| Describe
about yourself |
| The
quality of the patient's life in relationship to loved ones, family, friends
and colleagues. Overall quality of energy available to function in daily
life, and under various circumstances. |
|
| Any
mental/emotional shocks occurring in the patient's life-grief, major financial
losses separation from loved ones, death, identity crisis and other stress
in life. |
|
| Memory,ability
to concentrate/comprehend |
|
| Are
you fearful of anything eg: Animals, people, being alone, darkness, death,
disease, robbers, thunder, storm, high places. |
|
| Are
you anxious about anything: if yes, give details |
|
| Are
you impatient |
|
| Are
you doubtful or suspicious |
|
| Are
you hurt easily (emotionally)how do you react. Does it cause hatred/revenge. |
|
| Does
your pride get hurt easily. |
|
| Are
you depressed, if so, reason/circumstances. |
|
| Do
you like to share your problems. |
|
| Effect
of consolation |
|
| Do
you ever become suicidal when? How |
|
| Memory-
quality if poor, for what ( eg. Names, places, people, what you read) |
|
| Do
you weep easily, effect of weeping, ie, does it make you worse or better |
|
| Are
you easily irritated. What makes you angry, how do you express it |
|
| Are
you destructive |
|
| |
| How good
are you in making decisions. |
|
| Do you like
company or like to remain alone. |
|
| How seriously
are you affected by disorder and uncleanness in your surroundings. |
|
| How does
failure appear to you? |
|
| Are there
any matters that you deeply dislike? |
|
| What activities
you deeply like? How does it affect your mood? |
|
| Are you
affectionate? How does others sorrow affect you? |
|
|
|