Name
Akshay
Identifying Data
Gender
male
Identifying Data
Work or academic pressure?
yes
Risk assessment/Screening ›
Psychosocial Stressors
Financial stress?
yes
Risk assessment/Screening ›
Psychosocial Stressors
Relationship or marital problems?
yes
Risk assessment/Screening ›
Psychosocial Stressors
Major life changes?
no
Risk assessment/Screening ›
Psychosocial Stressors
Substance use in family?
yes
Risk assessment/Screening ›
Family History
Psychiatric illness in family?
no
Risk assessment/Screening ›
Family History
Family conflict or instability?
yes
Risk assessment/Screening ›
Family History
Stress management?
Avoidance / Sleep
Risk assessment/Screening ›
Risk Behaviors & Coping Skills
Coping style adaptive vs maladaptive?
Rarely
Risk assessment/Screening ›
Risk Behaviors & Coping Skills
Leisure activities?
Sometimes
Risk assessment/Screening ›
Risk Behaviors & Coping Skills
Supportive family?
yes
Risk assessment/Screening ›
Protective Factors
Positive peer group?
yes
Risk assessment/Screening ›
Protective Factors
Religion or spirituality?
Very important
Risk assessment/Screening ›
Protective Factors
Healthy coping strategies?
Sometimes
Risk assessment/Screening ›
Protective Factors
Trauma or abuse?
Yes
Risk assessment/Screening ›
Personal & Psychiatric History
Depression, anxiety?
Yes, both
Risk assessment/Screening ›
Personal & Psychiatric History
ADHD or other disorders?
Yes, other psychiatric disorder(s)
Risk assessment/Screening ›
Personal & Psychiatric History
Previous psychiatric treatment?
Yes – other (please specify)
Risk assessment/Screening ›
Personal & Psychiatric History
Insomnia?
yes
Risk assessment/Screening ›
Sleep & Daily Functioning
Irregular sleep?
yes
Risk assessment/Screening ›
Sleep & Daily Functioning
Daytime fatigue?
yes
Risk assessment/Screening ›
Sleep & Daily Functioning
Effect on daily functioning?
yes
Risk assessment/Screening ›
Sleep & Daily Functioning
Peer pressure?
yes
Risk assessment/Screening ›
Social & Environmental Factors
Community/cultural norms?
no
Risk assessment/Screening ›
Social & Environmental Factors
Exposure to substance use?
yes
Risk assessment/Screening ›
Social & Environmental Factors
Impulsivity?
yes
Risk assessment/Screening ›
Cognitive & Behavioral Patterns
Novelty seeking?
Sometimes
Risk assessment/Screening ›
Cognitive & Behavioral Patterns
Poor decision-making?
yes
Risk assessment/Screening ›
Cognitive & Behavioral Patterns
Aggression or risk-taking?
Yes-Both
Risk assessment/Screening ›
Cognitive & Behavioral Patterns
Medical illnesses
Yes- Past
Past History
Psychiatric illnesses
Yes- Ongoing
Past History
Past substance use
Yes- Ongoing
Past History
Substance use in family
yes
Family History
Psychiatric illnesses in family
no
Family History
Family environment
Conflictual
Family History
Birth and developmental history
Not sure / don’t know
Personal History
Childhood adjustment
Moderate difficulties (frequent struggles at home/school/with peers)
Personal History
Education history
Severe difficulties (significant academic problems or school dropouts)
Personal History
Occupational history
Unemployed / student / homemaker
Personal History
Marital and sexual history
Married / cohabiting, some difficulties
Personal History
Social relationships
Mostly positive, occasional conflicts
Personal History
Forensic or legal history
Moderate legal issues (e.g., arrests, short-term detentions)
Personal History
Leisure and coping
Some leisure activities, occasional healthy coping
Personal History
Traits
Generally impulsive or risk-taking
Premorbid personality
Interpersonal relations
Mostly positive, occasional conflicts
Premorbid personality
Hobbies
Some hobbies/interests, occasional engagement
Premorbid personality
Appearance and behavior
Disorganized appearance, restless or agitated behavior
Mental status Examination
Speech
Rapid or pressured
Mental status Examination
Mood and affect
Depressed / sad
Mental status Examination
Thought
Tangential or disorganized
Mental status Examination
Perception
Occasionally distracted or preoccupied
Mental status Examination
Cognition
Moderate difficulties (frequent forgetfulness, distractibility)
Mental status Examination
Insight
Poor insight (limited awareness, denies problems)
Mental status Examination
Judgment
Moderately impaired (frequent poor decisions)
Mental status Examination
Recently reduced or stopped
Yes – With medical supervision
Withdrawal Questions
Onset of symptoms
Yes, symptoms started after a week
Withdrawal Questions
Severity 1 to 10
5–6: Moderate, noticeable and uncomfortable
Withdrawal Questions
Time of day pattern
Continuous throughout the day
Withdrawal Questions
Interference with daily life
Moderate interference (frequent disruptions, some activities affected)
Withdrawal Questions
Cravings to relieve symptoms
Very strong / uncontrollable cravings
Withdrawal Questions
Ever needed medical help
Yes, minor assistance (advice, outpatient support)
Withdrawal Questions