The DSM-5 Level 2—Substance Use—Adult is an adapted version of the NIDA-Modified ASSIST.

The 15-item measure is used to assess the pure domain of prescription medicine, and illicit substance use in adults age 18 and older. It is completed by the individual prior to a visit with the clinician.

If the individual receiving care is of impaired capacity and unable to complete the form (e.g., an individual with dementia), a knowledgeable informant may complete the measure. Each item asks the individual receiving care (or informant) to rate the severity of the individual’s use of various substances during the past 2 weeks.

  • During the past TWO (2) WEEKS, about how often did you use any of the following medicines ON YOUR OWN, that is, without a doctor’s prescription, in greater amounts or longer than prescribed?

 

 

The DSM-5 Level 2—Somatic Symptom—Adult measure is an adaptation of the 15-item Patient Health Questionnaire Physical Symptoms (PHQ-15) that assesses the domain of somatic symptoms.

The measure is completed by the individual (or his or her informant) prior to a visit with the clinician. If the individual is of impaired capacity and unable to complete the form (e.g., an individual with dementia), a knowledgeable informant may complete the measure.

Each item asks the individual (or informant) to rate the severity of the individual’s somatic symptom during the past 7 days

 

  • In the past seven days....

 

 

The DSM-5 Level 2—Sleep Disturbance—Adult measure is the 8-item PROMIS Sleep Disturbance Short Form that assesses the pure domain of sleep disturbance in individuals age 18 and older. The measure is completed by the individual prior to a visit with the clinician. If the individual receiving care is of impaired capacity and unable to complete the form (e.g., an individual with dementia), a knowledgeable informant may complete the measure as done in the DSM-5 Field Trials.

However, the PROMIS Sleep Disturbance Short Form has not been validated as an informant report scale by the PROMIS group. Each item
asks the patient (or informant) to rate the severity of the patient’s sleep disturbance during the past 7 days.

 

  • In the past seven days....

 

 

The ASRM (Altman Self-Rating Mania Scale) is a 5-item self-rating mania scale designed to assess the presence and/or severity of manic symptoms. The measure is completed by the individual prior to a visit with the clinician.

If the individual receiving care is of impaired capacity and unable to complete the form (e.g., an individual with dementia), a knowledgeable informant may complete the measure.

Each item asks the individual (or informant) to rate the severity of the individual’s manic symptoms during the past 7 days.

 

  • Choose the one statement in each group that best describes the way you (the individual receiving care) have been feeling for the past week Please note: The word “occasionally” when used here means once or twice; “often” means several times or more and “frequently” means most of the time.

The National Stressful Events Survey PTSD Short Scale (NSESSS) is a 9-item measure that assesses the severity of posttraumatic stress disorder in individuals age 18 and older following an extremely stressful event or experience. The measure was designed to be completed by an individual upon receiving a diagnosis of posttraumatic stress disorder (or clinically significant posttraumatic stress disorder symptoms) and thereafter, prior to follow-up visits with the clinician. Each item asks the individual receiving care to rate the severity of his or her posttraumatic stress disorder during the past 7 days.

  • How much have you been bothered during the PAST SEVEN (7) DAYS by each of the following problems that occurred or became worse after an extremely stressful event/experience?

The DSM-5 Level 2 - Repetitive Thoughts and Behavior Adult measure is an adapted version of the 5-item Florida Obsessive-Compulsive Inventory (FOCI) Severity Scale (Part B) that is used to assess the domain of repetitive thoughts and behaviors in individuals age 18 and older.

The measure is completed by an individual prior to a visit with the clinician.

  • Choose the one statement in each group that best describes the way you (the individual receiving care) have been feeling for the past week Please note: The word “occasionally” when used here means once or twice; “often” means several times or more and “frequently” means most of the time.

The Mood Disorder Questionnaire (MDQ) was developed by a team of psychiatrists, researchers and consumer advocates to address the need for timely and accurate evaluation of bipolar disorder.

Clinical Utility: The MDQ is a brief self-report instrument that takes about 5 minutes to complete.n This instrument is designed for screening purposes only and is not to be used as a diagnostic tool.

A positive screen should be followed by a comprehensive evaluation

Each item inquires about how much (or how often) the individual has been bothered by the specific symptom during the past 2 weeks.

  • Has there ever been a period of time when you were not your usual self and...

The GAD - 7 is intended to help clinicians identify and screen for the presence and severity of anxiety. The measure may be used to track changes in the individual’s symptom presentation over time.

The results of the GAD - 7 may be used to make a anxiety diagnosis according to DSM-IV criteria and takes less than 3 minutes to complete. The total of all 7 responses from the GAD - 7 aims to predict the presence and severity of anxiety

Each item inquires about how much (or how often) the individual has been bothered by the specific symptom during the past 2 weeks.

  • Over the last two weeks, how often have you been bothered by the following problems? Please note, all fields are required for this screen.

The PHQ - 9 is intended to help clinicians identify and screen for the presence and severity of depression. The measure may be used to track changes in the individual’s symptom presentation over time.

The results of the PHQ-9 may be used to make a depression diagnosis according to DSM-IV criteria and takes less than 3 minutes to complete. The total of all 9 responses from the PHQ-9 aims to predict the presence and severity of depression

Each item inquires about how much (or how often) the individual has been bothered by the specific symptom during the past 2 weeks.

  • Over the last two weeks, how often have you been bothered by the following problems? Please note, all fields are required for this screen.
    Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual

The DSM-5 Level 1 Cross-Cutting Symptom Measure is intended to help clinicians identify additional areas of inquiry that may have significant impact on the individual’s treatment and prognosis.

In addition, the measure may be used to track changes in the individual’s symptom presentation over time.

This adult version of the measure consists of 23 questions that assess 13 psychiatric domains, including depression, anger,
mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors,
dissociation, personality functioning, and substance use.

Each item inquires about how much (or how often) the individual has been bothered by the specific symptom during the past 2 weeks.

  • Over the last two weeks, how often have you been bothered by the following problems? Please note, all fields are required for this screen.
  • [e.g., painkillers (like Vicodin), stimulants (like Ritalin or Adderall), sedatives or tranquilizers (like sleeping pills or Valium), or drugs like marijuana, cocaine or crack, club drugs (like ecstasy), hallucinogens (like LSD), heroin, inhalants or solvents (like glue), or methamphetamine (like speed)]?
If you are in crisis, call the National Suicide Prevention Lifeline, a free, 24-hour hotline, at 1.800.273.8255.
If this is an emergency, call 911 or go to your nearest emergency room. RethinkMyHealthcare does not offer crisis counseling or emergency services.