Adapted
                           from the Family Practice Notebook website. 
Other references are listed below. 
Links in blue are from the Family Practice Notebook website. 
 

 
GERIATRIC DEPRESSION SCALE (GDS)

CHOOSE
                           THE BEST ANSWER FOR HOW YOU FELT THIS PAST WEEK                                                   
                           

CIRCLE ONE 

* 1.  Are you basically satisfied with your life?    
                                     yes     NO

  2.  Have you dropped many of your activities
                           and 

       interests?                                    
                                                    
                           YES     no

  3.  Do you feel that your life is empty?                      
                           YES     no

  4.  Do you often get bored?                        
                                         
                           YES     no

* 5.  Are you hopeful about the future?             
                                      yes     NO

  6.  Are you bothered by thoughts you can't get out

      
                           of your head?                                 
                                                 YES    
                           no

* 7.  Are you in good spirits most of the time?             
                           yes     NO

  8.  Are you afraid that something bad is going to

       happen to you?                                
                                               
                           YES     no

* 9.  Do you feel happy most of the time?            
                                   yes    
                           NO

 10.  Do you often feel helpless?                    
                                        YES     no

 11. 
                           Do you often get restless and fidgety?         
                                  YES    
                           no

 12.  Do you prefer to stay at home, rather than

       going out and doing new things?                           YES    
                           no

 13.  Do you frequently worry about the future?           YES     no

 14. 
                           Do you feel you have more problems with

      
                           memory than most?                             
                                           
                           YES     no

*15.  Do you think it is wonderful to be alive now?        yes     NO

 16.  Do you often feel downhearted and blue?        
                              YES     no

 17.  Do you feel pretty worthless the way you are

       now?                                          
                                                     
                           YES     no

 18.  Do you worry a lot about the past?                       YES    
                           no

*19.  Do you find life very exciting?                               yes    
                           NO

 20.  Is it hard for you to get started on new

       projects?                                     
                                                    
                           YES     no

*21.  Do you feel full of energy?                
                                            
                           yes     NO

 22.  Do you feel that your situation is hopeless?         YES     no

 23.  Do you think that most people are better off

       than you are?                                 
                                                
                           YES     no

 24.  Do you frequently get upset over little things?     YES     no

 25. 
                           Do you frequently feel like crying?            
                                     YES     no

 26.  Do you
                           have trouble concentrating?             
                                  YES    
                           no

*27.  Do you enjoy getting up in the morning?             
                           yes     NO

 28.  Do you prefer to avoid social gatherings?      
                                YES    
                           no

*29.  Is it easy for you to make decisions?                    yes     NO

*30.  Is your mind as clear as it used to be?        
                                   yes    
                           NO

*Appropriate (nondepressed) answers = yes, all others= no        
                           

 or count number of CAPITALIZED (depressed) answers

Score:
                           _____  (Number of "depressed" answers)  
                           

Norms

----------------------------

Normal                           5 +/- 4

Mildly
                           depressed         
                           15 +/- 6

Very depressed     
                                 23 +/- 5

________________________________________________________________

References: 

1.  Yesavage JA, Brink TL, Rose TL, et al.  Development
                           and

validation of a geriatric depression rating scale:  a
                           preliminary

report.  J Psych Res. 1983; 17:27. 

2.  Sheikh JI, Yesavage JA.  Geriatric Depression Scale:  recent

evidence and development of a shorter version. 
                           Clin Gerontol. 

1986; 5:165-172. 

The Geriatric Depression Scale may be used freely for patient

assessment
                           according to the authors.

Hamilton Depression Rating Scale (HAM-D)

Background 

Twenty one question Survey completed by physician 

Background
                           
Twenty one question Survey completed by physician 

CAGE Questions 

2.     
                           Screening for Alcohol Dependence

 Hamilton Anxiety Scale (HAM-A)

Symptom Rating Scale (0=Not Present, 4=Disabling) 
Anxious
                           Mood 
Worries 
Anticipates
                           worst 
Tension 
Startles
                           
Cries easily 
Restless 
Trembling 
Fears 
Fear of the dark 
Fear of strangers 
Fear of being alone 
Fear of animal 
Insomnia 
Difficulty falling asleep
                           or staying asleep 
Difficulty with Nightmares 
Intellectual 
Poor concentration 
Memory
                           Impairment 
Depressed Mood 
Decreased interest in activities 
Anhedonia
                           
Insomnia 
Somatic Complaints: Muscular
                           
Muscle aches or pains 
Bruxism
                           
Somatic Complaints: Sensory 
Tinnitus 
Blurred vision 
Cardiovascular Symptoms 
Tachycardia
                           
Palpitations 
Chest Pain 
Sensation of feeling faint 
Respiratory Symptoms 
Chest pressure
                           
Choking sensation 
Shortness of Breath 
Gastrointestinal symptoms
                           
Dysphagia 
Nausea or Vomiting 
Constipation 
Weight loss 
Abdominal
                           fullness 
Genitourinary symptoms 
Urinary
                           frequency or urgency 
Dysmenorrhea 
Impotence 
Autonomic Symptoms 
Dry Mouth 
Flushing 
Pallor 
Sweating
                           
Behavior at Interview 
Fidgets
                           
Tremor 
Paces