| |
| Question 1 |
Overactive, aggressive, disruptive behaviour
|
| No problems of this kind during the period rated. |
| Some irritability, quarrels, restlessness, etc. |
| Occassional aggressive gestures, pushing or pestering others; threats or verbal aggression; lesser damage to property (e.g. broken cup, window); marked overactivity or agitation. |
| Physically aggressive to others or animals; persistently threatening manner; more serious overactivity or destruction of property. |
| At least one serious physical attack on others or on animals; destructive of property (e.g. fire setting); persistent serious intimidation or obscene behaviour. |
| Not known or not applicable |
| |
| Question 2 |
Non-accidental self-injury
|
| No problems of this kind during the period rated. |
| Fleeting thoughts about ending it all but little risk; no self harm. |
| Minor risk during period; includes non-hazardous self-harm, e.g. wrist-scratching. |
| Moderate to serious risk of deliberate self-harm; includes preparatory acts e.g. collecting tablets. |
| Serious suicide attempt and/or serious deliberate self-harm injury during period. |
| Not known or not applicable |
| |
| Question 3 |
Problem-drinking or drug-taking
|
| No problems of this kind during the period rated. |
| Over-indulgence but within social norm |
| Loss of control of drinking or drug-taking, but not seriously addicted |
| Marked dependence on alcohol or drugs with frequent loss of control, drunk driving, etc. |
| Incapacitated by alcohol/drug problems |
| Not known or not applicable |
| |
| Question 4 |
Cognitive problems
|
| No problems of this kind during the period rated. |
| Minor problems with memory or understanding, e.g. forgets names occasionally. |
| Mild but definite problems, e.g. has lost the way in a familiar place or failed to recognise a familiar person, sometimes mixed up about simple decisions |
| Marked disorientation in time, place or person, bewildered by everyday events; speech is sometimes incoherent, mental slowing. |
| Severe disorientation, e.g. unable to recognise relatives, at risk of accidents, speech incomprehensible; clouding or stupor. |
| Not known or not applicable |
| |
| Question 5 |
Physical illness or disability problems
|
| No physical health problem during the period rated. |
| Minor health problem during the period (e.g. cold, non-serious fall, etc.). |
| Physical health problem imposes mild restriction on mobility and activity. |
| Moderate degree of restriction on activity due to physical health problem. |
| Severe or complete incapacity due to physical health problem. |
| Not known or not applicable |
| |
| Question 6 |
Problems associated with hallucinations and delusions
|
| No evidence of hallucinations or delusion during the period rated. |
| Somewhat odd or eccentric beliefs not in keeping with cultural norms. |
| Delusions or hallucinations (e.g. voices, visions) are present but there is little distress to patient or manifestation in bizarre behaviour, i.e. clinically present but mild. |
| Marked preoccupation with delusions or hallucinations, causing much distress and/or manifested in obviously bizarre behaviour, i.e. moderately severe clinical problem. |
| Mental state and behaviour is seriously and adversely affected by delusions or hallucinations, with severe impact on patient and/or others. |
| Not known or not applicable |
| |
| Question 7 |
Problems with depressed mood
|
| No problems associated with depressed mood during the period rated. |
| Gloomy; or transient mood changes. |
| Mild but definite depression and distress: e.g. feelings of guilt; sleep disturbance; loss of appetite; loss of self-esteem. |
| Depression with inappropriate self-blame, preoccupied with feelings of guilt. |
| Severe or very severe depression, with guilt or self-accusation. |
| Not known or not applicable |
| |
| Question 8 |
Other mental and behavioural problems (Specify condition e.g. phobic, somatoform, anxiety etc)
|
| No evidence of these problems during the period rated. |
| Minor non-clinical problems. |
| A problem is clinically present, but there are relatively symptom-free intervals and patient/client has a degree of control i.e. mild level. |
| Constant preoccupation with problem. Occasional severe attack or distress, with loss of control (e.g. has to avoid anxiety provoking situations altogether, call in a neighbour to help, etc.). i.e. moderately severe level of problem |
| Severe persistent problem dominates most activities |
| Not known or not applicable |
| |
| Question 9 |
Problems with relationships
|
| No significant problems during the period rated. |
| Minor non-clinical problem. |
| Definate problems in making or sustaining supportive relationships; patient complains and/or problems are evident to others. |
| Persisting major problems due to active or passive withdrawal from social relationships that provide little or no comfort or support. |
| Severe and distressing social isolation due to inability to communicate socially and/or withdrawal from social relationships. |
| Not known or not applicable |
| |
| Question 10 |
Problems with activities of daily living
|
| No problems during the period rated; good ability to function in all areas. |
| Minor problems only; e.g. untidy, disorganised |
| Self-care adequate, but major lack of performance of one or more complex skills. |
| Major problems in one or more area of self-care (eating, washing, dressing, toilet) as well as major inability to perform several complex skills. |
| Severe disability or incapacity in all or nearly all areas of self-care and complex skills. |
| Not known or not applicable |
| |
| Question 11 |
Problems with living conditions
|
| Accommodation and living conditions are acceptable; helpful in keeping any disability rated at scale 10 to the lowest level possible, and supportive of self-help. |
| Accommodation is reasonably acceptable although there are minor or transient problems (e.g. not ideal location, not preferred option, doesn't like the food, etc.). |
| Significant problems with one or more aspects of the accommodation
and/or regime: e.g. restricted choice; staff or household have little understanding of how to limit disability, or how to use or develop new or intact skills. |
| Distressing multiple problems with accommodation: e.g. some basic necessities absent; housing environment has minimal or no facilities to improve patient's independence. |
| Accommodation is unacceptable: e.g. lack of basic necessities, patient is at risk of eviction, or 'roofless', or living conditions are otherwise intolerable and making patient's problems worse. |
| Not known or not applicable |
| |
| Question 12 |
Problems with occupation and activities
|
| Patient's day-time environment is acceptable: helpful in keeping any disability rated at scale 10 to the lowest possible, and supportive of self-help |
| Minor or temporary problems e.g. late social security or health benefit payments; reasonable facilities available but not always at the desired times, etc. |
| Limited choice of activities: e.g. there is a lack of reasonable tolerance (e.g. unfairly refused entry to public library or baths, etc.); or handicapped by lack of permanent address; or insufficient carer or professional support; or helpful day setting available but for very limited hours. |
| Marked deficiency in skilled services available to help minimise level of existing disability; no opportunities to use intact skills or add new ones; unskilled care difficult to access. |
| Lack of any opportunity for day time activities makes patient's problems worse. |
| Not known or not applicable |
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