Weiss Diagnostic Screen
Name of Patient Current medications: School/Occupation Patient__Teacher__Parent__Friend__Partner__ Other: The following is a list of different kind of problems. Everyone has some of these difficulties at some time. We want to know if any of these things are causing more difficulty than is typical for most people. If the item is not relevant check N/A for not applicable. The scale refers to the last month.
Scoring: Clinical: review items scored 2 or 3. Diagnostic: Items scored 2 or 3 summed to determine if they meet DSM criteria. Severity: Total dx score
Age
Name of the person completing this form
Date
N/A
IA 6/9
No
A little
Pretty much
Very much
Making careless mistakes Difficulty staying focussed Difficulty listening Trouble following instructions Disorganized Procrastinates and avoids boring tasks Losing things Distractible Forgetful Fidgets Restless Hyperactive Difficulty engaging in quiet time Always on the go Talks too much Talks out of turn Difficulty waiting Interrupting Loses temper Argues with people Defiant Annoys people Blames others instead of his or herself Touchy Angry Mean or spiteful Skipping class or not showing up at work Lies Bullies Physical fights Verbal fights Stealing Setting fires Cruel to animals Sexually inappropriate Does not really feel sorry when in trouble
1
HI 6/9
ODD 4/8
CD >3
N/A
TD 1
No
A little
Pretty much
Very much
Repetitive movements (blinking, twitching) Makes noises (throat clearing, sniffing) Worry Fearful Nervous Complains of aches and pains when not sick Fear of germs, dirt Checking, counting Doing something over and over Cannot shake strange or distressing thoughts Perfectionist Panic attacks Shy Self conscious doing things in front of others Still haunted by a past traumatic event Trouble separating A specific fear (heights, crowds, bugs, animals etc.) Bad mood No enthusiasm for doing things Negative thoughts Feels worthless Hopeless No energy Not happy Feeling guilty Thoughts of death Violent thoughts Change in weight Change in sleep Change in concentration Mood changes with the season Feels speeded up Feeling powerful Does not sleep and does not feel tired Seems out of control Mood swings Ideas run together in an illogical way Hearing voices Seeing things that are not there Feels super powerful Feeling people are against you Can read peoples thoughts Feeling the radio or TV talks about you
2
GAD
1
OCD
1
PD SAD
PTSD Sep A SP
MDD >5
SAD
BAD >3
PD
1
N/A
No
A little
Pretty much
Very much
Strange and fixed beliefs
ASD
>5
Not interested in people Gets stuck on details Does not understand feelings Poor people skills Strange behaviours Trouble playing or socializing with groups of people Does not seek out other people for company Trouble making close friends Poor ability for mutual emotional connectedness Distant, hard to cuddle Problems with communication Talks in an odd voice (flat, robot like or monotonous) Poor eye contact Preoccupied with one area of interest Repeats an action or phrase over and over Gets stuck on one thing Difficulty understanding social relationships Does not always understand jokes Lacks sensitivity to whether others are interested Over sensitive to noise, smells, or the feel of clothes Reactive to changes in routine Thinking is concrete, poor abstraction Stormy Sees people as good or bad Feels empty inside Easily disappointed Manipulative Mood swings Self destructive Fears abandonment Emotionally sensitive Distorted or unstable self image Self injury (cutting, piercing, head banging) Self centred Entitled (feeling the world owes you) Trouble sleeping Daytime fatigue Napping Trouble falling asleep Waking in the night Difficulty getting up in the morning Nightmares Snoring
BPD >5
NPD
>2
SD
N/A
ED
No
A little
Pretty much
Very much
Eats too much Eating binges Eats too little Eats too much junk food Vomiting Poor body image Picky eater Overweight Binges Diarrhea Constipation Soiling Cannot control urination (peeing the bed or in clothes) Difficulty reading Difficulty writing or printing Difficulty with arithmetic Performance seems very variable Difficulty following instructions Difficulty doing several steps in order Trouble with maps, puzzles, sense of direction Difficulty getting the main idea in conversation Makes irrelevant comments Rambling speech Immature for age Clumsy Not interested in learning Performs below potential Procrastination Lack of motivation Rages Explosive Reactive to stress
(If age appropriate) Misuses, abuses, or dependency on:
LD
Other
SUD
Alcohol Cigarettes Marijuana Other drugs
If female and adult:
Problems with menstruation Problems with menopause
This scale is copyrighted by Margaret Danielle Weiss. It is free for use in clinical practice, can be posted on the internet and replicated as needed with no fees. If you wish to change the scale you can do so at your discretion, but in this case it cannot be referred to as the Weiss Diagnostic Scale. People using this scale in research, or those who wish to alter the content or translate it should contact me at
[email protected]. This scale has been deliberately written to assist with differential diagnosis, to be completed by any informant and is relevant to anyone older than 4. This allows for comparison between informants and over time. The left hand row describes DSM criteria for a disorder. This scale is not in any way a substitute for a good clinical mental status but may be useful as a cross check to assure that areas that are prominent are investigated thoroughly, to allow clinician to assess performance in other settings, and to assure that the mental status does not miss major areas of pathology.
