Section 1
Did you take your medicine as perscribed?
Headaches
General Pain
Heartburn
Constipation
Diarrhea
Section 2 Totally withdrawn
Doesn't talk
Unable to eat
Unable to respond
Suicidal or too depressed to self harm
Hear voices of guilt, hate, or doom
Hospitalization needed
Section 3 Needs prodding to function
Serious sleep disorder
Weight loss or gain
Suicidal ideas
Very withdrawn
Feelings of guilt, hate, or paranoia
May need hospitalization
Section 4 Loss of energy or desire to work
Loss of interest
Disturbed sleep
Disturbed appetite
Disturbed ability to function
Withdrawn
Desire to stay in bed
Feel that life isn't worthwhile
Section 5 Feel unfocused, unsure, or slowed down
Lack of optimism
Lack of pleasure
Lack of desire
Lack of sexual interest
Crying spells
Section 6 No symptoms
Section 7 Feel wonderful
Feel confident
Feel perceptive
Feel creative
Increased interest in travel
Increased interest in business
Increased interest in projects
Increased interest in sex
Increased interest in religion
Increased interest in spending money
Section 8 Excessive confidence
Excessive activity
Excessive talking
Excessive thinking
Excessive sexual desire
Excessively irritable
Excessive need to control
Excessively spending money
Decreased eating
Decreased caution
Decreased sleep
Section 9 Very rapid talking
Very rapid thinking
Very little eating
Very little sleeping
Very little control
Unusual ideas
Unusual behavior
Religious fervor
Hostile
May need hospitalization
Section 10 Restless or hyper
Hostile or violent
Non-stop talking
Paranoid
Hear voices
Incoherent
Can't function
Elated or wild
Little or no eating
Little sleeping
Little or no control
Little or no organization
Need hospitalization
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