PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| Since the last interview, have you had any panic attacks, when suddenly you felt frightened and had physical symptoms like heart palpitations, shortness of breath, chest pains, etc.? Or have you had at least one attack followed by a month of persistent fear of having such an attack or a change in behavior related to the attack? | ad_10 | N | yesno | - | - | PANIC DISORDER WITHOUT AGORAPHOBIA | |
| DIAGNOSTIC CRITERIA FOR PANIC DISORDER WITHOUT AGORAPHOBIA Four or more symptoms in 1A-1M must be checked and the symptom(s) endorsed in 2A-2C must be present for a month or more. | ad_10_desc | N | checkbox | 21, 1, Recurrent, discrete periods of intense fear or discomfort, in which at least four of the following symptoms developed unexpectedly and abruptly and reached a peak within 10 mins | 1, 1A. palpitations, pounding heart, or accelerated heart rate | 2, 1B. sweating | 3, 1C. trembling or shaking | 4, 1D. sensations of shortness of breath or smothering | 5, 1E. feeling of choking | 6, 1F. chest pain or discomfort | 7, 1G. nausea or abdominal distress | 8, 1H. feeling dizzy, unsteady, lightheaded, or faint | 9, 1I. derealization (feeling of unreality) or depersonalization (being detached from oneself) | 10, 1J. fear of losing control or going crazy | 11, 1K. fear of dying | 12, 1L. parasthesias (numbness or tingling sensations) | 13, 1M. chills or hot flushes | 14, 2A. persistent concern about having additional attacks | 15, 2B. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy") | 16, 2C. a significant change in behavior related to the attacks | 17, 3. Both (1) and (2) | 18, 4. Absence of Agoraphobia | 19, 5. The Panic Attacks are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or general medical condition (e.g. hyperthyroidism). | 20, 6. 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 (e.g., on exposure to specific phobic situations); Obsessive Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination); Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor); or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives). | - | ||
| Since the last interview, have there been any situations or places that you have avoided because you were afraid you might have a panic attack or panic like symptoms? What about any situations or places that you have endured with marked distress or anxiety | ad_10a | N | yesno | - | - | PANIC DISORDER WITH AGORAPHOBIA | |
| DIAGNOSTIC CRITERIA FOR PANIC DISORDER WITH AGORAPHOBIA Note: 2A-2C must last a month or more | ad_10a_desc | N | checkbox | 1, 1. recurrent and unexpected panic attacks | 2, 2A. persistent concern about having additional attacks | 3, 2B. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy") | 4, 2C. a significant change in behavior related to the attacks | 5, A. Both (1) and (2) | 6, B.1. Presence of Agoraphobia - Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help might 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 | 7, B.2. Presence of Agoraphobia - The 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 | 8, B.3. The anxiety or phobic avoidance is not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations); Specific Phobia (e.g., on exposure to specific phobic situations); Obsessive Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination); Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor); or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives). | 9, C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or general medical condition (e.g. hyperthyroidism). | 10, 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 (e.g., on exposure to specific phobic situations); Obsessive Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination); Posttraumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor); or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives). | - | ||
| Since the last interview, have there been times when you were afraid of going out of the house alone, being in crowds, standing in a line, or travelling on buses or trains? | ad_11 | N | yesno | - | - | DIAGNOSTIC CRITERIA FOR AGORAPHOBIC WITHOUT HISTORY OF PANIC DISORDER | |
| DIAGNOSTIC CRITERIA FOR AGORAPHOBIA WITHOUT HISTORY OF PANIC DISORDER | ad_11_desc | N | checkbox | 1, Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or which help might 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, in car | 2, The 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 | 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); Obsessive Compulsive Disorder (e.g., avoidance of dirt in someone with an obsession with 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) | 4, B. Criteria have never been met for Panic Disorder | 5, C. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse. a medication) or a general medical condition. | 6, 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. | - | ||
| Since the last interview, has there been anything that you have been afraid of like flying, heights, closed places, or certain kind of animals or insects? Have you avoided such objects or situations or have you experienced anxiety when exposed to such objects or situations? | ad_12 | N | yesno | - | - | SPECIFIC PHOBIA | |
| DIAGNOSTIC CRITERIA FOR SPECIFIC PHOBIA | ad_12_desc | N | checkbox | 1, Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood) | 2, Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack | 3, The person recognizes that the fear is excessive or unreasonable | 4, The phobic situation(s) is avoided or else endured with intense anxiety and distress | 5, The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with the person's normal routine, occupational (or academic) functioning, or social activities or relationships, or there is a marked distress about having the phobia | 6, In individuals under 18 years of age, the duration is at least 6 months | 7, The anxiety, Panic Attacks, or phobic avoidance associated with he specific object or situation are not better accounted for by another mental disorder, such as Obsessive Compulsive 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. | - | ||
| Since the last interview, have there been any social situations that you have avoided or endured with marked distress? Have you been afraid or felt uncomfortable doing things in front of other people, like speaking, eating, writing? | ad_13 | N | yesno | - | - | SOCIAL PHOBIA | |
| DIAGNOSTIC CRITERIA FOR SOCIAL PHOBIA | ad_13_desc | N | checkbox | 1, A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible 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 | 2, Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack | 3, The person recognizes that this fear is excessive or unreasonable | 4, The feared social or performance situations are avoided or else endured with intense anxiety or distressed | 5, The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia. | 6, In individuals under age 18 years, the duration is at least six months | 7, The fear or avoidance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or general medical conditions and is not better accounted for by another mental disorder (e.g., Panic Disorder With or Without Agoraphobic, Separation Anxiety Disorder, Body Dysmorphic Disorder, a Pervasive Developmental Disorder, or Schizoid Personality Disorder). | 8, If a general medical condition or another mental disorder is present, the fear in criterion A is unrelated to it, e.g., the fear is not of stuttering, trembling in Parkinson's disease or exhibiting abnormal eating behavior in Anorexia Nervosa or Bulimia Nervosa. | - | ||
| Since the last interview, have you been particularly anxious about things like work/school/children etc.? Do you find it difficult to control your worries? Do you have any physical symptoms when you are anxious or worried? | ad_14 | N | yesno | - | - | GENERALIZED ANXIETY DISORDERS/FEATURES | |
| DIAGNOSTIC CRITERIA FOR GENERALIZED ANXIETY DISORDER Note: 3 or more of the 6 associated physical symptoms are required for diagnosis (only 1 symptom needed in children). | ad_14_desc | N | checkbox | 1, 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) | 2, The person finds it difficult to control the worry | 3, Anxiety and worry associated with - restlessness or feeling keyed up or on edge | 4, Anxiety and worry associated with - being easily fatigued | 5, Anxiety and worry associated with - difficulty concentrating or mind going blank | 6, Anxiety and worry associated with - irritability | 7, Anxiety and worry associated with - muscle tension | 8, Anxiety and worry associated with - sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) | 9, The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a panic attack (as in Panic Disorder), being embarrassed in pubic (as in Social Phobia), being contaminated (as in Obsessive Compulsive Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatoform Disorder) or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder) | 10, The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning | 11, The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during Mood Disorder, a Psychotic Disorder, or a Pervasive Development Disorder. | - | ||
| Since the last interview, have you been bothered by any thoughts that don't make sense to you and that keep coming back to you even when you have tried to put them out of your mind? What about anything that you had to do over and over again and you could not resist doing, like washing your hands again and again, or checking something several times to make sure you did it right? | ad_15 | N | yesno | - | - | OBSESSIVE COMPULSIVE DISORDER | |
| DIAGNOSTIC CRITERIA FOR OBSESSIVE COMPULSIVE DISORDER | ad_15_desc | N | checkbox | 1, Obsession - 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 | 2, Obsession - the thoughts, impulses, or images are simply excessive worries about real-life problems | 3, Obsession - the person attempts to ignore or suppress such thoughts, impulses or images, or to neutralize them with some other thought or action | 4, Obsession - the person recognizes that the obsessional thoughts, impulses, or images are the product of his or her own mind (not imposed from without as in thought insertion) | 5, Compulsion - repetitive behaviors (e.g., hand washing, 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 | 6, Compulsion - 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 | 7, At some point during the course of the disorder, the person has recognized that the obsession or compulsion are excessive or unreasonable | 8, The obsessions or compulsions cause marked distress, are time-consuming (take more than one hour a day), or significantly interfere with the person's normal routine, occupational (or academic) functioning, or usual social activities or relationships | 9, If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of Eating Disorder, hair pulling in the presence of Trichotillomania; concern about appearance in the presence of Body Dismorphic Disorder; preoccupation of drugs in the presence of Substance Use Disorder, preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder) | 10, The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. | - | ||
| Since the last interview, has anything happened to you that would be extremely stressful or disturbing for anyone? By that I mean things like a major earthquake, flood, very serious accident or fire, physical assault or rape, seeing other people killed or dead, being in a war or combat, or any other type of disaster? | ad_ptsd_1 | N | yesno | - | - | PTSD | |
| DIAGNOSTIC CRITERIA FOR POST TRAUMATIC STRESS DISORDER Note: For diagnosis, the individual must have 1(or more) of the B symptoms; 3 (or more) of the C symptoms and 2(or more) of the D symptoms. | ad_ptsd_2 | N | checkbox | 1, A.(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 or self or others. | 2, A.(2) The person's response involved intense fear, helplessness or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior. | 3, B.(1) Recurrent and intrusive distressing recollections of the event, including images thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. | 4, B.(2) Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content | 5, B.(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). Note: In young children, trauma-specific reenactment may occur | 6, B.(4) Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event | 7, B.(5) Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event | 8, C.(1) Efforts to avoid thoughts, feelings, or conversations associated with the trauma | 9, C.(2) Efforts to avoid activities, places, or people that arouse recollections of the trauma | 10, C.(3) Inability to recall an important aspect of the trauma | 11, C.(4) Markedly diminished interest or participation in significant activities | 12, C.(5) Feeling of detachment or estrangement from others | 13, C.(6) Restricted range of affect (e.g., unable to have loving feelings) | 14, C.(7) Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) | 15, D.(1) Difficulty falling or staying asleep | 16, D.(2) Irritability or outbursts of anger | 17, D.(3) Difficulty concentrating | 18, D.(4) Hypervigilance | 19, D.(5) Exaggerated startle response | 20, E. Duration of the disturbance (symptoms in criteria B, C, and D) is more than one month. | 21, The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. | - | ||
| Anxiety disorder not otherwise specified | ad_17 | N | yesno | - | - | ||
| DIAGNOSTIC CRITERIA FOR ANXIETY DISORDER NOT OTHERWISE SPECIFIED This category includes disorders with prominent anxiety or phobic avoidance that do not meet criteria for any specific Anxiety and Depressed Mood | ad_17_desc | Y | notes | - | - |