Structured Clinical Interview for DSM-IV Axis I Disorders

1 Structured Clinical Interview for DSM-IV Axis I DisordersPatient Edition (February 1996 FINAL)SCID-I/P (Version )OverviewINTERVIEW INFORMATIONS tatus:O In progressO CompletedO Consensus reviewedType:O ComputerO PaperSubject ID:Subject Initials:Rater:Site:Date of Interview :Sources of information(check all that apply):O SubjectO FamilyO Health professional/chart/referral noteRelationship to Proband:Edited and checked by:Date:Recruitment Source:DEMOGRAPHIC DATAI'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. Do you haveany questions before we begin?InformationGender:Date of Birth:Age:What do you consider to be your ethnic origin?Marital StatusWhat is your current marital status?

2 Dates of MarriageStart DateEnd DateCommentsChildrenDo you have any children? O YesO NoChildrenGenderAge CommentsLiving SituationWith whom do you live?ReligionWhat was your childhood religious affiliation, if any?What is your current religion, if any?FAMILY HISTORYWere you adopted?O YesO NoMotherLiving:O YesO NoBrief Description (age, current location and living situation, general disposition, etc):Occupation:Highest Level of Education:Religion:# of Siblings:FatherLiving:O YesO NoBrief Description (age, current location and living situation, general disposition, etc):Occupation:Highest Level of Education:Religion:# of Siblings:Do you have any siblings?O YesO No(If yes, note genders and ages. Also indicate half of step siblings.)

3 Are you close to any of your siblings?What was it like growing up in your family?(Briefly describe home environment and relationships, including any trauma or abuse.)Family History FormInterviewer: "Tell me about your biological parents, children, siblings and grandparents." Ask if they have had any problems with their moodor anxiety or problems with drugs or alcohol. If adopted, ask about biological family; if not known, indicate "Adoptive Family" and answeraccordingly. If deceased, note both date of death and "+" symbol in current age (list)PsychiatricTreatmentCommentsDEVELO PMENTAL HISTORYW here were you born and raised?(Significant moves, health, school, friends, activities, etc.)EDUCATIONHow far did you get in school?

4 EVER FAILED TO COMPLETE A PROGRAM IN WHICH S/HE WAS ENROLLED: Why didn't you finish?MILITARY HISTORYM ilitary Service:O YesO NoBranch:End of Service:Start of Service:Theater:Veteran:O YesO NoCombat:O YesO NoType of Discharge:Rank at Discharge:MOS:Service ConnectedDisabilityO YesO NoPercentReasonWORK HISTORYAre you working now? What is your job? How long have youbeen there?[IF LESS THAN 6 MONTHS: Why did you leave your last job?]Have you always done this kind of work? [IF NOT: What kind of work have you done?] What is the highest level job you have ever held?[Chronology of work history: (include longest job held and longest time unemployed)] How are you supporting yourself now? (If disability,list type, date and reason.)

5 Has there ever been a period of time when you were unable to work or go to school? (When? Why was that?)OVERVIEW OF PRESENT ILLNESSHave you been in any kind of treatment in the past month?[IF CURRENTLY IN TREATMENT:Date of admission to inpatient or outpatient facility.]CHIEF COMPLAINT(Description of presenting problem): [RECORD DIRECT QUOTE]What led to your coming here? What is the major problem you have been having?HISTORY OF PRESENT ILLNESSDo you currently have any psychiatric symptoms or emotionalproblems?O YesO NoIF YES: When did your current symptoms begin? When were you last feeling your normal self? Is this something new or a return ofsomething you have had before? What was going on in your life when this began?

6 (Environmental context for precipitants of presentillness or exacerbation) Did anything happen or change? Since this began, when have you felt the worst? (IF MORE THAN A YEARAGO: In the last year, when have you felt the worst?)Have you had any other problems in the last month? What has your mood been like? How have you been spending your free time? Whodo you spend time with?How much have you been drinking (alcohol) (in the past month)? Have you been taking any drugs (in the past month)? (What aboutmarijuana, cocaine, other street drugs?)PAST PSYCHIATRIC HISTORYWhen in your life did you first experience your symptoms? When was the first time you saw someone for emotional or psychiatricproblems? (What was that for?)

7 What treatment(s) did you receive? What medications?) Were there other times when you hadcounseling or treatment of any kind? (What type? When?)Age of first treatment for DepressionAge of first treatment for ManiaAge of first treatment for HypomaniaAge of first treatment for Mixed StateAge of first treatment for Psychosis/SZHOSPITALIZATIONS:Have you ever been a patient in a psychiatric hospital?O YesO No(IF YES: When? Where? Why?)Number of previous hospitalizations for Depression(Do not include transfers)Number of previous hospitalizations for ManiaNumber of previous hospitalizations for Mixed StateNumber of previous hospitalizations for Non-moodEstimated lifetime total time of psychiatric hospitalization inweeks:SUBSTANCE/ALCOHOL TREATMENT:Have you ever had treatment for drugs or alcohol?

8 O YesO NoTreatment Information:ATTENTION DEFICIT-HYPERACTIVITY DISORDER:Have you ever been diagnosed with AttentionDeficit-Hyperactivity Disorder?O YesO No(Include symptoms, presentation, age at diagnosis, age of first symptoms and treatment)Medication Assessment FormCategory:Class:Drug Name:Start Date:End Date:O UnknownMultiple Trials:Duration Used:Reason Stopped:Response Type:Treatment Induced:Comments[Record side effect information whenever possible.]MEDICAL HISTORYHave you had any medical problems now or in the past? (What were they? How were they treated?) Were you ever in the hospital fortreatment of a medical problem? (What was that for?) Have you ever had any surgeries (including outpatient)? (When?)

9 What were theyfor?)O YesO NoALLERGIES:Do you have any allergies? To Medications? Other?O YesO NoGENETIC Disorders :Do you have any other genetic Disorders ? (What and when diagnosed?) Do you know of any genetic Disorders that run in your family?(What? Who?)O YesO NoTHYROID DISORDER:Have you ever been treated for a thyroid disorder? (Include diagnosis, age of diagnosis, and treatment) Was this only while on Lithium?O YesO NoHEAD INJURY:Have you ever had a head injury? (Did you lose consciousness? How long? How many times have you lost consciousness due to a headinjury?)O YesO NoFEMALES ONLY:Have you gone through menopause? (Have you ever had any serious emotional problems associated with menopause?

10 O YesO NoOTHER CURRENT PROBLEMSMOST LIKELY CURRENT DIAGNOSISDIAGNOSES THAT NEED TO BE RULED OUTGLOBAL ASSESSMENT OF FUNCTIONINGC urrent GAFDSM-IV Axis V: Global Assessment of Functioning ScaleConsider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not includeimpairment in functioning due to physical (or environmental) limitations. Indicate appropriate code for the LOWEST level of functioningduring the week of POOREST functioning. (Use intermediate level when appropriate, , 45, 58, 72.)10091 Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because ofhis or her many positive qualities.