Survey of Patient Concerns – Dr. Thomas Kremer

Survey of Patient Concerns (SPC)

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I feel sad, unhappy, and depressed most of the time.

Yes

I have lost interest in most things that used to make me happy.

Yes

Lately I have very little appetite.

Yes

I have lost much weight recently.

Yes

I wake-up from sleep throughout the night.

Yes

I wake-up early in the morning and can't go back to sleep.

Yes

I feel restless, agitated, and can't relax.

Yes

I have little energy and feel fatigued most of the time.

Yes

I feel worthless and ashamed of myself.

Yes

I have lost interest in sex.

Yes

I have difficulty paying attention and concentrating on things.

Yes

I have trouble making decisions.

Yes

I often think about death.

Yes

I think about suicide.

Yes

I have a plan to take my life or commit suicide soon.

Yes

My future is hopeless.

Yes

I am easily frustrated and become emotionally overwhelmed.

Yes

I feel unmotivated and have difficulty getting started on things.

Yes

I cry easily and often.

Yes

My level of depression is fairly constant throughout the day.

Yes

I feel more depressed early in the day.

Yes

I feel more depressed later in the day.

Yes

My arms and legs often feel heavy as if they were made of "lead".

Yes

I have gained much body weight recently.

Yes

I regularly sleep nine or more hours per day.

Yes

I feel like I have been depressed all my adult life.

Yes

I have had periods or severe depression with a more "normal" mood between these periods.

Yes

I feel intensely happy and emotionally "high" for periods of time with no reason.

Yes

I have periods of such intense anger and irritability that I argue for no reason.

Yes

My periods of intense emotional "high" or intense anger last for several days to weeks.

Yes

I can go several days at a time with no need or desire for sleep.

Yes

At times I talk constantly and feel that I must keep talking.

Yes

There are times that I am so easily distracted by things around that I cannot focus my attention.

Yes

At times my thoughts race or are greatly speeded up.

Yes

There are times that I have unlimited energy and am hyperactive.

Yes

I have periods of intense sexual interest and greatly increased sexual activity.

Yes

At times I am so overly confident that I feel I can do anything.

Yes

Sometimes my lack of common sense about sex, money, drugs or safety could hurt me.

Yes

At times I feel very witty and constantly joke and entertain others.

Yes

Sometimes my behavior is so extreme that I end up embarrassing myself.

Yes

At times my thinking and memory are unusually clear, sharp and creative.

Yes

I have been told by others that I was "manic".

Yes

I feel nervous, tense and jumpy most of the time.

Yes

I have trouble initially getting to sleep in the evening.

Yes

I get so nervous that I fear loss of, emotional control or feel like I'm going crazy.

Yes

I have panic episodes with rapid heart beat, shortness of breath, dizziness, and feel faint.

Yes

I often feel like something terrible will happen to me.

Yes

I am phobic and avoid some object or situation because it causes me distress.

Yes

I constantly worry and go over-and-over things in my head.

Yes

I often have a thought or unpleasant image in my mind that I can't shake.

Yes

I repeat unnecessary acts such as counting, checking, repeating or washing over-and-over again.

Yes

Everything in my life must be orderly, neat or in "perfect" shape or I feel uncomfortable.

Yes

I am very sensitive to noise and confusion and become nervous and feel uncomfortable.

Yes

I experience great emotional difficulty traveling away from home or being in public places.

Yes

My thoughts are often strange, confusing and not clear.

Yes

I have odd experiences that are difficult to explain or understand.

Yes

I hear voices talking or whispering to me when no one else is around.

Yes

I see visions and things other people can't see.

Yes

People are able to read my mind and know what I am thinking.

Yes

Others are able to send or insert thoughts into my mind.

Yes

People are removing thoughts from my mind.

Yes

My feelings, thoughts and actions are no longer under my control.

Yes

There is a plot or conspiracy to harm me.

Yes

Others are observing me and saying "bad" things about me.

Yes

I often hear or see things that have a secret or special meaning for me.

Yes

I feel that I am no longer a person.

Yes

I hear strange or peculiar noises when I am alone.

Yes

Often the things or people around me seem strange and somehow not real.

Yes

I use "street drugs" to excess.

Yes

I drink alcohol to excess.

Yes

I have received one or more DUI charges.

Yes

I have missed school or work due to hangover from drugs or alcohol.

Yes

Drugs or alcohol have caused me to have relationship problems.

Yes

I have a plan to physically harm someone.

Yes

I have spent time in jail or prison.

Yes

I have been hospitalized for emotional or mental problems.

Yes

I have received treatment for substance abuse.

Yes

I have taken medicines for mental or emotional problems.

Yes

I have received counseling for mental or emotional problems.

Yes

My biological mother has serious mental or emotional problems.

Yes

My biological father has serious mental or emotional problems.

Yes

One or more of my biological siblings has serious mental or emotional problems.

Yes

One or more of my other biological relatives has serious mental or emotional problems.

Yes

As a child or teenager I had serious emotional or mental problems.

Yes

My life as a child or teenager was unhappy and difficult.

Yes

As a child I received special education in school.

Yes

I was a very hyperactive and inattentive child.

Yes

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