1. I CAN SIT DOWN AND RELAX QUITE EASILY.
2. I WORRY ABOUT WHAT IS GOING TO HAPPEN.
3. WHEN I HAVE A PROBLEM ,I FEEL SHAKY OR NOTICE MY HEART BEATS.
4. I HAVE DIFFICULTY FALLING ASLEEP DUE TO WORRYING THOUGHTS.
5. I HAVE HEADACHE OR ACHES IN MY SHOULDER/ BACK/NECK.
6. I SUDDENLY START TO TREMBLE OR SHAKE WHEN THERE IS NO REASON FOR THIS.
7. I FEEL AFRAID THAT I WILL MAKE A FOOL OF MYSELF IN FRONT OF PEOPLE.
8. I AVOID SITUATIONS WHEN I HAVE TO MEET NEW PEOPLE OR GO TO NEW PLACES.
How much are you distressed or bothered by the following items in the past month:
1. Unpleasant / Unwanted or bad thoughts come into mind against will and I cannot get rid of them.
2. I check things more often than necessary.
3. I am excessively concerned about cleanliness.
4. I get behind my work because I repetitively things over and over again.
5. After I have done things, I have persistent doubts about whether I really did them.
A. Tik all the products which you have used in the last three months
1. In the past 3 months how often have you used above drinks you please mention.
2. In the past 3 months how often have you had a strong desire or urge to use above drinks.
3. In the past 3 months how often you had health problems like vomiting and stomach pain Or social problem like arguments with people and relationship problems, Or legal problems like road accidents and drunken driving Or financial problems .
4. In the past 3 months how often have you failed to do what was normally expected of you because of your drink usage.
5. Has a friend or relative or anyone else ever expressed concern about your drinking.
6. Have you ever tried to cut down or stop drinking but failed.
7. Do you experience any withdrawal symptoms in the form shakes when you stop or reduce your alcohol .
1. In the past 3 months how often have you used above tobacco substances you please mention.
2. In the past 3 months how often have you failed to do what was normally expected of you because of your tobacco usage.
3. Has a friend or relative or anyone else ever expressed concern about your tobacco use.
4. Have you ever tried to cut down or stop tobacco substances but failed.
5. Do you experience any withdrawal symptoms when you stop using tobacco products.
1. In the past 3 months how often have you used substances.
2. In the past 3 months how often have you had a strong desire or urge to use above substances.
3. Has a friend or relative or anyone else ever expressed concern about your substance use.
4. Have you ever tried to cut down or stop substances but failed.
5. Do you experience any withdrawal symptoms when you stop using drugs.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
1. Little interest or pleasure in doing things.
2. Feeling down, depressed, or hopeless.
3. Trouble falling or staying asleep, or sleeping too much.
4. Feeling tired or having little energy.
5. Poor appetite or overeating.
6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down.
7. Trouble concentrating on things, such as reading the newspaper or watching television.
8. Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual .
9. Thoughts that you would be better off dead or of hurting yourself in some way.
1. Have you ever had unusual experiences like hearing voices when there was nobody around ?
2. Have you ever believed or still believe that some forces are trying to harm you?
3. Have you ever suffered from the mental health or behavioural problem requiring admission to a hospital?
4. Have you withdrawn from social activities( such as meeting, attending social functions etc) in the last six months?
5. Have you ever experienced abnormally high moods such a s feeling high, very energetic with lots of ideas and activities lasting for more than a month?
6. Do you often feel that people or talking about you.
