Page 82 - Complementary and Alternative Medicine Treatments in Psychiatry

82 | Complementary and Alternative Medicine Treatments in Psychiatry

Patient Questionnaires
The importance of patient information cannot be
overemphasized. A few pieces of significant data gleaned from
the patient—that he or she may even consider unimportant—can
make or break a patient’s recovery. Here is a questionnaire my
patients fill out.

If you answer “yes” to any of the following, please provide
details below:
 Do you have a history of allergies, asthma, eczema? Are you
taking any medication?
 Do you have food cravings? Which foods? Sugar? Carbs?
(Circle here or list below.)
 Alcohol use—# of drinks per day _______
 Caffeine use—# of cups per day _______
 Past or current drug or alcohol use? Current cravings? Provide
details.

Stress inventory:
Please check any current areas of stress in your life:
 Parents  Children  Spouse  Work  School
 Social life  Finances  Sex
 Do you find it hard to relax?
 Do your symptoms vary with stress?
 Are you a perfectionist?

Depression inventory
 Do you feel unfulfilled?
 Are you lonely?
 Are you sad?
 Do you cry often?
 Do you find it hard to enjoy anything?
 Do you often wish you did not exist?
 Do you withdraw socially?