COSIG Assessment Training

1. COSIG AssessmentTraining

2. M.I.N.I MINI INTERNATIONAL NEUROPSYCHITRIC INTERVIEW

3. Major Depressive EpisodeScreening Questions A1 Have you been consistently depressed or down, most of the day, nearly every day, for the past two weeks? A2 In the past two weeks, have you been much less interested in most things or much less able to enjoy the things you used to enjoy most of the time? If “YES” to either question, proceed to A3 If “NO” to both questions, skip to Section B, Dysthmia

4. Major Depressive Episode (Continued) A3 Over the past two weeks, when you felt depressed or uninterested: • Was your appetite decreased or increased nearly every day? Did your weight increase without trying intentionally? • Did you have trouble sleeping nearly every night (difficulty falling asleep, waking up in the middle of the night, early morning wakening, or sleeping excessively)?

5. Major Depressive Episode (Continued) • Did you talk or move more slowly than normal or were you fidgety, restless, or having trouble sitting still almost every day? • Did you feel tired or without energy almost every day? • Did you feel worthless or guilty almost every day? • Did you have difficulty concentrating or making decisions almost every day? • Did you repeatedly consider hurting yourself, feel suicidal, or wish that you were dead?

6. Major Depressive Episode (Continued) If 5 or more of the 7 symptoms are “YES” in A3 then the diagnosis of Major Depressive Episode, Current is made and proceed to A4 If less than 5 of the 7 symptoms are “YES” in A3 then skip to Section B, Dysthmia

7. Major Depressive Episode, Recurrent A4 During your lifetime, did you have other periods of two weeks or more when you felt depressed or uninterested in most things, and had most of the problems we just talked about? If “YES”, proceed to next question If “NO”, proceed to Section D, Manic Episode Did you ever have an interval of at least 2 months without any depression and any loss of interest between 2 episodes of depression? If “YES”, Major Depressive Episode, Recurrent diagnosis is made

8. DysthmiaScreening Question B1 Have you felt sad, low, or depressed most of the time for the last two years? If “YES” proceed to B2 If “NO” skip to Section D, Manic Episode

9. Dysthmia (Continued) B2 Was this period interrupted by your feeling OK for two months or more? If “YES” skip to Section D, Manic Episode If “NO” proceed to B3

10. Dysthmia (Continued) B3 During this period of feeling depressed most of the time: • Did your appetite change significantly? • Did you have trouble sleeping or sleep excessively? • Did you feel tired or without energy? • Did you lose self-confidence? • Did you have trouble concentrating or making decisions? • Did you feel hopeless?

11. Dysthmia (Continued) If two or more symptoms in B3 are “YES” proceed to B4 If less than 2 symptoms are “YES” in B3 skip to Section D, Manic Episode

12. Dysthmia (Continued) B4 Did the symptoms of depression cause you significant distress or impair your ability to function at work, socially or in some other important way? If “YES” Dysthmia diagnosis is made If “NO” proceed to Section D, Manic Episode

13. Manic and Hypomanic EpisodeScreening Questions D1a Have you ever had a period when you were feeling “up” or “high” or “hyper” or so full of energy or full of yourself that you got into trouble, or that other people thought you were not your usual self? (Do not consider times when you were intoxicated on drugs or alcohol.) If “YES” ask: D1b Are you currently feeling “up” or “high” or full of energy?

14. Manic and Hypomanic EpisodeScreening Questions D2a Have you ever been persistently irritable, for several days, so that you had arguments or verbal or physical fights, or shouted at people outside your family? Have you or others noticed that you have been more irritable or over reacted, compared to other people, even in situations that you felt were justified? If “Yes” ask: D2b Are you currently feeling persistently irritable?

15. Manic or Hypomanic Episode(Continued) If D1b or D2b is “YES” proceed to D3 and explore only current episode If D1b and D2b are “NO” proceed to D3 and explore the most problematic past episode If D1a and D2a are both “NO” skip to Section E, Panic Disorder

16. Manic and Hypomanic Episode(Continued) D3 During the times when you felt high, full of energy, or irritable did you: • Feel that you could do things others couldn’t do, or that you were an especially important person? • Need less sleep (for example, feel rested after only a few hours sleep)? • Talk too much without stopping, or so fast that people had difficulty understanding? • Have racing thoughts?

17. Manic and Hypomanic Episode(Continued) D3 During the times when you felt high, full of energy, or irritable did you: (continued) • Become easily distracted so that any little interruption could distract you? • Become so active or physically restless that others were worried about you? • Want so much to engage in pleasurable activities that you ignored the risks or consequences (for example, spending sprees, reckless driving, or sexual indiscretions)?

18. Manic and Hypomanic Episode(Continued) If 3 or more of the D3 symptoms are “YES” (or 4 or more symptoms if D1a is “NO” when rating past episode or D1b is “NO” when rating current episode) then proceed to D4 If less than 3 symptoms are present, skip to Section E, Panic Disorder

19. Manic or Hypomanic Episode(Continued) D4 Did these symptoms last at least a week and cause significant problems at home, at work, socially, or at school, or were you hospitalized for these problems? If D4 is “NO” the diagnosis of Hypomanic Episode (Current or Past) is made If D4 is “YES” the diagnosis of Manic Episode (Current or Past) is made

20. Panic DisorderScreening Questions E1a Have you, on more than one occasion, had spells or attacks when you suddenly felt anxious, frightened, uncomfortable or uneasy, even in situations where most people would not feel that way? E1b Did the spells surge to a peak within 10 minutes of starting? If E1a and E1b are “YES” then proceed to E2

21. Panic Disorder(Continued) E2 At any time in the past, did any of those spells or attacks come on unexpectedly or occur in an unpredictable manner? If E2 is “YES” proceed to E3 If E2 is “NO” skip to Section H, Obsessive Compulsive Disorder

22. Panic Disorder(Continued) E3 Have you ever had one such attack followed by a month or more of persistent concern about having another attack, or worries about the consequences of the attack?

23. Panic Disorder(Continued) E4 During the worst spell that you can remember: • Did you have skipping, racing, or pounding of your heart? • Did you have sweating or clammy hands? • Were you trembling or shaking? • Did you have shortness of breath or difficulty breathing? • Did you have a choking sensation or lump in your throat?

24. Panic Disorder(Continued) E4 During the worst spell that you can remember: • Did you have chest pain, pressure, or discomfort? • Did you have nausea, stomach problems, or sudden diarrhea? • Did you feel dizzy, unsteady, lightheaded, or faint? • Did things around you feel strange, unreal, detached or unfamiliar, or did you feel outside of or detached from part or all of your body?

25. Panic Disorder(Continued) E4 During the worst spell that you can remember: • Did you fear that you were losing control or going crazy? • Did you fear that you were dying? • Did you have tingling or numbness in parts of your body? • Did you have hot flushes or chills?

26. Panic Disorder(Continued) If E3 is “YES” and 4 or more of the symptoms in E4 are “YES”, diagnosis of Panic Disorder, Lifetime is made and proceed to E7 E7 In the past month, did you have such attacks repeatedly (2 or more) followed by persistent concern about having another attack? If E7 is “YES”, diagnosis of Panic Disorder, Current is made

27. Obsessive-Compulsive DisorderScreening Question H1 In the past month, have you been bothered by recurrent thoughts, impulses, or images that were unwanted, distasteful, inappropriate, intrusive, or distressing? If H1 is “YES” proceed to H2 IF H1 is “NO” skip to H4

28. Obsessive-Compulsive Disorder(Continued) H2 Did they keep coming back into your mind even when you tried to ignore or get rid of them? IF H2 is “YES” proceed to H3 If H2 is “NO” skip to H4

29. Obsessive-Compulsive Disorder(Continued) H3 Do you think that these obsessions are the product of your own mind and that they are not imposed from the outside? If “YES” then criteria for “Obsessions” has been met and proceed to H4

30. Obsessive-Compulsive Disorder(Continued) H4 In the past month, did you do something repeatedly without being able to resist doing it, like washing or cleaning excessively, counting or checking things over and over, or repeating, collecting, arranging things, or other superstitious rituals? If “YES” then criteria for Compulsions has been met and proceed to H5 If both H3 and H4 are “NO” skip to Section J, Alcohol Abuse and Dependence

31. Obsessive-Compulsive Disorder(Continued) H5 Did you recognize that either these obsessive thoughts or these compulsive behaviors were excessive or unreasonable? If H5 is “YES” proceed to H6 If H5 is “NO” skip to Section J, Alcohol Abuse and Dependence

32. Obsessive-Compulsive Disorder(Continued) H6 Did these obsessive thoughts and/or compulsive behaviors significantly interfere with your normal routine, occupational functioning, usual social activities, or relationships, or did they take more than one hour a day? If “YES” then diagnosis of Obsessive-Compulsive Disorder is made

33. Posttraumatic Stress DisorderScreening Questions I1 Have you ever experienced or witnessed or had to deal with an extremely traumatic event that included actual or threatened death or serious injury to you or someone else? If “YES” proceed to I2 If “NO” skip to Section J, Alcohol Abuse and Dependence

34. Posttraumatic Stress DisorderScreening Questions I2 Did you respond with intense fear, helplessness, or horror? If “YES” proceed to I3 If “NO skip to section J, Alcohol Abuse and Dependence

35. Posttraumatic Stress Disorder I3 During the past month, have you re- experienced the event in a distressing way (such as dreams, intense recollections, flashbacks, or physical reactions)? If “YES” proceed to I4 If “NO” skip to Section J, Alcohol Abuse and Dependence

36. Posttraumatic Stress Disorder(Continued) I4 In the past month: • Have you avoided thinking about or talking about the event? • Have you avoided activities, places, or people that remind you of the event? • Have you had trouble recalling some important part of what happened? • Have you become much less interested in hobbies and social activities?

37. Posttraumatic Stress Disorder(Continued) I4 In the past month: • Have you felt detached or estranged from others? • Have you noticed that your feelings are numbed? • Have you felt that your life will be shortened or that you will die sooner than other people? If 3 or more of the 7 symptoms in I4 are “YES” proceed to I5 If less than 3 symptoms are “YES” skip to Section J, Alcohol Abuse and Dependence

38. Posttraumatic Stress Disorder(Continued) I5 In the past month: • Have you had difficulty sleeping? • Were you especially irritable or did you have outbursts of anger? • Have difficulty concentrating? • Were you nervous or constantly on your guard? • Were you easily startled? If 2 or more symptoms in I5 are “YES” proceed to I6 If less than 2 symptoms are “YES” skip to Section J

39. Posttraumatic Stress Disorder(Continued) I6 During the past month, have these problems significantly interfered with your work or social activities, or caused significant distress? If “YES” diagnosis of Posttraumatic Stress Disorder is made If “NO” proceed to Section J, Alcohol Abuse and Dependence

40. Alcohol Abuse and DependenceScreening Question J1 In the past 12 months, have you had 3 or more alcoholic drinks within a 3 hour period on 3 or more occasions? If “YES” proceed to J2 If “NO” skip to Section K, Psychoactive Substance Use Disorders

41. Alcohol Abuse and Dependence(Continued) J2 In the past 12 months: • Did you need to drink more in order to get the same effect that you got when you first started drinking? • When you cut down on drinking, did your hands shake, did you sweat or feel agitated? Did you drink to avoid these symptoms or to avoid being hung over, for example “the shakes,” sweating, or agitation? (If “YES” to either, code “YES”)

42. Alcohol Abuse and Dependence(Continued) J2 In the past 12 months: • During the times when you drank alcohol, did you end up drinking more than you planned when you started? • Have you tried to reduce or stop drinking alcohol but failed? • On the days that you drank, did you spend substantial time in obtaining alcohol, drinking, or recovering from the effects of alcohol?

43. Alcohol Abuse and Dependence(Continued) J2 In the past 12 months: • Did you spend less time working, enjoying hobbies, or being with others because of your drinking? • Have you continued to drink even though you knew that the drinking caused you health or emotional problems?

44. Alcohol Abuse and Dependence(Continued) If 3 or more questions in J2 are “YES” then diagnosis of Alcohol Dependence is made and skip to Section K, Psychoactive Substance Use Disorders If less than 3 questions in J2 are “YES” then proceed to J3 to assess for Alcohol Abuse

45. Alcohol Abuse and Dependence(Continued) J3 In the past 12 months: • Have you been intoxicated, high, or hung over more than once when you had other responsibilities at school, work, or at home? Did this cause any problems? (Code “YES” only if this caused problems.) • Were you intoxicated more than once in any situation where you were physically at risk, for example, driving a car, riding a motorbike, using machinery, etc.?

46. Alcohol Abuse and Dependence(Continued) J3 In the past 12 months: • Did you have legal problems more than once because of your drinking, for example, an arrest or disorderly conduct? • Did you continue to drink even though your drinking caused problems with your family or other people?

47. Alcohol Abuse and Dependence(Continued) If one or more questions in J3 are “YES” then diagnosis of Alcohol Abuse is made If no questions in J3 are “YES” proceed to Section K, Psychoactive Substance Use Disorders

48. Psychoactive Substance Use DisordersScreening Question K1 Now I am going to show (or read) you a list of street drugs or medications. In the past 12 months, did you take any of these drugs more than once, to get high, to feel better, or to change your mood? If “YES” proceed to K2 If “NO” skip to Section L, Psychotic Disorders

49. Psychoactive Substance Use Disorders(Continued) K2 Considering your use of (specified drug), in the past 12 months: • Have you found that you needed to use more (specified drug) to get the same effect that you did when you first started taking it? • When you reduced or stopped using (specified drug), did you have withdrawal symptoms (aches, shaking, fever, weakness, diarrhea, nausea, sweating, heart pounding, difficulty sleeping, or feeling agitated, anxious, irritable, or depressed)? Did you use any drug(s) to keep yourself from getting sick (withdrawal symptoms) or so that you would feel better? (If “YES” to either, code “YES”)

50. Psychoactive Substance Use Disorders(Continued) K2 Considering your use of (specified drug), in the past 12 months: • Have you often found that when you used (specified drug), you ended up taking more than you thought you would? • Have you tried to reduce or stop taking (specified drug) but failed? • On the days that you used (specified drug), did you spend substantial time (> 2 hours), obtaining, using, or in recovering from the drug, or thinking about the drug?