National Survey of Health and Development
1982 (Age 36)
1982 Present State Examination
nshd_82_pse
STRICTLY CONFIDENTIAL
1982
NATIONAL SURVEY OF HEALTH AND DEVELOPMENT
(Medical Research Council)
Canynge Hall,
Interviewer's Name
PRESENT STATE EXAMINATION
1. INTRODUCTION and 2. HEALTH, WORRYING, TENSION
Now I should like to get some idea of how you have been getting along in the past month, how your general health has been and how you have been feeling about things. Some of the things that I shall ask may not apply to you; I am just making sure that everything has been mentioned.
** Most people have some sort of worry or trouble from time to time. What sort of things do you worry about?
RECORD THE MAIN PROBLEMS SPONTANEOUSLY MENTIONED AND THE FIRST SENTENCE OF THE SUBJECT'S REPLY VERBATIM.
Means of exploration if subject gives inadequate information:
If subject's statement too brief: Can you tell me more about that?
If subject has no more to add: What else has been troubling you?
If statements are difficult to understand: Can you explain what you mean by ...?
If subject is vague: Could you give me an example of ...?
** What is it like when you worry?
RATE WORRYING (4) A round of painful thought which cannot be stopped and is out of proportion to the subject worried about.
(What sort of state of mind do you get into?)
(Do unpleasant thoughts constantly go round and round in your mind?)
(Can you stop them by turning your attention to something else?)
** Have you had headaches or other aches or pains during the past month?
RATE ONLY TENSION PAINS (5) e.g. 'band round head', 'pressure', 'tightness in scalp ', 'ache in back of neck' etc., not migraine.
(What kind?)
** Have you been getting exhausted and worn out during the day or evening even when you haven't been working very hard?
RATE TIREDNESS OR EXHAUSTION (6) Do not include tiredness due to 'flu, etc. (rate 9)
** Have you had difficulty in relaxing during the past month?
RATE MUSCULAR TENSION (7) Do not include a subjective feeling of nervous tension, which is rated later.
(Do your muscles feel tensed up?)
** Have you been so fidgety and restless that you couldn't sit still?
RATE RESTLESSNESS (8)
(Do you have to keep pacing up and down?)
** Is your physical health good?
(Does your body function normally?)
** Do you feel that you are physically ill in any way?
RATE SUBJECT'S OWN SUBJECTIVE EVALUATION OF PRESENT PHYSICAL HEALTH (1) (Irrespective of whether physical disease is present)
(What is that like? How serious is it?)
** Do you tend to worry over your physical health?
RATE HYPOCHONDRIASIS (9) Overconcern with possibility of death, disease or malfunction. Re-rate at end of interview if necessary.
** Do you often feel on edge, or keyed up, or mentally tense or strained?
RATE SUBJECTIVE FEELING OF 'NERVOUS TENSION' (10) There is no need for autonomic accompaniments for this symptom to be rated present.
(Do you generally suffer with your nerves?)
(Do you suffer from nervous exhaustion?)
3. AUTONOMIC ANXIETY
In this section, rate only subjective anxiety with autonomic accompaniments, either free floating or situational. Do not include worrying or nervous tension. Do not include anxiety due to e.g. persecutory delusions.
(CHECKLIST of autonomic accompaniments: Blushing, Butterflies in stomach, Choking, Difficulty in getting breath, Dizziness, Dry Mouth, Giddiness, Palpitations, Sweating, Trembling.)
** Have there been times lately when you have been very anxious or frightened?
RATE FREE-FLOATING AUTONOMIC ANXIETY (11) Exclude if due to delusions. Exclude if purely situational.
(What was this like?)
(Did your heart beat fast? - ask for other autonomic symptoms)
(How often in the past month?)
** Have you had the feeling that something terrible might happen?
RATE ANXIOUS FOREBODING WITH AUTONOMIC ACCOMPANIMENT (12)
(That some disaster might occur but you are not sure what? Like illness or death or ruination?)
(Have you been anxious about getting up in the morning because you are afraid to face the day?)
(What did it feel like?)
** Are there any special situations that make you anxious?
Have you had times when you felt shaky, or your heart pounded, or you felt sweaty, and you simply had to do something about it?
RATE PANIC ATTACKS WITH AUTONOMIC SYMPTOMS: (14) A panic attack is intolerable anxiety leading to some action to end it, e.g. leaving a bus, phoning husband at work, going in to see a neighbour, etc.
(What was it like?)
(What was happening at the time?)
(How often during the past month?)
Do you tend to get anxious in certain situations, such as travelling or being alone, or being in a lift or tube train?
RATE SITUATIONAL AUTONOMIC ANXIETY (15)
(What situations? How often in the past month?)
(CHECKLIST: make a note of each situation:
Crowds (shop, street, theatre, cinema, church)
Going out alone; being at home alone.
Enclosed spaces (hairdressers, phone booth, tunnel)
Open spaces, bridges
Traveiling (buses, cars, trains))
What about meeting people e.g. going into a crowded room, making conversation?
RATE AUTONOMIC ANXIETY ON MEETING PEOPLE (16)
(CHECKLIST: make a note of each situation:
Speaking to an audience.
Eating, drinking or writing in front of other people.
Parties.)
Do you have any special fears, like some people are scared of feathers, or cats, or spiders, or birds?
RATE ONLY SPECIFIC PHOBIAS (17) NOT GENERAL SITUATIONAL ANXIETY)
(CHECKLIST: make a note of each situation:
Heights , thunderstorms, darkness, animals or insects of any kind, dentists, injections, blood, injury)
Do you avoid any of these situations (specify as appropriate) because you know you will get anxious?
RATE AVOIDANCE OF ANXIETY-PROVOKING SITUATIONS (18)
(How much does it affect your life?)
Do you avoid any of these situations (specify as appropriate) because you know you will get anxious?
DESCRIBE ANXIETY SYMPTOMS AND LIST PHOBIAS IF NOT ALREADY RECORDED
4. THINKING, CONCENTRATION, INTERESTS
** Can you think clearly or is there any interference with your thoughts?
** Do your thoughts tend to be muddled or slow?
RATE SUBJECTIVELY INEFFICIENT THINKING (19) If due to intrusion of alien thoughts, rate 9.
(Can you make up your mind about simple things quite easily?)
(Make decisions about everyday matters?)
Are you in full control of your thoughts? Can people read your mind? Who? How? Is anything like hypnotism or telepathy going on? Are thoughts put into your head which are not your own? Do you feel under the control of some force or power other than yourself?
DESCRIBE IN DETAIL
IF DELUSIONS OF THOUGHT INSERTION ETC. (SYMPTOMS 55-59) MAY BE PRESENT,
IF DELUSIONS OF CONTROL (SYMPTOM 71) MAY BE PRESENT,
** What has your concentration been like recently?
RATE POOR CONCENTRATION (20)
(Can you read an article in the paper or watch a TV programme right through?)
(Do your thoughts drift off so that you don't take things in?)
** Do you tend to brood on things?
RATE NEGLECT DUE TO BROODING (21)
(So much that you even neglect your work?)
** What about your interests, have they changed at all?
RATE LOSS OF INTEREST (22) continuing during past month
(Have you lost interest in work, or hobbies or recreations?)
(Have you let your appearance go?)
5. DEPRESSED MOOD
** Do you keep reasonably cheerful or have you been very depressed or low-spirited recently?
** Have you cried at all?
RATE DEPRESSED MOOD (23) N. B. When rating clinical severity of depression remember that deeply depressed people may not necessarily cry. See definition in glossary.
(When did you last really enjoy anything?)
** How do you see the future?
RATE HOPELESSNESS (24) on subject's subjective view at present
(Has life seemed quite hopeless?)
(Can you see any future?)
(Have you given up or does there still seem some reason for trying?
USE JUDGEMENT ABOUT WORDING THE FOLLOWING:
** Have you felt that life wasn't worth living?
RATE SUICIDAL PLANS OR ACTS (25)
(Did you ever feel like ending it all?)
(What did you think you might do?)
(Did you actually try?)
(N.B. Examiner should judge clinically whether there was intent to end life or not. If in doubt, assume not.)
** Have you felt that life wasn't worth living?
DESCRIBE ANY ATTEMPT:
Which seems worse, the depression or the anxiety? (use subject's own terms)
RATE ANXIETY OR DEPRESSION PRIMARY (26) See definition in glossary. If subject suffers from both anxiety and depression, try to decide which is primary
Is the depression worse at any particular time of day?
RATE MORNING DEPRESSION (27) (particularly on waking)
6. SELF AND OTHERS
** Have you wanted to stay away from other people?
RATE SOCIAL WITHDRAWAL (28)
(Why?)
(Have you been suspicious of their intentions? Of actual harm?)
** What is your opinion of yourself compared to other people?
RATE SELF-DEPRECIATION (29)
(Do you feel better, or not as good, or about the same as most?)
(Do you feel inferior or even worthless?)
** How confident do you feel in yourself?
RATE LACK OF SELF-CONFIDENCE WITH OTHER PEOPLE (30) Consider only competence in social relationships, not competence in mechanical work, etc.
(For example, in talking to others, in managing with other people?)
** Are you self-conscious in public?
RATE SIMPLE IDEAS OF REFERENCE (31) (not delusions)
(Do you get the feeling that other people are taking notice of you in the street or a bus or a restaurant?)
(Do they ever seem to laugh at you or talk about you critically?)
(Do you consider people really are looking at you, or is it perhaps the way you feel about it?)
IF NO EVIDENCE OF GUILT, OR OF DELUSIONS OF REFERENCE OR PERSECUTION, PROCEED TO NEXT **
Do you have the feeling that you are being blamed for something or even accused? What about?
RATE GUILTY IDEAS OF REFERENCE (32) Do not include justifiable blame or accusation. Exclude delusions of guilt.
Do you tend to blame yourself at all?
RATE PATHOLOGICAL GUILT ONLY (33)
(If people are critical, do you think you deserve it?)
Do you feel you have committed a crime or sinned greatly or deserve punishment?
DESCRIBE IN DETAIL
(Have you felt you might contaminate or ruin other people?)
IF DEPRESSIVE DELUSIONS (SYMPTOMS 88, 91, 92) MAY BE PRESENT
Do people seem to drop hints or say things with a double meaning? Do things seem specially arranged?
DESCRIBE IN DETAIL
(Do people follow you about?)
(Do you see any reference to yourself on TV or in the papers?)
(How do you explain it?)
IF DELUSIONS OF REFERENCE OR MISINTERPRETATION (SYMPTOMS 72 and 73) MAY BE PRESENT
Is anyone trying to harm you?
DESCRIBE IN DETAIL:
(How? Is there any organization behind it?)
(How do you explain it?)
IF DELUSIONS OF PERSECUTION (SYMPTOM 74) MAY BE PRESENT
7. APPETITE, SLEEP, RETARDATION, LIBIDO
** What has your appetite been like recently?
RATE LOSS OF WEIGHT DUE TO POOR APPETITE (34) Do not include changes due to physical illness
(Have you lost any weight during the past 3 months?)
** Have you had any trouble getting off to sleep during the past month?
RATE DELAYED SLEEP (35)
(How long do you lie awake?)
(What happens if you take sleeping tablets?)
(How often does it happen?)
** Do you seem to be slowed down in your movements, or have too little energy recently? How much has it affected you?
RATE SUBJECTIVE ANERGIA AND RETARDATION (36)
(Do things seem to be moving too fast for you?)
IF NO APPETITE OR SLEEP DISTURBANCE, AND NO DEPRESSION PROCEED TO NEXT **
Do you wake early in the morning?
RATE EARLY WAKING (37) (1 hour before usual)
(Use discretion whether to ask this)
Has there been any change in your interest in sex?
RATE LOSS OF LIBIDO WITHIN PRESENT EPISODE OF ILLNESS AND PERSISTING DURING PAST MONTH
Ask if appropriate:
Does the depression or tension get worse just before the start of the monthly period?
RATE PREMENSTRUAL EXACERBATION (39)
8. IRRITABILITY
** Have you been very much more irritable than usual recently?
RATE IRRITABILITY (40)
(How do you show it?)
(Do you keep it to yourself, or shout, or even hit people?)
9. EXPANSIVE MOOD AND IDEATION
** Have you sometimes felt particularly cheerful and on top of the world, without any reason?
RATE EXPANSIVE MOOD (41 Not ordinary high spirits
(Too cheerful to be healthy?)
(How long does it last?)
** Have you felt particularly full of energy lately, or full of exciting ideas?
RATE SUBJECTIVE IDEOMOTOR PRESSURE (42)
(Do things seem to go too slowly for you?)
(Do you need less sleep than usual?)
(Do you find yourself extremely active but not getting tired?)
(Have you developed new interests recently?)
IF NO EVIDENCE OF EXPANSIVE MOOD AND IDEATION, PROCEED TO NEXT **
Have you seemed super-efficient at work, or as though you had special powers or talents quite out of the ordinary?
RATE GRANDIOSE IDEAS AND ACTIONS (43)
(Have you felt specially healthy?)
(Have you been buying any interesting things recently?)
Is there anything special about you?
DESCRIBE IN DETAIL:
(Is there a special purpose or mission to your life?)
(Are you specially clever or inventive?)
(Are you a very prominent person?)
(How do you explain this?)
IF GRANDIOSE DELUSIONS (SYMPTOMS 75-77) MAY BE PRESENT
10. OBSESSIONS
These symptoms are usually experienced as occurring against conscious resistance. (See definition in glossary)
** Do you find that you have to keep on checking things that you know you have already done?
RATE OBSESSIONAL CHECKING AND REPEATING (44)
(Like gas taps, doors, switches, etc.)
(Do you have to touch or count things many times or repeat the same action over and over again?)
(What happens when you try to stop?)
** Do you spend a lot of time on personal cleanliness, like washing over and over again even though you know you are clean? What about tidiness?
RATE OBESSIONAL CLEANLINESS AND SIMILAR RITUALS (45)
(Do you get worried by contamination with germs?)
(Do you have other rituals?)
(What happens when you try to stop?)
** Do you find it difficult to make decisions even about trivial things?
RATE OBSESSIONAL IDEAS AND RUMINATION (46)
(Do you constantly have to question the meaning of the universe?)
(Do you get awful thoughts coming into your mind even when you try to keep them out?)
(What happens when you try to stop?)
11. DEPERSONALISATION AND DEREALISATION
** Have you had the feeling recently that things around you were unreal?)
RATE DEREALISATION (47)
(As though everything was an imitation of reality, like a stage set, with people acting instead of being themselves?)
(What is it like? How do you explain it?)
** Have you yourself felt unreal, that you were not a person, not in the living world?
RATE DEPERSONALISATION (48)
(Or that you were outside yourself, looking at yourself from outside?)
(Or that you look unreal in the mirror?)
(Or that some part of your body did not belong to you?)
(How do you explain it?)
12. OTHER PERCEPTUAL DISTORTION, ETC.
** Does your imagination ever play tricks on you?
** Do you get the feeling something odd is going on you can't explain?
** Is there anything unusual about the way things look or sound or smell or taste?
DESCRIBE IN DETAIL
(Is your own appearance normal?)
(How do you explain it?)
IF PERCEPTUAL DISTORTION (SYMPTOMS 49-54) MAY BE PRESENT
-
- Do you ever seem to hear what seem to be voices when nobody is about?
DESCRIBE IN DETAIL:
(When? What is it like?)
(What are the words? Is there more than one person?)
(How do you explain it?)
IF AUDITORY HALLUCINATIONS (SYMPTOMS 60-64) MAY BE PRESENT
** Have you ever had a vision or seen things other people couldn't see?
DESCRIBE IN DETAIL:
(When? What is that like?)
(How do you explain it?)
IF VISUAL HALLUCINATIONS (SYMPTOMS 64, 66, 67) MAY BE PRESENT
IF YOU SUSPECT OTHER DELUSIONS MAY BE PRESENT
16. SENSORIUM AND FACTORS AFFECTING, AND TREATMENT
** Have you had any lapses of memory recently?
** Have there been any periods in which you completely forgot what happened?
RATE FUGUES, BLACKOUTS, AMNESIA (97) for more than 1 hour: irrespective of aetiology
(What was it like?)
(How do you explain it?)
IF NO EVIDENCE OF POOR MEMORY, PROCEED TO **
May I ask one or two standard questions we ask of everybody?
RATE ORGANIC IMPAIRMENT OF MEMORY (103)
How old are you?
When is your birthday?
Can you tell me the year and the month?
What is the name of the Prime Minister?
** What medicines or drugs do you take?
OBTAIN LIST OF DRUGS
** What medicines or drugs do you take?
RATE DRUG ABUSE DURING MONTH (98) (ONE, THE HIGHEST CATEGORY, ONLY)
(Do you take anything for your nerves or your mood?)
(Who prescribes them? Do you buy them over the counter?)
(What about other types of drugs, like cannabis?)
** May I ask about your drinking habits?
** How much do you usually drink each day?
RATE ALCOHOL ABUSE DURING MONTH (99)
(Is alcohol in any way a problem for you?)
(In what way?)
(CHECKLIST: During the past month have you: Had family problems because of your drinking? Missed work because of drinking? Had morning shakes? Had blackouts for several hours? Heard voices or seen visions?)
Take subjects' previous replies into account when asking next 3 questions
** I have been asking about the last month; now may I ask if there has been any time in the past year when you have felt consistently sad and low spirited for a considerable period?
(When was that? ... )
** Has there been any time during the past year when you have felt anxious or fearful or nervous over a considerable period? (Such that you were prone to nervous sweating, trembling or 'butterflies' in the stomach?)
(When was that? ... )
** Has there been any time during the past year when you have felt full to overflowing of energy or exciting ideas for days at a stretch? (Such that you needed less sleep than usual?)
(When was that? ... )
** May I ask if you are seeing a doctor for your nerves?
(Or specify any psychosomatic complaints?)
** What kind of doctor is he?
(Your own GP, a private doctor, a psychiatrist, at hospital outpatients?)
** Have you seen a doctor in the past year for any nervous condition?
** Are you attending for treatment, any person who is not medically qualified e.g. lay therapist, herbalist, acupuncturist, faith healer, Christian Scientist, church which forbids medical advice? Or have you done so in the past year?
SPECIFY TREATMENT:
** Are you attending for treatment, any person who is not medically qualified e.g. lay therapist, herbalist, acupuncturist, faith healer, Christian Scientist, church which forbids medical advice? Or have you done so in the past year?
SPECIFY COMPLAINT:
(When?)
(What were you complaining of at the time?)
Now return to Questionnaire A, page 18, question 73
nshd_82_pse
1. INTRODUCTION and 2. HEALTH, WORRYING, TENSION
3. AUTONOMIC ANXIETY
4. THINKING, CONCENTRATION, INTERESTS
5. DEPRESSED MOOD
6. SELF AND OTHERS
7. APPETITE, SLEEP, RETARDATION, LIBIDO
8. IRRITABILITY
9. EXPANSIVE MOOD AND IDEATION
10. OBSESSIONS
11. DEPERSONALISATION AND DEREALISATION
12. OTHER PERCEPTUAL DISTORTION, ETC.
16. SENSORIUM AND FACTORS AFFECTING, AND TREATMENT
1982 Present State Examination