SCID Baseline/Lifetime Data Entry · PDF fileSCID Baseline/Lifetime Data Entry Form . SWAN Core Lifetime Data Entry Form 1 ... SCID Interview conducted more than 1 month after the

SCID Baseline/Lifetime Data Entry Form

Study of Women’s Health Across the Nation

SECTION A. GENERAL INFORMATION

A1. RESPONDENT ID: AFFIX ID LABEL HERE

A2. SWAN STUDY VISIT#: 12 A3. SCID INTERVIEW FORM VERSION: ___ ___/ ___ ___/ ___ ___ ___ ___ M M D D Y Y Y Y A4. DATA ENTRY FORM VERSION: 07/01/2010 A5. DATE INTERVIEW COMPLETED: ___ ___ / ___ ___ / ___ ___ ___ ___ M M D D Y Y Y Y

A6. INTERVIEWER’S INITIALS: ___ ___ ___ A7. TRANSCRIBER’S INITIALS: ___ ___ ___ A8. RESPONDENT’S DOB: ___ ___ /___ ___ / ___ ___ ___ ___ M M D D Y Y Y Y VERIFY WITH RESPONDENT ___________________________________________________________________ A9. INTERVIEW COMPLETED IN: RESPONDENT'S HOME.......................................1 CLINIC/OFFICE.....................................................2 RESPONDENT'S HOME BY PROXY....................3 CLINIC/OFFICE BY PROXY..................................4 TELEPHONE..........................................................5 TELEPHONE BY PROXY......................................6 Begin transcription with SCID page SWAN-12.

SCID Version 2.0 07/01/2010 Annual Follow-up 12

SCID Baseline/Lifetime Data Entry Form

SWAN Core Lifetime Data Entry Form 1 07/01/2010

SCID SUMMARY SCORE SHEET SWAN-3 Diagnosis Lifetime Meets Symptomatic Prevalence DX Criteria Past Month (DX Inade- Sub- Code) quate Ab- thresh- Thresh- Info. sent old old Absent Present MOOD DISORDERS (01) Bipolar I ? 1 2 3 - - - - - - - - - -> 1 3 Disorder Current Episode

Single manic episode 1 Manic 1

Recurrent episode 2 Mixed 2

Hypomanic 3

Major depressive 4 Unspecified 5

Not post-partum (4 not circled) 0

Post-partum (4 circled) 1

(only if not current) In partial remission 6

In full remission 7

NP9

NP11

NP8

NP10

NP8_A

NP15


SWAN-4 Diagnosis Lifetime Meets Symptomatic Prevalence DX Criteria Past Month MOOD DISORDERS (continued) (DX Inade- Sub- Code) quate Ab- thresh- Thresh- Info. sent old old Absent Present (02) Bipolar II ? 1 2 3 - - - - - - - - - -> 1 3 Disorder Current Episode

Hypomanic 1

Major 2 depressive



(only if not current)

In partial remission 6

In full remission 7

--------------------------------------------------------------------------------------------------------------------------

(03) Other Bipolar ? 1 2 3 - - - - - - - - - -> 1 3 Disorder

Cyclothymic disorder 1

Intermittent hypomanic episodes 2

Manic or hypomanic episode 3 superimposed on psychotic disorder

Other 4

NP17 NP18

NP19

NP17_A

NP23

NP25 NP26

NP27


SWAN-5 Diagnosis Lifetime Meets Symptomatic Prevalence Dx Criteria Past Month MOOD DISORDERS (continued) (Dx Inade- Code) quate Ab- Thresh- Info. sent old Absent Present (04) Major Depres- ? 1 3 - - - - - - - - - -> 1 3 sive Disorder Current Episode

Single episode 1 Neither melan- 0

cholic, atypical,

Recurrent 2 or catatonic

Melancholic 1

Atypical 2



(only if not current)

In partial remission 6

In full remission 7

Subthreshold recurrence 8

--------------------------------------------------------------------------------------------------------------------------

Subthreshold (05) Dysthymic ? 1 2 3 Disorder (current only) Early onset 1

Late onset 2

--------------------------------------------------------------------------------------------------------------------------

NP28 NP29

NP30 NP31

NP28_A

NP33

NP35

NP36


SWAN-6 Diagnosis Lifetime Meets Symptomatic Prevalence Dx Criteria Past Month MOOD DISORDERS (continued) Dx Inade- Code quate Ab- Thresh- Info sent old Absent Present (06) Depressive ? 1 3 - - - - - - - - - -> 1 3 Disorder Not Otherwise Spec. 0 Not Postpartum 0

1 Postpartum 1

3a Possible premenstrual dysphoric disorder 3b

4a Minor Depressive disorder 4b

6a Other 6b

------------------------------------------------------------------------------------------------------------------------

(07) Mood Disorder ? 1 3 - - - - - - - - - -> 1 3 due to a General Medical Condition Specify GMC _____________________

With major depressive-like episode 1

With depressive features 2

With manic features 3

With mixed features 4

------------------------------------------------------------------------------------------------------------------------

(08) Substance-In- ? 1 3 - - - - - - - - -> 1 3 duced Mood Disorder Specify Substance _________________

With depressive-like episode 1

With manic features 2

With mixed features 3

------------------------------------------------------------------------------------------------------------------------

(9) Psychotic ? 1 3 - - - - - - - - -> 1 3 Symptoms

Primary Psychotic Symptoms (not part of Mood Disorder)

NP37 NP38

NP38-A NP38_B

NP39 NP39_A

NP40 NP41

NP42

NP43 NP44

NP45

NP40A

NP43A

NP46 NP47


SWAN-7

Diagnosis Lifetime Meets Symptomatic Prevalence Dx Criteria Past Month ANXIETY DISORDERS Dx Inade- Panic Code quate Ab- Panic Thresh- Attacks Info sent Attacks old Absent Disorder Present (26) Panic ? 1 2 3 - - - - - -> 1 2 3 Disorder/Attacks without Agoraphobia 1 with Agoraphobia 2 ------------------------------------------------------------------------------------------------------------------------ (28) Social Phobia ? 1 3 - - - - - -> 1 3 ------------------------------------------------------------------------------------------------------------------------ Refused Sub-threshold

(31) Posttraumatic -7 ? 1 2 3 - - - - - -> 1 3 Stress ------------------------------------------------------------------------------------------------------------------------ (32) Generalized ? 1 3 Anxiety (current only) ------------------------------------------------------------------------------------------------------------------------ (33) Anxiety ? 1 3 - - - - - -> 1 3 Disorder Due To a General Medical Condition Specify GMC: _______________ with Panic Attacks 1

with Generalized Anxiety 2

Social Phobia 3

Anxiety NOS 6

------------------------------------------------------------------------------------------------------------------------

NP66

NP68

NP67

NP71 NP72

NP79

NP77 NP78

NP80A

NP80 NP81

NP82


SWAN-8 Diagnosis Lifetime Meets Symptomatic Prevalence Dx Criteria Past Month

ANXIETY DISORDERS (Continued) Dx Inade- Code quate Ab- Thresh- Info sent old Absent Present ---------------------------------------------------------------------------------------------------------------------------- (35) Anxiety- ? 1 3 - - - - - -> 1 3 Disorder NOS ----------------------------------------------------------------------------------------------------------------------------

NP86 NP87


SWAN-9 Diagnosis Lifetime Meets Symptomatic Prevalence Dx Criteria Past Month (Dx Inade- Sub- Code) quate Ab- thresh- Thresh- Info. sent old old Absent Present (44)ADJUSTMENT 1 3

DISORDER (current only)

CODE SUBTYPE BASED ON PREDOMINANT SYMPTOMS 1 WITH DEPRESSED MOOD (e.g., depressed mood, tearful- ness, feelings of hopelessness) 2 WITH ANXIETY (e.g., nervousness, worry, jitteriness, or in children, fears of separation from major attachment figures) 3 WITH MIXED ANXIETY AND DEPRESSED MOOD (e.g., a combination of depression and anxiety) ------------------------------------------------------------------------------------------------------------------------ 45) OTHER SELF- ? 1 2 3 - - - - - - - - - -> 1 3

REPORTED DSM IV AXIS I DISORDER:

Specify: ____________________ ------------------------------------------------------------------------------------------------------------------------ (46) OTHER NON- ? 1 2 3 - - - - - - - - - -> 1 3 DMS IV AXIS I DISORDER: ------------------------------------------------------------------------------------------------------------------------

NP99_A

NP99

NP101_A NP101_B

NP100 NP101

NP100A


SWAN-10

DSM-IV Axis V: Global Assessment of Functioning (GAF) Scale

Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical (or environmental) limitations.

Indicate appropriate code for the LOWEST level of functioning during the week of POOREST functioning in past month. (Use intermediate level when appropriate, e.g., 45, 68, 72.)

Note: Make a rating of 0 (zero) if inadequate information _____ _____ _____ NP104

100 Superior functioning in a wide range of activities, life’s problems never seem to get out of 91 hand, is sought out by others because of his or her many positive qualities. No symptoms.

90 Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all

areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional

81 argument with family members).

80 If symptoms are present, they are transient and expectable reactions to psychosocial stress-ors (e.g., difficulty concentrating after family argument), no more than slight impairment in

71 social, occupational, or school functioning (e.g., temporarily falling behind in school or work).

70 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or absences from work), but

61 generally functioning pretty well, has some meaningful interpersonal relationships.

60 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends,

51 conflicts with co-workers).

50 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends,

41 unable to keep a job).

40 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is

31 failing at school).

30 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job,

21 home, or friends).

20 Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death, frequently violent, manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication

11 (e.g., largely incoherent or mute).

10 Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicide act with clear expectations

1 of death.


SWAN-11 Baseline Core Assessment Date: ____________________________ 1. SCID Interview conducted more than 1 month after the Baseline Core Assessment: 1 = No (STOP) 2 = Yes (go to #2) 2. Is there a current episode or disorder in partial remission? 1 = No (go to #3) 2 = Yes, and episode onset after baseline core (go to #3) 3 = Yes, and episode onset before baseline core (STOP) 3. Was there another episode in year prior to SCID? 1 = No (STOP) 2 = Yes (go to #4) 4. At Baseline Core Assessment, episode was 1 = full remission 2 = Current or in partial remission (go to #5) 5. List diagnosis and diagnostic code(s) of episode(s): Code Diagnosis a. ______________________ ______________________ b. ______________________ ______________________ c. ______________________ ______________________


SWAN-12 OVERVIEW DEMOGRAPHIC DATA Age: _____ _____ Marital Status: 1 married or living with someone as if married

2 widowed

3 divorced or annulled

4 separated

5 never married

Any children? (What are their ages?) How many?: _____ _____ Age of youngest child?: _____ _____ Age of oldest child?: _____ _____ Education Level: 1 grade 6 or less

2 grade 7 to 12 (without graduating high school)

3 graduated high school or high school equivalent

4 part college

5 graduated 2 year college

6. graduated 4 year college

7 part graduate/professional school

8 completed graduate/professional school

SWAN-13 Are you working now? 1 No 2 Yes

NP106

NP108_A

NP108_B

NP108_C

NP109

NP108

NP109_A


SWAN-13 PAST PERIODS OF PSYCHOPATHOLOGY LIFETIME Treatment for emotional problems with 1 No a physician or mental health professional 2 Yes Treated with psychotherapy? 1 No 2 Yes Treated with medication? 1 No 2 Yes If Yes, what drug code number (s)? _____, _____, _____, _____, _____. (May code up to 5 drugs) CURRENT Treated with psychotherapy? 1 No 2 Yes Treated with medication? 1 No 2 Yes If Yes, what drug code number (s)? _____, _____, _____, _____, _____. (May code up to 5 drugs) LIFETIME Treatment for drugs/alcohol? 1 No 2 Yes SWAN-14 Have you ever been a patient in a psychiatric hospital? If Yes: How many times? 0 1 2 3 4 5 (or more) Have you ever been hospitalized for drugs or alcohol? 1 No 2 Yes

NP111_A

NP110

NP110_A

NP110_B

NP110_C

NP111

NP110_D

NP110_E

NP110_F

NP110_G

SWAN-18 A. MOOD EPISODES - CURRENT MAJOR DEPRESSIVE EPISODE A1 Depressed mood ? 1 2 3 A1 A2 Markedly diminished interest or pleasure ? 1 2 3 A2 if either A1 or A2 above is coded “2” or“3”, continue; otherwise go to SWAN-28 (Q.A52)

SWAN-19 A3 Weight/appetite change ? 1 2 3 A3

A4 Weight loss or decreased appetite (1) Checked (2) Not Checked A4 A5 Weight gain or increased appetite (1) Checked (2) Not Checked A5

A6 Insomnia or hypersomnia ? 1 2 3 A6

A7 Insomnia (1) Checked (2) Not Checked A7 A8 Hypersomnia (1) Checked (2) Not Checked A8

A9 Psychomotor agitation or retardation ? 1 2 3 A9

A10 Psychomotor retardation (1) Checked (2) Not Checked A10 A11 Psychomotor agitation (1) Checked (2) Not Checked A11

A12 Fatigue or loss of energy ? 1 2 3 A12 SWAN-20 A13 Feelings of worthlessness or excessive ? 1 2 3 A13 or inappropriate guilt

A14 Worthlessness (1) Checked (2) Not Checked A14 A15 Inappropriate guilt (1) Checked (2) Not Checked A15

A16 Diminished ability to think or concentrate, or indecisiveness ? 1 2 3 A16

A17 Diminished ability to think (1) Checked (2) Not Checked A17 A18 Indecisiveness (1) Checked (2) Not Checked A18

A19 Recurrent thoughts of death, recurrent suicidal ? 1 2 3 A19

A20 Thoughts of own death (1) Checked (2) Not Checked A20 A21 Suicidal ideation (1) Checked (2) Not Checked A21 A22 Specific plan (1) Checked (2) Not Checked A22 A23 Suicide attempt (1) Checked (2) Not Checked A23

If not current MDE, go to SWAN-28 (Q.A52); otherwise, continue

? = inadequate information 1 = absent or false 2 = subthreshold 3 = threshold or true SWAN Lifetime Data Entry Form 07/01/2010 12

SWAN-22 (if Current MDE D criterion is coded “1”, go to SWAN-28, Q.A52; otherwise, continue) A28_A Change in your life? A28_A 0=NO 1=YES 2=UNSURE

A28_B If yes, event # _____, _____, _____, _____, _____ A28_B A28_B1 If “9”, Specify: ______________________________ A28_B1 A28_C (Events) had anything to do with your becoming sick, depressed, etc.? A28_C 0=NO 1=YES 2=UNSURE 3=NA A28_D Treatment for this episode? A28_D 0=NO 1=YES 2=UNSURE A29 Number of Major Depressive Episodes ____ ____ A29 A29_A Episodes since SWAN started 1 3 A29_A SWAN-24 MELANCHOLIC FEATURES A38 Lack of reactivity ? 1 2 3 A38 (if either criterion A(1) or A(2) are coded “3”, continue; otherwise, go to SWAN-26, Q.A46)

A39 Distinct quality of depressed mood ? 1 2 3 A39 A40 Depression is regularly worse in the morning ? 1 2 3 A40

SWAN-25 A41 Early morning awakening ? 1 2 3 A41 SWAN-26 ATYPICAL FEATURES (if not checked, continue; if checked go to SWAN-35, CME) A46 Mood reactivity ? 1 2 3 A46 Go to SWAN-35

(if coded “1”, go to SWAN-35 CME; otherwise, continue)

A49 Leaden paralysis ? 1 2 3 A49

A50 Long-standing pattern of interpersonal ? 1 2 3 A50 rejection sensitivity

SWAN-28 PAST MAJOR DEPRESSIVE EPISODE

A52 Depressed mood ? 1 2 3 A52

A53 Markedly diminished interest/pleasure ? 1 2 3 A53

(if either A52 or A53 above are coded “2” or“3”, continue; otherwise, go to SWAN-35, CME)

SWAN-29 A54 Weight/appetite change ? 1 2 3 A54

A55 Weight loss or decreased appetite (1) Checked (2) Not checked A55 A56 Weight gain or increased appetite (1) Checked (2) Not checked A56

A57 Insomnia or hypersomnia ? 1 2 3 A57

A58 Insomnia (1) Checked (2) Not checked A58 A59 Hypersomnia (1) Checked (2) Not checked A59


SWAN-29 A60 Psychomotor agitation or retardation ? 1 2 3 A60

A61 Psychomotor agitation (1) Checked (2) Not checked A61 A62 Psychomotor retardation (1) Checked (2) Not checked A62

A63 Fatigue or loss of energy ? 1 2 3 A63

SWAN-30 A64 Feelings of worthlessness or excessive ? 1 2 3 A64 or inappropriate guilt

A65 Worthlessness (1) Checked (2) Not checked A65 A66 Inappropriate guilt (1) Checked (2) Not checked A66

A67 Diminished ability to think or concentrate, ? 1 2 3 A67 or indecisiveness

A68 Diminished ability to think (1) Checked (2) Not checked A68 A69 Indecisiveness (1) Checked (2) Not checked A69

A70 Recurrent thoughts of death, recurrent suicidal ? 1 2 3 A70 A71 Thoughts of own death (1) Checked (2) Not checked A71 A72 Suicidal ideation (1) Checked (2) Not checked A72 A73 Specific plan (1) Checked (2) Not checked A73 A74 Suicide attempt (1) Checked (2) Not checked A74

SWAN-31 (if at least 5 sx are coded “3”, continue; otherwise, go to SWAN-35, CME) SWAN-32 (if Criterion D coded “3”, continue; otherwise, go to SWAN-35, CME) SWAN-33 A79_A Change in your life A79_A 0=NO 1=YES 2=UNSURE A79_B If yes, event # _____, _____, _____, _____, _____. A79_B A79_B1 If “9”, Specify: ______________________________________________. A79_B1 A79_C (Events) had anything to do with your becoming sick, depressed, etc.? A79_C 0=NO 1=YES 2=UNSURE 3=NA A79_D Treatment for this episode? A79_D 0=NO 1=YES 2=UNSURE SWAN-34 A80 Age at onset of Past Major Depressive Episode ___ ___ A80

A81 Total number of Major Depressive Episodes ___ ___ A81 A81_A Episodes since SWAN started 1 3 A81_A


SWAN-35 CURRENT MANIC (if checked, go to SWAN-44; if not checked and criterion A, ‘irritable/expansive mood’ is coded “1”, go to SWAN-44; if criterion A, ‘lasting at least 1 week’ is coded “1” or “2”, go to SWAN-40; otherwise, continue) SWAN-39 A100 Number of Manic Episodes, including current ___ ___ A100 SWAN-40 CURRENT HYPOMANIC EPISODE (if checked, go to SWAN-62; otherwise, continue)

A108 Period of persistently elevated expansive, ? 1 2 3 A108 or irritable mood go SWAN-44

A109 Elevated, expansive mood (1) Checked (2) Not checked A109 A110 Irritable mood (1) Checked (2) Not checked A110

A111 Inflated self-esteem or grandiosity ? 1 2 3 A111

A112 Decreased need for sleep ? 1 2 3 A112

A113 More talkative ? 1 2 3 A113 A114 Flight of ideas, thoughts are racing ? 1 2 3 A114

SWAN-41 A115 Distractibility ? 1 2 3 A115

A116 Increased in goal-directed activity or psychomotor ? 1 2 3 A116 agitation

A117 Increase in activity (1) Checked (2) Not checked A117

A118 Psychomotor agitation (1) Checked (2) Not checked A118

A119 Excessive involvement, a high potential for ? 1 2 3 A119

painful consequences SWAN-44 (if criterion A, ‘irritable/expansive mood’ is coded “1”, go to SWAN-54; if criterion A, ‘lasting at least 1 week’, is coded “1” or “2”, go to SWAN-49; otherwise, continue) SWAN-46 (if at least three “B” symptoms are coded “3” continue, otherwise, go to SWAN-54) SWAN-48 (if MANIC EPISODE is coded “1”, go to SWAN-54 - Q.A163; otherwise, continue) A143 Age at onset - Past Manic Episode ___ ___ A143

A144 Number of Manic Episodes ___ ___ A144 (go to SWAN-66)


SWAN-49 PAST HYPOMANIC EPISODE A145 Period of sustained elevated, expansive, ? 1 2 3 A145 or irritable mood go to SWAN-54

A146 Elevated, expansive mood (1) Checked (2) Not checked A146 A147 Irritable mood (1) Checked (2) Not checked A147

A148 Inflated self esteem or grandiosity ? 1 2 3 A148 A149 Decreased need for sleep ? 1 2 3 A149 A150 More talkative ? 1 2 3 A150 A151 Flight of ideas, thoughts racing ? 1 2 3 A151

SWAN-50 A152 Distractibility ? 1 2 3 A152

A153 Increase in goal-directed activity or psychomotor ? 1 2 3 A153 agitation

A153_A Increase in activity (1) Checked (2) Not checked A153_A A153_B Psychomotor agitation (1) Checked (2) Not checked A153_B

A154 Excessive involvement, painful consequences ? 1 2 3 A154

SWAN-53 (if past hypomanic episode criteria coded “3”, continue; otherwise, go to SWAN-54) A161 Age at onset of Past Hypomanic Episode ___ ___ A161

A162 Total number of Hypomanic Episodes ___ ___ ___ A162 SWAN-54 DYSTHYMIC DISORDER (if checked, go to SWAN-66; otherwise, continue)

A163 Depressed mood ? 1 2 3 A163 go to SWAN-66

SWAN-55 A164 Poor appetite or overeating ? 1 2 3 A164

A165 Insomnia or hypersomnia ? 1 2 3 A165 A166 Low energy or fatigue ? 1 2 3 A166 A167 Low self-esteem ? 1 2 3 A167 A168 Poor concentration or difficulty making decisions ? 1 2 3 A168 A169 Feelings of hopelessness ? 1 2 3 A169


SWAN-56 (if criterion D is coded “3”, continue; otherwise, go to SWAN-66) A173 Age at onset of current Dysthymic Disorder ___ ___ A173 SWAN-57 (if DYSTHYMIC DISORDER coded “3”, continue: otherwise, go to SWAN-66) A179 1 - Early Onset: Onset before age 21 A179 2 - Late Onset: Onset age 21 or older SWAN-66 MOOD DISORDERS (if checked, go to SWAN-76, F. Anxiety Disorders; otherwise, continue) SWAN-68 OTHER BIPOLAR DISORDERS (If diagnosis made, code D20 and then go to SWAN-76; if diagnosis not made, go to SWAN-72) SWAN-69 D20 Age at onset of disorder ____ ____ D20 SWAN-71 DEPRESSIVE DISORDER NOS (If diagnosis is made, continue; otherwise, go to SWAN-74) SWAN-72 D31_A Change in your life D31_A

0=NO 1=YES 2=UNSURE D31_B If yes, list event # _____, _____, _____, _____, _____ D31_B D31_B1 If “9”, Specify: _____________________________________________ D31_B1 D31_C (Events) had anything to do with your becoming sick, depressed, etc.? D31_C 0=NO 1=YES 2=UNSURE 3=NA D31_D Treatment for this episode? D31_D 0=NO 1=YES 2=UNSURE

SWAN-73 D33_A Age at first onset of disorder ____ ____ D33_A go to SWAN-76 if only 1 episode, otherwise, continue D33_B Episodes since SWAN started 1 3 D33_B SWAN-74 MOOD CHRONOLOGY

(if past month is coded “3”, go to D37) D35 Number of months last had depressed, ____ ____ ____ or D35 euphoric or irritable mood (episode) D37 Age at onset of first Manic, Mixed, or Major ____ ____ or NA D37 Depressive Episode (for Bipolar Disorder) (if not Bi-polar Disorder)

D39 Age at onset of first Major Depressive Episode ____ ____ or NA D39

(for Major Depressive Disorder) (if not MDD)



SWAN-76 ANXIETY DISORDERS - PANIC DISORDER/ATTACKS (if criterion A1 is coded “1”, go to SWAN-82; otherwise, continue) SWAN-77 (if criterion B is coded “1”, go to SWAN-82; otherwise, continue) F4 Palpitations, pounding heart ? 1 2 3 F4

F5 Sweating ? 1 2 3 F5 F6 Trembling or shaking ? 1 2 3 F6 F7 Shortness of breath or smothering ? 1 2 3 F7 F8 Feeling of choking ? 1 2 3 F8 F9 Chest pain or discomfort ? 1 2 3 F9 F10 Nausea or abdominal distress ? 1 2 3 F10 F11 Dizzy, unsteady, light-headed or faint ? 1 2 3 F11 F12 Derealization ? 1 2 3 F12 F13 Fear of losing control/going crazy ? 1 2 3 F13 F14 Fear of dying ? 1 2 3 F14

SWAN-78 F15 Numbness or tingling ? 1 2 3 F15

F16 Chills or hot flushes ? 1 2 3 F16 (if Panic Disorder criterion D is coded “1”, go to SWAN-82; otherwise, continue)

SWAN-81 F26 4 - Partial Remission F26 5 - Full Remission 6 - Prior History NA - i.e., past month coded “3”; Go to F28

F27 Number of months ago last had a symptom ___ ___ ___ F27

of Panic Disorder/Attacks F28 Age at onset of Panic Disorder/Attacks ____ ____ F28

F28_A Episodes since SWAN started 1 3 F28_A


SWAN-82 SOCIAL PHOBIA (if criterion A is coded “3”, continue; otherwise, go to SWAN-88)

F48 Public speaking (1) Checked (2) Not checked F48

F49 Eating in front of others (1) Checked (2) Not checked F49

F50 Writing in front of others (1) Checked (2) Not checked F50

F51 Generalized (1) Checked (2) Not checked F51

F52 Other (1) Checked (2) Not checked F52

F52_1 Specify:________________________________ F52_1

SWAN-85 If Social Phobia criteria A-H are met (i.e., coded “3”), continue; otherwise, go to SWAN-88) SWAN-86 F64 4 - Partial Remission F64

5 - Full Remission 6 - Prior History NA - i.e., past month coded “3”; Go to F66

F65 Number of months last had a symptom ____ ____ ____ F65

of Social Phobia

F66 Age at onset of Social Phobia ____ ____ F66

SWAN-87 POSTTRAUMATIC STRESS DISORDER (if F103 is checked, go to SWAN-93, GAD; otherwise, continue) Event Age when first How long did this Event assessed Code event occurred last (# months) (y/n) _____ ____________ ______________ ________ F103b F103c F103d F103e _____ ____________ ______________ ________ F103g F103h F103i F103j _____ ____________ ______________ ________ F103l F103m F103n F103o _____ ____________ ______________ ________ F103q F103r F103s F103t _____ ____________ ______________ ________ F103v F103w F103x F103y (if F104 is checked, go to SWAN-93, GAD; otherwise, continue) SWAN-88 F105 Threatening event ? 1 2 3 F105

F106 Intense fear, helplessness ? 1 2 3 F106

F107 Recurrent, intrusive recollections ? 1 2 3 F107

F108 Recurrent distressing dreams ? 1 2 3 F108

F109 Feel like event recurring, reliving experience ? 1 2 3 F109 F110 Intense psychological distress ? 1 2 3 F110

Go to “GAD” SWAN-93



SWAN-89 F111 Physiological reactivity ? 1 2 3 F111 F112 AT LEAST ONE “B” SX IS CODED “3” ? 1 3 F112

F113 Avoid thoughts associated with trauma ? 1 2 3 F113 F114 Avoid activities that remind of trauma ? 1 2 3 F114 F115 Unable to recall aspects of trauma ? 1 2 3 F115 F116 Diminished interest in activities ? 1 2 3 F116 F117 Feeling detached from others ? 1 2 3 F117 F118 Restricted range of affect ? 1 2 3 F118 SWAN-90 F119 Foreshortened future ? 1 2 3 F119 F120 AT LEAST THREE “C” SXS ARE CODED “3” 1 3 F120 F121 Difficulty sleeping ? 1 2 3 F121 F122 Irritable or angry ? 1 2 3 F122 F123 Difficulty concentrating ? 1 2 3 F123 F124 Hypervigilance ? 1 2 3 F124 F125 Exaggerated startle response ? 1 2 3 F125

F126 AT LEAST TWO “D” SXS ARE CODED “3” 1 3 F126

If either criterion “C” or “D” = 3, continue.

SWAN-91 F127 Duration greater than 1 month ? 1 2 3 F127

F128 Disturbance causes clinically significant distress ? 1 2 3 F128

F129 PTSD CRITERIA A, B,C,D,E AND F ARE CODED “3”. 1 2 3 F129

SWAN-92 POSTTRAUMATIC STRESS DISORDER CHRONOLOGY F130 PTSD threshold/Subthreshold current in past month? ? 1 3 F130 (if past month is coded “3”, go to F134; otherwise continue)

F132 4 - In Partial Remission F132 5 - In Full Remission 6 - Prior History NA - i.e., past month coded “3”, Go to F134

F133 Number of months last had a symptom ____ ____ ____ F133 of Posttraumatic Stress Disorder F134 Age at onset of Posttraumatic Stress Disorder ____ ____ F134





? = inadequate information 1 = absent or false 2 = subthreshold 3 = threshold or true 21

SWAN-93 GENERALIZED ANXIETY DISORDER (GAD)

F135 Excessive anxiety or worry ? 1 2 3 F135

(if GAD criteria A, B, and F coded “2” or “3”, continue; otherwise, go to SWAN-102)

SWAN-94 F138 Restlessness or feeling keyed up or on edge ? 1 2 3 F138

F139 Being easily fatigued ? 1 2 3 F139 F140 Difficulty concentrating or mind going blank ? 1 2 3 F140 F141 Irritability ? 1 2 3 F141 F142 Muscle tension ? 1 2 3 F142 F143 Sleep disturbance ? 1 2 3 F143

SWAN-97 F149 Age at onset of Generalized Anxiety Disorder ____ ____ F149

SWAN-102 ANXIETY DISORDER NOS (If diagnosis made, i.e., coded “3”, continue; otherwise, go to SWAN-104)

SWAN-103 F158 Experienced a number of these symptoms (1) Checked (2) Not Checked F158

the past month

F158_A Age at first onset ____ ____ F158_A F159 1 Social Phobia Subthreshold F159 2 Panic Disorder/Attacks Subthreshold 3 Multiple Anxiety SX that didn’t meet criteria

for a specific diagnosis 4 GAD Subthreshold

SWAN-104 ADJUSTMENT DISORDER (if checked , end of interview) I2 Symptoms in response to an identifiable stressor ? 1 2 3 I2

NOTES:

Go to SWAN-102

Documents

SCID Baseline/Lifetime Data Entry · PDF fileSCID Baseline/Lifetime Data Entry Form . SWAN Core Lifetime Data Entry Form 1 ... SCID Interview conducted more than 1 month after the