PsychiatricUniversityHospitalZurich,1931,CH-8032Zurich,Switzerland27.12.2007
©2004
PsychiatricUniversityHospitalZurich,DivisionofClinicalPsychiatry
SYMPTOMCHECKLIST
SCL90
tis,,
STUDY[____]
1-4
GROUP[__]
5-6
PATIENT[___]
7-9
RATINGDAY[___]
10-12
CARDNUMBER[__]
13-14
Sex(1=male,2=female)[_]
15
Birthday()[__:__:__]
16-21
Dateofhospitalization()[__:__:__]
22-27
Firstdiagnosis[___.__]
28-32
Seconddiagnosis[___.__]
33-37
Diagnosticsystem(1=ICD9,2=ICD10,3=DSM3-R,4=DSM4)[_]
38
Ageatont[__]
39-40
Cour(1=firstmanifestation,2=intermittent,3=progredient,4=chronic)[_]
41
DurationofCurrentEpisodePriortoHospitalization(days)[___]
42-44
MedicationPriortoHospitalization(0=none,1=antidepr.,2=neuroleptics,3=other)[_]
45
CurrentMedication(codes)[___]
46-48
Educationallevel(1=remedial,2=juniorhigh,3=high,4=college)[_]
49
DATE()[__:__:__]
50-55
INTERVIEWER[___]
56-58
HOSPITAL[__]
59-60
PATIENTID(thehospital’sinternalPID)[____________]
61-72
PsychiatricUniversityHospitalZurich,1931,CH-8032Zurich,Switzerland27.12.2007
2
readeachonecarefully.
Afteryouhavedoneso,pleafillinthenumber(0to4,ebelow)whichbestdescribeshow
muchthatproblemhasbotheredordistresdyouduringthepast4weeksincluding
hange
yourmind,stionnaireswillbetreated
confidentially!
0=notatall;1=alittlebit;2=moderately;3=quiteabit;4=extremely;
Pleafillintheappropriatenumberwithinthebrackets!
1-12dupl
Cardnumber[__]
13-14
Howmuchwereyoubotheredordistresdoverthepast4weeksby
1Headaches[_]
15
2Nervousnessorshakinessinside[_]
16
3Unwantedthoughtsorideasthatwon’tleaveyourhead[_]
17
4Faintnessordizziness[_]
18
5Lossofxualinterestorpleasure[_]
19
6Feelingcriticalofothers[_]20
7Theideathatsomeoneelcancontrolyourthoughts[_]
21
8Feelingothersaretoblameformostofyourtroubles[_]
22
9Troublerememberingthings[_]
23
10Worriedaboutsloppinessorcarelessness[_]
24
11Feelingeasilyannoyedorirritated[_]
25
12Painsinheartorchest[_]
26
13Feelingafraidinopenspacesoronthestreet[_]
27
14Feelinglowinenergyorsloweddown[_]
28
15Thoughtsofendinglife[_]
29
16Hearingvoicesthatotherpeopledonothear[_]
30
17Trembling[_]
31
18Feelingthatmostpeoplecannotbetrusted[_]
32
19Poorappetite[_]
33
20Cryingeasily[_]
34
21Feelingshyoruneasywiththeoppositx[_]
35
22Feelingofbeingtrappedorcaught[_]
36
23Suddenlyscaredfornoreason[_]
37
24Temperoutburststhatyoucouldnotcontrol[_]
38
PsychiatricUniversityHospitalZurich,1931,CH-8032Zurich,Switzerland27.12.2007
3
25Feelingafraidtogooutofyourhoualone[_]
39
26Blamingyourlfforthings[_]
40
27Painsinlowerback[_]
41
28Feelingblockedingettingthingsdone[_]
42
29Feelinglonely[_]
43
30Feelingblue[_]
44
31Worryingtoomuchaboutthings[_]
45
32Feelingnointerestinthings[_]
46
33Feelingfearful[_]
47
34Yourfeelingsbeingeasilyhurt[_]
48
35Otherpeoplebeingawareofyourprivatethoughts[_]
49
36Feelingothersdonotunderstandyouorareunsympathetic[_]
50
37Feelingthatpeopleareunfriendly[_]
51
38Havingtodothingsveryslowly[_]
52
39Heartpoundingorracing[_]
53
40Nauaoruptstomach[_]
54
41Feelinginferiortoothers[_]
55
42Sorenessofyourmuscles[_]
56
43Feelingthatyouarewatchedortalkedaboutbyothers[_]
57
44Troublefallingasleep[_]
58
45Havingtocheckanddoublecheckwhatyoudo[_]
59
46Difficultymakingdecisions[_]
60
47Feelingafraidtotravelonbus,subwaysortrains[_]
61
48Troublegettingyourbreath[_]
62
49Hotorcoldspells[_]
63
50Havingtoavoidcertainthings,placesoractivities[_]
64
51Yourmindgoingblank[_]
65
52Numbnessortinglinginpartsofyourbody[_]
66
53Alumpinyourthroat[_]
67
54Feelinghopelessaboutthefuture[_]
68
55Troubleconcentrating[_]
69
56Feelingweakinpartsofyourbody[_]
70
57Feelingtenorkeyedup[_]
71
58Heavyfeelingsinyourarmsorlegs[_]
72
PsychiatricUniversityHospitalZurich,1931,CH-8032Zurich,Switzerland27.12.2007
4
1-12dupl
Cardnumber[__]
13-14
59Thoughtsofdeathordying[_]
15
60Overeating[_]
16
61Feelinguneasywhenpeoplearewatchingortalkingaboutyou[_]
17
62Havingthoughtsthatarenotyourown[_]
18
63Havingurgestobeat,injureorharmsomeone[_]
19
64Awakeningintheearlymorning[_]
20
65Havingtorepeatthesameactionssuchastouching,counting,washing[_]
21
66Sleepthatisrestlessordisturbed[_]
22
67Havingurgestobreakorsmashthings[_]
23
68Havingideasorbeliefsthatothersdonotshare[_]
24
69Feelingverylf-consciouswithothers[_]
25
70Feelinguneasyincrowdssuchasshoppingoratamovie[_]
26
71Feelingeverythingisaneffort[_]
27
72Spellsofterrororpanic[_]
28
73Feelinguncomfortableabouteatingordrinkinginpublic[_]
29
74Gettingintofrequentarguments[_]
30
75Feelingnervouswhenyouareleftalone[_]
31
76Othersnotgivingyoupropercreditforyourachievments[_]
32
77Feelinglonelyevenwhenyouarewithpeople[_]
33
78Feelingsorestlessyoucouldn’tsitstill[_]
34
79Feelingofworthlessness[_]
35
80Feelingthatfamiliarthingsarestrangeorunreal[_]
36
81Shoutingorthrowingthings[_]
37
82Feelingafraidyouwillfaintinpublic[_]
38
83Feelingthatpeoplewilltakeadvantageofyouifyouletthem[_]
39
84Havingthoughtsaboutxthatbotheryoualot[_]
40
85Theideathatyoushouldbepunishedforyoursins[_]
41
86Feelingpushedtogetthingsdone[_]
42
87Theideathatsomethingriousiswrongwithyourbody[_]
43
88NeverfeelingclotoanotherPERSONAL[_]
44
89Feelingsofguilt[_]
45
90Theideathatsomethingiswrongwithyourmind[_]
46
Pleagobackandcheckthatyouhaveansweredallquestions.
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