF CHILDREN: or not
taking proper care of your children]
because of using (DRUG[S])?
IF YES TO EITHER: How often?
(Over what period of time?)

SUDs

H.15

NON-ALCOHOL SUBSTANCE ABUSE CRITERIA
A. 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 twelve month period:
SED

H88

STIM

H89

OPI

H90

CAN

H91

HER

H92

COC

H93

HAL

H94

INH

H95

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

H96

H97

H98

H99

HER

H100

COC

H101

HAL

H102

INH

H103

(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)

__________________________________
__________________________________
__________________________________
…have you used (DRUG[S]) in a situation
in which it might have been dangerous to
be using (DRUG[S]) at all? During the past
year, have you driven while you were really
too high to drive?)
IF YES AND UNKNOWN: How many
times? (When?)
__________________________________
__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

SUDs

H.16

H104

H105

IF YES AND UNKNOWN: How often?
(Over what period of time?)

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

H106

__________________________________

CAN

H107

__________________________________

HER

H108

__________________________________

COC

H109

HAL

H110

INH

H111

SED

H112

STIM

H113

OPI

H114

CAN

H115

HER

H116

COC

H117

HAL

H118

INH

H119

…has your use of (DRUG[S]) gotten you
into trouble with the law?

IF NOT ALREADY KNOWN: Has your use
of (DRUG[S]) caused problems with other
people, such as with family members,
friends, or people at work? (Did you get
into physical fights or bad arguments about
your [DRUG(S)] use?)
IF YES: Did you keep on using
(DRUG[S]) anyway? (Over what period
of time?)

(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
consequences of
intoxication, physical fights)

__________________________________
__________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)
SUBSTANCE ABUSE

Non-Alcohol SUDs Past Year (March 2011)
AT LEAST ONE "A" ITEM
CODED "3"

SUDs

H.17

SED

H120

STIM

H121

OPI

H122

CAN

H123

HER

H124

COC

H125

HAL

H126

INH

H127

Substance
Abuse

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Non-Alcohol SUDs Past Year (March 2011)

SUDs

H.18

LIST OF WITHDRAWAL SYMPTOMS (FROM DSM-IV CRITERIA)
Listed below are the characteristic withdrawal symptoms for those classes of psychoactive
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 psychoactive 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, which 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 substance use which 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 which 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

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Adjustment Disorder Past Year (March 2011)

J.1

J. ADJUSTMENT DISORDER
IF THERE IS A DISTURBANCE IN THE PAST YEAR AND IT DOES NOT MEET
THE CRITERIA FOR ANOTHER AXIS I DSM-IV DISORDER, CIRCLE 3 AND
CONTINUE. OTHERWISE, CIRCLE 1 AND GO TO *END OF INTERVIEW* ON
PAGE K.1.

DISTURBANCE IN
PAST YEAR THAT
DOES NOT MEET
CRITERIA FOR
DSM DISORDER

INFORMATION OBTAINED FROM OVERVIEW OF PRESENT ILLNESS WILL
USUALLY BE SUFFICIENT TO RATE THE CRITERIA.

NO
1

YES
3

ADJUSTMENT DISORDER CRITERIA
IF UNKNOWN: Did anything happen to
you just before (ONSET OF CURRENT
DISTURBANCE)?
IF YES: Do you think that
[STRESSOR] had anything to do
with your getting [SYMPTOMS]?

A. The development of emotional or
behavioral symptoms in response to
an identifiable stressor(s) occurring
within three months of the onset of
the stressor(s).

GO TO *END
OF
INTERVIEW*,
K.1

DESCRIBE:
______________________________
______________________________
(What effect has [SYMPTOMS] had on
you and your ability to do things?) (How
upset were you?) (Has it made it hard for
you to do your work or be with friends?)
_________________________________
_________________________________

B. These symptoms or behaviors are
? 1 2
clinically significant as evidenced by
either of the following:
GO TO *END
(1) marked distress that is in
excess of what would be
expected from exposure to the
stressor

OF
INTERVIEW*,
K.1

_________________________________
_________________________________

(Have you had this kind of reaction many
times before?)
(Were you having these [SYMPTOMS]
even before [STRESSOR] happened?)

(2) significant impairment in social
or occupational (academic)
functioning
C. The stress-related disturbance does
not meet the criteria for another
specific Axis I disorder and is not
merely an exacerbation of a
preexisting Axis I or Axis II disorder.

GO TO *END
OF
INTERVIEW*,
K.1

_________________________________
_________________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Adjustment Disorder Past Year (March 2011)

IF UNKNOWN: Did someone close to you
die just before (ONSET OF CURRENT
DISTURBANCE)?

J.2

D. The symptoms do not represent
Bereavement.

GO TO *END
OF
INTERVIEW*,
K.1

_________________________________
_________________________________
(How long has it been now since
[STRESSOR AND COMPLICATIONS
ARISING FROM THE STRESSOR] was
over?)

E. Once the stressor (or its
consequences) has terminated, the
symptoms do not persist for more
than an additional 6 months.

_________________________________

GO TO *END
OF
INTERVIEW*,
K.1

_________________________________
ADJUSTMENT DISORDER CRITERIA
A, B, C, D, AND E ARE CODED “3”

GO TO *END OF
INTERVIEW*, K.1

CODE SUBTYPE BASED ON
PREDOMINANT SYMPTOMS

?=inadequate information

ADJUSTMENT
DISORDER

WITH DEPRESSED MOOD
(e.g., depressed mood, tearfulness, feelings of
hopelessness)

WITH ANXIETY
(e.g., nervousness, worry, jitteriness, or in children, fears
of separation from major attachment figures)

WITH MIXED ANXIETY AND DEPRESSED MOOD
(e.g., a combination of depression and anxiety)

WITH DISTURBANCE OF CONDUCT
(a disturbance in conduct in which there is a violation of
the rights of others or of major age-appropriate societal
norms or rules, e.g., truancy, vandalism, reckless driving,
fighting, defaulting on legal responsibilities)

WITH MIXED DISTURBANCE OF EMOTIONS AND
CONDUCT (e.g., depression and disturbance of conduct)

UNSPECIFIED
(e.g., physical complaints, social withdrawal, or work or
academic inhibition)

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

End of Interview (March 2011)

This page has been intentionally left blank.

K.1

Deleted: August 2010

SCID-I (for DSM-IV-TR)

End of Interview (March 2011)

K.2

BEFORE YOU END THIS ASSESSMENT, REVIEW THE INFORMATION YOU HAVE ABOUT THE
RESPONDENT’S PAST YEAR SYMPTOMS AND FUNCTIONING. IN ORDER TO ACCURATELY ASSIGN A
GAF SCORE ON THE NEXT PAGE, YOU NEED TO UNDERSTAND THE EXTENT TO WHICH MENTAL
HEALTH/ILLNESS HAS:


IMPAIRED/INHIBITED THE RESPONDENT’S ABILITY TO MAINTAIN A HOME, CARE FOR
CHILDREN;



IMPAIRED/INHIBITED THE RESPONDENT’S ABILITY TO FUNCTION AT WORK AND OR SCHOOL;



IMPAIRED/IMHIBITED THE RESPONDENT’S ABILITY TO TAKE CARE OF HIM/HERSELF WITH
REGARD TO PERSONAL HYGIENE AND SAFETY;



IMPAIRED/INHIBITED THE RESPONDENT’S ABILITY TO MAINTAIN FRIENDSHIPS AND POSITIVE
RELATIONSHIPS WITH FAMILY MEMBERS;



MADE THE RESPONDENT A DANGER TO HIM/HERSELF OR OTHERS

QUERY ANY UNKNOWN DIMENSIONS OF THE RESPONDENT’S PAST YEAR SYMPTOMATOLOGY
AND FUNCTIONING, AND ASSIGN A GAF SCORE ON THE NEXT PAGE.

Deleted: August 2010

SCID-I (for DSM-IV-TR)

End of Interview (March 2011)

K.3

DSM-IV Axis V: Global Assessment of Functioning Scale
Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Rate
the respondent’s period of worst functioning in the past year. Do not include impairment in functioning due to physical (or
environmental) limitations.

CODE (Note: Use intermediate codes when appropriate, e.g., 45, 68, 72). ___ ___ ___
100
|

EOI1

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.

91
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.

Inadequate information.

Deleted: August 2010

SCID-I (for DSM-IV-TR)

End of Interview (March 2011)

K.4

That was my last question. Thank you for your time and cooperation in completing this interview.
Sometimes the personal issues we’ve discussed cause people to become upset and in need of speaking with
a counselor. If you are feeling upset or disturbed by the personal issues we have discussed in this interview
and would like to talk with someone about your feelings, we suggest you call your doctor, counselor, or other
treatment provider if you are currently under someone’s care. If not, there is also a national lifeline number you
can call. This number is on the receipt for the $30 you received for this interview from the interviewer who met
with you earlier. Do you still have that receipt?
IF NO: We would like to give you the hotline number for the National Lifeline Network where counselors are
available to talk at any time of the day or night. They can also give you information about (additional) mental
health services in your area. Their toll-free number is 1-800-273-8255.
IF YES: OK. Please know that counselors at the National Lifeline are available to talk at any time of the day or
night. They can also give you information about mental health services in your area if you request this
information.
Do you have any additional questions you’d like to ask me before we end our call?
Thank you again for your time, and have a good (day/afternoon/evening).

Interview End Time: ___ ___ : ___ ___ AM/PM

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Interviewer Debriefing (March 2011)

X.1

INTERVIEWER DEBRIEFING SECTION
Distressed Respondent Protocol
No Yes
Was the Distressed Respondent Protocol used?

IDS1
IDS2

Specify problems:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Cognitive Impairment Screener
No Yes
Was the Short Blessed Scale used?

Specify problems:

IDS3
IF IDS3 =
1, SKIP
IDS4 and
IDS4a
IDS4

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Indicate score on the Short Blessed

___________
(0-28)

Stressful Life Circumstances

No Yes

IDS4a

Were there significant problems in these areas?
Problems with primary support group

IDS5

Problems related to social environment

IDS6

Educational problems

IDS7

Occupational problems

IDS8

Housing problems

IDS9

Economic problems

IDS10

Problems with access to health care services

IDS11

Problems related to interaction with the legal system/crime

IDS12

Life-threatening Illness – self

IDS13

Life-threatening illness – partner, spouse, family member

IDS14

Other psychosocial and environmental problems

IDS15

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Interviewer Debriefing (March 2011)

X.2

Comprehension Rating
Estimate the respondent’s understanding of the interview:

Circle response

No difficulty -- No language or comprehension problem

Just a little difficulty – almost no language or comprehension problems

A fair amount of difficulty - some language or comprehension problems

A lot of difficulty – considerable language or comprehension problems

Extreme problems with language or comprehension problems

IDS16

IDS17

Specify problems:

Cooperation Rating
Rate how cooperative the respondent was during the interview

Circle response

Very Cooperative

Fairly Cooperative

Not Very Cooperative

Uncooperative

Openly Hostile

Specify problems:

IDS18

IDS19

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Interviewer Debriefing (March 2011)

X.3

Privacy Rating
Indicate on a scale of 1 through 5 how private the interview was:

Circle response

IDS20

Completely Private – No one who could overhear any part of the interview
appeared present

Minor Distractions – Other person(s) seemed present or listening for less
than 1/3 of the time

Moderate Distractions – Others seemed to present about 1/3 of the time

Severe Distractions - Interruptions of Privacy More Than Half the Time

Constant Presence of Other Person(s)

5
IDS21

Specify problems:

Global Validity Rating
Rate the overall validity of the interview

Circle response

Excellent, no reason to suspect invalid responses

Good, factors present that may adversely affect validity

Fair, factors present that definitely reduce validity

Poor, substantially reduced validity

IDS22

Invalid responses, severely impaired mental status or possible deliberate
“faking bad” or “faking good”
Specify problems:

5
IDS23

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Interviewer Debriefing (March 2011)

Potential Disorders Not Assessed

X.4
No Yes

Were there any disorders not assessed that would need to be ruled out?

IDS24
IF IDS24 =
1, SKIP
IDS24a and
IDS25

Rule-out disorder present

Specify disorders implicated:

1 Rule-out Other Axis I
IDS24a
Disorder (not assessed
in study)
2 Rule-out Axis II Disorder
– Personality Disorder
(not assessed in study)
3 Rule-out Axis II Disorder
– Other (e.g.
Developmental
Disability) (not assessed
in study)
4 Rule-out Axis I Disorder
assessed but missed
(due to CI or R error)
IDS25

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Interviewer Debriefing (March 2011)

X.5

CLINICAL SUPERVISOR’S RATINGS
CS: Global Validity Rating
Rate the overall validity of the interview

Circle response

Excellent, no reason to suspect invalid responses

Good, factors present that may adversely affect validity

Fair, factors present that definitely reduce validity

Poor, substantially reduced validity

IDS26

Invalid responses, severely impaired mental status or possible deliberate
“faking bad” or “faking good”

5
IDS27

Specify problems:

CS: Potential Disorders Not Assessed

No Yes

Were there any disorders not assessed that would need to be ruled out?

IDS28
IF IDS28 =
1, SKIP
IDS28a and
IDS29

Rule-out disorder present

Specify disorders implicated:

1 Rule-out Other Axis I Disorder (not IDS28a
assessed in study)
2 Rule-out Axis II Disorder –
Personality Disorder (not assessed
in study)
3 Rule-out Axis II Disorder – Other
(e.g. Developmental Disability) (not
assessed in study)
4 Rule-out Axis I Disorder assessed
but missed (due to CI or R error)

IDS29

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Interviewer Debriefing (March 2011)

This page has been intentionally left blank.

X.6

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Due to a GMC

(March 2011)

Mood Episodes MDGS.1

*GMC/SUBSTANCE CAUSING MOOD SYMPTOMS*
MOOD DISORDER DUE TO A
MOOD DISORDER DUE TO A GENERAL
GENERAL MEDICAL CONDITION
MEDICAL CONDITION CRITERIA
IF SYMPTOMS NOT TEMPORALLY ASSOCIATED WITH A GENERAL MEDICAL CONDITION,
CHECK HERE ___ AND GO TO *SUBSTANCE-INDUCED MOOD DISORDER,* MDGS.3.
CODE BASED ON INFORMATION
ALREADY OBTAINED

A. A prominent and persistent
disturbance in mood predominates
in the clinical picture and is
characterized by either (or both) of
the following:
(1) depressed mood or markedly
?
diminished interest or pleasure in
all, or almost all, activities

B./C.There is evidence from the history, ?
1
2
physical examination, or laboratory
findings that the disturbance is the
GO TO
direct physiological consequence *SUBof a general medical condition and STANCE
INDUCED*,
the disturbance is not better
MDGS.3
accounted for by another mental
disorder (e.g., Adjustment Disorder
With Depressed Mood, in
response to the stress of having a
general medical condition).

(2) elevated, expansive, or irritable
mood
Do you think your (MOOD SXS) were
in any way related to your
(COMORBID GENERAL MEDICAL
CONDITION)?
IF YES: Tell me how.
______________________________
(Did the [MOOD SXS] start or get
much worse only after [COMORBID
GENERAL MEDICAL CONDITION]
began?)
IF YES AND GMC HAS
RESOLVED: Did the (MOOD
SXS) get better once the
(COMORBID GENERAL
MEDICAL CONDITION) got
better?

THE FOLLOWING FACTORS SHOULD
BE CONSIDERED AND SUPPORT
THE CONCLUSION THAT THE GMC IS
ETIOLOGIC TO THE MOOD
SYMPTOMS:
1) THERE IS EVIDENCE FROM THE
LITERATURE OF A WELL-ESTABLISHED ASSOCIATION BETWEEN
THE GMC AND MOOD
SYMPTOMS.
2) THERE IS A CLOSE TEMPORAL
RELATIONSHIP BETWEEN THE
COURSE OF THE MOOD SYMPTOMS AND THE COURSE OF THE
GENERAL MEDICAL CONDITION.
3) THE MOOD SYMPTOMS ARE
CHARACTERIZED BY UNUSUAL
PRESENTING FEATURES (E.G.,
LATE AGE AT ONSET)

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Due to a GMC

(March 2011)

Mood Episodes MDGS.2

4) THERE ARE NO ALTERNATIVE
EXPLANATIONS (E.G., MOOD
SYMPTOMS AS A
PSYCHOLOGICAL REACTION TO
THE GMC).
IF UNCLEAR: How much did (MOOD
SYMPTOMS) interfere with your life?

E. The symptoms cause clinically
?
1
significant distress or impairment in
social, occupational, or other
GO TO
*SUBimportant areas of functioning
NOTE: THE D CRITERION (DELIRIUM
R/O) HAS BEEN OMITTED.
MOOD DISORDER DUE TO GMC
CRITERIA A, B/C, AND E CODED “3”

STANCE
INDUCED*,
MDGS.3

3
MOOD DISORDER DUE
TO A GMC

CHECK HERE ___ IF CURRENT
IN PAST MONTH

Indicate which type of symptom presentation
predominates:
1 - With Major Depressive-like episode
2 - With Depressive Features
(if predominant mood is depressed
but the full criteria are not met for a
Major depressive episode)
3 - With Manic Features
4 - With Mixed Features

CONTINUE ON NEXT PAGE

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Substance- Induced

*SUBSTANCE-INDUCED MOOD
DISORDER*

(March 2011)

Mood Episodes MDGS.3

SUBSTANCE-INDUCED MOOD EPISODE BEING EVALUATED:
DISORDER CRITERIA
Past Year MDE
A.5
Lifetime MDE

A.11
A.17
A.22
A.29

IF SYMPTOMS NOT TEMPORALLY ASSOCIATED WITH SUBSTANCE, Past Year Manic
Lifetime Manic
CHECK HERE ___ AND RETURN TO EPISODE BEING EVALUATED.
Dysthymic
CODE BASED ON INFORMATION
ALREADY OBTAINED.

A. A prominent and persistent
disturbance in mood predominates
in the clinical picture and is
characterized by one (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

IF NOT KNOWN: When did the
(MOOD SYMPTOMS) begin? Were
you already using (SUBSTANCE) or
had you just stopped or cut down your
use?

B. There is evidence from the history, ?
physical examination or laboratory
findings that either (1) the symptoms
in A developed during or within a
month of substance intoxication or
withdrawal, or (2) medication use is
etiologically related to the
disturbance

Do you think your (MOOD SXS) are in
any way related to your (SUBSTANCE
USE)?

C. The disturbance is not better
accounted for by a Mood Disorder
that is not substance-induced.
Evidence that the symptoms are
better accounted for by a Mood
Disorder that is not substanceinduced might include:

IF YES: Tell me how.
ASK ANY OF THE FOLLOWING
QUESTIONS AS NEEDED TO RULE
OUT A NON-SUBSANCE-INDUCED
ETIOLOGY
IF UNKNOWN: Which came first, the
(SUBSTANCE USE) or the (MOOD
SYMPTOMS)?

NOT SUBSTANCE
INDUCED RETURN
TO EPISODE
BEING EVALUATED

1) the mood symptoms precede the
onset of the Substance Abuse or
Dependence (or medication use)

IF UNKNOWN: Have you had a
2) the mood symptoms persist for a
period of time when you stopped using
substantial period of time (e.g.,
(SUBSTANCE)?
about a month) after the cessation of
acute withdrawal or severe
IF YES: After you stopped using
intoxication
(SUBSTANCE) did the (MOOD
SXS) get better?
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Substance- Induced

(March 2011)

Mood Episodes MDGS.4

IF UNKNOWN: How much of
(SUBSTANCE) were you using when
you began to have (MOOD
SYMPTOMS)?

3) the mood symptoms are
substantially in excess of what
would be expected given the type,
duration or amount of the substance
used

IF UNKNOWN: Have you had any
other episodes of (MOOD
SYMPTOMS)?

4) there is evidence suggesting the
existence of an independent nonsubstance-induced Mood Disorder
(e.g. , a history of recurrent Major
Depressive Episodes)

IF YES: How many? Were you
using (SUBSTANCES) at those
times?
IF UNKNOWN: How much did
(MOOD SYMPTOMS) interfere with
your life?

E. The symptoms cause clinically
?
1
2
significant distress or impairment in
RETURN TO
social, occupational, or other
EPISODE
important areas of functioning.

BEING
EVALUATED

NOTE: THE D CRITERION (DELIRIUM
R/O) HAS BEEN OMITTED.
SUBSTANCE-INDUCED MOOD
DISORDER CRITERIA A, B, C, AND E
ARE CODED “3”

SUBSTANCE-INDUCED
MOOD DISORDER

CHECK HERE ___ IF
CURRENT IN PAST MONTH

Indicate which type of symptom
presentation predominates:
1 – With Depressive Features
2 – With Manic Features
3 – With Mixed Features

Indicate context of development of mood
symptoms:
1 – With Onset During Intoxication
2 – With Onset During Withdrawal

RETURN TO EPISODE BEING EVALUATED

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Due to GMC

(March 2011)

Anxiety Symptoms ADGS.1

*GMC/SUBSTANCE AS ETIOLOGY FOR ANXIETY SYMPTOMS*
ANXIETY DISORDER DUE TO A
GENERAL MEDICAL CONDITION

ANXIETY DISORDER DUE TO A GENERAL
MEDICAL CONDITION CRITERIA

IF SYMPTOMS NOT TEMPORALLY ASSOCIATED WITH A GENERAL MEDICAL CONDITON
CHECK HERE ___ AND GO TO *SUBSTANCE-INDUCED ANXIETY DISORDER,* ADGS.3
A. Prominent anxiety, panic attacks, ?
obsessions or compulsions
predominate in the clinical picture.

CODE BASED ON INFORMATION
ALREADY OBTAINED

Did the (ANXIETY SYMPTOMS) start
or get much worse only after (GMC)
began?
IF GMC HAS RESOLVED: Did the
(ANXIETY SYMPTOMS) get better
once the (GMC) got better?
_______________________________
_______________________________

B/C. There is evidence from this
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 (e.g., adjustment
disorder With Anxiety), in which the
stressor is a serious general medical
condition).

GO TO
*SUBSTANCE
INDUCED*
ADGS.3

THE FOLLOWING FACTORS SHOULD BE
CONSIDERED AND SUPPORT THE CONCLUSION
THAT THE GMC IS ETIOLOGIC TO THE ANXIETY
SYMPTOMS.
1) THERE IS EVIDENCE FROM THE LITERATURE
OF A WELL-ESTABLISHED ASSOCIATION
BETWEEN THE GMC AND ANXIETY SYMPTOMS.
2) THERE IS A CLOSE TEMPORAL RELATIONSHIP
BETWEEN THE COURSE OF THE ANXIETY
SYMPTOMS AND THE COURSE OF THE GENERAL
MEDICAL CONDITION.
3) THE ANXIETY SYMPTOMS ARE
CHARACTERIZED BY UNUSUAL PRESENTING
FEATURES (E.G., LATE AGE AT ONSET)
4) THE ABSENCE OF ALTERNATIVE
EXPLANATIONS (E.G., ANXIETY SYMPTOMS AS A
PSYCHOLOGICAL REACTION TO THE GMC).

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Due to GMC

IF UNCLEAR: How much did
(ANXIETY SYMPTOMS) interfere with
your life?
(Has it made it hard for you to do your
work or be with your friends?)
_______________________________

(March 2011)

E. The disturbance causes clinically
significant distress or impairment
in social, occupational or other
important areas of functioning.

Anxiety Symptoms ADGS.2
?

NOTE: THE D CRITERION
(DELIRIUM R/O) HAS BEEN
OMITTED.

GO TO
*SUBSTANCE
INDUCED*
ADGS.3

_______________________________
ANXIETY DISORDER DUE TO GMC
CRITERIA A, B/C, AND E CODED
“3”

ANXIETY
DISORDER
DUE TO A
GMC

CHECK HERE ___ IF CURRENT
IN PAST MONTH

Indicate which type of symptom
presentation predominates:
1 - With Generalized Anxiety
2 - With Panic attacks
3 - With Obsessive-Compulsive
symptoms

CONTINUE ON NEXT PAGE

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Substance-Induced

SUBSTANCE-INDUCED ANXIETY
DISORDER

(March 2011)

ADGS.3

Anxiety Symptoms

SUBSTANCE-INDUCED ANXIETY
DISORDER CRITERIA

IF SYMPTOMS NOT TEMPORALLY ASSOCIATED WITH
SUBSTANCE USE, CHECK HERE ___ AND RETURN TO
DISORDER BEING EVALUATED.

EPISODE BEING EVALUATED:
Panic
E.12
AWOPD
E.17
Social Phobia
E.21
OCD
E.31
GAD
E.36

CODE BASED ON INFORMATION
ALREADY OBTAINED

A. Prominent anxiety, panic attacks, ?
obsessions or compulsions
predominate in the clinical picture.

IF NOT KNOWN: When did the
(ANXIETY SYMPTOMS) begin? Were
you already using (SUBSTANCE) or
had you just stopped or cut down your
use?

_______________________________

B. There is evidence from the
history, physical examination, or
laboratory findings that either: (1)
the symptoms in A developed
during, or within a month of,
substance intoxication or
withdrawal, or (2) medication use
is etiologically related to the
disturbance

ASK ANY OF THE FOLLOWING
QUESTIONS AS NEEDED TO RULE
OUT A NON-SUBSTANCE-INDUCED
ETIOLOGY:

C. The disturbance is NOT better
accounted for by an Anxiety
Disorder that is not substanceinduced.

_______________________________

NOT
SUBSTANCE
INDUCED
RETURN TO
DISORDER
BEING
EVALUATED

Guidelines for Primary Anxiety:
Evidence that the symptoms are
better accounted for by a primary
(i.e., non-substance-induced) Anxiety
Disorder may include any (or all) of
the following:
IF UNKNOWN: Which came first, the
(SUBSTANCE USE) or the (ANXIETY
SYMPTOMS)?
IF UNKNOWN: Have you had a period
of time when you stopped using
(SUBSTANCE)?
IF YES: After you stopped using
(SUBSTANCE) did the (ANXIETY
SYMPTOMS) get better or did
they continue?
_______________________________

NOT
SUBSTANCE
INDUCED
RETURN TO
DISORDER
BEING
EVALUATED

(1) the anxiety symptoms
precede the onset of the
Substance Abuse or
Dependence (or medication
use)
(2) the anxiety symptoms persist
for a substantial period of
time (e.g., about a month)
after the cessation of acute
withdrawal or severe
intoxication

_______________________________
?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Substance-Induced

IF UNKNOWN: How much (SUBSTANCE) were you using when you
began to have (ANXIETY
SYMPTOMS)?
_______________________________

(March 2011)

ADGS.4

Anxiety Symptoms

(3) the anxiety symptoms are
substantially in excess of
what would be expected
given the character,
duration, or amount of the
substance used

_______________________________

IF UNKNOWN: Have you had any
other episodes of (ANXIETY
SYMPTOMS)?

(4) there is evidence suggesting
the existence of an
independent, nonsubstance-induced Anxiety
Disorder (e.g., a history of
recurrent non-substancerelated panic attacks)

IF YES: How many? Were you
using (SUBSTANCES) at those
times?
_______________________________
_______________________________

IF UNKNOWN: How much did
(ANXIETY SYMPTOMS) interfere with
your life?
(Has it made it hard for you to do your
work or be with your friends?)
_______________________________

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

RETURN TO
DISORDER
BEING
EVALUATED

NOTE: THE D CRITERION
(DELIRIUM R/O) HAS BEEN
OMITTED.

_______________________________

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Substance-Induced

(March 2011)

ADGS.5

Anxiety Symptoms

SUBSTANCE-INDUCED ANXIETY
DISORDER CRITERIA A, B, C, AND
E ARE CODED “3”

SUBSTANCE-INDUCED
ANXIETY DISORDER

CHECK HERE ___ IF CURRENT IN PAST
MONTH

Indicate which type of symptom
presentation predominates:
0 - Unspecified
1 - With Generalized Anxiety
2 - With Panic Attacks
3 - With ObsessiveCompulsive symptoms
4 - With Phobic Symptoms

Indicate context of development of
anxiety symptoms:
1- With Onset During Intoxication
2- With Onset During Withdrawal

RETURN TO EPISODE BEING EVALUATED

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I (for DSM-IV-TR)

Substance-Induced

(March 2011)

Anxiety Symptoms

ADGS.6

This page has been intentionally left blank.

?=inadequate information

1=absent or false

2=subthreshold

3=threshold or true

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Distressed Respondent Protocol (March 2011)

DRP.1

Specific Guidelines
If respondents report any of the issues listed below during any interactions with the recruiter or clinical
interviewer, including before, during, or after a telephone screening or interview, the staff member will
immediately refer to the scenario chart below and follow the instructions provided. Details of all
incidents will be documented on the case management system and reported to project management
staff immediately.
•

•

Has had any suicidal thoughts in the past two weeks (p. A.3), including
– passive suicidal thoughts (i.e. thoughts or wishes about his/her death in the absence of
thoughts about specific ways s/he could die or attempt suicide, plans for how s/he could
die or attempt suicide, or intention of dying or attempting suicide) [SCENARIO 1] or
– active suicidal thoughts (i.e. thoughts or wishes about his/her death combined with
thoughts about specific ways s/he could die or attempt suicide, plans for how s/he could
die or attempt suicide, the intention of dying or attempting suicide, and the means to
carry out that plan) [SCENARIO 2]
Has had any homicidal thoughts in the past two weeks, including
– passive homicidal thoughts (i.e. thoughts or wishes about seriously harming someone
else in the absence of thoughts about specific ways in which s/he could seriously harm
another person, plans for how s/he could seriously harm another person, intentions of
seriously harming another person) [SCENARIO 3] or
– active homicidal thoughts (i.e. thoughts or wishes about seriously harming someone else
combined with thoughts about specific ways s/he could seriously harm another person,
plans for how s/he could seriously harm another person, the intention of seriously
harming another person, and the means to carry out that plan) [SCENARIO 4]

Deleted: August 2010
Deleted: ¶
NSDUH Mental Health Surveillance Study ¶
Certification Interviews and Follow-up
Study Interviews¶
Distressed Respondent Protocol¶
¶
Overview¶
¶
Due to the nature of the sample targeted for
the NSDUH Mental Health Surveillance Study
certification interviews and the nature of the
clinical interview questions asked during
certification and data collection, it is possible
that a respondent will indicate during the
course of their interactions with the certification
interview recruiter or the clinical interviewers
that he or she poses a likely threat to his or her
own safety or the safety of others. It is
essential that NSDUH project staff members be
prepared to handle these situations
appropriately. ¶
... [1]
Deleted: T
Deleted: he certification interview recruiter
...or
[2]
Deleted: a
Deleted: licensed
Deleted: clinical
Deleted: psychologists
Deleted:
Deleted: employed by RTI
Deleted: ,
Deleted: when appropriate based on the ... [3]
Deleted: Dr. Karg

Scenario Chart

Deleted: and the certifier/clinical interviewer
... [4]

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

Deleted: Dr. Karg
Deleted: will make the final decision as to...
what
[5]
Deleted: Dr. Karg
Deleted: (Drs. Karg, Blazei and Panzer). ...
Any
[6]

Self

Possible / Yes

Other(s)

Deleted: Lifeline
Deleted: or 911 will be deferred to
Deleted: Dr. Karg
Deleted: the Clinical Supervisors (Drs. Karg,
... [7]
Deleted: ¶

Other(s)

Possible / Yes

Deleted: ¶

... [11]

Formatted Table

No risk of harm; respondent is
agitated or upset

Deleted: Lifeline
Deleted: emergency care representative or
...911
[8]
Deleted: Lifeline
Deleted: emergency care representative or
...911
[9]
Deleted: the
Deleted: to follow the guidelines herein.¶
Deleted: ¶
Deleted: Although some situations may require
... [10]

SCID-I/NP (for DSM-IV-TR)

Distressed Respondent Protocol (March 2011)

DRP.2

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Distressed Respondent Protocol (March 2011)

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

Possible / Yes

DRP.3

Deleted: August 2010

Formatted Table

STEPS
A. END SCREENING/INTERVIEW AND THEN READ TO R: When you agreed to participate
in this interview, I promised that I would not tell anyone what you have told me unless it was
necessary to protect you or other people. You told me earlier that you are thinking about
harming yourself. I strongly suggest that we contact emergency care services in your area, such
as a crisis center or nearby hospital. I am going to look-up that number. Can you remain on the
line while I do that? It may take a few minutes.
IF NO: Okay, if I don’t connect you with the local emergency care provider, then I will need
to call the provider myself to see if they can send someone to you who can provide the care
you need in order to keep you safe. I’ll call you back to let you know what I find out.
B. FIND THE NEAREST EMERGENCY PSYCHIATRIC SERVICES USING THE SAMHSA
WEBSITE (http://mentalhealth.samhsa.gov/databases/). SEARCH FOR INPATIENT MH
TREATMENT USING THE R’S CURRENT ZIP CODE.
C. CALL THEIR LOCAL INPATIENT PSYCHIATRIC CARE FACILITY OR CRISIS CENTER
AND READ THIS STATEMENT: I work for RTI International, a research company in North
Carolina, and we are conducting a research study. During an interview with a respondent, the
respondent told me that (he/she) is thinking about killing or harming (himself/herself) and I am
concerned about (his/her) safety. I can give you additional information about the research
study, if you would like. I can also provide you with the respondent’s contact information.

Deleted: )

IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use
and Health sponsored by the United States Public Health Service, is designed to test
procedures for use in future NSDUH surveys. Questions ask about various mental health
issues such as depression, anxiety, post traumatic stress disorder, and substance
dependence. Please note that this information was obtained through the respondent’s
participation in a research study. We went through appropriate informed consent
procedures, during which I told the respondent that if (he/she) told me something that
caused me to be concerned about (his/her) well-being, I would report that to someone else
who could help or intervene. Given the context in which the information was obtained,
however, we cannot guarantee that the participant understood the questions nor that
(he/she) provided truthful responses. Do you have any questions about the study?
ANSWER QUESTIONS.
D. GIVE R FIRST NAME, TELEPHONE NUMBER, AND ADDRESS (IF KNOWN) TO LOCAL
EMERGENCY CARE REPRESENTATIVE. IF THEY ARE UNABLE TO PROVIDE SERVICES
THAT ENSURE THE R’S SAFETY, SEARCH FOR THE R’S LOCAL EMERGENCY NUMBER
USING THE NATIONAL 911 DATABASE.
E. IF R ON THE OTHER LINE, CONNECT R TO EMERGENCY CARE REPRESENTATIVE OR
LOCAL 911 DISPATCHER AND STAY ON THE LINE; IF YOU HANG-UP, THEIR
CONNECTION WILL ALSO END.
IF R NOT ON THE OTHER LINE, END CALL WITH THE EMERGENCY CARE PROVIDER
OR LOCAL 911 DISPATCHER AND ATTEMPT TO CONTACT R AGAIN WITH AN UPDATE.

Deleted: ¶
F. WHEN CALL IS COMPLETED, CALL DR.
KARG TO DEBRIEF. IF SHE DOES NOT
RETURN CALL WITHIN 15 MINUTES, CALL
DR. BLAZEI OR DR. PANZER TO DEBRIEF.
IF NEITHER ONE OF THEM IS AVAILABLE,
CONTACT MS. GRANGER OR MR.
CUNNINGHAM TO NOTIFY ONE OF THEM
ABOUT THE INCIDENT. FILL OUT ONLINE
INCIDENT REPORT.¶

SCID-I/NP (for DSM-IV-TR)

Distressed Respondent Protocol (March 2011)

F. WHEN CALL IS COMPLETED, CALL DR. KARG TO DEBRIEF. IF SHE DOES NOT
RETURN CALL WITHIN 15 MINUTES, CALL DR. BLAZEI OR DR. PANZER TO DEBRIEF.
IF NEITHER ONE OF THEM IS AVAILABLE, CONTACT MS. GRANGER OR MR.
CUNNINGHAM TO NOTIFY ONE OF THEM ABOUT THE INCIDENT. FILL OUT ONLINE
INCIDENT REPORT.

DRP.4

Deleted: August 2010

Formatted Table

SCID-I/NP (for DSM-IV-TR)

Distressed Respondent Protocol (March 2011)

DRP.5

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Other(s)

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Distressed Respondent Protocol (March 2011)

DRP.6

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Other(s)

Possible / Yes

STEPS
A. END SCREENING/INTERVIEW AND END CALL.
B. SEARCH FOR THE R’S LOCAL EMERGENCY NUMBER USING THE NATIONAL 911
DATABASE.
C. CALL THEIR LOCAL 911, AND READ THIS STATEMENT: I work for RTI International, a research
company in North Carolina, and we are conducting a research study. During an interview with a
respondent, the respondent told me that (he/she) is thinking about killing or harming another individual.
I am concerned about this individual’s safety. I can give you additional information about the research
study, if you would like. I can also provide you with the respondent’s contact information.
IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use and
Health sponsored by the United States Public Health Service, is designed to test procedures for use in
future NSDUH surveys. Questions ask about various mental health issues such as depression,
anxiety, post traumatic stress disorder, and substance dependence. Please note that this information
was obtained through the respondent’s participation in a research study. We went through
appropriate informed consent procedures, during which I told the respondent that if (he/she) told me
something that caused me to be concerned about (him/her) harming someone else, I would report
that to someone else who could help or intervene. Given the context in which the information was
obtained, however, we cannot guarantee that the participant understood the questions nor that
(he/she) provided truthful responses. Do you have any questions about the study? ANSWER
QUESTIONS.
D. GIVE R FIRST NAME, TELEPHONE NUMBER, ADDRESS (IF KNOWN), AND VICTIM’S
IDENTIFYING INFORMATION TO LOCAL 911 DISPATCHER. END CALL.
E. WHEN CALL IS COMPLETED, CALL DR. KARG TO DEBRIEF. IF SHE DOES NOT RETURN
CALL WITHIN 15 MINUTES, CALL DR. PANZER OR DR. BLAZEI TO DEBRIEF. IF NEITHER
ONE OF THEM IS AVAILABLE, CONTACT MS. GRANGER OR MR. CUNNINGHAM TO NOTIFY
ONE OF THEM ABOUT THE INCIDENT. FILL OUT ONLINE INCIDENT REPORT.

Deleted: August 2010

SCID-I/NP (for DSM-IV-TR)

Distressed Respondent Protocol (March 2011)

DRP.7

Scenario Number

Individual at Risk of Harm

Imminent Danger?

No risk of harm; respondent is
agitated or upset

STEPS
A. END SCREENING/INTERVIEW AND THEN READ TO R: I know these questions are very
personal, and they seem to be upsetting you. Do you have a doctor or someone you can talk to
about how you are feeling?
IF YES: I suggest that you call that individual immediately so that she or he can help you
talk about and work through how you are feeling. There is also a national Lifeline hotline you
can call where counselors are available to talk at any time of the day or night. Their toll-free
number is 1-800-273-8255. THANK R FOR THEIR PARTICIPATION IN THE STUDY
AND END CALL.
IF NO: I suggest that you contact the national Lifeline hotline at 1-800-273-8255. Lifeline is a
24-hour hotline that you could call to discuss this with a counselor. They may also help you
locate (additional) mental health services in your area. If you feel that this is an emergency
now or later, you should go to a hospital emergency room right away or call 911 for
assistance. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END CALL.
B. WHEN CALL IS COMPLETED, CALL DR. BLAZEI OR DR. PANZER IF YOU HAVE ANY
QUESTIONS OR NEED TO DEBRIEF. FILL OUT ONLINE INCIDENT REPORT.

Deleted: August 2010

Deleted: If respondents report any of the
issues listed below during any interactions with
the recruiter or clinical interviewer, including
before, during, or after a telephone screening
or interview, the staff member will immediately
refer to the scenario chart below and follow the
instructions provided. Details of all incidents
will be documented on the case management
system and reported to project management
staff immediately. ¶
¶
<#>Has had any suicidal thoughts in the
past two weeks (p. A.3), including¶
Deleted: <#> Deleted: <#>passive suicidal thoughts (i.e.
thoughts or wishes about his/her death in the
absence of thoughts about specific ways s/he
could die or attempt suicide, plans for how s/he
could die or attempt suicide, or intention of
dying or attempting suicide) [SCENARIO 1] or ¶
Deleted: <#>–
Deleted: <#>active suicidal thoughts (i.e.
thoughts or wishes about his/her death
combined with thoughts about specific ways
s/he could die or attempt suicide, plans for
... how
[12]
Deleted: <#>
Deleted: <#>¶

... [13]

Deleted: <#> Deleted: <#>passive homicidal thoughts...(i.e.
[14]
Deleted: <#>–
Deleted: <#>active homicidal thoughts...
(i.e.
[15]
Deleted: ¶
Deleted: ¶

... [16]

Deleted: ¶
Deleted: ¶

... [17]

Formatted Table
Deleted: SCENARIO 1 (Continued)

... [18]

Deleted: ¶
Deleted:

Page Break

Deleted: ¶

... [19]
... [20]

Deleted: ¶
Deleted:

Page Break

... [21]

Deleted:
Deleted:

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... [22]

Formatted Table
Deleted: ¶
Deleted:

... [23]
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... [24]

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... [25]

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... [26]

SCID-I/NP (for DSM-IV-TR) Cognitive Impairment Protocol (March 2011)

CIP.1

SHORT BLESSED SCALE EXAM
THE SHORT BLESSED SCALE IS TO BE COMPLETED AT ANY POINT DURING THE INTERVIEW
IF THE RESPONDENT APPEARS TO BE COGNITIVELY IMPAIRED.

Deleted: August 2010

Comment [s1]: There is text in the header
that is outside the margin (X.1); should it be
within the margins? If not, it should be deleted
to avoid printer error message.

ERROR SCORES
SB-1.

What year is it now? _____________
CIRCLE 4 FOR ANY ERROR ........................................................ 0 4

SB-2.

What month is it now? _______________
CIRCLE 3 FOR ANY ERROR ........................................................ 0 3
Please repeat this phrase after me: John Brown, 42 Market Street, Chicago.
NO SCORE – FOR ITEM SB-6.

SB-3.

About what time is it? _______________
CIRCLE 3 FOR ANY ERROR ........................................................ 0 3

SB-4.

Please count backwards from 20 to 1.
[20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 6, 5, 4, 3, 2, 1]
2 PER ERROR ............................................................................... 0 2 4

SB-5.

Please say the months of the year in reverse order.
[DEC, NOV, OCT, SEP, AUG, JUL, JUN, MAY, APR, MAR, FEB, JAN]

2 PER ERROR ............................................................................... 0 2 4
SB-6.

Please repeat the phrase I asked you to repeat before.
[JOHN BROWN / 42 MARKET STREET / CHICAGO]
2 PER ERROR ............................................................................... 0 2 4 6 8 10

TOTAL NUMBER OF ERRORS IN SB-1 TO SB-6: ..................... _______
IF THE TOTAL NUMBER OF ERRORS IS GREATER THAN 10, TERMINATE THE INTERVIEW.

Deleted:

SCID-I/NP (for DSM-IV-TR) Cognitive Impairment Protocol (March 2011)

This page has been intentionally left blank.

CIP.2

Deleted: August 2010

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NSDUH Mental Health Surveillance Study
Certification Interviews and Follow-up Study Interviews
Distressed Respondent Protocol
Overview
Due to the nature of the sample targeted for the NSDUH Mental Health Surveillance Study
certification interviews and the nature of the clinical interview questions asked during
certification and data collection, it is possible that a respondent will indicate during the course
of their interactions with the certification interview recruiter or the clinical interviewers that he
or she poses a likely threat to his or her own safety or the safety of others. It is essential that
NSDUH project staff members be prepared to handle these situations appropriately.
The certification interview recruiter and all clinical interviewers will be instructed to be alert to
signs of distress or agitation, or indication of imminent danger of harm to oneself or another
based on indirect and direct statements made by respondents. In all such circumstances, the
recruiter or clinical interviewer will follow the protocol outlined in this document.
There are essentially two situations that would constitute imminent danger of harm:
A respondent tells the interviewer that he/she is thinking about killing or harming
himself or herself, has a plan, and has a means to carry out that plan.
A respondent tells the interviewer that he/she intends to hurt or kill someone else (not
necessarily someone living in the household) has a plan, and has a means to carry
out that plan.
In cases where imminent danger is or may be involved, t
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he certification interview recruiter or clinical interviewer will contact Dr. Rhonda Karg (919-6415460), Dr. Ryan Blazei (919-720-1452), or Dr. Kate Panzer (336-420-1421), all
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when appropriate based on the instructions in the tables below. As Clinical Supervisors, Drs.
Karg, Blazei, and Panzer will act primarily as a sounding board for the certifier/clinical
interviewer. If there is a question about what action to take in response to the
certifier’s/clinical interviewer’s interactions with a respondent, the Clinical Supervisor
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and the certifier/clinical interviewer will discuss the situation and the Clinical Supervisor
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will make the final decision as to what action, if any beyond documenting the situation in an
online incident form, should be taken. If emergency psychiatric services, including 911, has

1421), Ms. Becky Granger (919-423-8198) or David Cunningham (919-247-0853). Because Ms.
Granger and Mr. Cunningham do not have clinical training, they will simply be made aware that
the Distressed Respondent Protocol has been enacted and that the certifier/clinical interviewer
is attempting to contact the Clinical Supervisors
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(Drs. Karg, Blazei and Panzer). Any questions about clinical diagnosis or whether to contact
emergency psychiatric services
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the Clinical Supervisors (Drs. Karg, Blazei, and Panzer). In the event that Ms. Granger or Mr.
Cunningham is contacted, they will also begin attempting to contact Drs. Karg, Blazei, and
Panzer. The following table will be printed on the inside cover of the clinical interviewer
handbook and in the instructions for handling distressed respondents:
Page Break

Call:

Cell Phone Numbers:

Dr. Rhonda Karg

919-641-5460

Dr. Ryan Blazei

919-720-1452

Dr. Kate Panzer

336-420-1421336-632-0321

Rebecca Granger

919-423-8198

David Cunningham

919-247-0853

If the instructions call for the recruiter/interviewer to report the respondent’s address to an
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emergency care representative or 911 dispatcher, the certification recruiter/interviewer will ask
the respondent for the address of his/her current location. In addition, for cases that have
been assigned to them by the RTI survey manager overseeing data collection, within the secure
web-based case management system, clinical interviewers will be able to click on a 7-digit case
ID to access a respondent’s address. Clinical interviewers will access a respondent’s address
only under these specific circumstances. In these circumstances, if the respondent told the
clinical interviewer that he/she was at a different address than appears in the case
management system record, the clinical interviewer will give both addresses to the
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on these guidelines. Even if the respondent refuses, we believe that having at least the
respondent’s phone number adequately minimizes respondent risk to themselves or others
because the screening questions are short and fairly innocuous. Furthermore, we do not
anticipate any certification recruitment respondents to become distressed or agitated, or to
indicate imminent danger of harm to oneself or another because mental health professionals
will not have given the recruitment flyer to anyone that had exhibited psychotic, severely
depressed, or suicidal symptoms to the clinician’s knowledge while under their care, or to
anyone else the clinician believes may become distressed, upset, violent, or suicidal while
completing the SCID interview over the phone. Nevertheless, because the certification
interview respondents will have received services from a mental health professional such as a
psychiatrist, psychologist, social worker, or substance abuse counselor at least once during the
past 12 months, there is a remote possibility that the individual may be more prone than the
average individual to becoming upset. For this reason, the certifier will be provided this
protocol and instructed
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Although some situations may require consultation with IRB representatives, we believe these
procedures will provide comprehensive guidelines to protect the safety of our human subjects.
The hotline information that we are providing is for the National Lifeline, a national hotline that
deals specifically with mental health issues. We have contacted the hotline and explained the
study to them, in order to alert them to potential calls. A National Lifeline representative has
confirmed that someone from the Lifeline will make calls to individuals if requested to do so.
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All information gathered from or about a respondent will be entered directly into the secure
web-based case management system. The recruiter will enter respondents’ names and phone
numbers directly into the website and clinical interviewers will access the name and phone
number directly from the website. No records will ever be written on paper.
All clinical interviewers hired to work on this study will confirm that these guidelines are
consistent with all legal and ethical guidelines by which they must abide. They will report that
they are under no obligation to, nor will they, convey any information about this study or about
respondents to anyone not involved with this study. They also will also confirm that they are
under no legal or ethical obligation to provide mental health services or counseling to a
respondent beyond referring individuals to other resources or contacting authorities as specified
in this document. Moreover, RTI legal counsel Chris Buchholz confirmed via e-mail to David
Cunningham on April 25, 2007 that in his judgment the guidelines are consistent with all
pertinent “duty to warn” laws in the states in which the certification recruiter, clinical
interviewers, and respondents reside because the individuals working on the project, even the
clinical interviewers clinically trained in mental health issues, will not be participating in a
medical or psychological professional capacity.
Although some situations may require consultation with IRB representatives, we believe these
procedures will provide comprehensive guidelines to protect the safety of our human subjects.

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active suicidal thoughts (i.e. thoughts or wishes about his/her death combined with thoughts
about specific ways s/he could die or attempt suicide, plans for how s/he could die or attempt
suicide, the intention of dying or attempting suicide, and the means to carry out that plan)
[SCENARIO 2]

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Has had any homicidal thoughts in the past two weeks, including
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passive homicidal thoughts (i.e. thoughts or wishes about seriously harming
someone else in the absence of thoughts about specific ways in which s/he
could seriously harm another person, plans for how s/he could seriously harm
another person, intentions of seriously harming another person) [SCENARIO 3]
or
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active homicidal thoughts (i.e. thoughts or wishes about seriously harming
someone else combined with thoughts about specific ways s/he could seriously
harm another person, plans for how s/he could seriously harm another person,
the intention of seriously harming another person, and the means to carry out
that plan) [SCENARIO 4]
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Scenario Chart
Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

Possible / Yes

Other(s)

Possible / Yes

No risk of harm; respondent is
agitated or upset

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Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

STEPS
A. COMPLETE SCREENING/INTERVIEW AND THEN READ TO R: When you agreed to
participate in this interview, I promised that I would not tell anyone what you have told me
unless it was necessary to protect you or other people. You told me earlier that you have
recently had thoughts or wishes about your death or dying. Do you have a doctor, counselor, or
someone you can talk to about how you are feeling now?
IF YES: I strongly suggest that you contact this person immediately so you can talk to him
or her about how you have been feeling, especially about the thoughts you’ve been having
about death and dying. Would you be willing to do that? THANK R FOR THEIR
PARTICIPATION IN THE STUDY AND END CALL.
IF NO: I strongly suggest that you contact the national Lifeline hotline and let them
know so they can talk to you about how you feel. I would like for you to stay on the
line while I call Lifeline. Is that all right with you?
B. IF R UNWILLING
IF YES: Okay. There is also a national lLifeline hotlinenumber you can call where
counselors are available to talk at any time of the day or night. Their toll-free
number is 1-800-273-8255. THANK R FOR THEIR PARTICIPATION IN THE
STUDY AND END CALL.
IF NO: I strongly suggest that you contact the national Lifeline hotline at 1-800-273-8255.
Lifeline has counselors available 24-hours a day to talk to you about how you are feeling.
They may also help you locate (additional) mental health services in your area. If you feel
that this is an emergency now or later, you should go to a hospital emergency room right
away. If you are not able to get to an emergency room immediately, you should call 911 for
assistance. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END CALL.
C. IF R WILLING: In just a minute I will call the Lifeline so we can talk with a counselor.
Lifeline counselors are available 24-hours a day to talk with you about how you are feeling. They
may also help you locate (additional) mental health services in your area. To contact the Lifeline
hotline, call 1-800-273-8255. If you feel that this is an emergency now or later, you should go to
a hospital emergency room right away or call 911 for assistance. Please stay on the line while I
contact Lifeline. If we get disconnected, I will call you back.
D. PUT R ON HOLD AND CALL LIFELINE: I work for RTI International, a research company
in North Carolina, and we are conducting a research study. During a telephone interview, a
respondent told me that (he/she) is thinking about killing or harming (himself/herself). I have
asked the respondent to wait on the line while I contacted you. I can give you additional

E. IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use
and Health sponsored by the United States Public Health Service, is designed to test procedures
for use in future NSDUH surveys. Questions ask about various mental health issues such as
depression, anxiety, post traumatic stress disorder, and substance dependence. Please note that
this information was obtained through the respondent’s participation in a research study. We
went through appropriate informed consent procedures, during which I told the respondent that
if (he/she) told me something that caused me to be concerned about (his/her) well-being, I
would report that to someone else who could help or intervene. Do you have any questions
about the study? ANSWER QUESTIONS.

F. CONNECT R AND INTRODUCE TO LIFELINE. STAY ON THE LINE WHILE THE R
TALKS WITH THE LIFELINE COUNSELOR; IF YOU HANG-UP, THEIR CONNECTION
WILL ALSO END. IF R DISCONNECTED AND YOU CANNOT REACH HIM/HER ON THE
PHONE AGAIN IMMEDIATELY, CALL LIFELINE AND PROVIDE INFORMATION IN D
AND E ABOVE AND GIVE R NAME, TELEPHONE NUMBER, AND ADDRESS (IF KNOWN).
G. IF THE LIFELINE COUNSELOR DOES NOT OFFER A REFERRAL FOR MENTAL HEALTH
SERVICES, INTERJECT AND SAY: This is X, the interviewer who connected us for this call.
Can you provide referral information about mental health services in [his/her] area now?
IF THE NAME, NUMBER, AND LOCATION OF A MENTAL HEALTH PROVIDER IS NOT
PROVIDED BY THE LIFELINE COUNSELOR, OBTAIN REFERRAL INFORMATION FOR
MENTAL HEALTH SERVICES IN THE RESPONDENT’S AREA FROM THE SAMHSA
WEBSITE (http://mentalhealth.samhsa.gov/databases/). CALL DR. KARG IMMEDIATELY TO
DISCUSS REFERRAL OPTIONS. AFTER SPEAKING WITH DR. KARG, RECONTACT THE
RESPONDENT AS SOON AS POSSIBLE TO PROVIDE THAT INFORMATION. IF WHEN
YOU CALL BACK, YOU GET AN ANSWERING MACHINE OR VOICEMAIL, LEAVE A
GENERIC MESSAGE SAYING, “This message is for [R’s name]. This is [your name] from RTI
International and I have some additional information that I wanted to share with you. I will try to
call you again [later today/tomorrow]. DOCUMENT ATTEMPTS TO RECONTACT THE R IN
THE CMS NOTES FOR CASE.
IF THE LIFELINE COUNSELOR DOES NOT PROVIDE INSTRUCTIONS ABOUT WHAT TO
DO IF THE R BECOMES DISTRESSED IN THE FUTURE, INTERJECT AND SAY: This is X,
the interviewer who connected us for this call. If you ever want to call Lifeline again, their
number again is 1-800-273-8255. If you feel that this is an emergency now or later, you should
go to a hospital emergency room right away. If you are not able to get to an emergency room
immediately, you should call 911 for assistance.
H..B. WHEN CALL IS COMPLETED, CALL DR. KARGBLAZEI OR DR. PANZER IF YOU
HAVE QUESTIONS OR WOULD LIKE TO DEBRIEF. FILL OUT ONLINE INCIDENT
REPORT.

CALL B. WHEN CALL IS COMPLETED, CALL DR. PANZER OR DR. BLAZEI IF YOU
WOULD LIKE TO DEBRIEF. FILL OUT ONLINE INCIDENT REPORT.
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Page Break

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Page Break

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

Possible / Yes

STEPS
A. END SCREENING/INTERVIEW AND THEN READ TO R: When you agreed to participate
in this interview, I promised that I would not tell anyone what you have told me unless it was
necessary to protect you or other people. You told me earlier that you are thinking about
harming yourself. I am concerned about your personal safety so I strongly suggest that we
contact the national Lifeline hotlineemergency care services in your area, such as a crisis center
or nearby hospital. I am going to look-up that number. and let them know so they can talk to
you about how you feel. I would like for you to stay Can you remain on the line while I do that?
call Lifeline. Is that all right with you? It may take a few minutes.
B. IF R WILLING: FOLLOW INSTRUCTIONS UNDER SCENARIO 1 ITEMS C-H.
C. IF R UNWILLING TO CONTACT LIFELINE: I am concerned about your personal safety. I
am going to call 911 for you right now. Can you remain on the line while I do that? WHETHER
R REMAINS ON LINE OR NOT, PROCEED TO D.
D. CALL 911, AND READ THIS STATEMENT TO LOCAL 911 DISPATCHERIF YES:
CALL 911 HOTLINE, AND READ THIS STATEMENT TO LOCAL 911 DISPATCHER
IF NO: Okay, if I don’t connect you with the local emergency care provider, then I will need
to call the provider myself to see if they can send someone to you who can provide the care
you need in order to keep you safe. I’ll call you back to let you know what I find out.
B. FIND THE NEAREST EMERGENCY PSYCHIATRIC SERVICES USING THE SAMHSA
WEBSITE (http://mentalhealth.samhsa.gov/databases/). SEARCH FOR INPATIENT MH
TREATMENT USING THE R’S CURRENT ZIP CODE.
C. CALL THEIR LOCAL INPATIENT PSYCHIATRIC CARE FACILITY OR CRISIS CENTER
AND READ THIS STATEMENT: I work for RTI International, a research company in North
Carolina, and we are conducting a research study. During an interview with a respondent, the
respondent told me that (he/she) is thinking about killing or harming (himself/herself). The
respondent was unwilling to contact anyone for help while I was on the phone with (him/her)
but) and I am concerned about (his/her) safety. I can give you additional information about the

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

Possible / Yes

STEPS
if they can send someone who can provide transportation to the nearest hospital. Can you
remain on the line while I do that? WHETHER R REMAINS ON THE LINE OR NOT, OBTAIN
REFERRAL INFORMATION FOR MENTAL HEALTH SERVICES IN THE RESPONDENT’S
AREA FROM THE SAMHSA WEBSITE (http://mentalhealth.samhsa.gov/databases/). CALL
THE LOCAL CRISIS CENTER AND READ THIS STATEMENT: I work for RTI International, a
research company in North Carolina, and we are conducting a research study. During an
interview with a respondent, the respondent told me that (he/she) is thinking about killing or
harming (himself/herself). The respondent was unwilling to contact anyone for help while I was
on the phone with (him/her) but I am concerned about (his/her) safety. I can give you
additional information about the research study, if you would like. I can also provide you with
the respondent’s contact information.
IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use
and Health sponsored by the United States Public Health Service, is designed to test
procedures for use in future NSDUH surveys. Questions ask about various mental health
issues such as depression, anxiety, post traumatic stress disorder, and substance
dependence. Please note that this information was obtained through the respondent’s
participation in a research study. We went through appropriate informed consent
procedures, during which I told the respondent that if (he/she) told me something that
caused me to be concerned about (his/her) well-being, I would report that to someone else
who could help or intervene. Given the context in which the information was obtained,
however, we cannot guarantee that the participant understood the questions nor that
(he/she) provided truthful responses. Do you have any questions about the study?
ANSWER QUESTIONS.
BD. GIVE R FIRST NAME, TELEPHONE NUMBER, AND ADDRESS (IF KNOWN) TO
LOCAL EMERGENCY CARE REPRESENTATIVE. IF THEY ARE UNABLE TO PROVIDE
SERVICES THAT ENSURE THE R’S SAFETY, SEARCH FOR THE R’S LOCAL EMERGENCY
NUMBER USING THE NATIONAL 911 DATABASE. 911 DISPATCHER
E. . IF R ON THE OTHER LINE, CONNECT R TO DISPATCHEREMERGENCY CARE
REPRESENTATIVE OR LOCAL 911 DISPATCHER AND STAY ON THE LINE; IF YOU
HANG-UP, THEIR CONNECTION WILL ALSO END.
IF R NOT ON THE OTHER LINE, END CALL WITH THE EMERGENCY CARE PROVIDER
OR LOCAL 911 DISPATCHER AND ATTEMPT TO CONTACT R AGAIN WITH AN
UPDATE.. IF R REACHED, ATTEMPT TO REMAIN ON LINE UNTIL AUTHORITIES
ARRIVE AT R’s LOCATION.

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Self

Possible / Yes

STEPS
INCIDENT REPORT.

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Page Break

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Other(s)

STEPS
A. COMPLETE SCREENING/INTERVIEW, AND THEN READ TO R: When you agreed to
participate in this interview, I promised that I would not tell anyone what you have told me
unless it was necessary to protect you or other people. You told me earlier that you have
recently had thoughts or wishes about seriously harming someone else. Do you have a doctor,
counselor, or someone you can talk to about how you are feeling now?
IF YES: I strongly suggest that you contact this person immediately so you can talk to him
or her about how you have been feeling, especially about the thoughts you’ve been having
about seriously harming someone else. Would you be willing to do that?
IF YES: Okay. There is also a national Lifeline hotline you can call where
counselors are available to talk at any time of the day or night. Their toll-free
number is 1-800-273-8255. THANK R FOR THEIR PARTICIPATION IN THE
STUDY AND END CALL.
IF NO: I strongly suggest that you contact the national Lifeline hotline at 1-800-273-8255.
Lifeline has counselors available 24-hours a day to talk to you about how you are feeling.
They may also help you locate (additional) mental health services in your area. If you feel
that this is an emergency now or later, you should go to a hospital emergency room right
away. If you are not able to get to an emergency room immediately, you should call 911 for
assistance. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END CALL.
B. CONSULT WITH DR. KARG. IF DIRECTED BY DR. KARG, CALL LIFELINE, AND READ
THIS STATEMENT:
C. CALLAND READ THIS STATEMENT: I work for RTI International, a research company in
North Carolina, and we are conducting a research study. During an interview with a respondent,
the respondent told me that (he/she) is thinking about killing or harming another individual.
Although the respondent denied a specific plan or any intention to harm this other individual, I

IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use
and Health sponsored by the United States Public Health Service, is designed to test
procedures for use in future NSDUH surveys. Questions ask about various mental health
issues such as depression, anxiety, post traumatic stress disorder, and substance
dependence. Please note that this information was obtained through the respondent’s
participation in a research study. We went through appropriate informed consent
procedures, during which I told the respondent that if (he/she) told me something that
caused me to be concerned about (him/her) harming someone else, I would report that to
someone else who could help or intervene. Given the context in which the information was
obtained, however, we cannot guarantee that the participant understood the questions nor
that (he/she) provided truthful responses. Do you have any questions about the study?
ANSWER QUESTIONS.
DC. GIVE R FIRST NAME, TELEPHONE NUMBER, ADDRESS (IF KNOWN) AND
VICTIM’S IDENTIFYING INFORMATION TO THE 911 DISPATCHER END CALL.
DE. B. WHEN CALL IS COMPLETED, CALL DR. KARG PANZER OR DR. BLAZEI TO
DEBRIEF. IF DIRECTED BY ONE OF THEM, FOLLOW SCENARIO 4 FOR POSSIBLE
IMMINENT DANGER TO OTHERS. FILL OUT ONLINE INCIDENT REPORT.
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Page Break

Scenario Number

Individual at Risk of Harm

Imminent Danger?

Other(s)

Possible / Yes

STEPS
A. END SCREENING/INTERVIEW, THANK R FOR THEIR PARTICIPATION IN THE
STUDY AND END CALL.
B. SEARCH FOR THE R’S LOCAL EMERGENCY NUMBER USING THE NATIONAL 911
DATABASE.
C. CALL THEIR LOCAL 911, AND READ THIS STATEMENT: I work for RTI International, a
research company in North Carolina, and we are conducting a research study. During an
interview with a respondent, the respondent told me that (he/she) is thinking about killing or
harming another individual. I am concerned about this individual’s safety. I can give you
additional information about the research study, if you would like. I can also provide you with
the respondent’s contact information.
IF ASKED FOR NSDUH OVERVIEW: This study, part of the National Survey on Drug Use
and Health sponsored by the United States Public Health Service, is designed to test
procedures for use in future NSDUH surveys. Questions ask about various mental health

procedures, during which I told the respondent that if (he/she) told me something that
caused me to be concerned about (him/her) harming someone else, I would report that to
someone else who could help or intervene. Given the context in which the information was
obtained, however, we cannot guarantee that the participant understood the questions nor
that (he/she) provided truthful responses. Do you have any questions about the study?
ANSWER QUESTIONS.
CD. GIVE R FIRST NAME, TELEPHONE NUMBER, ADDRESS (IF KNOWN), AND
VICTIM’S IDENTIFYING INFORMATION TO LOCAL 911 DISPATCHER. END CALL.
DE. WHEN CALL IS COMPLETED, CALL DR. KARG TO DEBRIEF. IF SHE DOES NOT
RETURN CALL WITHIN 15 MINUTES, CALL DR. PANZER OR DR. BLAZEI TO DEBRIEF.
IF NEITHER ONE OF THEM IS AVAILABLE, CONTACT MS. GRANGER OR MR.
CUNNINGHAMCALL MS. GRANGER OR MR. CUNNINGHAMTHE NEXT STAFF ON THE
LIST AND SO ON TO NOTIFY ONE OF THEM ABOUT THE INCIDENT. FILL OUT ONLINE
INCIDENT REPORT.
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Pam Tuck

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Pam Tuck

4/1/2011 9:20:00 AM

Page Break

Scenario Number

Individual at Risk of Harm

Imminent Danger?

No risk of harm; respondent is
agitated or upset

is an emergency now or later, you should go to a hospital emergency room right away or call
911 for assistance. THANK R FOR THEIR PARTICIPATION IN THE STUDY AND END
CALL.
IF R WANTS YOU TO MAKE THE THIRD PARTY CALL FOR THEM, DO SO, THEN STAY
ON THE LINE UNTIL THE R IS DONE TALKING TO LIFELINE.
IF R DOES NOT WANT YOU TO MAKE THE THIRD PARTY CALL, THANK THEM FOR
THEIR PARTICIPATION IN THE STUDY AND END CALL.
BD. WHEN CALL IS COMPLETED, CALL DR. KARGBLAZEI OR DR. PANZER IF YOU
HAVE ANY QUESTIONS OR NEED TO DEBRIEF. FILL OUT ONLINE INCIDENT REPORT.
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snaauw

3/11/2011 1:51:00 PM

File Type	application/pdf
File Title	Microsoft Word - 2011 Production SCID_04-01-11.doc
Author	snaauw
File Modified	2011-06-14
File Created	2011-04-11