ID: Initial: Sex: Age: |
Blood pressure, Pulse rate, Body temperature |
Japan coma scale |
(1) DSM-IV diagnosis: |
(2) Precedent infectious symptoms (fever/headache/throat pain/diarrhea) |
(3) The first episode or the exacerbation |
3–1) How much time had passed from the onset of symptoms until receiving a medical examination? |
3–2) How long have you been under psychiatric care in the hospital? |
less than 1 month/less than 3 months/less than 1 year |
less than 5 years/less than 10 years/more than 10 years |
3–3) How many times did your symptoms exacerbate? |
two/three/four/five/more than five |
(4) Psychiatric symptom(s) (possible plural answers) |
a) anxiety/depression symptom |
irritation/anxiety/depressive mood/depersonalization |
sleep disorder/will drop/concentration drop/suicidal feeling |
b) mania symptom |
hyperthymia/hyperlogia/hyperactivity/flight of idea |
c) schizophrenia-like symptom |
auditory hallucination/visual hallucination/delusion/obfuscation |
excitement/echolalia/echopraxia/stereotypic language |
stereotypic movement/catalepsy/idle–autosynnoia/flattened feeling |
(5) Neurological symptom(s) |
convulsions/orolingual dyskinesia/systemic dyskinesia/eyeball dyskinesia |
instability of blood pressure and pulse/sweat and drooling abnormality |
respiratory depression/disorientation/amnesia |