CASH Instrument

COMPREHENSIVE ASSESSMENT OF
SYMPTOMS AND HISTORY

(CASH)
by
Nancy C. Andreasen, M.D., Ph.D.
Address correspondence and requests to use the CASH
to the MH-CRC Administrator
Department of Psychiatry
Mental Health Clinical Research Center
University of Iowa Hospitals & Clinics
200 Hawkins Drive, 2911 JPP
Iowa City, Iowa 52242-1057
This interview was developed by the group working on research on schizophrenia and affective illness at the
University of Iowa College of Medicine, especially within the Mental Health Clinical Research Center (MH-
CRC). Major contributors include Michael Flaum, M.D., William Hubbard, Carol McNamara, Jane Meller,
Nancy Olson, Jane Therme, Linda Tookey, Gary Tyrrell, and Steven Ziebell.
Copyright 1987
(SAS Variable Name edition: 2000)
INTRODUCTION
The CASH is designed as a structured interview and recording instrument for documenting the signs,
symptoms, and history of subjects evaluated in research studies of the major psychoses and
affective disorders. Its major emphasis is to provide broad descriptive coverage in order to permit
investigators to make diagnoses using a variety of criteria (e.g., RDC, DSM III, DSM III-R) and also to
examine biological, social, or cognitive psychological correlates in relation to phenomenology rather
than just diagnosis alone. This later aspect is especially important because of the flux in diagnostic
systems and because of the well recognized arbitrariness of most diagnostic systems. We hope that
this interview will eventually facilitate the development of better nosologies based on pathophysiology
and etiology.
It is assumed that this instrument will be used subsequent to adequate screening. At the time the
interviewer begins his or her evaluation, he/she should be reasonably certain that the patient has
some type of relevant illness. The major emphasis then involves describing the current symptoms,
history, and course of the illness in considerable detail, as well as documenting other data of interest
in research on major psychoses and affective disorders, such as handedness and tests of the
sensorium.
The interview is divided into three main sections: Present State (which includes sociodemographic
data), Past History, and Lifetime History. This order was selected to give the interview a natural flow.
Sociodemographic data can be used in order to establish rapport with the patient. The remainder of
the present section permits the interviewer to discuss the present illness. The past section attempts
to recover as much information as possible concerning previous episodes of illness, and the lifetime
section allows for recording lifetime information about the patient. While outside information may
(and often should) be used when patients are difficult to interview, it may be mandatory in some
cases to obtain past records to adequately collect detailed information concerning past history.
All judgments should be recorded within the booklet. If the subject is too disturbed to be interviewed
initially, notations and/or ratings should be made for relevant items (such as derailment) and the
interview should be resumed as soon as possible.
The CASH is designed for use by individuals with experience and training in dealing with psychiatric
patients. In addition to physicians, these might include nurses, psychologists, or social workers.
More important than level of academic degree may be level of experience in dealing with patients
who are seriously ill. Prior to using it, interviewers will need practice and training. Training manuals
and tapes are available on request. Good reliability for most items has been established.
The CASH is one component of a modular assessment battery. Other components include The
Scales for the Assessment of Negative and Positive Symptoms (SANS and SAPS), and a Mania
Rating Scale, which can be used for weekly assessments in order to record change in
psychopathology over time. Related instruments are also available for extensive longitudinal follow-
up studies, including the PSYCH, the PSYCH-UP, and the CASH-UP. Requests for information
about any of these instruments should be addressed to MH-CRC Administrator.
10/24/2000 Biostatistical Core Unit

Table of Contents
3
Part One
PRESENT STATE Page
Sociodemographic Data 9
Evaluation of Current Condition 15
Psychotic Syndrome 16
Delusions 16
Hallucinations 26
Bizarre Behavior 32
Positive Formal Thought Disorder 34
Catatonic Motor Behavior 39
Alogia 41
Affective Flattening or Blunting 44
Inappropriate Affect 47
Avolition-Apathy 47
Anhedonia-Asociality 49
Attention 52
Duration of Psychotic Syndrome 53
Role of Precipitants 53
Role of "Organic" Factors 54
Current Symptom Factors 54
Manic Syndrome 55
Symptoms 56
Number of Symptoms 59
Duration of Manic Behavior 59
Major Depressive Syndrome 61
Symptoms 62
Number of Symptoms 66
Duration of Depressive Syndrome 68
Treatment 70
Cognitive Assessment 72
Handedness and Laterality Data 72
Modified Mini-Mental Status Examination 74
Global Assessment Scale 76
Diagnoses for Current Episode 78
4
Table of Contents
Part Two
PAST HISTORY Page

History of Onset and Hospitalization 80
Past Symptoms of Psychosis 82
Delusions 83
Hallucinations 87
Bizarre Behavior 91
Positive Formal Thought Disorder 93
Catatonic Motor Behavior 94
Alogia 95
Affective Flattening or Blunting 96
Inappropriate Affect 96
Avolition-Apathy 97
Anhedonia-Asociality 98
Attention 99
Characterization of Course 100

Pattern of Symptoms 100
Pattern of Severity 101
Past Symptoms of Affective Disorder 101
Manic Syndrome 102
Episodes of Major Depressive Disorder 106
Suicidal Behavior 112
5
Table of Contents
Part Three
LIFETIME HISTORY Page

History of Somatic Therapy 113
Alcoholism 117
Drug Use, Abuse, and Dependence 123
Barbiturates or Other Hypnotics 124
Opioids 125
Cocaine 127
Amphetamines and Other Sympathomimetics 129
Phencyclydine and Other Arylcyclohexylamines 131
Hallucinogens 132
Marijuana 133
Modified Premorbid Adjustment Scale 135
Premorbid or Intermorbid Personality 137
Schizotypal Personality Characteristics 137
Other Prodromal Features 143
Affective Personality Syndrome 144
Hypomanic Symptoms 145
Dysthymic Symptoms 147
Predominant Personality Pattern 148
Functioning During Past Five Years 149
Global Assessment Scale 152
Diagnoses for Lifetime 154
6
CASH
Batch Number $BATCHNUM INITIALS INITIALS
Document Number $DOCNUM ID __ __ __ __ __ __ __ __ ID
Entry1 ENT1 Entry2 ENT2
Form/Version CASH/02.1 FOLLOW-UP PERIOD (# months) __ __ __ FUPER

$FRM/VER (Intake=000.)
TYPE: Proband 1 TYPE
Informant 2
Consensus 3
Blind 4
Other 5
Consensus II 6
ASSESSMENT: 1st time studied 1 ASS

2nd time studied 2
RELIABILITY MEASUREMENT#: Original 1 REL

Second 2
Third 3
Fourth 4
FAMILY STUDY No 0 CA1

Skip to Date (29-34)
Yes 1
TYPE: Index 1 CA2

Relative 2
FAMILY NUMBER __ __ __ CA3
DATE __ __ /__ __ /__ __ DATE
RATERS (1) ___ ___ (2) __ __ RATER

RATER2
STATUS: Normal Control 0 CA6
Neuroleptic Naive 1
Non-Naive 2
Almost Neuroleptic Naive 3
Totally Psychoactive Drug Naive 4
MEDICATION AT TIME OF INTERVIEW: No Medication 0 CA7

Medication 1
7
RELATIONSHIP OF INFORMANT Proband Interview 0 Female Child 5 CA8
TO PROBAND: Mother 1 Male Child 6
Father 2 Spouse/Mate 7
Female Sibling 3 Friend 8
Male Sibling 4 Other_________ 9
BIRTH DATE __ __ /__ __ /__ __ CA9
AGE __ __ CA10
SEX: Male 1 CA11

Female 2
HEIGHT(cm.) __ __ __ CA12
WEIGHT(kg.) __ __ __ CA13
PSYCHIATRIC TREATMENT STATUS: CA14
Inpatient 1
Outpatient 2
Other patient (e.g., care facility) 3
Nonpatient 4
Outpatient and Day Treatment 5
ADMISSION DATE __ __ /__ __ /__ __ CA15
DISCHARGE DATE __ __ /__ __ /__ __ CA16
ENTRY INTO STUDY DATE __ __ /__ __ /__ __ CA17
SOURCES OF INFORMATION: No Yes

Interview with subject 0 1 CA18
Ward staff 0 1 CA19
Hospital records 0 1 CA20
Interview with relatives/friends 0 1 CA21
Other (patient writings and art work) 0 1 CA22
Records from other institutions 0 1 CA23
8
PRESENT STATE
SOCIODEMOGRAPHIC DATA
Social Background
First, I'd like to get a little background information from you.
Marital Status
Are you married now? Never Married 1 CA24
(Have you ever been married?) Married/common law 2
(How many times have you been married?) Separated 3
Divorced and not remarried 4
Divorced and remarried 5
Divorced two or more times and

not currently married 6
Divorced two or more times and

now married 7
Widowed 8
Current Occupational Status

Have you been working or going to school during No 0 CA25
the past month?
Yes 1
Skip to Current Occupation
Is the subject unemployed because of retirement? No 0 CA26
Yes 1
Skip to Previous Occupation
Code length of unemployment in months. Use last ___ ___ ___ CA27
job of at least two months duration or last period in
school as anchor point. Do not code
unemployment time for students during scheduled
vacations or voluntary homemakers. If subject has
never been employed, use age 18 as an anchor
point.
How long have you been unemployed?
9
Previous Occupation
If unemployed, rate previous occupation. Have you High executive, major professional 1 CA28
ever had a job?
Administrative personnel, minor
(What was your most recent job?) professional, owner small business 2
(How long did you do that?) Clerical, sales, technician, farmer 3
(Have you had any other jobs?) Skilled manual employee 4
Unskilled employee 5
Student 6
Homemaker 7
Unemployed 9
Current Occupation
(What kind of work have you been doing?) High executive, major professional 1 CA29
(Have you been a student during the past month?) Administrative personnel, minor
professional, owner small business 2
(Do you consider yourself a homemaker?)
Clerical, sales, technician, farmer 3
Skilled manual employee 4
Student 6
Homemaker 7
Retired 8
Unemployed 9
10
Occupation of Parents
Rate highest level sustained for one High executive, major professional 1 CA30
year. If mother was primary source of
support, use mother's occupation. Administrative personnel, minor
professional, owner small business 2
What did your father do for a living?
Clerical, sales, technician, farmer 3
Did your mother work?
Skilled manual employee 4
(What did she do?)
Student 6
Homemaker 7
Unknown 8
Unemployed 9
Educational Achievement of Parents

Number of years. (Do not count kindergarten.) Father ___ ___ CA31
Enter 99 for unknown
Mother ___ ___ CA32
How far did your parents go in school?
Social Class of Parents

Summarize social class using the standard Families of wealth, education, top-
Hollingshead-Redich scale, which is based on rank social prestige 1 CA33
occupation and educational level of both parents.
This will be a "global" or "gestalt" rating which Families in which the adults hold
should reflect the highest level sustained for a college or advanced degrees; in
substantial period of time. If unusual professional or high-rank managerial
circumstances have occurred, note these (e.g., positions 2
father was a CEO of a large company for a number
of years, but became unemployed after age 50 Small businessmen, white-collar and
because of a severe depression). This example skilled workers; high school graduates 3
would be coded as a "1," but with some ambiguity
and imprecision. Semi-skilled workers, laborers;
education below secondary level 4
Unskilled and semi-skilled workers;

elementary education 5
Unknown 9
Educational Achievement of Subject

Number of years. (Do not count kindergarten.) ___ ___ CA34
(How far did you go in school?)
11
Educational Performance
Use typical level of performance in high school. Earned superior grades, mostly A's 1 CA35
Were you interested in school? Earned good grades, mostly B's 2
What kind of grades did you get? Earned average grades, mostly C's 3
Earned poor grades, mostly D's 4
Earned primarily failing grades 5
Unknown 9
Educational Problems
Were you ever held back for a year or more in Never held back or in special
school or placed in a special education program? education 1 CA36
Held back one year, no special

education 2
Required special education but

progressed at a rate of one grade
per year 3
Held back two or more years 4
Was not able to complete school

because of learning disabilities 5
Unknown 9
Social Class of Subject
(As in the case of "Social Class of Parents," this is Situation of wealth, education, top-
a difficult rating since it combines education and rank social prestige 1 CA37
employment, which may be at disparate levels in
some subjects. In general, code highest level College or advanced degree;
characteristic of the past 5 years; e.g., a 40-year- professional or high-rank managerial
old subject with a Ph.D. who has never been position 2
employed and lives on disability would be coded as
a "5" in spite of his educational level.) Small businessman, white-collar and
skilled worker; high school graduate 3
Semi-skilled worker, laborer;

education below secondary level 4
Unskilled and semi-skilled worker;

elementary education 5
Unknown 9
Living Circumstances
Ascertain with whom the subject has lived, for the No 0 CA38
greatest amount of time for the past year.
Yes 1
Have you been living alone? Skip to Type of Dwelling
Has this been the case for most of the time?
12
If Subject Lives with Someone
Ask (a) through (g) and code each appropriately.
Who lives with you?
Is there someone else in the household?
(a) Parents? No 0 CA39

Yes, both parents 1
Yes, mother only 2
Yes, father only 3
(b) Mate? No 0 CA40

Yes, mate legally married/common law 1
Yes, living together, heterosexual 2
Yes, living together, homosexual 3
(c) Children? Younger than six years Number ___ ___ CA41
Six to twelve years Number ___ ___ CA42
Include all children, whether they be biological, Thirteen to eighteen Number ___ ___ CA43
adopted, step, etc. Code the appropriate number Older than eighteen Number ___ ___ CA44
under each category.
(d) Brothers and/or sisters Number ___ ___ CA45
(e) Other relatives Number ___ ___ CA46
(f) Friends or some other group-living Number ___ ___ CA47

arrangement
Number ___ ___ CA48
(g) Halfway house or group home
(Enter 99 for institutionalized subjects.)
13
Type of Dwelling
Ascertain the type of dwelling in which the House/townhouse/mobile home – no persons reside
subject has lived for the greatest amount above or below; includes duplex; private entrance; own
of time for the past year. bath and kitchen; privately owned; no matter how small 1 CA49
Do you live in a house, apartment, Apartment/condominium - must include own bath

dormitory, halfway house, etc.? & kitchen; share hallways or entrance 2
Have you lived there for most of the past Rooming house - share bath and kitchen;
year? without formal supervision 3
Halfway house - run by social agency with

formal supervision 4
Dormitory - building providing sleeping provisions 5
Transient - lodger/boarder/frequent traveler

who remains for a short time in any given residence 6
Institutionalized 7
Other (Specify) 8
Unknown 9
Financial Responsibility for the Dwelling

Ascertain who assumes the major Self or mate 1 CA50
financial responsibility for the dwelling. In
any kind of shared or group living Parents or parents-in-law 2
situation, if the respondent assumes the
responsibility for his share of the cost, Other relatives 3
code the item as "1."
Other structured--i.e., social agency, military housing4
Who pays the rent or makes the
payments for your (dwelling)? Other unstructured--i.e., friend, transients 5
(Who assumes the major financial Other (Specify) 6

responsibility?)
Unknown 9
Source of Income/Resources
(If income derives from several Employment/Retirement Funds 1 CA51
sources, code the one that provides the
majority of the income.) Parents 2
Social Security Disability Insurance 3
Aid to Dependent Children 4
Other social agency 5
Employment and other support 6
Other (Specify) 7
Unknown 9
14
Is Evaluation of Current Condition section applicable for research project? No 0 CA52
Skip to Past History Section
Yes 1
EVALUATION OF CURRENT CONDITION

Determining the "time set" for evaluation of current condition is a crucial part of evaluating psychopathological status.
Several different approaches are possible and an excellent rationale can be developed for each.
This instrument was developed with the expectation that, in general, investigators will want to use a time set covering the
past month for the section describing current psychopathology. Some of the measures, such as avolition and anhedonia,
may describe relatively stable and enduring states that may not change much over time. Nevertheless, an attempt was
made to define even these measures so that they could be used to describe the past month, in order that the instrument
could be applicable to treatment and outcome studies, and could be used as a measure of change in clinical status. An
attempt was also made to define the items so that they would be applicable to both inpatients and outpatients.
In cases where the current episode (affective and/or psychotic) is longer than six months in duration, use the Current
Condition Section to rate each sign and symptom at its worst during the past month. Rate signs and symptoms present
prior to the past month in the Past History Section. In cases where the current episode is less than six months in duration
and has an identifiable onset, use the Current Condition Section to rate all signs and symptoms at their worst during the
entire episode. If the current episode is the first episode (overall) of illness and is less than six months in duration, the
Past History Section need not be completed.
The current section of the interview falls into five natural parts. The first section covers symptoms and signs such as
delusions, hallucinations, or bizarre behavior. Often, these symptoms are also conceived of as positive symptoms of
psychosis. They are usually elicited by direct interview with the subject, although additional information may be gained
through interviewing a significant other or through observation by the investigator or nurses.
The second main section consists primarily of observational items, including disorders of affect, language and
communication, and volition. Information for these items will be gained through a mixture of direct observation and direct
questioning. In addition, the interviewer may need to draw on other sources of information, such as reports from the
subject's family or from nurses. With the exception of positive formal thought disorder, most symptoms in this section are
considered to be "negative symptoms." The third section covers manic symptoms and the fourth depressive symptoms. A
fifth section evaluates cognitive function and laterality.
In addition to individual ratings for specific signs and symptoms, the evaluation also includes a global rating for the overall
severity of the sign or symptom complex; e.g., global rating of severity of hallucinations, global rating of alogia, etc. This
should be a true global rating based on both the nature and the severity of the various components. In some cases, a
single component that is present to a severe degree may lead to a very high global rating, even if the other components
are not particularly severe. For example, a subject who has only auditory hallucinations of a single voice making critical
comments to him, but hears this voice once or twice every day, would be considered to have severe hallucinations, even
though he has not had other forms of hallucinations or has not had multiple Schneiderian hallucinations.
When beginning this portion of the interview the interviewer should start with relatively open-ended questions. Try to get
the subject to spend about five to ten minutes talking about why he came to the hospital or clinic before focusing on
specific symptoms.
Can you tell me a little bit about why you are here in the hospital or clinic?
What was happening that led to your coming to the hospital or clinic?
(Why did you come here for help?) (How long have those things been happening?)
15
This initial discussion should provide an overview of the nature of the current symptomatology. In particular, the
interviewer should ascertain whether the predominant syndrome is primarily psychotic (schizophrenia and related
disorders, with symptoms of delusions, hallucinations, etc.), primarily manic, or primarily depressive. When this is
determined, the interviewer should go to that section first, later returning to the sections covering the other two syndromes
and asking the relevant questions therein. After the syndromal material is reviewed, the final sections dealing with
treatment, cognitive assessment, etc., are to be completed.
Types of presenting complaints:
Predominantly Psychotic Go first to Page 16 Psychotic Syndrome

Predominantly Manic Go first to Page 55 Manic Syndrome
Predominantly Depressive Go first to Page 61 Depressive Syndrome
PSYCHOTIC SYNDROME
Delusions
Delusions represent an abnormality in content of thought. They are false beliefs that cannot be explained on the basis of
the subject's cultural background. Although delusions are sometimes defined as "fixed false beliefs," in their mildest form
delusions may persist only for weeks to months, and the subject may question his beliefs or doubt them. The subject's
behavior may or may not be influenced by his delusions. The rating of severity of individual delusions and of the global
severity of delusional thinking should take into account their persistence, their complexity, the extent to which the subject
acts on them, the extent to which the subject doubts them, and the extent to which the beliefs deviate from the ones that
normal people might have. For each positive rating, specific examples should be noted in the margin.
Persecutory Delusions
People suffering from persecutory delusions None 0 CA53
believe that they are being conspired against or
persecuted in some way. Common manifestations Questionable 1
include the belief that one is being followed, that
one's mail is being opened, that one's room or Mild: Delusion clearly present, but
office is bugged, that the telephone is tapped, or the subject may question it
that police, government officials, neighbors, or occasionally 2
fellow workers are harassing the subject.
Persecutory delusions are sometimes relatively Moderate: Delusion that is firmly
isolated or fragmented, but sometimes the subject held 3
has a complex system of delusions involving both a
wide range of forms of persecution and a belief that Marked: Firmly held delusion that
there is a well-designed conspiracy behind them: the subject acts on 4
for example, that his house is bugged and that he
is being followed because the government wrongly Severe: Complex, well-formed
considers him a secret agent of a foreign delusion that the subject acts on and
government; this delusion may be so complex that that preoccupies him a great deal of
it explains almost everything that happens to him. the time 5
The ratings of severity should be based on duration
and complexity of the delusion.
Have you had trouble getting along with people?
Have you felt that people are against you?
Has anyone been trying to harm you in any way?
(Do you think people have been plotting against

you?)
16
Delusions of Jealousy
The subject believes that his mate is having an None 0 CA54
affair with someone. Miscellaneous bits of
information are construed as "evidence." The Questionable 1
person usually goes to great effort to prove the
existence of the affair, searching for hair in the Mild: Delusion clearly present, but the
bedclothes, the odor of shaving lotion or smoke on subject may question it occasionally 2
clothing, or receipts or checks indicating a gift has
been bought for the lover. Elaborate plans are Moderate: Delusion that is firmly held 3
often made in order to trap the two together.
Marked: Firmly held delusion that the
Have you worried that your (husband, wife, subject acts on 4
boyfriend, girlfriend) might be unfaithful to you?
Severe: Complex, well-formed
(What evidence do you have?) delusion that the subject acts on and
that preoccupies him a great deal of
the time 5
Delusions of Sin or Guilt

The subject believes that he has committed some None 0 CA55
terrible sin or done something unforgivable.
Sometimes the subject is excessively or Questionable 1
inappropriately preoccupied with things he did
wrong as a child, such as masturbating. Mild: Delusion clearly present, but the
Sometimes the subject feels responsible for subject may question it occasionally 2
causing some disastrous event, such as a fire or
accident, with which he in fact has no connection. Moderate: Delusion that is firmly held 3
Sometimes these delusions have a religious flavor
involving the belief that the sin is unpardonable and Marked: Firmly held delusion that the
that the subject will suffer eternal punishment from subject acts on 4
God. Sometimes the subject simply believes that
he deserves punishment by society. The subject Severe: Complex, well-formed
may spend a good deal of time confessing these delusion that the subject acts on and
sins to whomever will listen. that preoccupies him a great deal of
the time 5
Have you felt that you have done some terrible
thing?
(Is there anything that's bothering your

conscience?)
(What is it?)
(Do you feel you deserve to be punished for it?)
17
Grandiose Delusions
The subject believes that he has special powers or None 0 CA56
abilities. He may think he is actually some famous
person, such as a rock star, Napoleon, or Christ. Questionable 1
He may believe he is writing some definitive book,
composing a great piece of music, or developing Mild: Delusion clearly present, but the
some wonderful new invention. The subject is subject may question it occasionally 2
often suspicious that someone is trying to steal his
ideas, and he may become quite irritated if his Moderate: Delusion that is firmly held 3
abilities are doubted.
Marked: Firmly held delusion that the
Do you have any special powers, talents, or subject acts on 4
abilities?
Severe: Complex, well-formed
Do you feel you are going to achieve great things? delusion that the subject acts on and
that preoccupies him a great deal of
the time 5
Religious Delusions
The subject is preoccupied with false beliefs of a None 0 CA57
religious nature. Sometimes these exist within the
context of a conventional religious system, such as Questionable 1
beliefs about the Second Coming, the Anti-Christ,
or possession by the Devil. At other times, they Mild: Delusion clearly present, but
may involve an entirely new religious system or a the subject may question it
pastiche of beliefs from a variety of religions, occasionally 2
particularly Eastern religions, such as ideas about
reincarnation or Nirvana. Religious delusions may Moderate: Delusion that is firmly
be combined with grandiose delusions (if the held 3
subject considers himself a religious leader),
delusions of guilt, or delusions of being controlled. Marked: Firmly held delusion that
Religious delusions must be outside the range the subject acts on 4
considered normal for the subject's cultural and
religious background. Severe: Complex, well-formed
delusion that the subject acts on
Are you a religious person? and that preoccupies him a great
deal of the time 5
Have you had any unusual religious experiences?
(What was your religious training as a child?)
18
Somatic Delusions
The subject believes that somehow his body is None 0 CA58
diseased, abnormal, or changed. For example, he
may believe that his stomach or brain is rotting, Questionable 1
that his hands have become enlarged, or that his
facial features are unusual (dysmorphophobia). Mild: Delusion clearly present, but
Sometimes somatic delusions are accompanied by the subject may question it
tactile or other hallucinations, and when this occasionally 2
occurs, both should be rated. (For example, the
subject believes that he has ballbearings rolling Moderate: Delusion that is firmly
about in his head, placed there by a dentist who held 3
filled his teeth, and can actually hear them clanking
against one another.) Marked: Firmly held delusion that
the subject acts on 4
Is there anything wrong with the way your body is
working? Severe: Complex, well-formed
delusion that the subject acts on
Have you noticed any change in your appearance? and that preoccupies him a great
deal of the time 5
Ideas and Delusions of Reference

The subject believes that insignificant remarks, None 0 CA59
statements, or events refer to him or have some
special meaning for him. For example, the subject Questionable 1
walks into a room, sees people laughing, and
suspects that they were just talking about him and Mild: Occasional ideas of reference 2
laughing at him. Sometimes items read in the
paper, heard on the radio, or seen on TV are Moderate: Have occurred at least
considered to be special messages to the subject. weekly 3
In the case of ideas of reference, the subject is
suspicious, but recognizes his idea maybe Marked: Occurs at least two to four
erroneous. When the subject actually believes that time weekly 4
the statements or events refer to him, then this is
considered a delusion of reference. Severe: Occurs frequently 5
Have you walked into a room and thought people

were talking about you or laughing at you?
Have you seen things in magazines or on TV that

seem to refer to you or contain a special message
for you?
Have you received special messages in any other

ways?
19
Delusions of Being Controlled
The subject has a subjective experience that his None 0 CA60
feelings or actions are controlled by some outside
force. The central requirement for this type of Questionable 1
delusion is an actual strong subjective experience
of being controlled. It does not include simple Mild: Subject has experienced
beliefs or ideas, such as that the subject is acting being controlled but doubts it
as an agent of God or that friends or parents are occasionally 2
trying to coerce him into something. Rather, the
subject must describe, for example, that his body Moderate: Clear experience of
has been occupied by some alien force that is control, which has occurred on two
making it move in peculiar ways, or that messages or three occasions 3
are being sent to his brain by radio waves and
causing him to experience particular feelings that Marked: Clear experience of control
he recognizes are not his own. which occurs frequently; behavior
may be affected 4
Have you felt that you were being controlled by
some outside force? Severe: Clear experience of control
which occurs frequently; pervades
Do you feel that any person is controlling you? the subject's life and often affects
his behavior 5
Delusions of Mind Reading

The subject believes that people can read his mind None 0 CA61
or know his thoughts. This is different from thought
broadcasting (see below) in that it is a belief Questionable 1
without a percept. That is, the subject subjectively
experiences and recognizes that others know his Mild: Subject has experienced mind
thoughts, but he does not think that they can be reading but doubts it occasionally 2
heard out loud. If the subject believes that he can
read other people's minds, it should be scored Moderate: Clear experience of mind
under Grandiose Delusions as a special power or reading which has occurred on two
ability. or three occasions 3
Have you had the feeling that people could read Marked: Clear experience of mind
your mind or know what you are thinking? reading which occurs frequently;
behavior may be affected 4
Severe: Clear experience of mind

reading which occurs frequently,
pervades the subject's life, and often
affects his behavior 5
20
Thought Broadcasting/Audible Thoughts
The subject believes that his thoughts are None 0 CA62
broadcast so that he or others can hear them.
Sometimes the subject experiences his thoughts Questionable 1
as a voice outside his head; this is an auditory
hallucination as well as a delusion. Sometimes the Mild: Subject has experienced
subject feels his thoughts are being broadcast, thought broadcasting but doubts it
although he cannot hear them himself. Sometimes occasionally 2
he believes that his thoughts are picked up by a
microphone and broadcast on the radio or TV. Moderate: Clear experience of
thought broadcasting which has
Have you heard your own thoughts out loud, as if occurred on two or three occasions 3
they were a voice outside your head?
Marked: Clear experience of
Have you felt your thoughts were broadcast so thought broadcasting which occurs
other people could hear them? frequently; behavior may be affected 4
Severe: Clear experience of thought

broadcasting which occurs
frequently, pervades the subject's
life, and often affects his behavior 5
Thought Insertion
The subject believes that thoughts that are not his None 0 CA63
own have been inserted into his mind. For
example, the subject may believe that a neighbor is Questionable 1
practicing voodoo and planting alien sexual
thoughts in his mind. This symptom should not be Mild: Subject has experienced
confused with experiencing unpleasant thoughts thought insertion but doubts it
that the subject recognizes as his own, such as occasionally 2
delusions of persecution or guilt.
Moderate: Clear experience of
Have you felt that thoughts were being put into thought insertion which has occurred
your head by some outside force or person? on two or three occasions 3

thought insertion which occurs
frequently; behavior may be affected 4
Severe: Thought insertion which

occurs frequently; pervades the
subject's life, and affects his
behavior 5
21
Thought Withdrawal
The subject believes that thoughts have been None 0 CA64
taken away from his mind. He is able to describe a
subjective experience of beginning a thought and Questionable 1
then suddenly having it removed by some outside
force. This symptom does not include the mere Mild: Subject has experienced
subjective recognition of alogia. thought withdrawal but doubts it
occasionally 2
Have you felt your thoughts were taken away by
some outside force or person? Moderate: Clear experience of
thought withdrawal which has
occurred on two or three occasions 3

thought withdrawal which occurs
frequently; behavior may be affected 4
Severe: Clear experience of thought

withdrawal which occurs frequently,
pervades the subject's life, and often
affects his behavior 5
Global Rating of Severity of Delusions

The global rating should be based on duration and None 0 CA65
persistence of delusions, the extent of the subject's Skip to Hallucinations
preoccupation with the delusions, his degree of
conviction, and their effect on his actions. Also Questionable 1
consider the extent to which the delusions might be Skip to Hallucinations
considered bizarre or unusual. Delusions not
mentioned above should be included in this rating. Mild: Delusion definitely present but
at times subject questions his false
Did you think (subject's delusion) was your belief 2
imagination?
Moderate: Generally has conviction
How did . . . affect what you did? in false belief but delusion has little,
if any, influence on behavior 3
Marked: Delusion has a significant

effect on his actions, e.g., often asks
family to forgive his sins,
preoccupied with belief that he is a
new Messiah 4
Severe: Actions based on delusions

have major impact on him or others,
e.g., stops eating because he
believes food is poisoned 5
22
Sensorium While Delusional
Determine the clarity of the subject's state of None: No distortion of subject's
consciousness while delusional. sensorium during delusional beliefs 0 CA66
(This item is used to identify whether some Questionable 1

subjects are experiencing delusions due to some
physical factor, such as an illness that produces Definite: Sensorium is clouded, due
delirium (e.g., fever) or the influence of drugs (e.g., to some physical cause, i.e., drugs,
steroids, barbiturates); this is rated on item 2. The physical illness 2
item also identifies subjects who are experiencing
mental confusion and a clouded sensorium without Definite: Clouded sensorium not
a physical cause {item 3}.) due to physical cause 3
When you believed . . . were you at all confused

about where you were, or the time of day?
Did you have trouble with your memory?
Were you taking any drugs or medications?
Were you physically ill?
Persistence of Delusions
The extent to which the delusions tend to remain Mild: Delusional ideas have been
chronically present during the past month. entertained on one or two
occasions, but not retained 0 CA67
Did you believe ... all the time, or have there been
times when you doubted it or stopped believing it? Delusions have been present much
of the time over the past month, but
occasionally doubted 1
Delusions have been present

continuously 2
Fragmentary
Delusions not organized into a consistent theme. Not at all. All delusions are around
For example, the subject thinks his room is a single theme, such as persecution 0 CA68
bugged, believes people doubt his sexual potency,
and suspects he may be the son of Paul Somewhat fragmentary. Several
McCartney. different, but possibly related,
themes 1
Definitely fragmentary. Unrelated

themes 2
Bizarre or Fantastic Quality

Extent to which the content of any of the delusional Not at all; e.g., wife is unfaithful 0 CA69
beliefs (whether suspected or definite) have a
bizarre or fantastic quality. Somewhat bizarre; e.g., subject is
being persecuted by witches 1
Definitely bizarre; e.g., little green

men from Mars have been recording
his dreams and broadcasting them
back home 2
23
Consistency of Delusions with Mood
Manic Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A MANIC SYNDROME.
Delusions Occurring in a Manic Syndrome

Determine if delusions have occurred in the No 0 CA70
presence of a manic mood. Skip to Consistency of
Delusions with Mood --
When you felt (whatever the subject's delusions), Depressive Syndrome
do you remember feeling unusually good or high?
Yes 1
Presence of Mood-Congruent Delusions*

Delusions occurring during a manic episode whose Not at all 0 CA71
content is entirely consistent with the themes of
inflated worth, power, knowledge, identity, or Questionable: Possibly a
special relationship to a deity or famous person. connection between delusion and
The content of these delusions should already be elated mood, but with some
known but the subject's rationale should be elicited ambiguity 1
to assist in rating its congruence with the mood.
Definite: Completely consistent with
Why did you think this was happening? an elated mood 2
Presence of Mood-Incongruent Delusion*

Delusions occurring during a manic episode whose Not at all 0 CA72
content was not consistent with themes of inflated
worth, power, knowledge, identity, or special Questionable: Delusions are
relationship to a deity or famous person. The possibly inconsistent with an
interviewer should already have sufficient elevated mood, but relationship is
information to rate this question. ambiguous 1
Definite: Completely inconsistent

with an elevated mood 2
* Rater must decide between mood congruence and mood

incongruence and not rate both a 1 or 2 for the same
delusion, although both items may be rated as a 1 or 2 if
each response is in reference to a different delusion. If both
are coded, note the specific delusions in the margin.
Depressive Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A MAJOR DEPRESSIVE SYNDROME
Delusions Occurring in a Depressive Syndrome

Determine if delusions have occurred in the No 0 CA73
presence of a dysphoric mood. Skip to Hallucinations
When you felt (whatever the subject's delusions), Yes 1

do you remember feeling (depressed, anxious)?
24
Presence of Mood-Congruent Delusions*
Delusions occurring during a major depressive Not at all 0 CA74
episode whose content is entirely consistent with
the themes of either personal inadequacy, guilt, Questionable: Possibly a
disease, nihilism, or deserved punishment. The connection between delusion and
content of these delusions should already be depressed mood, but not readily
known, but the subject's rationale for the delusion apparent 1
should be elicited to assist in rating its congruence.
Definite: Complete identification
Why did you think this was happening? between mood and delusion, e.g.,
being persecuted because he has
committed a terrible sin 2
Presence of Mood-Incongruent Delusions*

Delusions occurring during a major depressive Not at all 0 CA75
episode whose content was not consistent with
themes of either personal inadequacy, guilt, Questionable: Possible mood-
disease, death, nihilism, or deserved punishment. incongruent delusions, but not
The interviewer should already have sufficient readily apparent 1
information to rate this question.
Definite: Has mood-incongruent
delusions 2
* Rater must decide between mood congruence and

mood incongruence and not rate both a 1 or 2 for the
same delusion, although both items may be rated as a 1
or 2 if each response is in reference to a different
delusion. If both are coded, note the specific delusions
in the margin.
25
Hallucinations
Hallucinations represent an abnormality in perception. They are false perceptions occurring in the absence of some
identifiable external stimulus. They may be experienced in any of the sensory modalities, including hearing, touch, taste,
smell, and vision. True hallucinations should be distinguished from illusions (which involve a misperception of an external
stimulus), hypnogogic and hypnopompic experiences (which occur when a subject is falling asleep or waking up), or
normal thought processes that are exceptionally vivid. If the hallucinations have a religious quality, then they should be
judged within the context of what is normal for the subject's social and cultural background. The subject should always be
requested to describe the hallucination in detail.
Auditory Hallucinations
The subject has reported voices, noises, or None 0 CA76
sounds. The most common auditory hallucinations
involve hearing voices speaking to the subject or Questionable 1
calling him names. The voices may be male or
female, familiar or unfamiliar, and critical or Mild: Subject hears noises or single
complimentary. Typically, subjects suffering from words; may occur only occasionally 2
schizophrenia experience the voices as unpleasant
and negative. Hallucinations involving sounds Moderate: Clear evidence of voices
other than voices, such as noises or music, should that have occurred at least weekly;
be considered less characteristic and less severe. frequent noises 3
Do not include if limited to name being called. Do
not include voices heard that are limited to voices Marked: Clear evidence of voices
commenting and/or voices conversing. which occur frequently 4
Have you heard voices or other sounds when no Severe: Voices occur almost daily 5
one is around, or when you couldn't account for it?
(What did they say?)
Voices Commenting
These hallucinations involve hearing a voice that None 0 CA77
makes a running commentary on the subject's
behavior or thought as it occurs. If this is the only Questionable 1
type of auditory hallucination the subject hears, it
should be scored instead of auditory Mild: Has occurred once or twice 2
hallucinations. Usually, however, voices
commenting will occur in addition to other types of Moderate: Occurs at least weekly 3
auditory hallucinations.
Marked: Occurs frequently 4
Have you heard voices commenting on what you
are thinking or doing? Severe: Occurs almost daily 5
(What do they say?)
26
Voices Conversing
As with voices commenting, voices conversing are None 0 CA78
considered a Schneiderian first-rank symptom.
They involve hearing two or more voices talking Questionable 1
with one another, usually discussing something
about the subject. As in the case of voices Mild: Has occurred once or twice 2
commenting, they should be scored
independently of other auditory hallucinations. Moderate: Occurs at least weekly 3
Have you heard two or more voices talking with Marked: Occurs frequently 4
each other?
Severe: Occurs almost daily 5
(What do they say?)
Were any voices heard? No 0 CA79
Skip to Somatic or Tactile Hallucinations
Yes 1
Types of Voices Heard
NO YES
Were the voices . . .? God 0 1 CA80
Satan/Devil 0 1 CA81
Male 0 1 CA82
Female 0 1 CA83
Familiar 0 1 CA84
Unfamiliar 0 1 CA85
Critical 0 1 CA86
Complimentary 0 1 CA87
Commanding 0 1 CA88
Multiple 0 1 CA89
Always the same 0 1 CA90
Heard inside his head 0 1 CA91
Heard outside his head 0 1 CA92
Heard on the left side 0 1 CA93
Heard on the right side 0 1 CA94
Somatic or Tactile Hallucinations

These hallucinations involve experiencing peculiar None 0 CA95
physical sensations in the body. They include
burning sensations, tingling, and perceptions that Questionable 1
the body has changed in shape or size.
Mild: Has occurred once or twice 2
Have you had burning sensations or other strange
feelings in your body? Moderate: Occurs at least weekly 3
(What were they?) Marked: Occurs frequently 4
27
Olfactory Hallucinations
The subject experiences unusual smells which are None 0 CA96
typically quite unpleasant. Sometimes the subject
may believe that he himself smells. This belief Questionable 1
should be scored here if the subject can actually
smell the odor himself, but should be scored Mild: Has occurred at least once 2
among delusions if he believes that only others can
smell the odor. Moderate: Occurs at least weekly 3
Have you experienced any unusual smells or Marked: Occurs frequently 4

smells that others don't notice?
(What were they?)
Visual Hallucinations
The subject sees shapes or people that are not None 0 CA97
actually present. Sometimes these are shapes or
colors, but most typically they are figures of people Questionable 1
or human-like objects. They may also be
characters of a religious nature, such as the Devil Mild: Has occurred once or twice 2
or Christ. As always, visual hallucinations involving
religious themes should be judged within the Moderate: Occurs at least weekly 3
context of the subject's cultural background.
Hypnogogic and hypnopompic hallucinations, Marked: Occurs frequently 4
which are relatively common, should be excluded
as should visual hallucinations occurring when the Severe: Occurs almost daily 5
subject has been taking hallucinogenic drugs.
Have you had visions or seen things that other

people cannot?
(What did you see?)
(Did this occur when you were falling asleep or

waking up?)
28
Global Rating of Severity of Hallucinations
This global rating should be based on the duration None 0 CA98
and severity of hallucinations, and extent of the Skip to Bizarre Behavior
subject's preoccupation with the hallucinations, his
degree of conviction, and their effect on his Questionable 1
actions. Also consider the extent to which the Skip to Bizarre Behavior
hallucinations might be considered bizarre or
unusual. Hallucinations not mentioned above, Mild: Definitely present, but subject
such as those involving taste, should be included in is generally aware that the
this rating. hallucination is "not real" and is
usually able to ignore it 2
Moderate: Generally believes in the

reality of the hallucination, but it has
little, if any, influence on his behavior
3
Marked: Convinced that his

hallucination is real, and it also has
a significant effect on his actions,
e.g., locks doors to keep pursuers
away from him 4
Severe: Actions based on

hallucinations have major impact on
him or on others, e.g., appears
preoccupied much of the time
causing major impairment in almost
all activities 5
Sensorium While Hallucinating

The extent to which the subject is aware of his None: No distortion of subject's
surroundings while hallucinating. sensorium during hallucinations 0 CA99
(This item is used to identify whether some Questionable 1

subjects are experiencing hallucinations due to
some physical factor, such as an illness that Definite: Sensorium is clouded, due
produces delirium {e.g., fever} or the influence of to some physical cause, i.e., drugs,
drugs {e.g., steroids, barbiturates}; this is rated on physical illness 2
item 2. The item also identifies subjects who are
experiencing mental confusion and a clouded Definite: Clouded sensorium not
sensorium without a physical cause {item 3}.) due to physical cause 3
When you were . . ..were you at all confused about

where you were or time of day?

Persistence of Hallucinations
Extent to which hallucinations have been Mild: Occur infrequently (once or twice) 0 CA100
chronically present during the past month.
Moderate: Occur at least weekly 1
Severe: Occur almost daily 2
29
Fragmentary
Hallucinations with content not organized into a Not fragmented: e.g., a voice makes
coherent theme. Example: Hears voices which he critical comments 0 CA101
cannot understand.
Somewhat fragmented: Voices
sometimes difficult to understand, or
say different and inconsistent things 1
Definitely fragmented: Voices tell

subject he is a savior, mumble
things he can't hear well, and call
him names 2
Consistency of Hallucinations with Mood
Manic Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A MANIC SYNDROME
Hallucinations Occurring During a Manic Syndrome

Determine if hallucinations have occurred in the No 0 CA102
presence of a manic mood.
Skip to Consistency of
When you experienced (whatever the subject's Hallucinations with Mood--
hallucination) do you remember feeling (unusually Depressive Syndrome
good or high)?
Yes 1
Presence of Mood-Congruent Hallucinations*

Hallucinations occurring during a manic episode Not at all 0 CA103
whose content is entirely consistent with the
themes of inflated worth, power, knowledge, Questionable: Possibly a
identity, or special relationship to a deity or famous connection between hallucination
person. The content of these hallucinations should and elated mood, but not readily
already be known, but the subject's rationale apparent 1
should be elicited to assist in rating its congruence
with the mood. Definite: Completely consistent with
an elated mood 2
Why did you think this was happening?
Presence of Mood-Incongruent Hallucinations*

Hallucinations occurring during a manic episode Not at all 0 CA104
whose content was not consistent with themes of
inflated worth, power, knowledge, identity, or Questionable: Possible mood-
special relationship to a deity or famous person. incongruent hallucinations but not
readily apparent 1
* Rater must decide between mood congruence
and mood incongruence and not rate both a 1 or 2 Definite: Has mood-incongruent
for the same hallucination, although both items hallucinations 2
may be rated as a 1 or 2 if each response is in
reference to a different hallucination. If both are
coded, note the specific hallucinations in the
margin.
30
Depressive Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A MAJOR DEPRESSIVE SYNDROME
Hallucinations Occurring in a Depressive Syndrome

Determine if hallucinations have occurred in the No 0 CA105
presence of a dysphoric mood. Skip to Bizarre Behavior
When you felt (whatever the subject's hallucination) Yes 1

do you remember feeling (depressed, anxious)?
Presence of Mood-Congruent Hallucinations*

Hallucinations occurring during a major depressive Not at all 0 CA106
episode whose content is entirely consistent with
the themes of personal inadequacy, guilt, disease, Questionable: Possibly a
nihilism, or deserved punishment. The content of connection between hallucination
these hallucinations should already be known, but and depressed mood, but with some
the subject's rationale for the hallucination should ambiguity 1
be elicited to assist in rating its congruence with the
mood. Definite: Hallucinations are
completely consistent with
Why did you think this was happening? depressed mood 2
Presence of Mood-Incongruent Hallucinations*

Hallucinations occurring during a major depressive Not at all 0 CA107
themes of personal inadequacy, guilt, disease, Questionable: Possible mood-
death, nihilism, or deserved punishment. The incongruent hallucinations, but with
interviewer should already have sufficient some ambiguity 1
information to rate this question.
Definite: Has mood-incongruent
hallucinations 2
* Rater must decide between mood congruence and mood

incongruence and not rate both a 1 or 2 for the same
hallucination, although both items may be rated as a 1 or 2 if
each response is in reference to a different hallucination. If
both are coded, note the specific hallucinations in the margin.
31
Bizarre Behavior
The subject's behavior is unusual, bizarre, or fantastic. The information for this item will sometimes come from the
subject, sometimes from other sources, and sometimes from direct observation. Bizarre behavior due to the immediate
effects of intoxication with alcohol or drugs should be excluded. Social and cultural norms must be considered in making
the rating, and detailed examples should be elicited and noted.
Clothing and Appearance

The subject dresses in an unusual manner or does None 0 CA108
other strange things to alter his appearance. For
example, he may shave off all his hair or paint Questionable 1
parts of his body different colors. His clothing may
be quite unusual; for example, he may choose to Mild: Occasional oddities of dress
wear some outfit that appears generally or appearance 2
inappropriate and unacceptable, such as a
baseball cap backwards with rubber galoshes and Moderate: Appearance or apparel
long underwear covered by denim overalls. He are clearly unusual and would attract
may dress in a fantastic costume representing attention 3
some historical personage or a man from outer
space. He may wear clothing completely Marked: Appearance or apparel are
inappropriate to the climatic conditions, such as markedly odd 4
heavy wools in the midst of summer.
Severe: Subject's appearance or
Has anyone made comments about the way you apparel are very fantastic or bizarre 5
look?
Social and Sexual Behavior

The subject may do things that are considered None 0 CA109
inappropriate according to usual social norms. For
example, he may masturbate in public, urinate or Questionable 1
defecate in inappropriate receptacles, walk along
the street muttering to himself, or begin talking to Mild: Occasional instances of odd
people whom he has never before met about his behavior 2
personal life (as when riding on a subway or
standing in some public place). He may drop to his Moderate: Frequent instances of
knees praying and shouting, or suddenly sit in an odd behavior (e.g., muttering to
unusual position when in the midst of a crowd. He himself) 3
may make inappropriate sexual overtures or
remarks to strangers. Marked: Very odd behavior (e.g.,
sexual overtures to strangers) 4
Have you done anything that others might think
unusual or that has called attention to yourself? Severe: Extremely odd behavior
(e.g., masturbating in public) 5
(Has anyone complained or commented about your
behavior?)
32
Aggressive and Agitated Behavior
The subject may behave in an aggressive, agitated None 0 CA110
manner, often quite unpredictably. He may start
arguments inappropriately with friends or members Questionable 1
of his family, or he may accost strangers on the
street and begin haranguing them angrily. He may Mild: Occasional instances, e.g.,
write letters of a threatening or angry nature to easily irritated 2
government officials or others with whom he has
some quarrel. Occasionally, subjects may perform Moderate: Behavior which is clearly
violent acts such as injuring or tormenting animals, inappropriate, e.g., writing angry
or attempting to injure or kill human beings. letters to strangers 3
Have you been unusually angry or irritable with Marked: Behavior which is
anyone? disruptive and potentially dangerous,
e.g., threatening people, public
(How did you express your anger?) harangues 4
(Have you done anything to try to harm animals or Severe: Behavior which is harmful,
people?) e.g., assaulting people, injuring
animals 5
Ritualistic or Stereotyped Behavior

The subject may develop a set of repetitive actions None 0 CA111
or rituals that he must perform over and over.
Sometimes he will attribute some symbolic Questionable 1
significance to these actions and believe that they
are either influencing others or preventing himself Mild: Occasional instances of
from being influenced. For example, he may eat ritualistic or stereotyped behavior,
jelly beans every night for dessert, assuming that e.g., rocking 2
different consequences will occur, depending on
the color of the jelly beans. He may have to eat Moderate: e.g., eating or dressing
foods in a particular order, wear particular clothes, rituals lacking symbolic significance;
or put them on in a certain order. He may have to frequent rocking 3
write messages to himself or to others over and
over, sometimes in an unusual or occult language. Marked: e.g., eating or dressing
rituals with a symbolic significance 4
Are there any things you do over and over?
Severe: e.g., keeping a diary in an
Are there any things that you have to do in a incomprehensible language 5
certain way or in a particular order?
(Why do you do it?)
(Does it have any special meaning or

significance?)
33
Global Rating of Severity of Bizarre Behavior
In making this rating, the interviewer should None 0 CA112
consider the type of behavior, the extent to which it
deviates from social norms, the subject's Questionable 1
awareness of the degree to which the behavior is
deviant, and the extent to which it is obviously Mild: Occasional instances of
bizarre. unusual or apparently idiosyncratic
behavior; subject usually has some
insight 2
Moderate: Behavior which is clearly

deviant from social norms and
seems somewhat bizarre; subject
may have some insight 3
Marked: Behavior which is markedly

clearly bizarre; subject may have
some insight 4
Severe: Behavior which is

extremely bizarre; may include a
single extreme act, e.g., attempting
murder; subject usually lacks insight 5
THE FOLLOWING ITEMS ARE OBSERVATIONAL. {Skip to Page 47 Avolition-Apathy for direct interview}
(Return to this section after interview with subject is completed and record the observational items.)
Positive Formal Thought Disorder

Positive formal thought disorder is fluent speech that tends to communicate poorly for a variety of reasons. The subject
tends to skip from topic to topic without warning, to be distracted by events in the nearby environment, to join words
together because they are semantically or phonologically alike, even though they make no sense, or to ignore the question
asked and answer another. This type of speech may be rapid, and it frequently seems quite disjointed. It has sometimes
been referred to as "loose associations." Unlike alogia (negative formal thought disorder), a wealth of detail is provided,
and the flow of speech tends to have an energetic rather than an apathetic quality to it.
In order to evaluate thought disorder, the subject should be permitted to talk for as long as five to ten minutes. This
normally will have occurred by this point in the interview. The interviewer should observe closely the extent to which the
subject's sequencing of ideas is well connected. He should also pay close attention to how well the subject can reply to a
variety of different types of questions, ranging from simple (when were you born?) to more complicated (why did you come
to the hospital?). If the ideas seem vague or incomprehensible, the interviewer should prompt the subject to clarify or
elaborate.
The anchor points for these ratings assume that the subject has been interviewed for a total of approximately forty-five
minutes. If the interview is shorter or longer, the ratings should be adjusted accordingly.
34
Derailment (Loose Associations)
A pattern of spontaneous speech in which the None 0 CA113
ideas slip off the track onto another that is clearly
but obliquely related, or onto one completely Questionable 1
unrelated. Things may be said in juxtaposition
which lack a meaningful relationship, or the subject Mild: Occasional instances of
may shift idiosyncratically from one frame of derailment, with only slight topic
reference to another. At times there may be a shifts 2
vague connection between the ideas, and at others
none will be apparent. This pattern of speech is Moderate: Several instances of
often characterized as sounding "disjointed." derailment; subject is sometimes
Perhaps the most common manifestation of this difficult to follow 3
disorder is a slow, steady slippage, with no single
derailment being particularly severe, so that the Marked: Frequent instances of
speaker gets farther and farther off the track with derailment; subject is often difficult
each derailment without showing any awareness to follow 4
that his reply no longer has any connection with the
question which was asked. This abnormality is Severe: Derailment so frequent
often characterized by lack of cohesion between and/or extreme that subject's
clauses and sentences and by unclear pronoun speech is almost incomprehensible 5
references.
Example: Interviewer: "Did you enjoy college?"

Subject: "Um-hm. Oh hey well I, I oh, I really
enjoyed some communities. I tried it, and the, and
the next day when I'd be going out, you know, um, I
took control like uh, I put, um, bleach on my hair in,
in California. My roommate was from Chicago and
she was going to the junior college. And we lived
in the Y.W.C.A., so she wanted to put it, um,
peroxide on my hair, and she did, and I got up and
I looked at the mirror and tears came to my eyes.
Now do you understand it - I was fully aware of
what was going on but why couldn't I, I ...why the
tears? I can't understand that, can you?"
Tangentiality
Replying to a question in an oblique, tangential, or None 0 CA114
even irrelevant manner. The reply may be related
to the question in some distant way, or the reply Questionable 1
may be unrelated and seem totally irrelevant.
Mild: One or two oblique replies 2
Example: Interviewer: "What city are you from?"
Subject: "Well, that's a hard question to answer Moderate: Occasional oblique
because my parents . . . I was born in Iowa, but I replies 3
know that I'm white instead of black, so apparently
I came from the North somewhere and I don't know Marked: Frequent oblique replies 4
where, you know, I really don't know whether I'm
Irish or Scandinavian, or I don't, I don't believe I'm Severe: Tangentiality so severe that
Polish, but I think I'm, I think I might be German or interviewing the subject is extremely
Welsh." difficult 5
35
Incoherence (Word Salad, Schizophasia)
A pattern of speech which is essentially None 0 CA115
incomprehensible at times. Incoherence is often
accompanied by derailment. It differs from Questionable 1
derailment in that in incoherence the abnormality
occurs within the level of the sentence or clause, Mild: Occasional instances of
which contains words or phrases that are joined incoherence 2
incoherently. The abnormality in derailment
involves unclear or confusing connections between Moderate: Frequent bursts of
larger units, such as sentences or clauses. This incoherence 3
type of language disorder is relatively rare. When it
occurs, it tends to be severe or extreme, and mild Marked: Much of subject's speech is
forms are quite uncommon. It may sound quite incomprehensible 4
similar to Wernicke's aphasia or jargon aphasia,
and in these cases the disorder should only be Severe: Most of subject's speech is
called incoherence definitively when history and incomprehensible 5
laboratory data exclude the possibility of a past
stroke and clinical testing for aphasia is negative.
Exclusions: Mildly ungrammatical constructions

or idiomatic usages characteristic of particular
regional or ethnic backgrounds, lack of education,
or low intelligence.
Example: Interviewer: "What do you think about

current political issues like the energy crisis?"
Subject: "They're destroying too many cattle and
oil just to make soap. If we need soap when you
can jump into a pool of water, and then when you
go to buy your gasoline, my folks always thought
they should, get pop but the best thing to get, is
motor oil, and, money. May, may as, well go there
and, trade in some, pop caps and, uh, tires, and
tractors to grip, car garages, so they can pull cars
away from wrecks, is what I believed in."
36
Illogicality
A pattern of speech in which conclusions are None 0 CA116
reached which do not follow logically. This may take
the form of non sequiturs (it does not follow), in Questionable 1
which the subject makes a logical inference between
two clauses which is unwarranted or illogical. It may Mild: Infrequent instances of
take the form of faulty inductive inferences. It may illogicality 2
also take the form of reaching conclusions based on
faulty premises without any actual delusional Moderate: Some of the subject's
thinking. speech is illogical 3
Exclusions: Illogicality may either lead to or result Marked: Frequent instances of

from delusional beliefs. When illogical thinking illogicality 4
occurs within the context of a delusional system, it
should be subsumed under the concept of delusions Severe: Much of subject's speech
and not considered a separate phenomenon is illogical 5
representing a different type of thinking disorder.
Illogical thinking which is clearly due to cultural or
religious values or to intellectual deficit should also
be excluded.
Example: "Parents are the people that raise you.

Anything that raises you can be a parent. Parents
can be anything - material, vegetable, or mineral -
that has taught you something. Parents would be the
world of things that are alive, that are there. Rocks -
a person can look at a rock and learn something
from it, so that would be a parent."
Circumstantiality
A pattern of speech which is very indirect and None 0 CA117
delayed in reaching its goal ideas. In the process of
explaining something, the speaker brings in many Questionable 1
tedious details and sometimes makes parenthetical
remarks. Circumstantial replies or statements may Mild: Occasional instances of
last for many minutes if the speaker is not interrupted circumstantiality 2
and urged to get to the point. Interviewers will often
recognize circumstantiality on the basis of needing to Moderate: Frequent instances of
interrupt the speaker in order to complete the circumstantiality 3
process of history-taking within an allotted time.
When not called circumstantial, these people are Marked: Much of subject's speech
often referred to as "long-winded." is circumstantial 4
Exclusions: Although it may co-exist with instances Severe: Most of subject's speech is
of poverty of content of speech or loss of goal, it circumstantial 5
differs from poverty of content of speech in
containing excessive amplifying or illustrative detail
and from loss of goal in that the goal is eventually
reached if the person is allowed to talk long enough.
It differs from derailment in that the details presented
are closely related to some particular goal or idea
and that the particular goal or idea must, by
definition, eventually be reached (unless the subject
is interrupted by an impatient interviewer).
37
Pressure of Speech
An increase in the amount of spontaneous speech None 0 CA118
as compared to what is considered ordinary or
socially customary. The subject talks rapidly and is Questionable 1
difficult to interrupt. Some sentences may be left
uncompleted because of eagerness to get on to a Mild: Slight pressure of speech,
new idea. Simple questions which could be some slight increase in amount,
answered in only a few words or sentences are speed, or loudness of speech 2
answered at great length so that the answer takes
minutes rather than seconds, and indeed may not Moderate: Usually takes several
stop at all if the speaker is not interrupted. Even minutes to answer simple questions,
when interrupted, the speaker often continues to may talk when no one is listening,
talk. Speech tends to be loud and emphatic. and/or speaks loudly and rapidly. 3
Sometimes speakers with severe pressure will talk
without any social stimulation and talk even though Marked: Frequently takes as much
no one is listening. When subjects are receiving as three minutes to answer simple
neuroleptics or lithium, their speech is often slowed questions; sometimes begins talking
down by medication, and then it can be judged only without social stimulation 4
on the basis of amount, volume, and social
appropriateness. If a quantitative measure is Severe: Subject talks almost
applied to the rate of speech, then a rate greater continually; very difficult to interrupt,
than 150 words per minute is usually considered and/or may shout to drown out the
rapid or pressured. This disorder may be speech of others 5
accompanied by derailment, tangentiality, or
incoherence, but it is distinct from them.
Distractible Speech
During the course of a discussion or interview, the None 0 CA119
subject stops talking in the middle of a sentence or
idea and changes the subject in response to a Questionable 1
nearby stimulus, such as an object on a desk, the
interviewer's clothing or appearance, etc. Mild: Is distracted once during an
interview 2
Example: "Then I left San Francisco and moved
to . . . where did you get that tie? It looks like it's Moderate: Is distracted from two to
left over from the 50's. I like the warm weather in four times during an interview 3
San Diego. Is that a conch shell on your desk?
Have you ever gone scuba diving?" Marked: Is distracted from five to ten
times during an interview 4
Severe: Is distracted more than ten

38
Clanging
A pattern of speech in which sounds rather than None 0 CA120
meaningful relationships appear to govern word
choice, so that the intelligibility of the speech is Questionable 1
impaired and redundant words are introduced in
addition to rhyming relationships. This pattern of Mild: Occurs once during the
speech may also include punning associations so interview 2
that a word similar in sound brings in a new
thought. Moderate: Occurs from two to four
Example: "I'm not trying to make a noise. I'm
trying to make sense. If you can make sense out Marked: Occurs five to ten times
of nonsense, well, have fun. I'm trying to make during an interview 4
sense out of sense. I'm not making sense (cents)
any more. I have to make dollars." Severe: Occurs more than ten
times, or so frequently that the
interview is nearly incomprehensible 5
Global Rating of Positive Formal Thought Disorder

In making this rating the interviewer should None 0 CA121
consider the type of abnormality, the degree to
which it affects the subject's ability to Questionable 1
communicate, the frequency with which abnormal
speech occurs, and its degree of severity. Mild: Occasional instances of
disorder; subject's speech is
understandable 2
Moderate: Frequent instances of

disorder; subject is sometimes hard
to understand 3
Marked: Subject is often difficult to

understand 4
Severe: Thought disorder so severe

that the subject is nearly
incomprehensible 5
Catatonic Motor Behavior

These symptoms are rare and should only be considered present when they are obvious and have been directly observed
by the rater or some other professional.
Stupor
Marked decrease in reactivity to environment and None 0 CA122
reduction of spontaneous movements and activity.
The subject may appear to be aware of the nature of Questionable 1
his surroundings.
Definitely present 2
39
Rigidity
Subject exhibits signs of motor rigidity, such as None 0 CA123
resistance to passive movement
Questionable 1
Waxy Flexibility
Subject maintains postures into which he is placed None 0 CA124
for at least fifteen seconds.
Questionable 1
Excitement
Apparently purposeless and stereotyped excited None 0 CA125
motor activity not influenced by external stimuli.
Questionable 1
Posturing and Mannerisms

Voluntary assumption of inappropriate or bizarre None 0 CA126
posture. Manneristic gestures or tics may also be Skip to Global Rating of Severity of Catatonic
observed. (Subjects with tardive dyskinesia may Motor Behavior
have manneristic gestures or tics; this rating should
be made descriptively without attempting to "correct" Questionable 1
for the effects of medications. If the rater suspects
that the gestures or tics may be due to tardive Definitely present 2
dyskinesia, this should be noted.)
Tics or mannerisms probably due to tardive No 0 CA127

dyskinesia.
Yes 1
Global Rating of Severity of Catatonic Motor Behavior

None 0 CA128
Questionable 1
Mild: e.g., an occasional mannerism 2
Moderate: Frequent mild symptoms,

e.g., mannerisms 3
Marked: Frequent severe symptoms,

e.g., alteration between stupor and
excitement 4
Severe: Several severe persistent

symptoms, e.g., stupor with waxy
flexibility and rigidity for the past two
weeks 5
40
Alogia
Alogia is a general term coined to refer to the impoverished thinking and cognition that often occur in subjects with
schizophrenia (Greek a = no, logos = mind, thought). Subjects with alogia have thinking processes that seem empty,
turgid, or slow. Since thinking cannot be observed directly, it is inferred from the subject's speech. The two major
manifestations of alogia are nonfluent empty speech (poverty of speech) and fluent empty speech (poverty of content of
speech). Blocking and increased latency of response may also reflect alogia.
Poverty of Speech
Restriction in the amount of spontaneous speech, so No poverty of speech; a substantial
that replies to questions tend to be brief, concrete, and appropriate number of replies to
and unelaborated. Unprompted additional questions include additional
information is rarely provided. Replies may be information 0 CA129
monosyllabic, and some questions may be left
unanswered altogether. When confronted with this Questionable poverty of speech 1
speech pattern, the interviewer may find himself
frequently prompting the subject in order to Mild: Occasional replies do not
encourage elaboration of replies. To elicit this include elaborated information even
finding, the examiner must allow the subject though appropriate 2
adequate time to answer and to elaborate his
answer. Moderate: Many replies do not
include appropriately elaborated
information, and some replies are
monosyllabic or very brief - "Yes."
"No." "Maybe." "Don't know." "Last
week." 3
Marked: Most replies do not include

appropriately elaborated information,
and many replies are monosyllabic
or very brief - "Yes." "No." "Maybe."
"Don't know." "Last week." 4
Severe: Subject says very little and

occasionally fails to answer
questions. 5
41
Poverty of Content of Speech
Although replies are long enough so that speech is No poverty of content 0 CA130
adequate in amount, it conveys little information.
Language tends to be vague, often overabstract or Questionable 1
overconcrete, repetitive, and stereotyped. The
interviewer may recognize this finding by observing Mild: Occasional replies are too
that the subject has spoken at some length but has vague to be comprehensible or can
not given adequate information to answer the be markedly condensed 2
question. Alternatively the subject may provide
enough information but require many words to do so, Moderate: Replies which are vague
so that a lengthy reply can be summarized in a or can be markedly condensed
sentence or two. make up at least a quarter of the
interview 3
Exclusions: This finding differs from
circumstantiality in that the circumstantial subject Marked: At least half of the
tends to provide a wealth of detail. subject's speech is composed of
vague or incomprehensible replies 4
Example: Interviewer: "Why is it, do you think, that
people believe in God?" Subject: "Well, first of all Severe: Nearly all of the speech is
because he uh, he are the person that is their vague, incomprehensible or can be
personal savior. He walks with me and talks with markedly condensed 5
me. And uh, the understanding that I have, um, a lot
of people, they don't readily, uh, know their own
personal self. Because, uh, they ain't, they all, just
don't know their personal self. They don't, know that
he uh - seemed like to me, a lot of 'em don't
understand that he walks and talks with 'em."
Blocking
Interruption of a train of speech before a thought or No blocking 0 CA131
idea has been completed. After a period of silence,
which may last from a few seconds to minutes, the Questionable 1
person indicates that he cannot recall what he has
been saying or meant to say. Blocking should only Mild: A single instance noted during
be judged to be present if a person voluntarily a fifteen minute period 2
describes losing his thought or if, upon questioning
by the interviewer, the person indicates that that was Moderate: Occurs twice during
his reason for pausing. fifteen minutes 3
Marked: Occurs three times during

fifteen minutes 4
Severe: Occurs more than three

times during fifteen minutes 5
42
Increased Latency of Response
The subject takes a longer time to reply to questions Not at all 0 CA132
than is usually considered normal. He may seem
"distant," and sometimes the examiner may wonder Questionable 1
if he has heard the question. Prompting usually
indicates that the subject is aware of the question, Mild: Occasional brief pauses
but has been having difficulty in formulating his before replying 2
thoughts in order to make an appropriate reply.
Moderate: Significant increase in
latency of response 3
Marked: Marked increase in latency

of response 4
Severe: Long pauses prior to nearly

all replies 5
Perseveration
Persistent repetition of words, ideas, or subjects so No perseveration 0 CA133
that, once a subject begins a particular subject or
uses a particular word, he continually returns to it in Questionable 1
the process of speaking.
Mild: Has a persistent repetition of
Exclusions: This differs from "stock words" in that one set of words or ideas, or
the repeated words are used in ways appropriate to displays clear but infrequent
their usual meaning. Some words or phrases are examples of perseveration. 2
commonly used as pause-fillers, such as "you know"
or "like." These should not be considered Moderate: Has persistent repetition
perseverations. of two or three different sets of
words or ideas, or perseverates
Example: Interviewer: "Tell me what you are like- occasionally but consistently
what kind of person you are." Subject: "I'm from throughout the interview. 3
Marshalltown, Iowa. That's sixty miles northwest,
northeast of Des Moines, Iowa. And I'm married at Marked: Has persistent repetition of
the present time. I'm thirty-six years old, my wife is four or five different sets of words or
thirty-five. She lives in Garwin, Iowa. That's fifteen ideas, or perseverates frequently
miles southeast of Marshalltown, Iowa. I'm getting a during the interview. 4
divorce at the present time. And I am at present in a
mental institution in Iowa City, Iowa, which is a Severe: Perseverates on a variety
hundred miles southeast of Marshalltown, Iowa. of topics during most of the
interview. 5
43
Global Rating of Alogia
Since the core features of alogia are poverty of No alogia 0 CA134
speech and poverty of content, the global rating
should place particular emphasis on these. Questionable 1
Mild: Mild but definite

impoverishment of thinking 2
Moderate: Significant evidence for

impoverished thinking 3
Marked: Subject's thinking seems

impoverished much of the time 4
Severe: Subject's thinking seems

impoverished most of the time 5
Affective Flattening or Blunting
Affective flattening or blunting manifests itself as a characteristic impoverishment of emotional expression, reactivity, and
feeling. Affective flattening can be evaluated by observation of the subject's behavior and responsiveness during a routine
interview. The rating of some items may be affected by drugs, since the Parkinsonian side-effects of neuroleptics may
lead to mask-like facies and diminished associated movements. Other aspects of affect, such as responsivity or
appropriateness, will not be affected, however.
Unchanging Facial Expression

The subject's face does not change expression, or Not at all: Subject is normal or labile 0 CA135
changes less than normally expected, as the
emotional content of discourse changes. It appears Questionable decrease 1
wooden, mechanical, frozen. Since neuroleptics
may partially mimic this effect, the interviewer should Mild: Some decrease in facial
be careful to note whether or not the subject is on expressiveness 2
medication, but should not try to "correct" the rating
accordingly. Moderate: Facial expressiveness is
significantly decreased 3
Marked: Facial expressiveness

markedly decreased 4
Severe: Facial expression is

essentially unchanging 5
44
Decreased Spontaneous Movements
The subject sits quietly throughout the interview and Not all all: Subject moves normally
shows few or no spontaneous movements. He does or is overactive 0 CA136
not shift position, move his legs, move his hands,
etc., or does so less than normally expected. Questionable decrease 1
Mild: Some decrease in

spontaneous movements 2
Moderate: Significant decrease in

spontaneous movements 3
Marked: Movements are markedly

decreased 4
Severe: Subject sits immobile

throughout most of the interview 5
Paucity of Expressive Gestures

The subject does not use his body as an aid in Not at all: Subject uses expressive
expressing his ideas through such means as hand gestures normally or excessively 0 CA137
gestures, sitting forward in his chair when intent on
subject, leaning back when relaxed, etc. This may Questionable decrease 1
occur in addition to decreased spontaneous
movements. Mild: Some decrease in expressive
gestures 2

expressive gestures 3
Marked: Marked decrease in

expressive gestures 4
Severe: Subject almost never uses

body as an aid in expression 5
Poor Eye Contact

The subject avoids looking at others or using his Not at all: Good eye contact 0 CA138
eyes as an aid in expression. He appears to be
staring into space even when he is talking. Consider Questionable 1
the quality of eye contact as well as quantity.
Mild: Some decrease in eye contact 2

eye contact 3
Marked: Very infrequent eye

contact 4
Severe: Subject almost never looks

at interviewer 5
45
Affective Nonresponsivity
Failure to smile or laugh when prompted may be Not at all 0 CA139
tested by smiling or joking in a way which would
usually elicit a smile from a normal individual. Questionable decrease 1
Mild: Slight but definite lack in

responsivity 2
Moderate: Moderate decrease in

responsivity 3
Marked: Marked decrease in

responsivity 4
Severe: Subject essentially

unresponsive, even on repeated
prompting 5
Lack of Vocal Inflections

While speaking the subject fails to show normal Not at all: Normal vocal inflection 0 CA140
vocal emphasis patterns. Speech has a monotonic
quality, and important words are not emphasized Questionable 1
through changes in pitch or volume. Subject also
may fail to change volume with changes of subject Mild: Slight decrease in inflections 2
so that he does not drop his voice when discussing
private topics or raise it as he discusses things which Moderate: Definite decrease in
are exciting or for which louder speech might be vocal inflections 3
appropriate.
Marked: Marked decrease in vocal
inflections 4
Severe: Nearly all speech in a

monotone 5
Global Rating of Affective Flattening

The global rating should focus on overall severity of No flattening: Normal affect 0 CA141
affective flattening or blunting. Special emphasis
should be given to such core features as Questionable 1
unresponsiveness, absence of inflections and an
overall decrease in emotional intensity. Mild affective flattening 2
Inappropriate affect appears in a number of studies
to be uncorrelated with other measures of affective Moderate affective flattening 3
blunting. Therefore, it should not be used as a
component of the global rating. Marked affective flattening 4
Severe affective flattening 5
46
Inappropriate Affect
Inappropriate Affect appears in factor analytic studies to be poorly correlated with blunted affect and more related to
positive thought disorder. Therefore it is sometimes considered a positive symptom.
Affect expressed is inappropriate or incongruous, not Not at all: Affect is not inappropriate 0 CA142
simply flat or blunted. Most typically, this
manifestation of affective disturbance takes the form Questionable 1
of smiling or assuming a silly facial expression while
talking about a serious or sad subject. (Occasionally Mild: At least one instance of
subjects may smile or laugh when talking about a inappropriate smiling or other
serious subject which they find uncomfortable or inappropriate affect 2
embarrassing. Although their smiling may seem
inappropriate, it is due to anxiety and therefore Moderate: Occasional instances of
should not be rated as inappropriate affect.) Do not inappropriate affect 3
rate affective blunting or flattening as inappropriate.
Marked: Frequent instances of
inappropriate affect 4
Severe: Affect is inappropriate most

of the time 5
Avolition-Apathy
Avolition manifests itself as a characteristic lack of energy and drive. Subjects are unable to mobilize themselves to initiate
or persist in completing many different kinds of tasks. Unlike the diminished energy or interest of depression, the
avolitional symptom complex in schizophrenia is usually not accompanied by saddened or depressed affect. The
avolitional symptom complex often leads to severe social and economic impairment.
Grooming and Hygiene

The subject displays less attention to grooming and No evidence of poor
hygiene than normal. Clothing may appear sloppy, grooming/hygiene 0 CA143
outdated or soiled. Subject may bathe infrequently
and not care for hair, nails, or teeth--leading to such Questionable 1
manifestations as greasy or uncombed hair, dirty
hands, body odor, or unclean teeth and bad breath. Mild: Some slight but definite
Overall the appearance is dilapidated and indication of inattention to
disheveled. In extreme cases, the subject may even appearance 2
have poor toilet habits.
Moderate: Appearance and
grooming are somewhat poor and
disheveled 3
Marked: Appearance and grooming

are significantly poor and
disheveled 4
Severe: Appearance and grooming

are extremely poor and disheveled 5
47
Impersistence at Work or School
The subject has difficulty in seeking or maintaining No evidence of impersistence 0 CA144
employment (or schoolwork) as appropriate for his
age and sex. If a student, he does not do homework Questionable 1
and may even fail to attend class. Grades will tend
to reflect this. If a college student, he may have Mild: Slight indications of
registered for courses, but dropped several or all of impersistence 2
them. If of working age, the subject may have found
it difficult to work at a job because of inability to Moderate: Definite indications of
persist in completing tasks and apparent impersistence 3
irresponsibility. He may go to work irregularly,
wander away early, fail to complete expected Marked: Significant indications of
assignments, or complete them in a disorganized impersistence 4
manner. He may simply sit around the house and
not seek any employment or seek it only in an Severe: Subject consistently fails to
infrequent or desultory manner. If a homemaker or a maintain a record at work or in
retired person, the subject may fail to complete school 5
chores, such as shopping or cleaning, or complete
them in an apparently careless and half-hearted way.
If in a hospital or institution, he does not attend or
persist in vocational or rehabilitative programs
effectively.
Have you been able to (work, go to school) during

the past month? (This should already be known
from employment status on page 8.)
Have you been attending vocational rehabilitation or

occupational therapy sessions (in the hospital)?
What have you been able to do?
Do you have trouble finishing what you start?
What kinds of problems have you had?
Physical Anergia
The subject tends to be physically inert; he may sit in No evidence of physical anergia 0 CA145
a chair for hours at a time and not initiate any
spontaneous activity. If encouraged to become Questionable 1
involved in an activity, he may participate only briefly
and then wander away or disengage himself and Mild anergia 2
return to sitting alone. He may spend large amounts
of time in some relatively mindless and physically Moderate anergia 3
inactive task such as watching TV or playing
solitaire. His family may report that he spends most Marked anergia 4
of his time at home "doing nothing except sitting
around." Either at home or in an inpatient setting, he Severe anergia 5
may spend much of his time sitting in his room.
How have you been spending your time?
Do you have any trouble getting yourself going?
48
Global Rating of Avolition-Apathy
The global rating should reflect the overall severity of No avolition 0 CA146
the avolitional symptoms, given the expected norms
for the subject's age and social status or origin. In Questionable 1
making the global rating, strong weight may be given
to only one or two prominent symptoms if they are Mild but definitely present 2
particularly striking.
Moderate avolition 3
Marked avolition 4
Severe avolition 5
Anhedonia-Asociality
This symptom complex encompasses the subject's difficulties in experiencing interest or pleasure. It may express itself as
a loss of interest in pleasurable activities, an inability to experience pleasure when participating in activities normally
considered pleasurable, or a lack of involvement in social relationships of various kinds.
Recreational Interests and Activities

The subject may have few or no interests, activities, No inability to enjoy recreation 0 CA147
or hobbies. Although this symptom may begin
insidiously or slowly, there will usually be some Questionable 1
obvious decline from an earlier level of interest and
activity. Subjects with relatively milder loss of Mild inability to enjoy recreational
interest will engage in some activities which are activities 2
passive or nondemanding, such as watching TV, or
will show only occasional or sporadic interests. Moderate inability to enjoy
Subjects with the most extreme loss will appear to recreational activities and interests 3
have a complete and intractible inability to become
involved in or enjoy activities. The rating in this area Marked inability to enjoy recreational
should take both the quality and quantity of activities and interests 4
recreational interests into account.
Severe inability to enjoy recreational
What do you do for enjoyment? activities and interests 5
How often do you do that (those things)?
Have you been attending recreational therapy?
What have you been doing?
Do you enjoy it?
49
Sexual Interest and Activity
The subject may show a decrement in sexual No inability to enjoy sex 0 CA148
interest and activity or enjoyment as would be judged
normal for the subject's age and marital status. Questionable loss of ability to enjoy
Individuals who are married may manifest disinterest sex 1
in sex or may engage in intercourse only at the
partner's request. In extreme cases the subject may Mild but definite loss of ability to
not engage in sex at all. Single subjects may go for enjoy sex 2
long periods of time without sexual involvement and
make no effort to satisfy this drive. Whether married Moderate loss of ability to enjoy sex 3
or single, they may report that they subjectively feel
only minimal sex drive or they take little enjoyment in Marked loss of ability to enjoy sex 4
sexual intercourse or in masturbatory activity even
when they engage in it. Severe loss of ability to enjoy sex 5
What has your sex drive been like?
Have you been able to enjoy sex lately?
(What is your usual sexual outlet?)
(When was the last time?)
Ability To Feel Intimacy and Closeness

The subject may display an inability to form close No difficulty in the ability to feel
and intimate relationships of a type appropriate for intimacy/closeness 0 CA149
his age, sex and family status. In the case of a
younger person, this area should be rated in terms of Questionable ability to feel intimacy
relationships with the opposite sex, and with parents and closeness 1
and siblings. In the case of an older person who is
married, the relationship with spouse and with Mild but definite inability to feel
children should be evaluated, while older unmarried intimacy and closeness 2
individuals should be judged in terms of relationships
with the opposite sex and any family members who Moderate inability to feel intimacy
live nearby. Subjects may display few or no feelings and closeness 3
of affection to available family members. Or they
may have arranged their lives so that they are Marked inability to feel intimacy and
completely isolated from any intimate relationships, closeness 4
living alone and making no effort to initiate contacts
with family or members of the opposite sex. If the Severe inability to feel intimacy and
subject is homosexual, then relationships with closeness 5
members of the same sex may be rated as
indications of ability to feel intimacy and closeness.
Do you feel close to your family - (husband, wife,

children)?
Is there anyone outside your family that you feel

especially close to?
How often do you see (them, him, her)?
50
Relationships with Friends and Peers
Subjects may also be relatively restricted in their No inability to form or maintain
relationships with friends and peers of either sex. friendships 0 CA150
They may have few or no friends, make little or no
effort to develop such relationships, and choose to Questionable inability to form or
spend all or most of their time alone. maintain friendships 1
Do you have many friends? Mild but definite inability to form or

maintain friendships 2
Are you very close to them?
Moderate inability to form or
How often do you see them? maintain friendships 3
(What do you do together?) Marked inability to form or maintain

friendships 4
Have you gotten to know any subjects in the
hospital? Severe inability to form or maintain
friendships 5
Do you spend much time with them?
Global Rating of Anhedonia-Asociality

The global rating should reflect the overall severity of No evidence of anhedonia-asociality 0 CA151
the anhedonia-asociality complex, taking into
account the norms appropriate for the subject's age, Questionable evidence of
sex and family status. anhedonia-asociality 1
Mild but definite evidence of

anhedonia-asociality 2
Moderate evidence of anhedonia-

asociality 3
Marked evidence of anhedonia-

asociality 4
Severe evidence of anhedonia-

asociality 5
51
Attention
Attention is often poor in psychotic subjects. The subject may have trouble focusing his attention, or he may only be able
to focus sporadically and erratically. He may ignore attempts to converse with him, wander away while in the middle of an
activity or task, or appear to be inattentive when engaged in formal testing or interviewing. He may or may not be aware of
his difficulty in focusing his attention.
Social Inattentiveness
While involved in social situations or activities, the No indication of inattentiveness 0 CA152
subject appears inattentive. He looks away during
conversations, does not pick up the topic during a Questionable signs of
discussion, or appears uninvolved or disengaged. inattentiveness 1
He may abruptly terminate a discussion or a task
without any apparent reason. He may seem Mild but definite signs of
"spacey" or "out of it." He may seem to have poor inattentiveness 2
concentration when playing games, reading, or
watching TV. Moderate signs of inattentiveness 3
Marked signs of inattentiveness 4
Severe signs of inattentiveness 5
Inattentiveness During Mental Status Testing

The subject may perform poorly on simple tests of No errors 0 CA153
intellectual functioning in spite of adequate
education and intellectual ability. This should be Questionable: No errors, but
assessed by having the subject spell "world" (or subject performs in a halting manner
some equivalent five letter word) backwards and by or makes and corrects an error 1
serial 7's (at least a tenth grade education) or serial
3's (at least a sixth grade education) for a series of Mild but definite (one error) 2
five subtractions. A perfect score is 10.
Moderate (two errors) 3
Marked (three errors) 4
Severe (more than three errors) 5
Informant 9
Global Rating of Attention

This rating should assess the subject's overall No indications of inattentiveness 0 CA154
ability to attend or concentrate and include both
clinical appearance and performance on tasks. Questionable 1
Mild but definite inattentiveness 2
Moderate inattentiveness 3
Marked inattentiveness 4
Severe inattentiveness 5
52
Duration of Psychotic Syndrome
Record duration in weeks, from onset of first symptom of the current psychotic syndrome. In subjects who have been
chronically ill and never achieved full remission, this item should be rated from age of onset. A remission is defined as a
period in which no positive, negative or mood symptoms would be judged to be more than of mild severity for a period of at
least two months. If the subject has had clear exacerbations and remissions, this item should be rated from the time of
onset of the most recent episode. In identifying onset of first symptom, include prodromal symptoms (social isolation,
impairment in role functioning, peculiar behavior, impaired hygiene and grooming, blunted affect, digressive or vague
speech, odd or magical thinking, and unusual perceptual experiences such as illusions). If subject has met criteria for
either manic or depressive syndrome prior to and during the onset of psychotic symptoms, record date of onset of first
symptom as that date when positive psychotic symptoms first appeared in the current episode.
Record duration in weeks from the onset of the full syndrome in the current illness to the date that symptoms clear or
discharge date if subject remains acutely ill. In identifying onset of full syndrome, use only florid psychotic symptoms
(delusions, hallucinations, catatonic motor behavior, bizarre behavior, or positive formal thought disorder); a global rating
of three or greater on any one of these is sufficient to constitute a full syndrome. If multiple symptoms are present, record
longest duration.
Was there a psychotic syndrome? No 0 CA155

Skip to Current Symptom
When did ... begin? Factors
Yes 1
Date of onset of first symptom __ __ /__ __ /__ __ CA156
Duration since onset of first symptom (in weeks) __ __ __ CA157
Date of onset of full syndrome __ __ /__ __ /__ __ CA158
Duration since onset of full syndrome (in weeks) __ __ __ CA159
Remains in Syndrome No 0 CA160

Yes 1
Role of Precipitants
Determine whether symptoms present during the past month occurred after some significant stressor, such as loss of job,
breakup of a significant relationship, etc. If the current symptoms have been present for more than the past month,
determine when the symptoms began and if there were any significant stressors prior to the onset of the psychotic
symptoms.
Did anything happen to upset you just before ... No evidence of a stressor 0 CA161
started?
Questionable mild stressor (e.g.,
(Were you having any trouble at home?) fighting with parents or wife,
argument with boss) 1
(At work?)
Definite stressor (e.g., marital
Specify and describe the nature of the stressor(s). separation or divorce, loss of job,
expelled from or failed in school) 2
53
Role of "Organic" Factors
The term "organic" is recognized to be unsatisfactory because it arbitrarily introduces a "mind-body distinction," but no
suitable substitution has as yet been proposed. It is used herein simply to refer to "physical" causes of "mental"
abnormalities such as substance abuse or nonpsychiatric medical illnesses.
Determine whether symptoms are due to some clearly identifiable "organic" factor, such as alcohol or drug abuse,
metabolic or endocrine disease, etc. This judgment will involve consideration of the chronological relationship between the
onset of symptoms and the relevant "organic" factor; the mere coexistence of symptoms and a possible "organic" factor
does not indicate that the "organic" factor is etiologic. For example, a young person who abuses hallucinogens, becomes
psychotic, and remains psychotic for two months after taking the hallucinogens would probably not be considered to be
psychotic due to an "organic" factor after remaining drug free for so long. Likewise, a depressed woman who has had
myxedema and who remains depressed two months after her thyroid status is normal would not be considered to be
depressed due to an "organic" factor.
Have you had any illnesses recently? No evidence of an "organic" etiologic

factor 0 CA162
Have you been taking any medications for them?
Questionable evidence of an
Have you been drinking at all? How much? "organic" etiologic factor (e.g., heavy
tranquilizer use in a depressed
Have you been using drugs? Which ones? How person, recent use of marijuana
much? several times per week) 1
Specify and describe the nature of the "organic" Definite evidence of an "organic"
factor(s). etiologic factor (onset of psychosis
after hallucinogens, onset of mania
after beginning steroid treatment) 2
Current Symptom Factors

Using the information collected in the Evaluation of Current Symptoms, classify the subject's current psychotic symptoms
into one of the following categories. These ratings should be made descriptively, without trying to infer what the symptom
pattern may have been had the subject remained untreated.
Predominantly Positive
The subject must have a global rating of "marked" or "severe" for delusions or 1 CA163
hallucinations, but no more than one global rating of marked or severe for any of the four
negative symptoms (affective flattening, alogia, avolition, and anhedonia).
Predominantly Negative
The subject must have a global rating of "marked" or "severe" on at least two of the 2
negative symptom categories (affective flattening, alogia, avolition, and anhedonia). The
global rating of delusions and hallucinations must not be scored as "marked" or "severe."
Mixed High
The subject meets criteria for both; positive (delusions or hallucinations) and negative 3
(affective flattening, alogia, avolition, anhedonia) symptom patterns rated "marked" or
"severe."
Mixed Low
The subject is not predominantly positive, negative, or mixed high. 4
54
MANIC SYNDROME
The symptoms described in this section may be present in disorders other than the affective disorders. The presence or
absence of these symptoms should be rated irrespective of the subject's prevailing mood. However, in order to diagnose
manic syndrome, the rater must establish the presence of a manic mood and a clustering of manic symptoms correlated
with that mood.
Euphoric Mood
Has had one or more distinct periods of euphoric, None 0 CA164
irritable, or expansive mood, not due to alcohol or Skip to Manic Syndrome--Symptoms
drug intoxication.
Questionable: Feels "up" or is
Have you been having any periods when you felt snappish but this is not striking to
extremely good or high - clearly different from your the observer 1
normal self? Skip to Manic Syndrome--Symptoms
Did your friends or family think this was more than Mild: Excessive cheerfulness; to
just feeling good? observer mood is clearly better than
a normal good mood; irritability
What about periods when you felt irritable and easily noticeable and bothersome to
annoyed? others; effusive feelings of warmth,
camaraderie, love that are out of
How long did this mood last? place; exaggerated benevolence 2
Moderate: Unjustified elation

(though subject may contrive an
explanation), e.g., always cracking
jokes; highly irritable, quick
tempered, argumentative,
moderately expansive 3
Marked: Extremely euphoric;

aggressive irritability, very angry at
any thwarting (may be transitorily
violent) 4
Severe: Exalted; rage when

thwarted (may go on rampage); very
expansive, e.g., goes around
blessing people 5
Code in days if duration is less than one week ___ CA165

OR
Code number of weeks if duration is one week or more ___ ___ ___ CA166
(Do not code days and weeks--leave one blank)
No Yes
Predominant nature of mood Euphoric 0 1 CA167
Irritable 0 1 CA168
Expansive 0 1 CA169
(More than one may be coded if present to at least a moderate degree.)
55
Symptoms
Increase in Activity
Consider changes in involvement or activity level None 0 CA170
associated with work, family, friends, sex drive, new
projects, interests, or activities (e.g., telephone calls, Questionable 1
letter writing).
Mild: Definite increase in general
Was there a time when you were more active or activity level in one or two areas,
involved in things compared to the way you usually e.g., does more house cleaning,
are? more productive at work; physically
restless; notices difficulty sitting still 2
(How about at work, at home, with your friends, or
with your family?) Moderate: Generalized increase in
activity level involving several areas;
(What about your involvement in hobbies or other pacing, but is interruptible 3
interests?)
Marked: Almost constantly involved
Were there times when you were unable to sit still or in numerous activities in many
you always had to be moving, or pacing up and areas; frequent persistent pacing 4
down?
Severe: Ceaseless activity in a wide
variety of activities, unpredictable
shifts in activity with little or no task
completion; frenzied, may need to
be restrained to keep from
exhausting himself 5
Increased Talkativeness/Pressure of Speech

Accelerated, pressured, or increased amounts of None 0 CA171
speech.
Questionable 1
Were there times when you spoke very rapidly or
talked on and on and could not be stopped? Mild: Slight pressure of speech,
some slight increase in amount,
(Did you feel as if you were under pressure to keep speed, or loudness of speech 2
talking?)
Moderate: Usually takes a minute or
(Did you have so much to say that you couldn't get it two to answer simple questions,
all out soon enough?) may talk when no one is listening,
and/or speaks loudly and rapidly 3
Rating of this item will often depend more heavily on
observation than on the subject's self report. Marked: Frequently takes as much
as three minutes to answer simple
questions; sometimes begins talking
without social stimulation, and/or is
difficult to interrupt 4
Severe: Subject talks almost

continually; is very difficult to
interrupt, and/or may shout to drown
out the speech of others 5
56
Racing Thoughts/Flight of Ideas
Subjective experience that thinking was markedly None 0 CA172
accelerated. Example: "My thoughts are ahead of
my speech." Questionable 1
Were there times when your thoughts raced through Mild: Thoughts more rapid than
your mind? usual 2
Did you have more ideas than usual? Moderate: Thoughts seem to race 3
Marked: Thoughts occur so quickly

that they are difficult to follow 4
Severe: Thoughts occur so quickly

that they are incomprehensible 5
Inflated Self-Esteem
Increased self-esteem and appraisal of his worth, None 0 CA173
contacts, influence, power, or knowledge (may be
delusional) as compared with his usual level. Questionable 1
Persecutory delusions should not be considered
evidence of grandiosity unless the subject feels Mild: Definite inflated self-esteem or
persecution is due to some special attributes (e.g., exaggerates talents somewhat out
power, knowledge, or contacts). of proportion to circumstances 2
Have you felt more self-confident than usual? Moderate: Inflated self-esteem
clearly out of proportion to
(What about special plans?) circumstances 3
Have you felt you are a particularly important person Marked: Clear grandiosity of
or that you have special talents or abilities? delusional proportions 4
Severe: Persistently preoccupied

with, or acts on the basis of,
grandiose delusions 5
Decreased Need for Sleep

Less sleep than usual needed to feel rested (this None 0 CA174
rating should be based on the average of several
days rather than a single severe night). Questionable 1
Have you needed less sleep than usual to feel Mild: Up to two hours less than
rested? usual 2
(How much sleep do you ordinarily need?) Moderate: Up to three hours less
than usual 3
(How much sleep do you need now?)
Marked: Up to four hours less than
usual 4
Severe: Four or more hours less

than usual 5
57
Distractibility
Attention too easily drawn to unimportant or None 0 CA175
irrelevant external stimuli. For example, the subject
gets up and inspects some item in the room while Questionable 1
talking or listening, shifts his topic of speech, etc.
This should be used to rate distraction by external Mild: Occasional distractions
stimuli. reported, or is distracted once
during a 45-minute interview 2
Have you found that things around you tend to
distract you? Moderate: Noticeable distractions
reported, or is distracted 2-4 times
during interview 3
Marked: Very frequent distractions 4
Severe: Subject is so distracted that

communication is difficult or
impossible 5
Poor Judgment
Excessive involvement in activities that have a high None 0 CA176
potential for painful consequences which are not
recognized, e.g., buying sprees, sexual indiscretions, Questionable 1
foolish business investments, reckless giving.
Mild: e.g., purchases several things
Have you done anything that caused trouble for you he does not need and/or can't
or your family or friends? afford; asks married co-worker out
on a date 2
Looking back now, was there anything you did that
showed poor judgment? Moderate: e.g., bounces several
checks; makes sexually suggestive
Did you do anything foolish with money? comments to strangers 3
Did you do anything sexually that was unusual for Marked: e.g., on impulse travels to
you? another city with insufficient money,
clothing, or plans; makes sexually
graphic comments to strangers 4
Severe: e.g., spends family savings

on worthless business ventures or
extravagant cars; attempts to
seduce boss's fifteen-year-old
daughter 5
58
Global Rating of Manic Behavior
The global rating should reflect the overall severity of None 0 CA177
manic behavior, including the persistence and Skip to Major Depressive Syndrome
frequency of incidents, the extent of interference to
the subject's life, and their effect on his actions Questionable 1
during the last month. Rate irrespective of length of Skip to Major Depressive Syndrome
manic mood.
Mild: Clear hypomanic syndrome 2
Moderate: Mania clearly evident

and has a noticeable effect on
person's life 3
Marked: e.g., marked euphoria with

very poor judgment, may be
delusional 4
Severe: e.g., delusional with

inappropriate behavior 5
Determination of Presence of a Manic Syndrome

These symptoms must occur together in a cluster and be present at least one week, rather than occur randomly at various
times. Euphoric Mood must be rated 3 or greater, and at least 3 symptoms (if mood is euphoric) or 4 symptoms (if
irritable/expansive) must be rated 3 or greater.
Euphoric Mood rated 3 or greater for at least one week? No 0 CA178

Yes 1
Total number of symptoms rated 3 or greater ___ CA179
Were criteria met for a manic syndrome? No 0 CA180

Skip to Major Depressive
Syndrome
Yes 1
Duration of Manic Syndrome

Episodes are considered distinct if they are separated by a well period lasting at least four weeks, which is determined
independent of medication status. Record for current episode only. Record duration in weeks, from onset of first
symptom and from onset of full syndrome, i.e., euphoric mood plus at least 3 symptoms (4 if mood is irritable).
Remains in syndrome? No 0 CA185

Yes 1
59
Determine whether symptoms occurred after some significant stressor, such as loss of job, breakup of a significant
relationship, etc. If the current symptoms have been present for more than the past month, determine when the symptoms
began and if there were any significant stressors prior to the onset of the manic syndrome.
Did anything happen to upset you just before you No evidence of a stressor 0 CA186
began having problems?
Questionable mild stressor, e.g.,
argument with boss 1
(At work?)
Definite stressor, e.g., marital
Specify and describe the nature of the stressor(s). separation or divorce, loss of job,
expelled from or failed in school 2

Determine whether symptoms are due to some clearly identifiable "organic" factor, such as alcohol or drug abuse,
metabolic or endocrine disease, etc. This judgment will involve consideration of the chronological relationship between the
onset of symptoms and the relevant "organic" factor; the mere coexistence of symptoms and a possible "organic" factor
does not indicate that the "organic" factor is etiologic.

factor 0 CA187
Have you been drinking at all? How much? "organic" etiologic factor, e.g., recent
use of amphetamines or
Have you been using any drugs or medication? hallucinogens, but lacking clean
temporal relationship to onset of
mania 1
Definite evidence of an "organic"

etiologic factor of etiologic
significance (onset of mania after
beginning steroid treatment) 2
60
MAJOR DEPRESSIVE SYNDROME
The symptoms described in this section may be present in disorders other than the affective disorders. The presence or
absence of these symptoms should be rated irrespective of the subject's prevailing mood. However, in order to diagnose
major depressive syndrome, the rater must establish the presence of a depressive mood and a clustering of depressive
symptoms within that mood.
Dysphoric Mood
The subject feels sad, despondent, discouraged, or Not at all 0 CA188
unhappy; significant anxiety or tense irritability should Skip to Major Depressive Syndrome--
also be rated as a dysphoric mood. The rating Symptoms
should be made irrespective of length of mood.
Questionable 1
Have you been having periods of feeling depressed, Skip to Major Depressive Syndrome--
sad or hopeless? When you didn't care about Symptoms
anything or couldn't enjoy anything?
Mild: A general dissatisfaction colors
Have you felt tense, anxious, or irritable? the subject's mood 2
(How long did this last?) Moderate: Dysphoria pervades the

subject's life, preventing him from
(Was the mood....?) entering with enthusiasm into normal
activities 3
Marked: Dysphoria present during 85%

of subject's waking hours 4
Severe: Subject is continually hampered

by dysphoric mood 5
Code in days if duration is less than one week ___ CA189

OR
Code number of weeks if duration is one week or more ___ ___ ___ CA190
(Do not code days and weeks--leave one blank)
No Yes
Predominant nature of mood Dysphoric 0 1 CA191
Anxious 0 1 CA192
61
SYMPTOMS
Change in Appetite or Weight
Significant weight loss should not include dieting, None 0 CA193
unless the dieting is associated with some Skip to Insomnia or Hypersomnia
depressive belief that approaches delusional
proportions. Questionable 1
Skip to Insomnia or Hypersomnia
Did you have any changes in your appetite - either
increase or decrease? Mild: Slight but noticeable change in
appetite 2
Did you lose or gain much more weight than is usual
for you? Moderate: Definite change in appetite
with some weight loss or gain 3
Marked: Continual poor appetite with

significant weight loss or gain (i.e., 5% of
normal body weight) 4
Severe: Severe loss of appetite or

excessive eating, leading to substantial
weight loss or gain (i.e., greater than 5%
of normal body weight) 5
Direction of change: No Yes

Increased appetite 0 1 CA194
Weight gain 0 1 CA195
Decreased appetite 0 1 CA196
Weight loss 0 1 CA197
Record amount gained

or lost during past month(kg.) __ __ __ CA198
Insomnia or Hypersomnia
Insomnia may include waking up after only a few None 0 CA199
hours of sleep, as well as difficulty in getting to sleep. Skip to Psychomotor Agitation
Have you had trouble sleeping? Questionable 1

Skip to Psychomotor Agitation
(What was it like?)
Mild: Sleeps one hour more or less than
(Do you have trouble falling asleep?) usual 2
(Do you wake up too early in the morning?) Moderate: Sleeps two hours more or
less than usual 3
Have you been sleeping more than usual?
Marked: Sleeps three hours more or
How much sleep do you get in a typical 24-hour less than usual 4
period?
Severe: Sleeps four hours more or less
than usual 5
62
Direction of change: No Yes
Increased amount of sleep 0 1 CA200
Decreased amount of sleep 0 1 CA201
If insomnia is present, note pattern:
Initial: Difficulty falling asleep and is

awake for at least one hour, or is
awake for an hour or two during initial
phase of his typical sleep cycle 0 1 CA202
Middle: Awakens in middle of night

and is awake for at least one hour, or
is awake for an hour or two during
middle phase of his typical sleep cycle 0 1 CA203
Terminal: Awakens at least one hour

before customary time, or is awake for
an hour or two during the terminal
phase of his typical sleep cycle 0 1 CA204
Psychomotor Agitation*
Being unable to sit still with a need to keep moving. None 0 CA205
Do not include mere subjective feelings of
restlessness. Objective evidence should be present Questionable 1
(e.g., handwringing, fidgeting, pacing).
Mild: Some occasional evidence of
Have you felt restless or agitated? Do you have agitation, fidgets, unable to sit still 2
trouble sitting still?
Moderate: e.g., physical signs of
agitation frequently present 3
Marked: e.g., signs of agitation

present most of the time 4
Severe: Constantly agitated while

awake 5
Psychomotor Retardation*
Feeling slowed down and experiencing great difficulty None 0 CA206
moving. Do not include mere subjective feelings of
being slowed down. Objective evidence (slowed Questionable 1
speech) should be present.
Mild: Slight retardation 2
Have you been slowed down?
Moderate: e.g., noticeably slowed
rate of speech 3
* Psychomotor agitation and/or retardation count as one Marked: e.g., moves and speaks
symptom toward meeting criteria for presence of the very slowly 4
depressive syndrome.
Severe: Sits in one position for
hours 5
63
Loss of Interest or Pleasure
Loss of interest or pleasure in usual activities, or a None 0 CA207
decrease in sexual drive, not limited to a period
when delusional or hallucinating. Questionable 1
Have you noticed a change in your interest in things? Mild: Occasional loss of interest or
decreased sex drive 2
What kinds of things do you normally enjoy?
Moderate: Interest diminished in
several activities usually engaged in 3
Marked: Minimal interest; rarely

enjoys self 4
Severe: Pleasure and/or interest

completely lacking for usual
activities 5
Loss of Energy
This symptom includes loss of energy, becoming None 0 CA208
easily fatigued, or feeling tired. These energy
comparisons should be based upon the person's Questionable 1
usual activity level whenever possible.
Mild: Slight energy loss or fatigue 2
Have you had a tendency to feel more tired than
usual? Moderate: Definite decrease in
energy; fatigues easily 3
(Have you been feeling as if all your energy is
drained?) Marked: Feels exhausted most of
the time 4
Severe: Severe decrease in energy;

unable to perform most customary
activities 5
Feelings of Worthlessness
In addition to feelings of worthlessness, subject may None 0 CA209
report feeling self-reproach, or excessive or
inappropriate guilt. (Either may be delusional.) Questionable 1
Have you been feeling down on yourself? Mild: Frequent feelings of

worthlessness 2
Have you been feeling guilty about anything?
Moderate: Pervasive feelings of
(Could you tell me about some of the things for worthlessness, some feelings of
which you feel guilty?) inappropriate guilt 3
Marked: Excessive and

inappropriate guilt 4
Severe: Guilt feelings pervade the

subject's life and are of delusional
proportions 5
64
Diminished Ability To Think or Concentrate
Complaints or experience of diminished ability to None 0 CA210
think or concentrate, such as slowed thinking or
indecisiveness; not associated with marked Questionable 1
derailment or incoherence.
Mild: Some lack of ability to
Have you had trouble thinking? concentrate 2
What about your concentration? Moderate: Noticeable impairment of

ability to concentrate 3
Have you had trouble making decisions?
Marked: Interferes with work or
most daily activities (e.g., reading,
watching TV) 4
Severe: Unable to do the simplest

task because of inability to think or
concentrate 5
Recurrent Thoughts of Death/Suicide

Thoughts about death and suicide, plus possible None 0 CA211
wishes to be dead and/or suicide attempts. Skip to Determination of a Presence
of a Depressive Syndrome
Have you been thinking about death, or about taking
your own life? Questionable 1
Skip to Determination of a Presence
(How often have these thoughts occurred?) of a Depressive Syndrome
If yes, inquire for more details. Mild: Occasional thought of death

and/or suicide without suicide plans
or attempts 2
Moderate: Frequent thought of death

and/or suicide, but without suicide
plans or recent suicide attempt 3
Marked: Frequent thoughts of death

or suicide, including suicide plans
and/or recent non-life-threatening
suicide gesture, or continual thoughts
of death or suicide without suicide
plans or recent attempt 4
Severe: Continual thoughts of death

and suicide, with suicide plans and/or
recent life-threatening suicide
attempt, considered to be at high risk
for harming self 5
65
Suicide Attempts No 0 CA212
Skip to Determination of a Presence of
a Depressive Syndrome
Yes 1
Number of attempts ___ ___ CA213
Suicidal Intent at Time of Most Serious Attempt Mild: A few pills, superficial wrist
slashing 1 CA214
Moderate: Potentially dangerous

overdose; deep wrist slashing 2
Severe: Massive overdose; gun shot;

attempted hanging 3
Determination of a Presence of Depressive Syndrome
These symptoms must occur together in a cluster and be present at least two weeks, rather than occurring randomly at
various times. Dysphoric Mood must be rated 3 or greater and at least 4 other symptoms must be rated 3 or greater in
order to rate the presence of a depressive syndrome. Do not count quality of mood, nonreactivity of mood, and diurnal
variation.
Dysphoric Mood rated 3 or greater for at least two weeks? No 0 CA215

Yes 1
Total number of symptoms rated 3 or greater __ CA216
Were criteria for a depressive syndrome met? No 0 CA217

Skip to Treatment
Yes 1
Other Depressive Symptoms
These additional symptoms may be rated in order to assist in determining whether the depressive syndrome is
endogenous or melancholic (using RDC, DSM III, or other criteria).
Distinct Quality to Mood

Depressed mood is experienced as distinctly No difference, or just more severe 0 CA218
different from the kind of feelings experienced after
the death of a loved one. If the subject has not lost Questionably different 1
a loved one, ask him to compare the feelings to
those after some significant personal loss Definitely different 2
appropriate to his age and experience.
The feelings of (sadness) you are having now - are

they the same as the feelings you would have had
when someone close to you died, or are they
different?
How are they similar or different?
66
Nonreactivity of Mood
Doesn't feel much better even temporarily, when Very responsive to pleasant stimuli 0 CA219
something good happens.
Usually responsive 1
Do your feelings of depression go away or get better
when you do something you enjoy - like talking with Often responsive 2
friends, visiting your family, or (mention some
favorite recreation)? Responds slightly, but still feels
depressed 3
Can anything cheer you up?
Rarely feels better 4
(Does that make you feel back to your normal self?)
Completely unresponsive 5
Diurnal Variation
Extent to which the mood shifts during the course of Worse in morning 1 CA220
the day. Some subjects feel terrible in the morning,
but steadily better as the day goes on, and even near Worse in evening 2
normal in the evening. Others feel good in the
morning and worse as the day progresses. No difference 3
Is there any time of the day that is especially bad for

you?
(Do you feel worse in the morning?) (In the

evening?)
(Or is it about the same all the time?)
Global Rating of Major Depressive Syndrome

The global rating of major depressive syndrome Mild: Meets criteria, but able to
should be based on persistence and severity of the maintain major role functioning and
depressive symptoms, the extent of the subject's general activities 2 CA221
preoccupation with the depression, and the
depression's affect on his actions. Moderate: Definite effect in
functioning either socially or
occupationally 3
Marked: Unable to maintain major

role functioning (e.g., unable to go to
work or when there can't accomplish
anything) 4
Severe: Unable to function in nearly

all aspects of daily life (e.g.,
depressive stupor) 5
67
Duration of Depressive Syndrome
Record actual duration of this episode in weeks; record both duration since onset of first symptom and duration since full
syndrome - dysphoric mood plus at least four symptoms were present.
Remains in syndrome? No 0 CA226

Yes 1
Determine whether symptoms present during the past month occurred after some significant stressor, such as loss of job,
breakup of a significant relationship, etc. If the current symptoms have been present for more than the past month,
determine when the symptoms began and if there were any significant stressors prior to the onset of the depressive
symptoms.
Did anything happen to upset you just before you No evidence of a stressor 0 CA227
began having problems?
Questionable mild stressor (e.g.
argument with boss) 1
(At work?)
Definite stressor (e.g., marital
Specify and describe the nature of the stressors. separation or divorce, loss of job,
expelled from or failed in school) 2
68
Determine whether symptoms are due to some clearly identifiable factor, such as alcohol or drug abuse, metabolic or
endocrine disease, etc. This judgment will involve consideration of the chronological relationship between the onset of
symptoms and the relevant factor; the mere coexistence of symptoms and a possible physical factor does not indicate that
the factor is etiologic. For example, a depressed woman who has had myxedema and who remains depressed two
months after the thyroid status is normal would not be considered to be depressed due to an "organic" factor.

factor 0 CA228
Have you been drinking at all? How much? "organic" etiologic factor, e.g., heavy
tranquilizer use in a depressed
Have you been using any drugs or medications? person 1
Definite evidence of an "organic"

etiologic factor (onset of psychosis
after hallucinogens) 2
69
TREATMENT
Indicate the various types of treatment the subject is currently receiving or has received during the past month. List all
drugs by specific name, and record dose, dates, and duration of dose. Detailed information concerning recent treatment
may be coded using the PSYCH.
Neuroleptics No Yes
Note types, doses, and responses in as much detail as possible 0 1 CA229
Antidepressants (Heterocyclic; including Tricyclic)

Antidepressants (MAO Inhibitors)

Anxiolytics
Lithium
Tegretol
ECT
Note dates and response 0 1 CA235
70
Other
Hospitalized
(Include institutional care, but exclude group homes, halfway No 0 CA236
houses and supervised apartments) Skip to Outpatient Treatment
Yes 1
Duration in days (note dates) from beginning of hospitalization
until discharge. (If directly transferred from another hospital, __ __ __ __ CA237
include length of time at that hospital also.)
Outpatient Treatment
Do not include Alcoholics Anonymous. No 0 CA238
Yes 1
Symptoms of Tardive Dyskinesia

If present, use a detailed instrument such as the AIMS to document types No 0 CA239
of abnormal movements. Skip to Cognitive Assessment
Yes 1
Age of onset ___ ___ CA240
Estimated duration of symptoms (in months) ___ ___ ___ CA241
Estimated number of months on neuroleptics prior to onset ___ ___ ___ CA242
71
Cognitive Assessment
Handedness and Laterality Data*
Do you consider yourself Right-Handed 1 CA243

Left-Handed 2
Mixed-Handed 3
No Yes
Have you ever been forced to change your hand preference? 0 1 CA244
Do you prefer to use your right hand for most skilled activities? 0 1 CA245
Which hand do you usually prefer to use for the following RIGHT LEFT EITHER
activities?
Writing 1 2 3 CA246
Throwing a ball a long distance 1 2 3 CA247
Swinging a golf club, baseball bat, etc. 1 2 3 CA248
Holding a knife to carve meat 1 2 3 CA249
Hammering a nail 1 2 3 CA250
Turning a screwdriver 1 2 3 CA251
Using a toothbrush 1 2 3 CA252
Dealing cards or tossing a light object a short distance for 1 2 3 CA253

accuracy
Cutting with a scissors 1 2 3 CA254
Using a needle in sewing or tweezers to remove a splinter 1 2 3 CA255
Subject's Handedness Right (uses right hand for most activities) 1 CA256
Left (uses left hand for most activities) 2
Mixed (no clear dominance of right or left

hand; e.g., uses left for writing, but right for
two or three other motor activities) 3
Do you consider your biological mother Right-handed 1 CA257

Left-handed 2
Mixed-handed 3
Don't know 9
Do you consider your biological father Right-handed 1 CA258

Left-handed 2
Mixed-handed 3
Don't know 9
Note: Count full and half siblings only. Do not count step or
adopted siblings. Enter 99 for unknown.
72
How many brothers (blood relations only) do you Number of right-handed brothers __ __ CA259
have?
Number of left-handed brothers __ __ CA260
Is he (are they) right or left-handed?
Number of mixed-handed brothers __ __ CA261
How many sisters (blood relations only) do you Number of right-handed sisters __ __ CA262
have?
Number of left-handed sisters __ __ CA263
Is she (are they) right or left-handed?
Number of mixed-handed sisters __ __ CA264
How many sons do you have? Number of right-handed sons __ __ CA265
Is he (are they) right or left-handed? Number of left-handed sons __ __ CA266
Number of mixed-handed sons __ __ CA267
How many daughters do you have? Number of right-handed daughters __ __ CA268
Is she (are they) right or left-handed? Number of left-handed daughters __ __ CA269
Number of mixed-handed daughters__ __ CA270
Is your husband/wife No Spouse 0 CA271

Right-handed 1
Left-handed 2
Mixed-handed 3
Unknown 9
Do you know of any (other) left or mixed- No 0 CA272

handedness in your biological family? (Include
grandparents, aunts, uncles, nieces, nephews.) Yes 1
Unknown 9
Family handedness: (First degree biological relatives Right-handed 1 CA273

excluding the subject. If anyone in family is left Left-handed 2
handed, classify as left; if anyone mixed, classify as Mixed-handed 3
mixed. If family has both left and mixed members, Unknown 9
classify as mixed.)
*Adapted, with permission, from Benton, A.L., Problems of test construction in the field of aphasia. Cortex 3:32-58, 1967.
73
MODIFIED MINI-MENTAL STATUS EXAMINATION*
This section may be skipped if the subject is an informant. Is this subject an No 0 CA274
informant (i.e., being interviewed about a specific subject's symptoms rather than
his own)? Yes 1
Skip to Global
Assessment Scale
Maximum Score
Score
Orientation
5 What is the (year) (season) (date) (day) (month)? ___ CA275
5 Where are we (state) (county) (town) (hospital) (floor)? ___ CA276
3 Registration
Name three objects or concepts for the subject (e.g., fish hook,
shoe, green): one second to say each. ___ CA277
Ask the subject all three after you have said them.
Give one point for each correct answer and count and record the
number of trials after the first attempt for the mental status score.
Repeat them until he learns all three.
10 Attention and Calculation
Serial 7's. One point for each correct. Stop after five answers. ___ CA278
- and -
Spell "world" (or some other 5-letter word) backwards.
One point for each letter in correct order. ___ CA279
3 Recall
Ask for the three objects repeated above. One point for each correct. ___ CA280
Language
2 Name a pencil and watch. (two points) ___ CA281
1 Repeat the following: "No ifs, ands, or buts." (one point) ___ CA282
3 Follow a three-stage command: ___ CA283

"Take a paper in your right hand, fold it in half, and put it on the
floor." (three points)
74
Read and obey the following:
1 Close your eyes (one point) ___ CA284
1 Write a sentence (one point) ___ CA285
1 Copy design. (one point) ___ CA286
TOTAL SCORE (35 possible) ___ ___ CA287
ASSESS LEVEL OF CONSCIOUSNESS: Alert 1 CA288

Drowsy 2
Stupor 3
*Adapted, with permission, from Folstein, M.F., Folstein, S.E., McHugh, P., "Mini Mental State:" A practical method for
grading the cognitive state of patients for the clinician, Journal of Psychiatric Research 12:189-198, 1975
75
GLOBAL ASSESSMENT SCALE*
Rate subject's lowest level of functioning during the past month (or at time of admission if hospitalized). Also rate
at time of discharge if hospitalized. Rate actual functioning regardless of treatment or prognosis.
100 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 warmth and integrity. No symptoms.
91
90 Good functioning in all areas, many interests, socially effective, generally satisfied with life.
| There may or may not be transient symptoms and "everyday" worries that only occasionally get
81 out of hand.
80 No more than slight impairment in functioning, varying degrees of "everyday" worries and
| problems that sometimes get out of hand. Minimal symptoms may or may not be present.
71
70 Some mild symptoms (e.g., depressive mood and mild insomnia) OR some difficulty in several
| areas of functioning, but generally functioning pretty well, has some meaningful interpersonal
61 relationships and most untrained people would not consider him "sick."
60 Moderate symptoms OR generally functioning with some difficulty (e.g., few friends and flat
| affect, depressed mood and pathological self-doubt, euphoric mood and pressure of speech),
51 moderately severe antisocial behavior.
50 Any serious symptomatology or impairment in functioning that most clinicians would think
| obviously requires treatment or attention (e.g., suicidal preoccupation or gesture, severe
| obsessional rituals, frequent anxiety attacks, serious antisocial behavior, compulsive drinking,
41 mild but definite manic syndrome).
40 Major impairment in several areas, such as work, family relations, judgment, thinking or mood
| (e.g., depressed woman avoids friends, neglects family, unable to do housework), OR some
| impairment in reality testing or communication (e.g., speech is at times obscure, illogical, or
31 irrelevant), OR single suicide attempt.
30 Unable to function in almost all areas (e.g., stays in bed all day) OR behavior is considerably
| influenced by either delusions or hallucinations OR serious impairment in communication (e.g.,
21 sometimes incoherent or unresponsive) or judgment (e.g., acts grossly inappropriate.)
20 Needs some supervision to prevent hurting self or others, or to maintain minimal personal
| hygiene (e.g., repeated suicide attempts, frequently violent, manic excitement, smears feces),
11 OR gross impairment in communication (e.g., largely incoherent or mute).
10 Needs constant supervision for several days to prevent hurting self or others or makes no
| attempt to maintain minimal personal hygiene or serious suicide act with clear intent and
1 expectation of death.
76
Is subject hospitalized? No 0 CA289
Complete Worst during past month only
Yes 1
Skip to GAS At admission
GAS Worst during past month ___ ___ ___ CA290
GAS At admission ___ ___ ___ CA291
GAS Worst during hospitalization ___ ___ ___ CA292
GAS At discharge ___ ___ ___ CA293
*Adapted, with permission, from Endicott, J., Spitzer, R.L., Fleiss, J.L., Cohen, J., The Global Assessment Scale: A
procedure for measuring overall severity of psychiatric disturbances, Archives of General Psychiatry, 33:766-771, 1976
Reliability and Completeness of Information Contained in Part I

(If poor or very poor, data should not Very good 1 CA294
be considered useful for research Good 2
purposes.) Fair 3
Poor 4
Very poor 5
77
DIAGNOSES FOR CURRENT EPISODE
Use DSM-III, III-R, or IV for list of Axis I & II codes
Use ICD-9 for Axis III codes
Which criteria were used for diagnoses?

DSM-III 0 CA295A
DSM III-R 1
DSM IV 2
Enter number of Axis I diagnoses and code 0 CA295B

Skip to Axis II diagnoses
1
Complete one code line below only
2
Complete two code lines below only
3
Complete all three code lines below
Specify code number(s) ___ ___ ___ . ___ ___ CA296
___ ___ ___ . ___ ___ CA297
___ ___ ___ . ___ ___ CA298
Enter number of Axis II diagnoses and code 0 CA299

Skip to Axis III diagnoses
1
2
3
___ ___ ___ . ___ ___ CA301
___ ___ ___ . ___ ___ CA302
78
Enter number of Axis III diagnoses and code 0 CA303
Skip to Past History
1
2
3
___ ___ ___ . ___ ___ CA305
___ ___ ___ . ___ ___ CA306
79
PAST HISTORY
This portion of the interview is designed to summarize the past history of the subject. These ratings do not include current
condition. Because the complexities of most histories are not easily reduced to coded formats, most investigators will find
it useful if this section and the previous one are accompanied by a detailed, typewritten case narrative which provides an
overview of the subject's history and symptoms in traditional historical form and fills in some of the details that cannot be
included in an instrument designed primarily for computerized analysis.
Begin by spending five to ten minutes obtaining an overview of the subject's past history. When the subject is acutely ill,
completion of this section may have to be delayed until the subject improves. This history may have to be supplemented
by previous case records or interviews with family members. If multiple sources are used, the most positive information
should be coded. The available records should be reviewed before the Past History is begun.
After completing the initial overview using the "History of Onset and Hospitalization" section, the interviewer should
determine whether the subject's psychiatric history has been primarily psychotic, primarily manic, or primarily depressive.
History of Onset and Hospitalization

Date from initial onset of symptoms; for cases of schizophrenia with insidious onset, use indicators of incapacity, e.g.,
marked drop in grades, loss of job, etc.; if onset is very unclear, arbitrarily assign an onset date of six months prior to the
first hospitalization or six months prior to the first outpatient evaluation for those subjects who have never been
hospitalized.
Now let's talk a little about your emotional and psychological

history.
Have you ever had any emotional (psychiatric) No 0 CA307

problems before (this hospitalization)? Skip to History of Somatic Therapy p. 113
Yes 1
What kinds of problems did you have?
How old were you when you first had problems? Age of onset __ __ CA308
Did you see someone (physician, psychologist, or Number of months since onset __ __ __ CA309
other professional) about them?
Age at first outpatient care __ __ CA310
(When was the first time you saw someone for ...?)
80
Were you ever hospitalized for any nervous or No 0 CA311
emotional problems? (Excluding the current Skip to Past Symptoms of Psychosis
hospitalization and hospitalizations for drug or
alcohol abuse.) Yes 1
(How old were you the first time you were Age at first hospitalization __ __ CA312
hospitalized?)
Number of previous
(How many times have you been in the hospital?) hospitalizations __ __ CA313
(Excluding current)
Total duration of
(For how long?) hospitalizations in months __ __ __ CA314
(Where?)
(Note names of hospitals and doctors when

possible)
During the past two years (not including this Not hospitalized in the past two
hospitalization, if presently hospitalized), have you years (exclusive of the present
been to the hospital? hospitalization) 1 CA315
(How many times?) Infrequent short hospitalization

during the past two years (one to
(How long each time?) two times per year, less than three
months total) 2
Intermittently hospitalized during the

past two years (episodes outside the
hospital with at least a minimal level
of functioning interspersed with
hospitalizations on an average of
three times per year or more over
the past two years) 3
Numerous short hospitalizations or

several long hospitalizations; i.e.,
months at a time 4
Hospitalized the majority of time

during the last two years 5
81
PAST SYMPTOMS OF PSYCHOSIS
The purpose of this section is to get some sense of whether or not the subject's characteristic symptoms have changed
over the course of time. Ratings indicate if the psychotic symptoms were ever present at any time in the past. Additional
ratings indicate whether the symptoms were present during the first two years of illness and whether or not they have been
present at least fifty percent of the time since onset. Because subjects will vary in their length of illness, the arbitrary time
period of the first two years of illness (defined as the two years subsequent to the "age of onset" noted previously) was
selected. While ideally it would be desirable to know the precise symptoms during each psychotic exacerbation, in many
instances it will not be possible to collect detailed data of that type. On the other hand, the subject and/or his family
members are most likely to be able to remember the symptoms that they noticed when they first realized that he was
becoming ill.
The definitions of all items are as noted previously. Many ratings are made dichotomously rather than continuously, as it is
very difficult to rate past symptoms reliably on a continuous scale. If an item is present to a mild degree, it should be rated
as a "yes." Because negative symptoms are sometimes best evaluated by direct observation, the interviewer may need to
contact family members and review old records in order to rate these items.
The next paragraph is one approach that can be used to orient the subject to the different time periods asked about in the
Past History section. Subjects who are not very ill may not need such a step-by-step explanation, but seriously ill subjects
may need more.
The next questions I am going to ask you are basically the same kinds of questions I asked in the first part of the interview.
Rather than asking if you are experiencing these things now, I want to know if you have noticed any of these things in the
past. If you have, then I'll need to ask you two more questions: Did you notice it during the first two years after you
(became ill) and how much of the time since ... has it been present.
Let me give you an example: Have you ever had a problem (getting along with people)?
You said you first (became ill) when you were (in high school) and you were about age ...
Between (onset date to two years later) when you were age ... to ..., did you have any (trouble getting along with people)?
Have you (felt that way, had that problem) most of the time since (onset date)?
82
Delusions
(See pages 16 to 25 for complete description.)
Persecutory Delusions Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever had trouble No Yes Unknown No Yes Unknown No Yes Unknown
getting along with people?
0 1 9 0 1 9 0 1 9
CA316-CA318
Have you ever felt that people
are against you?
Has anyone ever tried to harm

you in any way?
(Did you ever think people had

been plotting against you?)
Jealousy Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever worried that your No Yes Unknown No Yes Unknown No Yes Unknown
(husband, wife, boyfriend,
girlfriend) might be unfaithful to 0 1 9 0 1 9 0 1 9
CA319-CA321
you?
(What evidence do you have?)

Guilt or Sin Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever felt that you have No Yes Unknown No Yes Unknown No Yes Unknown
done some terrible thing?
0 1 9 0 1 9 0 1 9
CA322-CA324
(What was it?)
(Do you feel that you deserve to

be punished for it?)
Grandiose Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever felt you had any No Yes Unknown No Yes Unknown No Yes Unknown
special powers, talents, or
abilities? 0 1 9 0 1 9 0 1 9
CA325-CA327
Do you feel you are going to

achieve great things?
Religious Ever Present First 2 Years of Illness Much of Time Since Onset
Are you a religious person? No Yes Unknown No Yes Unknown No Yes Unknown
Have you had any unusual 0 1 9 0 1 9 0 1 9

CA328-CA330
religious experiences?
(What was your religious

training as a child?)
Somatic Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever felt anything is No Yes Unknown No Yes Unknown No Yes Unknown
wrong with the way your body is
working? 0 1 9 0 1 9 0 1 9
CA331-CA333
Have you ever noticed any

change in your appearance?
83
Reference Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever walked into a No Yes Unknown No Yes Unknown No Yes Unknown
room and thought people were
talking about or laughing at you? 0 1 9 0 1 9 0 1 9
CA334-CA336
Have you ever seen things in

magazines or on TV that seem
to refer to you or contain a
special message for you?
Have you ever received special

messages in any other ways?
Being Controlled Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever felt you were No Yes Unknown No Yes Unknown No Yes Unknown
being controlled by some
outside force? 0 1 9 0 1 9 0 1 9
CA337-CA339
Mind Reading Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever had the feeling No Yes Unknown No Yes Unknown No Yes Unknown
that people could read your
mind or know what you are
thinking? 0 1 9 0 1 9 0 1 9
CA340-CA342
Thought Ever Present First 2 Years of Illness Much of Time Since Onset
Broadcasting/Audible No Yes Unknown No Yes Unknown No Yes Unknown
Thoughts
Have you ever heard your own
0 1 9 0 1 9 0 1 9
thoughts out loud, as if they CA343-CA345
were a voice outside your head?
Have you ever felt your thoughts

were broadcast so other people
could hear them?
Thought Insertion Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever felt that thoughts No Yes Unknown No Yes Unknown No Yes Unknown
were being put into your head
by some outside force? 0 1 9 0 1 9 0 1 9
CA346-CA348
Thought Withdrawal Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever felt your thoughts No Yes Unknown No Yes Unknown No Yes Unknown
were taken away by some
outside force?
0 1 9 0 1 9 0 1 9
CA349-CA351
84
Global Rating of Severity of Delusions
The purpose of these ratings is to provide an index of the severity of the subject's problems with delusions of any type.
When several delusions of varying severity have occurred, rate the most severe. "Worst Ever" refers to the symptom at
its most severe at any time since onset, excluding current condition. "Much of Time Since Onset" refers to the most
characteristic level since onset, i.e., the level occurring more than 50 percent of the time. Consider duration, conviction in
delusions, preoccupation, and effect on his actions. Also consider the extent to which the delusions are bizarre or
unusual. (This rating also includes any delusions not specified above.)
Did you ever think (subject's delusion)

was "all in your mind?"
How did ...effect what you did?
0 None First 2 Years Much of Time

Worst Ever of Illness Since Onset
1 Questionable 0 0 0 CA352-CA354
Skip to Hallucinations
2 Mild: Delusion definitely present, but at
times subject questions his false belief. 1 1 1
Skip to Hallucinations
3 Moderate: Generally has conviction in
false belief but delusion has little if any 2 2 2
influence on behavior
3 3 3
4 Marked: Delusion has a significant effect
on his actions, e.g., often asks family to 4 4 4
forgive his sins, preoccupied with belief
that he is a new Messiah 5 5 5
5 Severe: Actions based on delusion have

major impact on him or others, e.g.,
stops eating because he believes food is
poisoned
Sensorium While Delusional
Determine the clarity of the subject's state of None: No distortion of subject's

consciousness while delusional. This item is used to sensorium during delusional beliefs 0 CA355
identify whether some subjects are experiencing
delusions due to some physical factor, such as an Questionable 1
illness that produces delirium (e.g., fever) or the
influence of drugs (e.g. steroids, barbiturates); this is Definite: Sensorium is clouded, due
rated on item 2. This item also identifies subjects to some physical cause, i.e. drugs,
who are experiencing mental confusion and a physical illness 2
clouded sensorium without a physical cause (item 3).
Definite: Clouded sensorium, but
When you believed ... were you at all confused about not due to physical cause 3
where you were, or time of day?
Were you taking any drugs or medication?
85
Consistency of Delusions with Mood
Manic Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A MANIC SYNDROME.
Delusions Occurring in a Manic Syndrome

Determine if delusions have ever occurred in the presence of a No 0 CA356
manic mood. Skip to Consistency of Delusions with
Mood--Depressive Syndrome
Have you ever felt that (whatever the subject's delusions) when
you were feeling unusually good or high? Yes 1
Presence of Mood-Congruent Delusions No Yes Unknown

Delusions occurring during any manic episode whose content is
entirely consistent with the themes of inflated worth, power, 0 1 9 CA357
knowledge, etc.
Presence of Mood-Incongruent Delusions

Delusions occurring during any manic episode whose content 0 1 9 CA358
was not consistent with themes of inflated worth, power, etc.
Persistence of Delusions with Affective Clearing

Determine if any delusions (mood-congruent or mood- 0 1 9 CA359
incongruent) persisted more than a month after the manic
episode cleared.
How long did it seem that (subject's delusions) went on?
Did you think that (subject's delusion) was happening when you
no longer felt (high, irritable)?
Depressive Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A MAJOR DEPRESSIVE SYNDROME.
Delusions Occurring in a Depressive Syndrome

Determine if delusions have ever occurred in the presence of a No 0 CA360
dysphoric mood. Skip to Hallucinations
Have you ever felt that (whatever the subject's delusions) when Yes 1
you were feeling (depressed, anxious)?
Presence of Mood-Congruent Delusions

Delusions occurring during any major depressive episode whose No Yes Unknown
content is entirely consistent with the themes of personal
inadequacy, guilt, etc. 0 1 9 CA361
Presence of Mood-Incongruent Delusions

Delusions occurring during any major depressive episode whose 0 1 9 CA362
content was not consistent with themes of personal inadequacy,
guilt, etc.
86
Persistence of Delusions with Affective Clearing
Determine if any delusions (mood-congruent or mood- No Yes Unknown
incongruent) persisted more than a month after the depressive
episode cleared. 0 1 9 CA363
How long did it seem that (subject's delusion) went on?
Did you think that (subject's delusion) was happening when you
no longer felt (depressed, anxious)?
Hallucinations
Auditory - Voices, Noises, Ever Present First 2 Years of Illness Much of Time Since Onset
Music No Yes Unknown No Yes Unknown No Yes Unknown
Have you ever heard voices or
other sounds when no one was 0 1 9 0 1 9 0 1 9
CA364-CA366
around or when you couldn't
account for it?
Auditory - Running Ever Present First 2 Years of Illness Much of Time Since Onset
Commentary No Yes Unknown No Yes Unknown No Yes Unknown
Have you ever heard voices
offer a running commentary on 0 1 9 0 1 9 0 1 9
CA367-CA369
what you are thinking or doing?
Auditory - Two or More Voices Ever Present First 2 Years of Illness Much of Time Since Onset
Converse No Yes Unknown No Yes Unknown No Yes Unknown
Have you ever heard two or
more voices talking with each 0 1 9 0 1 9 0 1 9
CA370-CA372
other?
87
Were any voices heard? No 0 CA373
Skip to Somatic or Tactile
Yes 1
Types of Voices Heard
No Yes
God 0 1 CA374
Satan/Devil 0 1 CA375
Male 0 1 CA376
Female 0 1 CA377
Familiar 0 1 CA378
Unfamiliar 0 1 CA379
Critical 0 1 CA380
Complimentary 0 1 CA381
Commanding 0 1 CA382
Multiple 0 1 CA383
Always the same 0 1 CA384
Heard inside his head 0 1 CA385
Heard outside his head 0 1 CA386
Heard on the left side 0 1 CA387
Heard on the right side 0 1 CA388
Somatic or Tactile Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever had burning No Yes Unknown No Yes Unknown No Yes Unknown
sensations or other strange
feelings in your body? 0 1 9 0 1 9 0 1 9
CA389-CA391
(What were they?)
Did your body ever appear to

change in shape or size?
Olfactory Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever experienced any No Yes Unknown No Yes Unknown No Yes Unknown
unusual smells or smells that
others didn't notice? 0 1 9 0 1 9 0 1 9
CA392-CA394
(What were they?)
Vision Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever had visions or No Yes Unknown No Yes Unknown No Yes Unknown
seen things that other people
cannot? 0 1 9 0 1 9 0 1 9
CA395-CA397
(What did you see?)
(Did this occur when you were

falling asleep or waking up?)
88
Global Rating of Severity of Hallucinations
The purpose of these ratings is to provide an index of the severity of the subject's problem with hallucinations of any type.
When several hallucinations of varying severity have occurred, rate the most severe. "Worst Ever" refers to the symptom
at its most severe at any time since onset, excluding current condition. "Much of Time Since Onset" refers to the most
characteristic level since onset (i.e., the level occurring more than 50 percent of the time.) Severity should be based on
the extent of the subject's preoccupation with the hallucinations; their effect on his actions, frequency, and persistence.
(This rating includes hallucinations not specifically mentioned above.)
Did you ever think ... was your imagination?
What did you do about it?

Skip to Bizarre Behavior
2 Mild: Definitely present, but subject
is generally aware that it is "not real" 1 1 1
and is usually able to ignore it Skip to Bizarre Behavior
3 Moderate: Generally believes in the

reality of the hallucination but it has 2 2 2
little, if any, influence on his behavior
3 3 3
4 Marked: Convinced his hallucination
is real and has a significant effect on 4 4 4
his actions, e.g., locks doors to keep
pursuers away from him 5 5 5
5 Severe: Actions based on

hallucinations have major impact on
him or others, e.g., hears voices so
much that he is unable to work
Sensorium While Hallucinating

This item is used to identify whether some None: No distortion of subject's 0 CA401
subjects are experiencing hallucinations due to sensorium during hallucinations
some physical factor, such as an illness that
produces delirium (e.g., fever) or the influence of Questionable 1
drugs (e.g., steroids, barbiturates); this is rated on
item 2. The item also identifies subjects who are Definite: Sensorium is clouded, due to
experiencing mental confusion and a clouded some physical cause, i.e., drugs,
sensorium without a physical cause (item 3). physical illness 2
When you were ...were you at all confused about Definite: Clouded sensorium, but not
where you were or time of day? due to physical cause 3
89
Consistency of Hallucinations with Mood
Manic Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A MANIC SYNDROME
Hallucinations Occurring in a Manic Syndrome

Determine if hallucinations have ever occurred in the No 0 CA402
presence of a manic mood. Skip to Consistency of Hallucinations with Mood--
Depressive Syndrome
Have you ever felt that (whatever the hallucinations)
occurred when you were feeling (irritable, high)? Yes 1
Presence of Mood-Congruent Hallucinations No Yes Unknown

Hallucinations occurring during a manic episode
whose content is entirely consistent with the themes 0 1 9 CA403
of inflated worth or power, etc.
Presence of Mood-Incongruent Hallucinations

Hallucinations occurring during a manic episode 0 1 9 CA404
whose content was not consistent with themes of
inflated worth or power, etc.
Persistence of Hallucinations with Affective Clearing

Determine if any hallucinations (mood-congruent or 0 1 9 CA405
mood-incongruent) persisted more than a month
after the manic episode cleared.
How long did it seem that (subject's hallucination)

went on?
Was (subject's hallucination) happening when you

no longer felt (high, irritable)?
Depressive Syndrome
RATE THESE ITEMS ONLY IN SUBJECTS WITH A DEPRESSIVE SYNDROME
Hallucinations Occurring in a Depressive Syndrome

Determine if hallucinations have ever occurred in the No 0 CA406
presence of a dysphoric mood. Skip to Bizarre Behavior
Have you ever felt that (whatever the hallucinations) Yes 1

occurred when you were feeling (depressed or
anxious)?
Presence of Mood-Congruent Hallucinations No Yes Unknown

Hallucinations occurring during a major depressive
episode whose content is entirely consistent with the 0 1 9 CA407
themes of personal inadequacy, guilt, etc.
90
Presence of Mood-Incongruent Hallucinations
Hallucinations occurring during a major depressive No Yes Unknown
themes of personal inadequacy, guilt, etc. 0 1 9 CA408
Persistence of Hallucinations with Affective Clearing

Determine if any hallucinations (mood-congruent or 0 1 9 CA409
mood-incongruent) persisted more than a month
after the depressive episode cleared.
How long did it seem that (subject's hallucination)

went on?
Was (subject's hallucination) happening when you

no longer felt (depressed, anxious)?
Bizarre Behavior
Clothing and Appearance Ever Present First 2 Years of Illness Much of Time Since Onset
Has anyone ever made No Yes Unknown No Yes Unknown No Yes Unknown
comments about your
appearance? 0 1 9 0 1 9 0 1 9
CA410-CA412
Social and Sexual Behavior Ever Present First 2 Years of Illness Much of Time Since Onset
Have you ever done anything No Yes Unknown No Yes Unknown No Yes Unknown
that others might think unusual
or that has called attention to 0 1 9 0 1 9 0 1 9
CA413-CA415
yourself?
(Has anyone complained or

commented about your
behavior?)
Aggressive and Agitated Ever Present First 2 Years of Illness Much of Time Since Onset
Behavior No Yes Unknown No Yes Unknown No Yes Unknown
Have you been unusually angry
or irritable with anyone? 0 1 9 0 1 9 0 1 9
CA416-CA418
(How did you express your

anger?)
Have you done anything to harm

animals or people?
91
Ritualistic or Stereotyped Ever Present First 2 Years of Illness Much of Time Since Onset
Behavior No Yes Unknown No Yes Unknown No Yes Unknown
Is there anything that you can't
resist doing over and over? 0 1 9 0 1 9 0 1 9
CA419-CA421
Is there anything that you have

to do in a certain way or in a
particular order?
(Why do you do it?)
(Does it have any special

meaning or significance?)
Global Rating of Bizarre Behavior

This rating should reflect the type of behavior and the extent to which it deviates from social norms.

1 Questionable
0 0 0 CA422-CA424
2 Mild: Occasional instances of Skip to Positive Formal
unusual or apparently idiosyncratic Thought Disorder
behavior; subject usually has some
insight 1 1 1
Skip to Positive Formal
3 Moderate: Behavior which is clearly Thought Disorder
clearly bizarre; subject may have 2 2 2
some insight
3 3 3
4 Marked: Behavior that is markedly
deviant from social norms and 4 4 4
clearly bizarre; subject may have
some insight 5 5 5
5 Severe: Behavior which is extremely

bizarre or fantastic; may include a
single extreme act, e.g., attempting
murder; subject usually lacks insight
92
Positive Formal Thought Disorder
Disorganized Speech Ever Present First 2 Years of Illness Much of Time Since Onset
A pattern of speech which is No Yes Unknown No Yes Unknown No Yes Unknown
difficult to follow or understand.
0 1 9 0 1 9 0 1 9
CA425-CA427
Have people ever complained
that your speech was hard to
understand or didn't make
sense?
How did they describe it?
Pressure of Speech Ever Present First 2 Years of Illness Much of Time Since Onset
The subject's speech is rapid No Yes Unknown No Yes Unknown No Yes Unknown
and difficult to interrupt; the
amount of speech is greater 0 1 9 0 1 9 0 1 9
CA428-CA430
than that considered normal.
Do you sometimes talk too fast?
Global Rating of Positive Formal Thought Disorder

This rating should reflect the frequency of abnormality and degree to which it affects the subject's ability to communicate.
This rating includes thought disorders not specifically mentioned above.

Skip to Catatonic Motor
2 Mild: Occasional instances of Behavior
thought disorder; subject is
sometimes hard to understand 1 1 1
Skip to Catatonic Motor
3 Moderate: Frequent instances of Behavior
disorder; subject is sometimes hard
to understand 2 2 2
4 Marked: Subject is often difficult to 3 3 3

understand
4 4 4
5 Severe: Thought disorder so severe
that subject is incomprehensible 5 5 5
93
Catatonic Motor Behavior
Stupor Ever Present First 2 Years of Illness Much of Time Since Onset
Marked decrease in reactivity to No Yes Unknown No Yes Unknown No Yes Unknown
environment and reduction of
spontaneous movements and 0 1 9 0 1 9 0 1 9
CA434-CA436
activity.
Rigidity Ever Present First 2 Years of Illness Much of Time Since Onset
Subject exhibits signs of motor No Yes Unknown No Yes Unknown No Yes Unknown
rigidity, such as resistance to
passive movement. 0 1 9 0 1 9 0 1 9
CA437-CA439
Waxy Flexibility Ever Present First 2 Years of Illness Much of Time Since Onset
Subject maintains postures into No Yes Unknown No Yes Unknown No Yes Unknown
which he is placed for at least
fifteen seconds. 0 1 9 0 1 9 0 1 9
CA440-CA442
Excitement Ever Present First 2 Years of Illness Much of Time Since Onset
Apparently purposeless and No Yes Unknown No Yes Unknown No Yes Unknown
stereotyped excited motor
activity not influenced by 0 1 9 0 1 9 0 1 9
CA443-CA445
external stimuli.
Posturing and Mannerisms Ever Present First 2 Years of Illness Much of Time Since Onset
Voluntary assumption of No Yes Unknown No Yes Unknown No Yes Unknown
inappropriate or bizarre
postures. Manneristic gestures 0 1 9 0 1 9 0 1 9
CA446-CA448
or tics may also be observed.
Global Rating of Severity of Catatonic Motor Behavior

First 2 Years Much of Time
0 None Worst Ever of Illness Since Onset
Skip to Alogia
2 Mild: An occasional mannerism
1 1 1
3 Moderate: Frequent mild symptoms Skip to Alogia
occurring on a weekly basis
2 2 2
4 Marked: Frequent severe
symptoms occurring on a weekly 3 3 3
basis
4 4 4
5 Severe: Several severe persistent
symptoms occurring on a daily basis 5 5 5
94
Alogia
Poverty of Speech Ever Present First 2 Years of Illness Much of Time Since Onset
The subject's replies to No Yes Unknown No Yes Unknown No Yes Unknown
questions are restricted in
amount and tend to be brief, 0 1 9 0 1 9 0 1 9
CA452-CA454
concrete, and unelaborated.

that you don't talk much?
Or that you don't seem to be

answering their questions?
Have you ever felt that your

mind was empty?
Poverty of Content of Speech Ever Present First 2 Years of Illness Much of Time Since Onset
The subject's replies are No Yes Unknown No Yes Unknown No Yes Unknown
adequate in amount but tend to
be vague, over-generalized, and 0 1 9 0 1 9 0 1 9
CA455-CA457
convey little information.
Or that you couldn't express

yourself well?
(What was that like?)
Global Rating of Alogia

The core features of alogia are poverty of speech and poverty of content of speech.

1 Questionable
0 0 0 CA458-CA460
2 Mild: Mild but definite Skip to Affective
impoverishment in thinking Flattening or
Blunting
3 Moderate: Significant evidence for
impoverishment in thinking 1 1 1
Skip to Affective
4 Marked: Subject's thinking seems Flattening or
impoverished much of the time Blunting
5 Severe: Subject's thinking seems 2 2 2

impoverished most of the time
3 3 3
4 4 4
5 5 5
95
Affective Flattening or Blunting
Global Rating of Affective Flattening/Blunting

This rating should focus on the overall severity of the symptoms, especially on unresponsiveness, poor eye contact, etc.
0 None Worst Ever of Illness Since Onset
Skip to Inappropriate
2 Mild affective flattening Affect
3 Moderate affective flattening 1 1 1

Skip to Inappropriate
4 Marked affective flattening Affect
5 Severe affective flattening 2 2 2
3 3 3
4 4 4
5 5 5
Inappropriate Affect
(See page 47 for complete description.)
Global Rating of Inappropriate Affect

This rating should focus on the expressed affect; not simply flat or blunted. Do not rate affective blunting or flattening as
inappropriate.

0 None 0 0 0 CA464-CA466
Skip to Avolition-
1 Questionable Apathy
2 Mild: One instance of inappropriate 1 1 1

affect Skip to Avolition-
Apathy
3 Moderate: Occasional instances of
inappropriate affect 2 2 2
4 Marked: Frequent instances of 3 3 3

inappropriate affect
4 4 4
5 Severe: Affect is inappropriate most
of the time 5 5 5
96
Avolition-Apathy
Avolition manifests as a characteristic lack of energy and drive.
Grooming and Hygiene Ever Present First 2 Years of Illness Much of Time Since Onset
The subject's clothes may be No Yes Unknown No Yes Unknown No Yes Unknown
sloppy or soiled and he may
have greasy hair, body odor, 0 1 9 0 1 9 0 1 9
CA467-CA469
etc.

about your grooming?
Impersistence at Work or Ever Present First 2 Years of Illness Much of Time Since Onset
School No Yes Unknown No Yes Unknown No Yes Unknown
Have you been able to (work, go
to school) regularly? 0 1 9 0 1 9 0 1 9
CA470-CA472
(What have you been able to

do?)
Do you have trouble finishing

what you start?
What kinds of problems have

you had?
Physical Anergia Ever Present First 2 Years of Illness Much of Time Since Onset
How did you spend your time? No Yes Unknown No Yes Unknown No Yes Unknown
Did you ever stay in bed or just 0 1 9 0 1 9 0 1 9

CA473-CA475
sit around all day doing nothing?
Global Rating of Avolition-Apathy

Strong weight may be given to one or two prominent symptoms if particularly striking.

0 None
0 0 0 CA476-CA478
1 Questionable Skip to Anhedonia-

Asociality
2 Mild but definitely present 1 1 1
Skip to Anhedonia-
3 Moderate Asociality
4 Marked 2 2 2
3 3 3
5 Severe
4 4 4
5 5 5
97
Anhedonia-Asociality
Decrease in Recreational Ever Present First 2 Years of Illness Much of Time Since Onset
Interests and Activities No Yes Unknown No Yes Unknown No Yes Unknown
What do you do for enjoyment?
0 1 9 0 1 9 0 1 9
CA479-CA481
How often do you do (those
things)?
Were they interesting and fun?
Lack of Sexual Interest and Ever Present First 2 Years of Illness Much of Time Since Onset
Activity No Yes Unknown No Yes Unknown No Yes Unknown
What has your sex life been
like? 0 1 9 0 1 9 0 1 9
CA482-CA484
Was there ever a time in the

past when you lost interest in
sex?
What was your usual outlet?
(When was the last time?)
Inability To Feel Intimacy and Ever Present First 2 Years of Illness Much of Time Since Onset
Closeness No Yes Unknown No Yes Unknown No Yes Unknown
Did you feel close to your
(family, husband, wife, 0 1 9 0 1 9 0 1 9
CA485-CA487
children)?
Has there ever been anyone

outside your family that you felt
especially close to?
How often did you see (them,

him, her)?
What did you do together?
Poor Relationships with Ever Present First 2 Years of Illness Much of Time Since Onset
Friends and Peers No Yes Unknown No Yes Unknown No Yes Unknown
Have you ever had many
friends? 0 1 9 0 1 9 0 1 9
CA488-CA490
Were you very close to them?
What did you do together?
98
Global Rating of Anhedonia-Asociality
This rating should reflect overall severity, taking into account the subject's age, family status, etc.
0 No evidence of anhedonia-asociality First 2 Years Much of Time

1 Questionable
0 0 0 CA491-CA493
2 Mild evidence Skip to Attention
3 Moderate evidence 1 1 1
Skip to Attention
4 Marked evidence
2 2 2
5 Severe evidence
3 3 3
4 4 4
5 5 5
Attention
(See page 52 for complete description.)
Global Rating of Attentional Impairment

This rating should reflect the subject's
overall concentration. First 2 Years Much of Time
0 None
0 0 0 CA494-CA496
1 Questionable inattentiveness Skip to
Characterization
2 Mild but definite inattentiveness of Course
3 Moderate inattentiveness 1 1 1
Skip to
4 Marked inattentiveness Characterization
of Course
5 Severe inattentiveness
2 2 2
3 3 3
4 4 4
5 5 5
99
CHARACTERIZATION OF COURSE
Using the information collected previously concerning onset, symptoms, and hospitalization, classify the course of the
subject's illness into one of the following patterns. Although the subject may not fit any of these patterns perfectly, select
the one that most closely approximates his course. These ratings should be made descriptively, without trying to infer
what the course might have been had the subject been untreated.
Has subject had a psychotic episode outside of current condition and/or

has current psychotic episode lasted more than 6 months? No 0 CA497
Skip to Past Symptoms of Affective Disorder
Yes 1
Pattern of Symptoms
(This rating can be made only for people with psychotic episodes.)
Continuously Positive 1 CA498

In this pattern the subject has predominantly positive symptoms when
ill. During periods of remission, he may have mild negative symptoms
or be relatively asymptomatic.
Predominantly Negative 2
The subject may have periods of mild psychosis with some delusions
and hallucinations, but the predominant clinical features during most of
his illness are negative symptoms. Thus, he is in a chronic deficit state
most of the time with occasional flickers of delusions, hallucinations, or
social disorganization.
Predominantly Positive Converting to Predominantly Negative 3

In this pattern the subject begins with a number of episodes
characterized by positive symptoms, but these become more widely
spaced, and the subject passes into a deficit state in between.
Eventually, he remains in a deficit state for a prolonged period of time
(e.g., two or three years), during which he may have occasional mild
flickerings of positive symptoms.
Negative Converting to Positive 4

In this pattern the subject begins in a deficit state with a history of poor
premorbid functioning. He then develops a florid psychotic picture
which is relatively prominent and persistent and thereafter does not
spend much time in the deficit state. It is likely that this pattern will be
quite uncommon. Subjects who have an adolescent history of poor
premorbid adjustment and who simply return to this level of functioning
between episodes, should be classified as Pattern 1 above rather than
as Pattern 4.
100
Pattern of Severity
Episodic or Shift-like 1 CA499

Episodes of illness are interspersed between
periods of health or near normality.
Mild Deterioration 2
Periods of illness occur, but there are also
extended periods of return to near normality, with
some ability to work at a job and near normal or
normal social functioning.
Moderate Deterioration 3
The subject may occasionally experience some
resolution of symptoms, but overall the course is
downhill culminating in a relatively severe degree
of social and occupational incapacitation.
Severe Deterioration 4
The subject's illness has become chronic
resulting in inability to maintain employment
(outside of sheltered workshop) and social
impairment.
PAST SYMPTOMS OF AFFECTIVE DISORDER

Symptoms that are typically associated with affective disorders (i.e., changes in mood, appetite, activity level, sleep
patterns, etc.) are frequently present in other disorders as well, particularly in schizoaffective disorder and schizophrenia.
The goal of the following section is to document the presence or absence of these symptoms as well as their temporal
relationship with affective and psychotic episodes. That is, the rater is trying to determine whether these symptoms
occurred during:
1) episodes of mania or depression (with or without mood-congruent psychotic features)

2) episodes of mania or depression with mood-incongruent psychotic features
3) episodes of psychosis when criteria for a major affective syndrome were not met
4) periods of time between psychotic episodes (for patients with schizophrenia-spectrum diagnoses)
In order to facilitate this, the section is arranged in columns, so that each "affective" symptom can be recorded as either
present or absent within the context of the above four categories. (For manic-type symptoms, category 4 is not included
since these symptoms rarely appear without a concurrent psychotic or affective episode.)
Admittedly, this can be a difficult task for both the subject and the rater. Before the rater is able to complete the columns,
he must establish what types of episodes the subject has experienced. This information is often available to the rater
through a review of psychiatric records. If it remains unclear, screening questions and criteria are provided in order to
determine which columns are most applicable.
Note: This section presumes that the subject has had affective or psychotic episodes in the past. If this is not the case,
i.e., none of the columns are applicable, the entire section can be skipped, and the affective symptoms will be documented
only in the "Affective Personality Syndrome" section.
101
Manic Syndrome
In order to diagnose a manic syndrome, the rater must establish the presence of a manic mood and a clustering of manic
symptoms correlated with that mood, as well as a one-week duration and evidence of impairment. Some subjects may
have had all three types of past situations; i.e., pure manic syndrome (column 1), a manic syndrome with mood-
incongruent features (column 2), an episode of psychosis with some manic symptoms but lacking the full syndrome
(column 3). When this occurs, all three should be rated, and an explanatory note should be made in the margin.
Criteria for Mania

There are three criteria listed consecutively so that failure to meet any one of them permits the rater to skip the "Occurred
in a Pure Manic Episode" and "Occurred in Manic Episode with Mood-Incongruent Psychotic Features" categories.
However, with subjects who may minimize the disturbance in mood during a manic episode (if the subject has no past
history of psychotic symptoms) it may be advisable to explore all three criteria before making a final judgment on the first.
Has had one or more distinct periods lasting at least one week during which he No 0 CA500
was experiencing either an elated or irritable mood. Mood must be of a moderate Yes 1
degree, 3 or higher.
Did you ever have a period that lasted at least one week when you were
experiencing feelings of elation or irritability clearly different from your normal
self?
Sought or was referred for help from someone during manic period(s), took No 0 CA501
medication, or had impaired functioning socially, with family, at home, at work, or Yes 1
at school.
During that time, did you seek help from someone, like a doctor or minister or
even a friend, or did someone suggest that you seek help?
Did you take any medication?
Did you act differently with people -your family, at work, or at school?
Had at least three symptoms (four, if only irritable/expansive) associated with the No 0 CA502
most severe period of elated or irritable/expansive mood. Mood must be of a Yes 1
moderate degree; 3 or higher. Each of the symptoms has to have been present
nearly every day for a period of at least one week.
Column 1 refers to the worst period of full manic syndrome without delusions or No 0 CA503
hallucinations or with mood-congruent psychotic features. Is Column 1 Skip Column 1
applicable to this subject?
Yes 1
Column 2 refers to the worst period of full manic syndrome with mood- No 0 CA504
incongruent psychotic features. Is Column 2 applicable to this subject? Skip Column 2
Yes 1
Column 3 refers to the worst period of psychosis when the subject did not meet No 0 CA505
criteria for a full manic syndrome. Is Column 3 applicable to this subject? Skip Column 3
If none of the columns apply, Skip to Major Depressive Disorder, (p. 106) Yes 1
102
Euphoric/Expansive/Irritable Occurred in Manic Episode
Mood Occurred in with Mood-Incongruent Occurred During
Has had one or more distinct Pure Manic Episode Psychotic Features Episode of Psychosis
periods of euphoria, irritability,
or expansive mood, not due to None 0 None 0 None 0
Questionable 1 Questionable 1 Questionable 1
alcohol or drug intoxication. Mild 2 Mild 2 Mild 2
Moderate 3 Moderate 3 Moderate 3
If mood is present, rate level; Marked 4 Marked 4 Marked 4
see page 55 for complete Severe 5 Severe 5 Severe 5
description Unknown 9 Unknown 9 Unknown 9
CA506-CA508
Have you had any periods
when you felt extremely good
or high-clearly different from
your normal self?
(Did your friends or family think

this was more than just feeling
good?)
What about periods when you

felt irritable and easily
annoyed?
Duration
What was the longest time this mood
lasted?
Code in Days ___ ___ ___ ___ ___ ___ ___ ___ ___CA509-CA511
Predominant nature of mood

No Yes No Yes No Yes
Euphoric 0 1 0 1 0 1 CA512-CA514
Irritable 0 1 0 1 0 1 CA515-CA517
Expansive 0 1 0 1 0 1 CA518-CA520
Impairment Occurred in Manic Episode

Manic symptoms are so severe Occurred in with Mood-Incongruent Occurred During
that there was serious Pure Manic Episode Psychotic Features Episode of Psychosis
impairment in functioning or No Yes Unknown No Yes Unknown No Yes Unknown
subject was hospitalized.
0 1 9 0 1 9 0 1 9
CA521-CA523
Were you hospitalized?
Were you so excited that it was

almost impossible to hold a
conversation with you?
Did it cause trouble with people,

with your family, your work, or
other usual activities?
103
Symptoms
Increase in Activity Occurred in Manic Episode

Was there ever a time when you Occurred in with Mood-Incongruent Occurred During
were more active or involved in Pure Manic Episode Psychotic Features Episode of Psychosis
things than usual? No Yes Unknown No Yes Unknown No Yes Unknown
0 1 9 0 1 9 0 1 9
(How about at work, at home, CA524-CA526
with your friends, or with your
family?)
(What about your involvement in

hobbies or other interests?)
Were there times when you

were unable to sit still-always
had to be moving or pacing
around?
Increased Talkativeness Occurred in Manic Episode

Were there times when you Occurred in with Mood-Incongruent Occurred During
spoke very rapidly or talked on Pure Manic Episode Psychotic Features Episode of Psychosis
and on and could not be No Yes Unknown No Yes Unknown No Yes Unknown
stopped?
0 1 9 0 1 9 0 1 9
CA527-CA529
Did you feel as if you were
under pressure to keep talking?
(Did you have so much to say

that you couldn't get it all out
soon enough?)
Flight of Ideas/Racing Occurred in Manic Episode

Thoughts Occurred in with Mood-Incongruent Occurred During
Were there times when your Pure Manic Episode Psychotic Features Episode of Psychosis
thoughts raced through your No Yes Unknown No Yes Unknown No Yes Unknown
mind?
0 1 9 0 1 9 0 1 9
CA530-CA532
Did you have more ideas than
usual, or more than you could
handle?
Inflated Self-Esteem Occurred in Manic Episode

Did you feel more self-confident Occurred in with Mood-Incongruent Occurred During
than usual? Pure Manic Episode Psychotic Features Episode of Psychosis
No Yes Unknown No Yes Unknown No Yes Unknown
Did you feel you were a
0 1 9 0 1 9 0 1 9
particularly important person or CA533-CA535
that you had special talents or
abilities?
(What about special plans?)
104
Decreased Need for Sleep Occurred in Manic Episode
Did you need less sleep than Occurred in with Mood-Incongruent Occurred During
usual? Pure Manic Episode Psychotic Features Episode of Psychosis
No Yes Unknown No Yes Unknown No Yes Unknown
(How much sleep do you
0 1 9 0 1 9 0 1 9
ordinarily need?) CA536-CA538
(How much sleep did you need

then?)
Distractibility Occurred in Manic Episode

Did you find that things around Occurred in with Mood-Incongruent Occurred During
you distracted you from your Pure Manic Episode Psychotic Features Episode of Psychosis
thoughts? No Yes Unknown No Yes Unknown No Yes Unknown
0 1 9 0 1 9 0 1 9
CA539-CA541
Poor Judgment Occurred in Manic Episode

Did you do anything that caused Occurred in with Mood-Incongruent Occurred During
trouble for you or your family or Pure Manic Episode Psychotic Features Episode of Psychosis
friends? No Yes Unknown No Yes Unknown No Yes Unknown
0 1 9 0 1 9 0 1 9
Was there anything you did that CA542-CA544
you thought showed poor
judgment?
Did you ever do anything foolish

with money?
Did you do anything sexually

that was unusual for you?
Did you do anything that could

get you in trouble if you were
caught?
TOTAL NUMBER OF SYMPTOMS DURING THE WORST PURE MANIC EPISODE ___ CA545
If euphoric, criterion = 3; if irritable/expansive, criterion = 4. (Column 1)
These symptoms must occur together in a cluster, rather than randomly at various times. In order to rate the manic
syndrome, be sure to assess delusions, if any. For mood-congruency, see Pages 24 and 30
TOTAL NUMBER OF SYMPTOMS DURING WORST MANIC EPISODE WITH MOOD-

INCONGRUENT PSYCHOTIC FEATURES (Column 2) ___ CA546
TOTAL NUMBER OF SYMPTOMS DURING WORST PSYCHOTIC EPISODE (Column 3) ___ CA547
105
TOTAL NUMBER OF EPISODES OF PURE MANIC SYNDROME (Column 1) ___ ___ CA548
(Separated from each other by at least two months)
Note a specific number rather than a range.
How many episodes like this have you had?
If unable to give number: Would you say that you have had at least ... different episodes like that?
TOTAL NUMBER OF MANIC EPISODES WITH MOOD-INCONGRUENT

PSYCHOTIC FEATURES (Column 2) ___ ___ CA549
Major Depressive Syndrome

In order to diagnose major depressive syndrome, the rater must establish the presence of a depressed mood and a
clustering of depressive symptoms correlated with that mood. The duration must be two weeks and there must be
evidence of impairment. Some subjects may have had all four types of past episodes or situations; when this occurs, all
should be rated, and an explanatory note should be made in the margin.
Criteria for Major Depressive Syndrome

There are three criteria listed consecutively so that failure to meet any one of them permits the rater to skip the "Occurred
in a Pure Depressive Episode" and "Occurred During a Depressive Episode with Mood-Incongruent Psychotic Features"
categories. However, with subjects who may minimize the disturbance in mood during a depressive episode (If the subject
has no past history of psychotic symptoms), it may be advisable to explore all three criteria before making a final judgment
on the first.
Has had one or more distinct periods lasting at least two weeks during which No 0 CA550
he was bothered by depressed or irritable mood or had a pervasive loss of Yes 1
interest or pleasure. Mood must be of a moderate degree, 3 or higher.
Did you ever have a period that lasted at least two weeks when you were bothered by
feeling depressed, sad, blue, hopeless, down in the dumps; that you didn't care
anymore, or didn't enjoy anything?
Sought or was referred for help from someone during dysphoric period(s), No 0 CA551
took medication, or had impaired functioning socially, with family, at home, Yes 1
at work, or at school.
During that time, did you seek help from someone, like a doctor or minister or even a
friend, or did someone suggest that you seek help?
Did you take any medication?
Did you act differently with people--your family, at work, or at school?
Had at least four symptoms associated with the most severe period of No 0 CA552
depressed or irritable mood or pervasive loss of interest or pleasure. Each of Yes 1
the symptoms has to have been present nearly every day for a period of at least two
weeks.
Column 1 refers to the worst period of major depressive syndrome without No 0 CA553
delusions or hallucinations or with mood-congruent psychotic features. Is Skip Column 1
Column 1 applicable to this subject?
Yes 1
106
Column 2 refers to the worst period of major depressive syndrome with No 0 CA554
mood-incongruent psychotic features. Is Column 2 applicable to this subject? Skip Column 2
Yes 1
Column 3 refers to the worst period of psychosis when the subject did not No 0 CA555
meet criteria for a major depressive syndrome. Is Column 3 applicable to this Skip Column 3
subject?
Yes 1
Column 4 refers to subjects with a schizophrenia spectrum diagnosis who No 0 CA556

experience periods of time following and/or between psychotic episodes. Is Skip Column 4
Column 4 applicable to this subject?
Yes 1
If none of the columns apply, Skip to Suicidal Behavior (p. 112)
Dysphoric Mood
Have you had periods of feeling depressed, sad, hopeless-when you didn't care about anything or couldn't enjoy
anything?
See pages 61-69 for complete description
Occurred in Depressive
Episode with Mood-
Occurred in Pure Incongruent Psychotic Occurred During Occurred After Episode
Depressive Episode Features Episode of Psychosis of Psychosis
None 0 None 0 None 0 None 0

Questionable 1 Questionable 1 Questionable 1 Questionable 1
Mild 2 Mild 2 Mild 2 Mild 2
Moderate 3 Moderate 3 Moderate 3 Moderate 3
Marked 4 Marked 4 Marked 4 Marked 4
Severe 5 Severe 5 Severe 5 Severe 3
Unknown 9 Unknown 9 Unknown 9 Unknown 9
CA557-CA560
Duration
What was the longest
time this mood lasted?
Code in ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___CA561-CA564
Weeks
Predominant nature of
mood
No Yes No Yes No Yes No Yes
Dysphoric 0 1 0 1 0 1 0 1 CA565-CA568
Anxious 0 1 0 1 0 1 0 1 CA569-CA572
107
Symptoms
Changes in Appetite
Did you ever have a change in your appetite?
...either an increase or decrease?

Episode with Mood-
No Yes Unknown No Yes Unknown No Yes Unknown No Yes Unknown
0* 1 9 0* 1 9 0* 1 9 0* 1 9
*If no, skip to Insomnia/Hypersomnia CA573-CA576
Increase
(Did you gain much more weight than is usual for you?)
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA577-CA580
Decrease
(Did you lose much more weight than is usual for you?)
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA581-CA584
Insomnia/Hypersomnia
Have you had trouble sleeping?
(What was it like?)
Episode with Mood-
0* 1 9 0* 1 9 0* 1 9 0* 1 9
*If no, skip to Psychomotor Agitation/Retardation CA585-CA588
108
Initial
(Did you have trouble falling asleep?)
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA589-CA592
Middle
(Did you wake up in the middle of the night?)
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA593-CA596
Terminal
(Did you wake up too early in the morning?)
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA597-CA600
Hypersomnia
Had you been sleeping more than usual?
(How much more?)
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA601-CA604
109
Psychomotor Agitation/Retardation*
Predominantly Agitated*
Did you feel restless or antsy?
Did you have trouble sitting still?
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA605-CA608
Predominantly Retarded*
Have you been slowed down?
* Psychomotor agitation and/or retardation count as one

symptom toward meeting criteria for presence of the depressive
syndrome.
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA609-CA612
Loss of Interest or Pleasure

Have you ever noticed a change in your interest in things?
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA613-CA616
Loss of Energy
Did you ever notice that you were feeling more tired than usual?
Had you ever felt as if all your energy was drained?
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA617-CA620
110
Feelings of Worthlessness
Did you feel down on yourself?
Had you been feeling very guilty about anything?
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA621-CA624
Diminished Ability To Think/Concentrate

Did you have trouble thinking?
What about your ability to concentrate?
Did you have trouble making decisions?
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA625-CA628
Recurrent Thoughts of Death

Did you ever think about death or of taking your life?
(How often have these thoughts occurred?)
Episode with Mood-
0 1 9 0 1 9 0 1 9 0 1 9
CA629-CA632
TOTAL NUMBER OF SYMPTOMS DURING WORST PURE DEPRESSIVE EPISODE

(If depressive, criterion = 4.) (Column 1) ___ CA633
These symptoms must occur together in a cluster, rather than randomly at various times, in order to rate the presence of a
depressive syndrome. Be sure to rate delusions and hallucinations, if any, for mood congruence. See Pages 24 and 30
TOTAL NUMBER OF SYMPTOMS DURING WORST EPISODE OF DEPRESSION WITH MOOD-

INCONGRUENT PSYCHOTIC SYMPTOMS (Column 2) ___ CA634
TOTAL NUMBER OF SYMPTOMS DURING WORST PSYCHOTIC EPISODE (Column 3) ___ CA635
TOTAL NUMBER OF SYMPTOMS AFTER PSYCHOTIC EPISODE (Column 4) ___ CA636
111
TOTAL NUMBER OF EPISODES OF PURE MAJOR DEPRESSIVE SYNDROME (Column 1) ___ ___ CA637
(Separated from each other by at least two months.)
Note a specific number rather than a range.
How many episodes like this have you had?
Would you say that you have had at least ... different episodes like that?
Did you ever experience (psychotic symptoms previously described) during any of these episodes?
(How often?)
TOTAL NUMBER OF DEPRESSIVE EPISODES WITH MOOD-INCONGRUENT PSYCHOTIC

FEATURES (Column 2) ___ ___ CA638
Suicidal Behavior
(Other than that which is described in Part 1)
Has made discrete suicidal gestures or attempts No 0 CA639

Skip to History of Somatic
Have you tried to kill yourself or done something that could have killed you? Therapy
If yes, inquire for details and for other suicide attempts. Yes 1
NUMBER OF GESTURES OR ATTEMPTS ___ ___ CA640
Suicidal Intent at Time of Most Serious Attempt

Determine circumstances and rate seriousness of No information 0 CA641
intent for the most serious attempt by considering
such factors as likelihood of being rescued, No intent or manipulative gesture 1
precautions against discovery, acting to gain help
during or after attempt, degree of planning of Not sure 2
attempt, and the apparent purpose of attempt
(manipulative versus killing self). Definite but ambivalent 3
Serious 4
Very serious 5
Extreme; careful planning and

expectation of death 6
Actual Medical Threat to Life or Physical Condition

Following the most serious suicide gesture(s) or No information 0 CA642
attempt(s), consider the method (gun shot wound
more serious than knife wound), impaired Minimal danger 1
consciousness at or during time of rescue,
seriousness of lesion or toxicity of ingested Mild; took ten aspirins 2
material(s), reversibility (amount of time expected for
complete recovery), and amount of treatment Moderate; took ten Seconals 3
required.
Severe; cut throat 4
Extreme; respiratory arrest or

prolonged coma 5
112
LIFETIME HISTORY
HISTORY OF SOMATIC THERAPY
In this section, an attempt is made to provide an overview of the various types of treatment received in the patient's lifetime
(including current condition). Because of the difficulties inherent in coding many treatment changes for computerized
analysis, it is not possible to collect these data in detail for punching. Nevertheless, the interviewer should take copious
notes for later review. Data concerning past treatment suitable for computerized analysis may be recorded using the
PSYCH. Coding rules for calculating dose years are available in the Somatic Therapy Worksheet.
No Yes
Lifetime Treatment - Neuroleptics 0 1 CA643

Note types, doses, and responses in as much detail as possible
If no, skip to Antidepressants-Heterocyclics
Estimate total number of months ___ ___ ___ CA644
Total number of dose years ___ ___ ___ . ___ CA645

(E.g., 100 mg of chlorpromazine/day for 5 years = 5 dose years)
Lifetime Treatment - Antidepressants
A. Heterocyclics; (including Tricyclics) 0 1 CA646

If no, skip to Antidepressants--MAO Inhibitors
113
No Yes
B. MAO Inhibitors 0 1 CA649
If no, skip to Anxiolytics
No Yes
Lifetime Treatment - Anxiolytics 0 1 CA652
If no, skip to Lithium
114
No Yes
Lifetime Treatment - Mood Stabilizers
A. Lithium 0 1 CA655
If no, skip to Tegretol
B. Carbamazepine (Tegretol) 0 1 CA658

If no, skip to ECT
115
No Yes
Lifetime Treatment - ECT 0 1 CA661
Note dates and responses
If no, skip to Leucotomy
Estimate number of treatments ___ ___ ___ CA662
Lifetime Treatment - Leucotomy 0 1 CA663

Note date and response
Caffeine - Average daily intake of caffeine (To calculate daily total use
the separate caffeine worksheet) ___ ___ ___ ___ CA664
Nicotine - Pack-years (To calculate pack-years use formula from separate

nicotine worksheet) ___ ___ ___ . ___ CA665
116
ALCOHOLISM
This section covers alcoholism up to the present. The subject should be reminded of this.
Two time periods will be considered 1) Current Use; use this column to indicate alcohol problems that have been
continuous in nature and/or have occurred during the past month. 2) Past Use; use this column to indicate alcohol
problems that occurred before a period of Current Use; i.e., alcohol problems that started and stopped prior to a period of
Current Use or stopped totally in the past.
If someone has had a symptom continuously it would be coded under Current Use only, regardless of the duration of the
symptom. If symptoms have been episodic, i.e., periods of abstinence for greater than 6 months, but the subject is
currently symptomatic, it would be coded under both Current and Past Use.
Criteria for Alcohol Abuse

The criteria for alcohol abuse include a pattern of pathological use, impairment in role function and a duration of one
month. Symptoms of tolerance or withdrawal may also be noted.
Current Use Past Use

No Yes No Yes
A. Pattern of Pathological Use
Needs Alcohol Daily To Keep Functioning

How much alcohol do you drink? 0 1 0 1 CA666-CA667
How much in an average week?
Did you find you needed to have a drink every day to

keep going?
When drinking the most, how much alcohol do you

drink?
Inability To Cut Down/Stop

Did you have trouble cutting down or stopping? 0 1 0 1 CA668-CA669
(What happened?)
Repeated Efforts To Stop/Reduce

Excessive Drinking
(How many times have you tried to cut down or stop?) 0 1 0 1 CA670-CA671
Binges
Drinking steadily for three or more days at least a fifth of 0 1 0 1 CA672-CA673
whiskey, 24 bottles of beer, or three bottles of wine daily;
must occur at least three times.
Have you ever gone on binges?
(How much did you drink then?)
(How long do they last?)
(How often do they happen?)
(What is the most you have drunk during a binge?)
117
No Yes No Yes
Occasional Consumption of a Fifth
Ever as much as a fifth of spirits (or equivalent?) 0 1 0 1 CA674-CA675
Blackouts
Have you ever had blackouts (i.e., memory loss for 0 1 0 1 CA676-CA677
events that occurred while conscious during drinking)?
Persistent Drinking During Illness Exacerbated by Alcohol

Have you ever continued to drink when you knew it was 0 1 0 1 CA678-CA679
bad for your health?
Drinking of Nonbeverage Alcohol

Have you ever drunk nonbeverage alcohol? 0 1 0 1 CA680-CA681
Evidence of Pattern of Pathological Use

Determine if there has been a pattern of pathological
use, either in Current or Past Use columns. If all items
were circled No in either column, circle No Evidence for
that column and skip to Drug Section. If one or more
items were circled Yes in either column, circle Yes for
that column and continue with the Alcohol section.
Current Evidence of Pathological Use 0 1 CA682

If no, skip to Drug Abuse Section
This column only
Past Evidence of Pathological Use 0 1 CA683

If no, skip to Drug Abuse
This column only
B. Impairment in Social or Occupational Functioning

Due to Alcohol
Violence While Intoxicated

Have you ever been physically violent while drinking? 0 1 0 1 CA684-CA685
(Must occur twice.)
(What did you do?)
Absence from Work

Have you missed work because of drinking? 0 1 0 1 CA686-CA687
Loss of Job
Have you ever lost a job because of drinking? 0 1 0 1 CA688-CA689
118
No Yes No Yes
Legal Difficulties
(Arrests for intoxication, traffic accidents, drunk driving) 0 1 0 1 CA690-CA691
Have you gotten into trouble with the law because of

drinking?
(What kind of trouble?)
Have you ever been arrested for drunk driving?
Have you ever had a car accident while drinking?
Have you ever been picked up by the police because of

how you were acting while drinking?
Arguments or Difficulties with Friends/Family

Have you ever had problems with your friends or family 0 1 0 1 CA692-CA693
because of your drinking?
(What kinds of problems?)
Have your friends or family ever complained about it?
Were you ever divorced or separated primarily because

of your drinking?
C. Duration of Impairment
Duration of current impairment (in months) ___ ___ ___ CA694
Total duration of all episodes of disturbance

excluding current episode (in months) ___ ___ ___ CA695
A pattern of pathological use coupled with impairment lasting at

least a month is required to make a diagnosis of alcohol abuse
(DSM-III)
Currently abuses alcohol? 0 1 CA696
Total number of episodes of alcohol abuse excluding

current episode. ___ ___ CA697
Meets criteria of abuse for current and/or past use No

Skip to Drug Use, Abuse, and Dependence
Yes
Continue with Alcohol Section
Onset and Treatment

Age when heavy drinking began. ___ ___ CA698
Age when heavy drinking stopped. ___ ___ CA699

(Leave blank if heavy drinking occurred during the past six months)
119
Have you ever sought treatment for drinking? No Yes
Outpatient 0 1 CA700
Inpatient 0 1 CA701
Skip to Additional Criteria for Alcohol Dependence
If inpatient, number of hospitalizations ___ ___ CA702
Additional Criteria for Alcohol Dependence

The conservative DSM III definition requires evidence of tolerance or withdrawal.

No Yes No Yes
Tolerance or Withdrawal
Tolerance
Need for markedly increased amounts to achieve desired 0 1 0 1 CA703-CA704
effect or markedly diminished effect with regular use.
Have you found that you have needed to increase your

alcohol intake in order to get the same effect?
(How much have you been increasing it?)
(How much did you drink last week?)
(How much did you drink a year ago?)
Withdrawal
Any of several symptoms occurring within several hours
after cessation or reduction of heavy alcohol intake
(DSM-III requires coarse tremor plus one additional
symptom).
When you try to cut down or stop your drinking, do you

ever get ...
Tremors
Tremors? 0 1 0 1 CA705-CA706
Nausea and Vomiting

Nausea and Vomiting? 0 1 0 1 CA707-CA708
Malaise or Weakness
Feeling of weakness, or just generally feeling rotten? 0 1 0 1 CA709-CA710
Autonomic Hyperactivity
(e.g., tachycardia, sweating, hyperthermia, elevated 0 1 0 1 CA711-CA712
blood pressure)
Pounding heart?
Sweating?
Increased temperature?
Increased blood pressure?
120
Anxiety
Feelings of anxiety? 0 1 0 1 CA713-CA714
Depressed or Irritable Mood

Feelings of depression or irritability? 0 1 0 1 CA715-CA716

No Yes No Yes
Orthostatic Hypotension
Feeling dizzy when you stand suddenly? 0 1 0 1 CA717-CA718
Alcohol Dependence
(Evidence of a pattern of pathological use or impairment in social
or occupation functioning plus tolerance or withdrawal is required
to diagnose alcohol dependence).
Criteria for dependence met? 0 1 0 1 CA719-CA720
Alcohol-Induced "Organic" Syndromes

Withdrawal Delirium
(A confusional state that includes disorientation, illusions, 0 1 0 1 CA721-CA722
and hallucinations.)
Have you ever had DT's?
Have you ever gotten confused and seen things that

weren't there after you quit drinking?
Withdrawal Seizures
Have you ever had a seizure or fit after you stopped 0 1 0 1 CA723-CA724
drinking?
Hallucinosis
(Auditory hallucinations beginning shortly after cessation 0 1 0 1 CA725-CA726
or reduction of intake.)
Have you ever started hearing voices after you stopped

drinking?
Amnestic Syndrome
Have you ever had any problems with your memory? 0 1 0 1 CA727-CA728
Do you have more trouble learning new things than you

used to?
Physical Complications of Alcohol

(pancreatitis, gastritis, cirrhosis, or neuritis) 0 1 0 1 CA729-CA730
Have you had a doctor tell you that you have had a
physical complication of alcoholism like cirrhosis,
gastritis, pancreatitis, or neuritis?
121
DRUG USE, ABUSE, AND DEPENDENCE
This following questions evaluate drug use up to the present. The subject should be reminded of this.
Have you ever taken anything on your own for No evidence of drug use or dependence 0 CA731
sleeping, or your mood, or to get high--like Skip to Modified Premorbid Adjustment Scale
Dexedrine, Seconal, or some other barbiturate?
Evidence of drug use or dependence 1
Have you ever used marijuana, narcotics, LSD, or
things like that?
Have you used anything to get high, lose weight, or

stay awake?
Have you ever wanted to stop taking drugs but

couldn't?
This section covers the details of substance intake for seven classes of substances. Within each class, two time periods
will be considered, (1) Current Use, employ this column to document current drug intake that has been continuous in
nature or that has occurred during the past month. That is, if a subject is currently taking a substance and has been doing
so continuously over time, use this column. (2) Past Use, use this column to document drug intake that occurred before a
period of current use, i.e., substance use that had started and stopped previous to any current intake. Within each time
period, three levels of substance intake will be documented, (1) Substance Use, (2) Substance Abuse, and (3)
Substance Dependence; all three are defined below.
SUBSTANCE USE
Prescription Drugs - For Current Use, substance use is defined as any use in a manner not prescribed by a doctor
within the past month. For Past Use, substance use is defined as use in a manner not prescribed by a doctor more
than four times ever.
Non-Prescription Drugs - For Current Use, substance use is defined as any use within the past month. For Past
Use, substance use is defined as use of a substance more than four times ever.
It is necessary to screen for drug use within both time periods for all substances. If there is no evidence of Substance
Use, as defined above, skip to the next substance.
SUBSTANCE ABUSE - Substance abuse is evaluated on the basis of three criteria:
- Pattern of pathological use
- Impairment in social or occupational functioning due to substance use
- Minimal duration of disturbance (impairment) of at least one month
SUBSTANCE DEPENDENCE - Substance dependence generally is a more severe form of Substance Abuse and
requires physiological dependence, evidenced by either:
- Tolerance
or
- Withdrawal
122
Barbiturates or Other Hypnotics
No Yes No Yes
Substance Use
Have you used sleeping pills, tranquilizers, downers, or ludes in a
manner not prescribed by a doctor...
Within the past month? 0 1 CA732

or If no, Skip to Opioids
More than four times ever (exclude current use)? This column only
0 1 CA733
If no, Skip to Opioids
This column only
Pattern of Pathological Use

Inability to cut down or stop use; intoxication throughout 0 1 0 1 CA734-CA735
the day; frequent use of the equivalent of 600 mg. or
more of secobarbitol or 60 mg. or more of diazepam;
amnesic periods for events that occurred while
intoxicated.
How many times have you taken sleeping pills, downers,

ludes, etc.?
How much did you usually take? For how long?
Did you take them throughout the day?
Did you have trouble cutting down or stopping?
Did you ever forget things that you had done while taking
them?
Impairment in Social or Occupational Functioning

Fights, loss of friends, absence from work, loss of job, or 0 1 0 1 CA736-CA737
legal difficulties (other than a single arrest due to
possession, purchase, or sale of the substance.)
What kind of problems has this caused for you?
At work? At home?
(and so on to evaluate impairment.)
Duration of Impairment
How long did these problems last?
Record in weeks the duration of current impairment. ___ ___ ___ CA738
Record in weeks the total duration of all episodes of

impairment (exclude current episode) ___ ___ ___ CA739
A pattern of pathological use coupled with impairment lasting at

least a month is required to make a diagnosis of substance abuse
(DSM-III).
123
No Yes No Yes
Currently abuses the substance? 0 1 CA740
Total number of episodes of abuse (exclude current ___ ___ CA741

episode)
Tolerance
Need for markedly increased amounts of the substance 0 1 0 1 CA742-CA743
to achieve the desired effect, or markedly diminished
effect with regular use of the same amount.
Have you found that you needed to take more and more
to get the same effect?
Withdrawal
Have you ever experienced: shakes, vomiting, sweating, 0 1 0 1 CA744-CA745
tremors, anxiousness, depression, or irritability when you
stopped taking them?
(Evidence of tolerance or withdrawal is needed to

diagnose substance dependence (DSM-III).)
Opioids
No Yes No Yes
Substance Use
Have you used pain killers such as codeine, morphine, demerol,
heroin, etc., in a manner not prescribed by a doctor?...
0 1 CA748
Within the past month? If no, skip to Cocaine
or This column only
More than four times ever? 0 1 CA749
If no, skip to Cocaine
This column only
124
No Yes No Yes
the day; use of opioids nearly every day for at least a
month; episodes of opioid overdose.
How many times have you taken pain killers such as

codeine, morphine, demerol, etc.
Did you ever overdose or come close to overdosing?

At work? At home?

A pattern of pathological use coupled with impairment

lasting at least a month is required to make a diagnosis
of substance abuse (DSM-III).

episode)
Tolerance
125
No Yes No Yes
Withdrawal
Have you ever experienced: insomnia, sweating, 0 1 0 1 CA760-CA761
diarrhea, fever, watery eyes, racing pulse, dilated pupils,
or a runny nose when you stopped taking them?

diagnose substance dependence {DSM-III}.)
Cocaine

No Yes No Yes
Substance Use
Have you used cocaine?

or If no, skip to Amphetamines
0 1 CA765
If no, skip to Amphetamines
This column only

the day; episodes of cocaine overdose (i.e.,
hallucinations and delusions occur in a clear sensorium).
How many times have you used cocaine?
Did it ever make you see or hear things?
Did it ever make you think strange or unusual thoughts?
126
No Yes No Yes
possession, purchase, or sale of the substance).
At work? At home?



episode)
Tolerance
Withdrawal (DSM-III-R)
Have you ever experienced: a bad mood along with 0 1 0 1 CA776-CA777
fatigue, insomnia, increased sleeping, or restlessness for
more than a day when you stopped taking it?
(DSM-III does not recognize cocaine dependence.)
127
Amphetamines and Other Sympathomimetics
No Yes No Yes
Substance Use
Have you used uppers, speed, or diet pills in a manner
not prescribed by a doctor...

or If no, skip to
More than four times ever (exclude current use)? Phencyclydines
This column only
0 1 CA781
If no, skip to
Phencyclydines
This column only

the day; use of the substance nearly every day for at
least a month; episodes of Amphetamine Induced
Delusion Disorder or Delirium.
How many times have you taken speed, uppers, diet

pills, etc?
Did it make you confused? So you didn't know where

you were or who you were?
Did you ever think that people might be trying to harm

you in some way?
128
No Yes No Yes
At work? At home?



episode)
Tolerance
Withdrawal
Have you ever experienced: a depressed mood along 0 1 0 1 CA792-CA793
with fatigue, disturbed sleep, or increased dreaming
when you stopped taking them?

diagnose substance dependence (DSM-III).)
Phencyclydine and Other Arylcyclohexylamines

No Yes No Yes
Substance Use
Have you used PCP?
129
or If no, skip to Hallucinogens
0 1 CA797
If no, skip to Hallucinogens
This column only

Intoxication throughout the day or episodes of delirium. 0 1 0 1 CA798-CA799
How many times have you taken PCP?
Did you take it throughout the day?
Did it make you confused? So you didn't know where

you were or who you were?

At work? At home?


No Yes No Yes

episode)
DSM-III does not recognize PCP Dependence
130
Hallucinogens
No Yes No Yes
Substance Use
Have you used acid, LSD, mushrooms, or other
hallucinogens?

or If no, skip to Marijuana
0 1 CA807
If no, skip to Marijuana
This column only

the day; or development of a Hallucinogen Delusional
Syndrome or Hallucinogen Affective Disorder.
How many times have you taken acid, LSD, etc?
Did your mood change to very high or very low?
Have you ever thought people were trying to harm you in

some way?

No Yes No Yes
At work? At home?

131
episode)
DSM-III does not recognize Hallucinogen Dependence
Marijuana
No Yes No Yes
Substance Use
Have you used marijuana or hashish?

or If no, skip to Onset
More than four times ever (exclude current use)? and Treatment
This column only
0 1 CA817
If no, skip to Onset
and Treatment
This column only

No Yes No Yes

Intoxication throughout the day/ use nearly every day for 0 1 0 1 CA818-CA819
at least a month; development of Cannabis Delusional
Disorder.
How many times have you smoked marijuana or

hashish?
How much did you usually smoke? For how long?
Did you smoke it throughout the day?
Did you think that people might be trying to harm you in

some way?

Marked loss of interest in activities previously engaged 0 1 0 1 CA820-CA821
in; loss of friends; absence from work; loss of job; legal
difficulties (other than a single arrest due to possession,
purchase, or sale of the substance).
Has smoking pot caused problems for you?
At work? At home? At school? Legally?
Has pot affected your interest in things?
Record in weeks the duration of impairment. ___ ___ ___ CA822
132
A pattern of pathological use coupled with impairment ___ ___ ___ CA823

episode)
Tolerance
133
No Yes No Yes
Dependence
Either a Pattern of Pathological Use or Impairment in
Social or Occupational Functioning plus Tolerance is
needed for cannabis dependence.
0 1 0 1 CA828-CA829
Criteria for dependence met?
Onset and Treatment

Does subject currently meet criteria for drug abuse? No 0 CA830
Yes 1
Has subject met criteria for drug abuse in the past? No 0 CA831
Skip to Modified Premorbid Adjustment Scale; if there
has been no current or past drug abuse
Yes 1
Age when first drug abuse began ___ ___ CA832
Age when all drug abuse stopped ___ ___ CA833

(Leave blank if subject abused drugs with last six months)
No Yes
Have you ever sought treatment for drug use? 0 1 CA834
If no, skip to Modified Premorbid Adjustment Scale
Outpatient? 0 1 CA835
Inpatient? 0 1 CA836
Number of hospitalizations (if inpatient) ___ ___ CA837
MODIFIED PREMORBID ADJUSTMENT SCALE*

This scale is used as an index of premorbid functioning. It separately examines functioning during childhood and
adolescence. Code highest level achieved.
Sixth year to adolescence (ages 6 to 12)
Withdrawal
Normal social interaction 0 CA838
Somewhat timid and quiet 1

Timid and quiet, reluctant to approach people 2
Withdrawn, unrelated - no interest in approaching others; not attracted to other
children 3
Peer Relationships
Many friends with a few close relationships 0 CA839
Few but close friends 1

Casual friends only 2
134
A few occasional casual friends only 3
Social isolate, no friends 4
Interests**
Active: Interested in a variety of school and social activities and hobbies 0 CA840
Normal 1
Introverted interests: One or a few hobbies which require no contact with others
(i.e., stamp collection, reading, movie going, school work) 2
No interests 3
Total Childhood Score __ __ CA841
Adolescence and Young Adulthood (ages 13 to 21)
Withdrawal
Normal social interaction 0 CA842
Somewhat timid and quiet 1

Timid and quiet, reluctant to approach people 2
Withdrawn, unrelated - no interest in approaching others; not attracted to others 3
Peer Relationships
Many friends with a few close relationships 0 CA843
Few but close friends 1

Casual friends only 2
A few occasional casual friends only 3
Social isolate, no friends 4
Interests**
Active: Interested in a variety of school and social activities and hobbies 0 CA844
Normal 1
Introverted interests: One or a few hobbies which require no contact with others
(i.e., stamp collection, reading, movie going, school work) 2
No interests 3
Socio-Sexual Adjustment
Active: Always showed a "healthy interest" in sex appropriate to social-cultural

background and mores 0 CA845
Normal: Dating regularly; had at least one friend with whom the subject went
"steady" for a period of time and had some sexual relationship appropriate to social-
cultural background and mores 1
Limited or impaired sexual interests: Some desire to have sexual relationships, but
unable to form ties; or excessively promiscuous sexual behavior 2
135
No sexual interests; or sexual interests involving only morbid or fantastic
preoccupations (e.g., fantasy lover) 3
Total Adolescence and Young Adulthood Score __ __ CA846
*Adapted, with permission, from Gittelman-Klein R., Klein DF: Premorbid asocial adjustment and prognosis in
schizophrenia. Journal of Psychiatric Research, 7:35-53, 1969.
**Modification of item 3 of Elgin Prognostic Scale, Wittman P: A scale for measuring prognosis in schizophrenic patients.
Elgin Papers, Volume IV, Read CF, Liebert E (eds), Elgin State Hospital, Elgin, Illinois, 1941.
PREMORBID OR INTERMORBID PERSONALITY

This section of the interview explores personality features that may precede periods of illness or appear between them. It
emphasizes personality disorders considered to be within the spectrum of psychotic and affective illnesses, i.e.,
schizotypal, dysthymic, hypomanic, and cyclothymic. Although some theories and data support a relationship between
specific personality types and florid illnesses (e.g., schizotypal and schizophrenia), clearly many subjects with periods of
serious illness have no evidence of personality abnormality before and between. Therefore, the interviewer should do his
best to avoid halo effects based on any diagnostic information gathered up to this point.
Subjects will sometimes find it difficult to describe aspects of their own personality. Further, some of the features are
observational; therefore, the interviewer should attempt to obtain supplemental information from clinicians or nurses and
from family members and should complete the scoring of the interview based on the largest data base possible,
considering the most positive information obtained to be the most valid because of the problem of under-reporting in
subjects who are attempting to describe themselves.
Schizotypal Personality Characteristics

Premorbid (Column 1) is defined as occurring up to one year prior to onset of No 0 CA847
positive symptoms (delusions or hallucinations) or affective syndromes. It may Skip Column 1
also be used for subjects who have never had prominent psychotic or affective
symptoms; in this case rate the presence or absence of schizotypal symptoms in Yes 1
the past year. Is Column 1 applicable to this subject?
Prodromal (Column 2) is defined as occurring during the year prior to the onset No 0 CA848
of psychotic episode or affective syndromes. Is Column 2 applicable to this Skip Column 2
subject?
Yes 1
Residual or Intermorbid (Column 3) refers to the periods of time after or No 0 CA849

between periods of psychotic episodes or affective syndromes. Is Column 3 Skip Column 3
Yes 1
Many schizotypal features are similar to or identical with negative symptoms. Some of those items in this section may be
rated on the basis of information collected earlier in this interview (e.g., social isolation, odd speech, or abnormalities of
affect).
The following probes are suggested to help the subject establish the appropriate time set.
Now I'd like to ask you about what you were like as a person before you first became ill. Try to think back to what you
were like in high school (or some appropriate time before the subject's initial onset of symptoms).
Were you ... (schizotypal symptoms)?
136
What about the year before you began to have (psychotic symptoms that the subject has reported, such as "began to hear
voices")?
What about when you got better and were no longer (psychotic symptom)?
Premorbid Prodromal Residual or Intermorbid

Magical Thinking, Odd or No Yes Unknown No Yes Unknown No Yes Unknown
Bizarre Ideation
Were you somewhat 0 1 9 0 1 9 0 1 9
CA850-CA852
superstitious?
Did you think that certain acts or

ideas could cause some wish to
be fulfilled?
Or ward off evil?
Have you ever thought you had

a "sixth sense?"
Have you felt you could foretell

the future?
Or that you had special powers?
Did anyone ever comment that

your thinking seemed strange?
Ideas of Reference Premorbid Prodromal Residual or Intermorbid

Have you ever thought that No Yes Unknown No Yes Unknown No Yes Unknown
things around you, such as TV
programs or newspaper articles, 0 1 9 0 1 9 0 1 9
CA853-CA855
have some special meaning just
for you?
Have you sometimes walked

into a room and felt that people
were talking about you or
laughing at you?
Have you received special

messages in other ways?
Have you felt as if people were

watching you?
Could you give me some

examples?
Could this have been your

imagination?
137
Suspiciousness/Paranoid Premorbid Prodromal Residual or Intermorbid
Are you reluctant to trust other No Yes Unknown No Yes Unknown No Yes Unknown
people?
0 1 9 0 1 9 0 1 9
CA856-CA858
Did you worry that people had it
in for you?
Did you have trouble reading

social situations and telling who
was a friend or enemy?
Or did you feel that most people

were your enemies?
Did you think people were

making fun of you?
(Or threatening you?)
(Or were trying to harm you?)
(Were you on your guard all the

time?)
Unusual Perceptual Premorbid Prodromal Residual or Intermorbid

Experiences, Recurrent No Yes Unknown No Yes Unknown No Yes Unknown
Illusions, Depersonalization
0 1 9 0 1 9 0 1 9
or Derealization CA859-CA861
Have you had any unusual
visual experience, such as
distortions of appearance (e.g.,
elongation of people's faces,
flashing light patterns)?
What about unusual

experiences of hearing, such as
whispers or crackling noises?
Have you ever had the

experience of sensing there was
a person or some unusual force
in the room?
Have you ever felt that the rest

of the world was unreal?
(Did this occur during a panic

attack?)
138
Undue Social Anxiety, Premorbid Prodromal Residual or Intermorbid
Sensitivity to Real or No Yes Unknown No Yes Unknown No Yes Unknown
Imagined Criticism
Were you ever nervous about 0 1 9 0 1 9 0 1 9
CA862-CA864
being around other people?
Did you get anxious before

going to a party or other social
events?
Were you nervous about going

out with (boys, girls)?
Were you especially sensitive to

criticism?
How did you react when

someone pointed out something
you had done or something
about you that they didn't like?
How long did it take you to

bounce back?
Odd Speech Premorbid Prodromal Residual or Intermorbid

(Vague, circumstantial, No Yes Unknown No Yes Unknown No Yes Unknown
digressive, over-elaborated;
include poverty of speech, 0 1 9 0 1 9 0 1 9
CA865-CA867
poverty of content of speech,
tangentiality, circumstantiality,
perseveration, and blocking)
Did anyone ever say that you

were hard to understand when
you talked?
Did they complain that you were

too vague?
Or that you would go into too

much detail?
Or that you tended to digress?
Or that you never talked

enough?
Or that you didn't answer

questions clearly enough?
(What do you think people were

complaining about?)
(Did you ever notice trouble

expressing yourself?)
139
Social Isolation Premorbid Prodromal Residual or Intermorbid
Did you have close friends? No Yes Unknown No Yes Unknown No Yes Unknown
How many friends did you 0 1 9 0 1 9 0 1 9

CA868-CA870
have?
How often did you see them?
What types of activities did you

enjoy doing with friends?
How often did you go out?
Inadequate Rapport in Face- Premorbid Prodromal Residual or Intermorbid

to-Face Interaction No Yes Unknown No Yes Unknown No Yes Unknown
(Constricted, blunted, or
inappropriate affect) 0 1 9 0 1 9 0 1 9
CA871-CA873
Have people ever said that you

seemed too distant? Or
aloof?
Or that you never seem to

express yourself emotionally?
Do you think that you have had

trouble showing your emotions?
Have people commented that

your face seems bland?
Or that you giggled or smiled at

the wrong time?
140
Other Prodromal Features
Markedly Peculiar Behavior Premorbid Prodromal Residual or Intermorbid

(e.g., collecting garbage) No Yes Unknown No Yes Unknown No Yes Unknown
Did anyone comment that your 0 1 9 0 1 9 0 1 9

CA874-CA876
behavior seemed strange?
Did you do anything that

seemed odd?
(Could you give me some

examples?)
Impairment of Role Premorbid Prodromal Residual or Intermorbid

Functioning No Yes Unknown No Yes Unknown No Yes Unknown
Did you have any trouble in
school? 0 1 9 0 1 9 0 1 9
CA877-CA879
(How were your grades when

you were in school?)
How did you get along at work?
Were you able to finish work

around the house that you were
supposed to do?
Impairment in Personal Premorbid Prodromal Residual or Intermorbid

Hygiene or Grooming No Yes Unknown No Yes Unknown No Yes Unknown
Did anyone complain that you
were not taking care of yourself? 0 1 9 0 1 9 0 1 9
CA880-CA882
(That you needed to pay more

attention to your grooming and
hygiene?)
(That you needed to bathe more

or take better care of your hair?)
(That you were not changing

your clothes often enough?)
(Do you think these things were

a problem?)
141
Affective Personality Syndromes
These include hypomania, dysthymia, and cyclothymia. It may be difficult to distinguish between these mild personality
syndromes and failure to recover fully from an episode of mania or depression. In order to identify personality features
during the intermorbid period, emphasize to the subject that you are trying to find out what he is like when he is "back to
his usual self."
The subject with dysthymia may report a predominance of depressive symptoms when he is his "usual self." The
hypomanic subject may report a predominance of hypomanic symptoms when he is his "usual self," and the cyclothymic
subject a tendency to alternate between the two. The cyclothymic subject may also report some euthymic periods. DSM-
III requires that a predominant pattern of symptoms be present for the past two years for diagnosis of dysthymic or
cyclothymic disorder. This instrument permits recording of symptoms both prior to the onset of illness and during the past
two years.
Begin by inquiring about personality patterns and trends toward hypomania, cyclothymia, or dysthymia before focusing on
the specific symptoms.
Before you became ill, did you tend to be moody?
Did you tend to feel low most of the time?
High a lot of the time?
Did you swing from high to low?
What about between and after the periods when you have been manic or depressed?
I would like you to think about what you are like when you are "your usual self" between or after episodes.
Are you still somewhat low or moody?
Or a little higher and more energetic than most people?
Or do you swing back and forth more than most people?
I would like to ask you about some specific symptoms - first, whether you had them before you became ill, and then
whether you have them after recovery from an episode when you are pretty much back to your usual self.
Premorbid (Column 1) is defined as occurring up to one year prior to onset of No 0 CA883

positive symptoms (delusions or hallucinations) or affective syndromes. It may Skip Column 1
also be used for subjects who have never had prominent psychotic or affective
symptoms; in this case rate the presence or absence of affective personality Yes 1
symptoms in the past year. Is Column 1 applicable to this subject?
Residual or Intermorbid (Column 2) refers to the periods of time after or No 0 CA884

between periods of psychotic episodes or affective syndromes. Is Column 2 Skip Column 2
Yes 1
142
Hypomanic Symptoms
Evidence of Hypomania? No 0 CA885

Skip to Dysthymic Symptoms
Yes 1
Periods with Elevated, Expansive, or Irritable Premorbid Residual or Intermorbid

Mood No Yes Unknown No Yes Unknown
Did you have periods when you felt better than
most people? 0 1 9 0 1 9 CA886-CA887
If no or unknown, If no or unknown
Skip to Dysthymic Skip to Dysthymic
During these periods, did you ... Symptoms Symptoms
This column only This column only
Decreased Need for Sleep Premorbid Residual or Intermorbid

need less sleep than usual? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA888-CA889
Increased Energy Premorbid Residual or Intermorbid

feel more energetic than most people? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA890-CA891
Inflated Self-Esteem Premorbid Residual or Intermorbid

feel especially self-confident or good about No Yes Unknown No Yes Unknown
yourself?
0 1 9 0 1 9 CA892-CA893
Increased Productivity, Often Associated Premorbid Residual or Intermorbid

with Unusual or Self-Imposed Working Hours No Yes Unknown No Yes Unknown
get a lot more done than most people or work
longer hours than most people by choice? 0 1 9 0 1 9 CA894-CA895
Sharpened and Unusually Creative Thinking Premorbid Residual or Intermorbid

think more clearly, feel more creative, or have No Yes Unknown No Yes Unknown
lots of good ideas?
0 1 9 0 1 9 CA896-CA897
Uninhibited People-Seeking Premorbid Residual or Intermorbid

(extreme gregariousness) No Yes Unknown No Yes Unknown
spend more time being with and talking to
people? 0 1 9 0 1 9 CA898-CA899
143
Hypersexuality without Recognition of Premorbid Residual or Intermorbid
Possibility of Painful Consequences No Yes Unknown No Yes Unknown
do anything sexual that is unusual for you, or get
involved sexually in a risky way such as having 0 1 9 0 1 9 CA900-CA901
an affair or were a bit over-aggressive sexually?
Excessive Involvement in Pleasurable Premorbid Residual or Intermorbid

Activities with Lack of Concern for the No Yes Unknown No Yes Unknown
Consequences
do things that you later regretted, or that caused 0 1 9 0 1 9 CA902-CA903
trouble for you or your family, like spending

sprees, reckless giving, or foolish investments?
Physical Restlessness Premorbid Residual or Intermorbid

feel physically restless? No Yes Unknown No Yes Unknown
have trouble sitting still? 0 1 9 0 1 9 CA904-CA905
More Talkative than Usual Premorbid Residual or Intermorbid

talk more than most people? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA906-CA907
Overly Optimistic Premorbid Residual or Intermorbid

feel too optimistic about the future? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA908-CA909
Inappropriate Laughing, Joking, Punning Premorbid Residual or Intermorbid

laugh or joke about things that other people No Yes Unknown No Yes Unknown
didn't think funny, or thought to be in poor taste?
0 1 9 0 1 9 CA910-CA911
Age when some symptoms were first noticed __ __ CA912
Has a cluster of 3 or more symptoms tended to be relatively

persistent (i.e., chronic, not episodic) since onset? No 0 CA913
Yes 1
Skip to Dysthymic Symptoms
Record the number of hypomanic episodes (i.e., clusters of 3 or more

symptoms with mood abnormality lasting at least a few days) in a typical
two-year period. __ __
If zero, skip to Dysthymic Symptoms
Record longest duration of a hypomanic episode (in months) __ __ __ CA914
144
Dysthymic Symptoms
Evidence of Dysthymia? No 0 CA915
Skip to Predominant Personality Pattern
Yes 1
Depressive Periods with Loss of Interest or Premorbid Residual or Intermorbid
Pleasure No Yes Unknown No Yes Unknown
Did you have periods when you felt down,
moody, or low? 0 1 9 0 1 9 CA916-CA917
If no or unknown, If no or unknown,
Skip to Predominant Skip to Predominant
When you lost interest in things? Personality Pattern Personality Pattern
This column only This column only
Or couldn't enjoy things?
During these periods did you ...
Insomnia or Hypersomnia Premorbid Residual or Intermorbid

have trouble sleeping or sleeping too much? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA918-CA919
Low Energy Level or Chronic Tiredness Premorbid Residual or Intermorbid

have low energy or feel tired all the time? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA920-CA921
Feelings of Inadequacy Premorbid Residual or Intermorbid

feel down on yourself, or worthless or like a No Yes Unknown No Yes Unknown
failure?
0 1 9 0 1 9 CA922-CA923
Decreased Effectiveness or Productivity at Premorbid Residual or Intermorbid

School, Work, or Home No Yes Unknown No Yes Unknown
have trouble getting things done, or doing things
well? 0 1 9 0 1 9 CA924-CA925
Decreased Attention, Concentration, or Premorbid Residual or Intermorbid

Ability To Think Clearly No Yes Unknown No Yes Unknown
have trouble concentrating or thinking clearly?
0 1 9 0 1 9 CA926-CA927
Social Withdrawal Premorbid Residual or Intermorbid

avoid being with people? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA928-CA929
145
Loss of Interest in or Enjoyment of Premorbid Residual or Intermorbid
Pleasurable Activities, Including Sex No Yes Unknown No Yes Unknown
have little or no interest in doing things you
usually enjoy? 0 1 9 0 1 9 CA930-CA931
Irritability or Excessive Anger Premorbid Residual or Intermorbid

feel irritable or get angry easily? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA932-CA933
Less Active or Talkative than Usual Premorbid Residual or Intermorbid

find yourself less active or talkative than usual? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA934-CA935
Restlessness Premorbid Residual or Intermorbid

feel restless or tense? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA936-CA937
Pessimistic Attitude Toward the Future, Premorbid Residual or Intermorbid

Brooding About Events or Feeling Sorry for No Yes Unknown No Yes Unknown
Self
feel pessimistic about the future, brood about the 0 1 9 0 1 9 CA938-CA939
past, or feel sorry for yourself?
Tearfulness or Crying Premorbid Residual or Intermorbid

get tearful or have crying spells? No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA940-CA941
Age when some symptoms were first noticed __ __ CA942
Has a cluster of 3 or more symptoms tended to be relatively

persistent (i.e., chronic, not episodic) since onset? No 0 CA943
Yes 1
Was there a cluster of three or more symptoms with

mood abnormality? No 0
Yes 1
Record longest duration (in months) of a cluster of 3 or more symptoms in

addition to mood abnormality. Leave blank if there has been no cluster;
enter 999 if duration is unknown. __ __ __ CA944
146
Predominant Personality Pattern
Hypomanic: No evidence of cyclothymia and Premorbid Residual or Intermorbid

meets one of the following: No Yes Unknown No Yes Unknown
1. Elevated mood and at least three other 0 1 9 0 1 9 CA945-CA946
hypomanic symptoms have been present

much of the time over at least a two-year
period.
2. Multiple (6 or more) hypomanic episodes

(lasting at least a few days to a week) in a
two-year period.
Dysthymic: No evidence of cyclothymia and low Premorbid Residual or Intermorbid

mood and at least three other dysthymic No Yes Unknown No Yes Unknown
symptoms have been present much of the time
over at least a two-year period. 0 1 9 0 1 9 CA947-CA948
Cyclothymic (Evidence of both hypomania and Premorbid Residual or Intermorbid

dysthymia) No Yes Unknown No Yes Unknown
0 1 9 0 1 9 CA949-CA950
FUNCTIONING DURING PAST FIVE YEARS

Outcome
Condition following the last episode if the subject has No information; not applicable 0 CA951
had an episode of illness prior to the current episode.
For patients who have been continuously ill for Virtually a complete return (at some
greater than six months, note the degree to which time) to level of functioning prior to
they have recovered, relative to their premorbid level first episode 1
of functioning, at some point during the course of
their disorder. Some residual impairment 2
Did you recover completely from your last episode Considerable residual impairment
(before this one), or did you have some problems from which he never recovered 3
which just lingered on until you got sick again?
Marked deterioration from which he
If subject has had more than one previous episode, never recovered 4
determine whether he returned to the level of
functioning he exhibited prior to the first episode.
Ask questions if unclear.
147
Overall Functioning
Healthiest overall functioning No information; not sure 0 CA952
characteristic of subject for at least a
few months during the last 5 years. Absent or minimal symptoms; good functioning
in all areas; interested and involved in a wide
This is a summary judgment which takes range of activities, socially effective, generally
into account work adjustment, social satisfied with life; "everyday" worries that only
conduct, symptomatology, and any occasionally get out of hand 1
indices of impaired functioning.
Absent or minimal symptoms; no more than
In the last five years, when were you slight impairment in functioning, varying
feeling best? degrees of "everyday" worries and problems
occasionally get out of hand 2
Did that last for at least a few months?
Mild symptoms; depressed mood and mild
What was bothering you then? insomnia; or some difficulty in several areas of
functioning, but generally functioning pretty
What about your mood, work, family, well; has some meaningful interpersonal
social life, etc. relationships; most untrained people would not
consider him "sick" 3
Moderate symptoms or generally functioning

with some difficulty, e.g., few friends, flat
affect, depressed mood with pathological self-
doubt, euphoric mood and pressure of speech,
occasional shoplifting 4
Any serious symptoms or impairment in

functioning that most clinicians would think
obviously require treatment or attention, e.g.,
suicidal preoccupation, severe obsessional
rituals, frequent anxiety attacks, serious
antisocial behavior, compulsive drinking 5
Major impairment in several areas, such as

work, family relations, judgment, thinking, or
mood, e.g., depressed woman avoids friends,
neglects family, unable to do housework, or
some impairment in reality testing or
communication, e.g., speech is at times
obscure, illogical, or irrelevant 6
148
Social Relations
Best level of social relations during the last five years No information; not sure 0 CA953
that lasted at least several months. Consider
contact that has a pleasurable quality and is not Superior; had many close friends
merely for the purpose of completing some task or seen regularly 1
fulfilling a duty. May include family members not
living in same household. Very good; several special friends
seen regularly 2
During the past five years, when was the period
when you had the most to do with other people Good; one or two special friends
socially? seen now and then 3
How much did you have to do socially with friends or Fair; only one special friend seen
with other people then? now and then; social contacts
limited to acquaintances 4
What about visiting or having people over to your
place? Poor; no special friends; social
contacts limited to a small number
Did you attend church activities; bowl, play cards, of acquaintances 5
etc.?
Very poor; no special friends;
Whom did you see? social contacts limited to one or
two acquaintances 6
How close were you to them?
Grossly inadequate; virtually no
Would you consider any of them close friends- social contact 7
people you could really trust?
No 0 CA954
Does this subject meet criteria for poor functioning? Skip to Global Assessment Scale
(Scores 5 or 6 on Overall Functioning or 5, 6, or 7 on
Social Relations) Yes 1
Poor functioning characteristic of most of subject's life? No 0 CA955

Yes 1
Poor functioning the result of deterioration? No 0 CA956

Yes 1
149
GLOBAL ASSESSMENT SCALE*
100 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 warmth and integrity. No symptoms.
91
90 Good functioning in all areas, many interests, socially effective, generally satisfied with life.
| There may or may not be transient symptoms and "everyday" worries that only occasionally get
81 out of hand.
80 No more than slight impairment in functioning, varying degrees of "everyday" worries and
| problems that sometimes get out of hand. Minimal symptoms may or may not be present.
71
70 Some mild symptoms (e.g., depressive mood and mild insomnia) OR some difficulty in several
| areas of functioning, but generally functioning pretty well, has some meaningful interpersonal
61 relationships and most untrained people would not consider him "sick.")
60 Moderate symptoms OR generally functioning with some difficulty (e.g., few friends and flat
| affect, depressed mood and pathological self-doubt, euphoric mood and pressure of speech,
51 moderately severe antisocial behavior.)
50 Any serious symptomatology or impairment in functioning that most clinicians would think
| obviously requires treatment or attention (e.g., suicidal preoccupation or gesture, severe
| obsessional rituals, frequent anxiety attacks, serious antisocial behavior, compulsive drinking,
41 mild but definite manic syndrome).
40 Major impairment in several areas, such as work, family relations, judgment, thinking or mood
| (e.g., depressed woman avoids friends, neglects family, unable to do housework), OR some
| impairment in reality testing or communication (e.g., speech is at times obscure, illogical, or
31 irrelevant), OR single suicide attempt.
30 Unable to function in almost all areas (e.g., stays in bed all day) OR behavior is considerably
| influenced by either delusions or hallucinations OR serious impairment in communication (e.g.,
21 sometimes incoherent or unresponsive) or judgment (e.g., acts grossly inappropriate.)
20 Needs some supervision to prevent hurting self or others, or to maintain minimal personal
| hygiene (e.g., repeated suicide attempts, frequently violent, manic excitement, smears feces),
11 OR gross impairment in communication (e.g., largely incoherent or mute).
10 Needs constant supervision for several days to prevent hurting self or others or makes no
| attempt to maintain minimal personal hygiene or serious suicide act with clear intent and
1 expectation of death.
RATE: Highest level of functioning in past year ___ ___ ___ CA957
Highest level of functioning during the last five years ___ ___ ___ CA958
*Adapted, with permission from, Endicott, J., Spitzer, R.L., Fleiss, J.L., Cohen, J., The Global Assessment Scale: A
procedure for measuring overall severity of psychiatric disturbances, Archives of General Psychiatry, 33:766-771, 1976
150
Reliability and Completeness of Information Contained in Part II
(If poor or very poor, data should not be considered Very good 1 CA959
useful for research purposes) Good 2
Fair 3
Poor 4
Very poor 5
151
LIFETIME DIAGNOSES
(includes current diagnoses)
Use DSM-III, III-R, or IV for list of Axis I & II codes

Use ICD-9 for Axis III codes
Which criteria were used for diagnoses?

DSM-III 0 CA960
DSM III-R 1
DSM IV 2
Enter number of Axis I diagnoses and code 0 CA961

Skip to Axis II diagnoses
1
2
3
___ ___ ___ . ___ ___ CA963
___ ___ ___ . ___ ___ CA964
Enter number of Axis II diagnoses and code 0 CA965

Skip to Axis III diagnoses
1
2
3
___ ___ ___ . ___ ___ CA967
___ ___ ___ . ___ ___ CA968
152
Enter number of Axis III diagnoses and code 0 CA969
Skip codes below
1
2
3
___ ___ ___ . ___ ___ CA971
___ ___ ___ . ___ ___ CA972
153

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COMPREHENSIVE ASSESSMENT OF

SYMPTOMS AND HISTORY

Nancy C. Andreasen, M.D., Ph.D.

Address correspondence and requests to use the CASH

to the MH-CRC Administrator

10/24/2000 Biostatistical Core Unit

PRESENT STATE Page

PAST HISTORY Page

Characterization of Course 100

LIFETIME HISTORY Page

Batch Number $BATCHNUM INITIALS INITIALS

Document Number $DOCNUM ID __ __ __ __ __ __ __ __ ID

Entry1 ENT1 Entry2 ENT2

Form/Version CASH/02.1 FOLLOW-UP PERIOD (# months) __ __ __ FUPER

ASSESSMENT: 1st time studied 1 ASS

RELIABILITY MEASUREMENT#: Original 1 REL

FAMILY STUDY No 0 CA1

TYPE: Index 1 CA2

FAMILY NUMBER __ __ __ CA3

DATE __ __ /__ __ /__ __ DATE

RATERS (1) ___ ___ (2) __ __ RATER

MEDICATION AT TIME OF INTERVIEW: No Medication 0 CA7

BIRTH DATE __ __ /__ __ /__ __ CA9

SEX: Male 1 CA11

PSYCHIATRIC TREATMENT STATUS: CA14

Other patient (e.g., care facility) 3

Outpatient and Day Treatment 5

ADMISSION DATE __ __ /__ __ /__ __ CA15

DISCHARGE DATE __ __ /__ __ /__ __ CA16

ENTRY INTO STUDY DATE __ __ /__ __ /__ __ CA17

SOURCES OF INFORMATION: No Yes

(Have you ever been married?) Married/common law 2

(How many times have you been married?) Separated 3

Divorced and not remarried 4

Divorced and remarried 5

Divorced two or more times and

Divorced two or more times and

Current Occupational Status

Is the subject unemployed because of retirement? No 0 CA26

How long have you been unemployed?

(How long did you do that?) Clerical, sales, technician, farmer 3

(Have you had any other jobs?) Skilled manual employee 4

Skilled manual employee 4

Educational Achievement of Parents

Social Class of Parents

Unskilled and semi-skilled workers;

Educational Achievement of Subject

(How far did you go in school?)

Were you interested in school? Earned good grades, mostly B's 2

Earned poor grades, mostly D's 4

Earned primarily failing grades 5

Held back one year, no special

Required special education but

Held back two or more years 4

Was not able to complete school

Semi-skilled worker, laborer;

Unskilled and semi-skilled worker;

Has this been the case for most of the time?

Who lives with you?

Is there someone else in the household?

(a) Parents? No 0 CA39

(b) Mate? No 0 CA40

(d) Brothers and/or sisters Number ___ ___ CA45

Document Number $DOCNUM ID ID

Form/Version CASH/02.1 FOLLOW-UP PERIOD (# months) __ FUPER

FAMILY NUMBER __ CA3

DATE / / DATE

RATERS (1) _ _ (2) RATER

BIRTH DATE / / CA9

ADMISSION DATE / / CA15

DISCHARGE DATE / / CA16

ENTRY INTO STUDY DATE / / CA17

(d) Brothers and/or sisters Number _ _ CA45

(e) Other relatives Number _ _ CA46

(f) Friends or some other group-living Number _ _ CA47