ID

27654

Descripción

Bipolar Affective Disorder (BipoläR) Swedish National Quality Registry Head of Registry: Mikael Landén Professor at the Sahlgrenska Academy, consultant at Sahlgrenska University Hospital, 411 18 Gothenburg Source: http://www.psykiatriregister.se/dokumentarkiv/bipolar S:t Göranprojekts (Making Projects) Anamnesis protocol for bipolar syndrom (version 3)

Link

http://www.psykiatriregister.se/dokumentarkiv/bipolar

Palabras clave

Versiones (2)
  1. 24/11/17 24/11/17 -
  2. 15/3/21 15/3/21 - Dr. rer. medic Philipp Neuhaus
Titular de derechos de autor

psykiatriregister.se (BipoläR)

Subido en

24 de noviembre de 2017

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC-ND 3.0
Comentarios del modelo :

Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.

Volver a los comentarios del modelo
Comentarios de grupo de elementos para :

Comentarios del elemento para :

Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.

Bipolar Affective Disorder (BipoläR) Swedish National Quality Registry

Inglés Sueco

Anamnesis

1 formularios  
  1. StudyEvent: ODM
    1. Anamnesis
General Information
Descripción

General Information

Alias
UMLS CUI-1
C1508263
Name
Descripción

Name

Tipo de datos

text

Alias
UMLS CUI [1]
C1299487
Patient-No.:
Descripción

Patient-ID

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Code Number
Descripción

Code Number

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0805701
UMLS CUI [1,2]
C0600091
Interviewer
Descripción

Interviewer

Tipo de datos

text

Alias
UMLS CUI [1]
C1550483
Date of Report
Descripción

Date of Report

Tipo de datos

date

Unidades de medida
  • yyyy-mm-dd
Alias
UMLS CUI [1]
C1302584
yyyy-mm-dd
Medical History
Descripción

Medical History

Alias
UMLS CUI-1
C0262926
Medical history Protocol entered online by:
Descripción

Investigator

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Date:
Descripción

Date of Medical History Taking

Tipo de datos

date

Unidades de medida
  • yyyy-mm-dd
Alias
UMLS CUI [1,1]
C0025084
UMLS CUI [1,2]
C0011008
yyyy-mm-dd
Actual Medical History:
Descripción

Actual Medical History

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0237400
Referring from:
Descripción

Referral

Tipo de datos

text

Alias
UMLS CUI [1]
C0034927
Comments:
Descripción

Comment

Tipo de datos

text

Alias
UMLS CUI [1]
C0947611
Social Anamnesis
Descripción

Social Anamnesis

Alias
UMLS CUI-1
C0424945
Enter the patient's main employment over the past 12 months.* * Mandatory
Descripción

The question relates to the main situation in the last year. If one of the patient's occupations exceeds 75 percent, only one option is indicated. If none of the patient's occupations exceeds 75 percent, two (2) alternatives may be specified. Several responses are possible.

Tipo de datos

text

Alias
UMLS CUI [1]
C0242271
Determine the number of affective episodes.
Descripción

Determine the number of affective episodes.

Alias
UMLS CUI-1
C1386525
Depressive episodes: Data not available?
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0349217
Enter the total number of depressive episodes during the past 12 months:
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0349217
UMLS CUI [1,2]
C4086638
Hypomanic episodes: Data not available?
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1396834
Enter the total number of hypomanic episodes during the past 12 months:
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

float

Alias
UMLS CUI [1,1]
C1396834
UMLS CUI [1,2]
C4086638
Manic episodes: Data not available?
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0349208
Enter the total number of manic episodes during the past 12 months:
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0349208
UMLS CUI [1,2]
C4086638
Mixed episodes: Data not available?
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

boolean

Alias
UMLS CUI [1]
C4290107
Enter the total number of depressive episodes during the past 12 months:
Descripción

Manic, hypomanic, depressive and mixed episodes separated by 4 weeks eutymi or episode of opposite polarity. Estimate the number when in doubt.

Tipo de datos

float

Alias
UMLS CUI [1,1]
C4290107
UMLS CUI [1,2]
C4086638
Enter the total number of weeks of affective episodes in the last 12 months. (0-52)
Descripción

Summarize the weeks for all verified affective episodes during the year. Give an approximate value in case of doubt.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1386525
UMLS CUI [1,2]
C0449238
Have the patient during the last 12 months had at least a two-month period without affective episodes?
Descripción

Complete remission = no significant signs or symptoms of bipolar affective episodes. Without complete remission between relapses = not completely symptom free but with symptoms of bipolar affective episodes that do not fully meet the criteria. One answer can be given.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0040223
UMLS CUI [1,2]
C0332288
UMLS CUI [1,3]
C1386525
Self-Injurious Behavior
Descripción

Self-Injurious Behavior

Alias
UMLS CUI-1
C0085271
Has the patient ever done self-injurious action without suicide?* * Mandatory
Descripción

Self-harmful action refers to the intentionally inflicting bodily injury without suicidal insight (eg by biting, headache, scratching, tearing, cutting, drowning of the body, ingestion of inedible substances and fluids, taking out of medication beyond ordination, dose poisoning with apparently non-lethal dosage or by burning).

Tipo de datos

text

Alias
UMLS CUI [1]
C3641595
If yes, occasionally OR Yes, recurrent for one or more periods, has the patient in the past 12 months done self-harmful action without suicide?* * Mandatory
Descripción

One Answer only.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3641595
UMLS CUI [1,2]
C0439228
Has the patient ever done any suicide attempt? * * Mandatory
Descripción

Suicide attempts are meant to be life-threatening or apparently life-threatening behavior, in order to put their lives at stake or to express such an intention but do not lead to death (eg severe tablet poisoning, drowning, shooting, hanging / tightening).

Tipo de datos

text

Alias
UMLS CUI [1]
C0038663
In 1-2 times OR 3 times or more, has the patient been suicidal in the last 12 months? * * Mandatory
Descripción

One Answer only.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0038663
UMLS CUI [1,2]
C0750480
Treatment History
Descripción

Treatment History

Alias
UMLS CUI-1
C0814462
Has the patient ever previously received patient education for bipolar disorder, systematic psychological treatment and / or neuropsychological investigation? * * Mandatory
Descripción

Treatment for bipolar disorder

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0005586
UMLS CUI [1,2]
C0087111
If YES, please specify (several answers are possible):* * Mandatory
Descripción

- Patient education for bipolar disorder (educational initiative that follows a predefined education program comprising a number of training courses where the content aims to provide increased knowledge about disease and treatment, strategies to handle everyday symptoms and opportunity for exchange of experience) - Systematic psychological treatment (eg psychodynamic, dialectic-behavioral, interpersonal, cognitive or cognitive behavioral therapeutic treatment) - Neuropsychological investigation (investigation with standardized tests that measure cognitive functions as attention, memory function, concentration ability, learning ability)

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0005586
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C2348235
If yes, the patient has received patient education for bipolar disorder in the past 12 months, systematically psychologically treatment and / or neuropsychological investigation? * * Mandatory
Descripción

Treatment for bipolar disorder: Time of Treatment

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0005586
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C2348792
If YES, please specify (several answers are possible):* * Mandatory
Descripción

- Patient education for bipolar disorder (educational initiative that follows a predefined education program comprising a number of training courses where the content aims to provide increased knowledge about disease and treatment, strategies to handle everyday symptoms and opportunity for exchange of experience) - Systematic psychological treatment (eg psychodynamic, dialectic-behavioral, interpersonal, cognitive or cognitive behavioral therapeutic treatment) - Neuropsychological investigation (investigation with standardized tests that measure cognitive functions as attention, memory function, concentration ability, learning ability)

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0005586
UMLS CUI [1,2]
C0087111
UMLS CUI [1,3]
C2348792
UMLS CUI [1,4]
C2348235
Has the patient ever been treated with ECT before?
Descripción

Regardless of the number of times in a treatment series. ECT = Electroconvulsive Treatment (KVÅ codes DA006, DA024 and DA025)

Tipo de datos

text

Alias
UMLS CUI [1]
C0013806
If yes, number of treatment series during life:
Descripción

Electroconvulsive Therapy: Number

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0013806
UMLS CUI [1,2]
C0449788
If yes, estimate outcomes for the latest treatment series:
Descripción

Estimate the treatment effect according to CGI-I. Compared with the patient's condition before treatment, how much has he / she changed? Circle the appropriate option.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0013806
UMLS CUI [1,2]
C1547647
If yes, has the patient been treated with ECT over the past 12 months?
Descripción

Electroconvulsive Therapy: Last Treatment

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013806
UMLS CUI [1,2]
C1517741
UMLS CUI [1,3]
C2745955
Ongoing Pharmacotherapy
Descripción

Ongoing Pharmacotherapy

Alias
UMLS CUI-1
C0013216
UMLS CUI-2
C0549178
Mood stabilizing drug
Descripción

Refers to ongoing drug treatment and includes Karbamazepine, Clonazepam, Lamotrigine, Lithium, Oxcarbazepine, Quetiapine, Topiramate, Valproate, and other mood stabilizing drugs. One answer can be given.

Tipo de datos

text

Alias
UMLS CUI [1]
C1533054
If Yes, please specify:
Descripción

Several answers are possible.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1533054
UMLS CUI [1,2]
C2348235
If the patient is treated with lithium at present: What year was lithium inserted for the first time?
Descripción

Lithium Therapy: Start Date

Tipo de datos

date

Unidades de medida
  • yyyy
Alias
UMLS CUI [1,1]
C3540800
UMLS CUI [1,2]
C1531783
yyyy
Enter the last value of S-Lithium, but not older than 12 months:
Descripción

(decimal with one decimal place)

Tipo de datos

float

Unidades de medida
  • mmol/L
Alias
UMLS CUI [1]
C0337452
mmol/L
Have kidney function been investigated with regard to glomerular filtration rate (GFR) in the last 12 months?
Descripción

Renal Function

Tipo de datos

text

Alias
UMLS CUI [1]
C0232804
Please specify: Creatinine. Enter the last value of Creatinine (not older than 12 months):
Descripción

Creatinine

Tipo de datos

integer

Unidades de medida
  • μmol/L
μmol/L
Please specify: Cystatin C. Enter value. (Decimal digit with two decimal places)
Descripción

Cystatin C

Tipo de datos

float

Unidades de medida
  • mg/L
Alias
UMLS CUI [1]
C1619716
mg/L
Please specify: Iohexol Clearance. Enter value.
Descripción

Iohexol Clearance

Tipo de datos

integer

Unidades de medida
  • mL/min/1,73 m2
Alias
UMLS CUI [1,1]
C0017654
UMLS CUI [1,2]
C0022005
mL/min/1,73 m2
Please specify: Other method.
Descripción

Renal Function Test

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0232804
UMLS CUI [1,2]
C0022885
Antipsychotic Agents * * Mandatory
Descripción

Refers to ongoing drug treatment including Alimemazine, Aripiprazole, Dixyrazine, Flufenazine, Flupentixol, Haloperidol, Chlorpromazine, Kloprotixen, Klozapine, Levomepromazine, Melperon, Olanzapine, Paliperidone, Perfenazine, Pimozide, Quetiapine, Risperidone, Sertindole, Sulpiride, Tioridazine, Ziprasidone, Zuclopentixol, Ev other antipsychotic drug.

Tipo de datos

text

Alias
UMLS CUI [1]
C0040615
Antipsychotic Agents: Please specify:
Descripción

Examples of typical antipsychotic drugs: Dixyrazine, Flufenazine, Haloperidol, Chlorpromazine, Chlorprotixen, Levomepromazine, Perfenazine, Tioridazine. Examples of atypical antipsychotic drugs: Aripiprazole, Klozapine, Risperidone, Olanzapine, Quetiapine, Paliperidone, Sertindole, Ziprasidone. Several response options can be specified

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0040615
UMLS CUI [1,2]
C2348235
Antidepressive Agents?* * Mandatory
Descripción

Antidepressive Agents

Tipo de datos

text

Alias
UMLS CUI [1]
C0003289
Antidepressive Agents: Please specify. Tick one or more answers.
Descripción

Antidepressive Agents: Specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0003289
UMLS CUI [1,2]
C2348235
Medicine against ADHD * * Mandatory
Descripción

Refers to ongoing drug treatment and includes Atomoxetine, central stimulant, and any other drug against ADHD. By central stimulant medicine is meant e.g. methylphenidate, dexamethetamine, modafinil, but not atomoxetine. One answer can be given.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1263846
UMLS CUI [1,2]
C0013216
Medicine against ADHD: If YES, please specify.
Descripción

Several answers are possible.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1263846
UMLS CUI [1,2]
C0013216
UMLS CUI [1,3]
C2348235
Benzodiazepines and benzodiazepine-like drugs
Descripción

Refers to ongoing drug treatment and includes Alprazolam, Buspiron, Diazepam, Flunitrazepam, Hydroxizin, Lorazepam, Klometiazole, Nitrazepam, Oxazepam, Pregabalin, Prometazin, Propiomazine, Propranolol, Triazolam, Valeriana, Zaleplon, Zolpidem, Zopiclone, and other benzodiazepine-like drugs.

Tipo de datos

text

Alias
UMLS CUI [1]
C0005064
Levothyroxine* * Mandatory
Descripción

Levothyroxine

Tipo de datos

text

Alias
UMLS CUI [1]
C1881373
Has the patient during the past 12 months been given any drug side effects that caused withdrawal or drug change? * * Mandatory
Descripción

Adverse reaction to drug

Tipo de datos

text

Alias
UMLS CUI [1]
C0041755
If Yes, specify the preparation:
Descripción

Adverse reaction to drug: Preparation

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0041755
UMLS CUI [1,2]
C1521827
If Yes, please specify the side effect:
Descripción

Adverse reaction to drug: Specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0041755
UMLS CUI [1,2]
C2348235
Somatic Factors
Descripción

Somatic Factors

Alias
UMLS CUI-1
C2986476
Are there any of the following conditions in addition to bipolar disorder?
Descripción

Includes diagnosed states, suspected conditions investigated (even if diagnosis is not yet established) as well as complicating circumstances.

Tipo de datos

text

Alias
UMLS CUI [1]
C2986476
If Yes, please specify:
Descripción

Several answers are possible.

Tipo de datos

text

If YES, please specify. If OTHER, please specify:
Descripción

Somatic Factors: Others

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2986476
UMLS CUI [1,2]
C0205394
HbA1c - Data not available?
Descripción

HbA1c

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0019018
Enter the current value of HbA1c.
Descripción

HbA1c = "long-term measure" of glucose levels (blood sugar). The HbA1c level reflects the average P-Glucose level below the last 6-8 weeks before sampling. The answer is given in integers.

Tipo de datos

integer

Unidades de medida
  • mmol/mol
Alias
UMLS CUI [1,1]
C0019018
UMLS CUI [1,2]
C0587081
mmol/mol
Current Systolic Blood Pressure - Data not available?
Descripción

Systolic Blood Pressure

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0871470
Enter current systolic blood pressure.
Descripción

Systolic blood pressure, upper pressure (mm Hg) registered in sitting after at least two minutes rest (recommendation).

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1,1]
C0871470
UMLS CUI [1,2]
C0587081
mmHg
Diastolic Blood Pressure - Data not available?
Descripción

Diastolic Blood Pressure

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0428883
Enter current diastolic blood pressure.
Descripción

Diastolic blood pressure, lower pressure (mm Hg) recorded in sitting after at least two minutes rest (recommendation).

Tipo de datos

integer

Unidades de medida
  • mmHg
Alias
UMLS CUI [1,1]
C0428883
UMLS CUI [1,2]
C0587081
mmHg
Weight - Data not available?
Descripción

Body Weight

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0005910
Enter current weight.
Descripción

Weight = kg, without outerwear, jacket and shoes. (Decimal by one decimal place)

Tipo de datos

float

Unidades de medida
  • kg
kg
Height - Data not available?
Descripción

Body Height

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0005890
Enter current height.
Descripción

Length = cm, without shoes.

Tipo de datos

integer

Unidades de medida
  • cm
Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C0587081
cm
Substance Use Disorders
Descripción

Substance Use Disorders

Alias
UMLS CUI-1
C0038586
Nicotine Does the patient use nicotine as much as daily?* * Mandatory
Descripción

Nicotine

Tipo de datos

text

Alias
UMLS CUI [1]
C0376384
If Yes, please specify:
Descripción

By nicotine replacement, nicotine patches and nicotine gum. Several responses can be specified.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0376384
UMLS CUI [1,2]
C2348235
Alcohol AUDIT C is answered by the patient * * Mandatory 1.How often do you dring alcohol?
Descripción

AUDIT C are the first three questions of the AUDIT. Score: 0-12 Risk Use ≥ 4 points (man), ≥ 3 points (female). A glass is defined as one of the following: 45 cl beer, 33 cl beer, 15 cl of wine, fortified wine Cl 8, 4 cl liquor.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0001948
UMLS CUI [1,2]
C0439603
Alcohol AUDIT C is answered by the patient * * Mandatory 2. How many "glass" (see example) do you drink on a typical day when you drink alcohol?
Descripción

AUDIT C are the first three questions of the AUDIT. Score: 0-12 Risk Use ≥ 4 points (man), ≥ 3 points (female). A glass is defined as one of the following: 45 cl beer, 33 cl beer, 15 cl of wine, fortified wine Cl 8, 4 cl liquor.

Tipo de datos

integer

Alias
UMLS CUI [1]
C0560578
Alcohol AUDIT C is answered by the patient * * Mandatory 3. How often do you (woman) 4 or (5) drink such "glasses" or more at the same time?
Descripción

AUDIT C are the first three questions of the AUDIT. Score: 0-12 Risk Use ≥ 4 points (man), ≥ 3 points (female). A glass is defined as one of the following: 45 cl beer, 33 cl beer, 15 cl of wine, fortified wine Cl 8, 4 cl liquor.

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0001948
UMLS CUI [1,2]
C0442802
AUDIT C Total Score:
Descripción

(0 - 12 points)

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0001948
UMLS CUI [1,2]
C0449820
Psychiatric comorbidity - Based on clinical interview, MINI interview or other instruments:
Descripción

Psychiatric comorbidity - Based on clinical interview, MINI interview or other instruments:

Alias
UMLS CUI-1
C0004936
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory
Descripción

Psychiatric comorbidity

Tipo de datos

text

Alias
UMLS CUI [1]
C0004936
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify:
Descripción

Several answers are possible.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0004936
UMLS CUI [1,2]
C2348235
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify: If Attention Deficit Disorder, please specify:
Descripción

One answer only.

Tipo de datos

text

Alias
UMLS CUI [1]
C0041671
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify: If Substance Use Disorder, please specify:
Descripción

Substance abuse refers to malicious use and / or addiction. Combination (F19.1 / F19.2) is applied when it is known that two or more psychoactive substances have been used but when it is impossible to determine which one contributed most to the disturbance. The category should be used as well when one or more of the substances are unknown or can not be accurately identified. Several answers are possible.

Tipo de datos

text

Alias
UMLS CUI [1]
C0038586
Global Assessment of Functioning
Descripción

Global Assessment of Functioning

Enter current value of GAF: sub-scale function: Current result of estimation on the GAF scale part scale for social and professional functional capacity.
Descripción

The question is answered if the patient is 21 years of age or older. The GAF scale is a global functional assessment scale for estimating psychological, social and professional functionalities. Instruction: Note that the value 0 (insufficient information) should always be stated when it is estimated that there is no basis for a clinically relevant assessment on the part scale. This may be the case when the symptom source makes the assessment of the level of functioning too uncertain or when the assessment is made in circumstances that are not representative or adequate as a basis for a functional assessment, e.g. when the patient is in closed care. (0 - 100)

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0017644
UMLS CUI [1,2]
C0814554
Enter current value of GAF: sub-scale symptom: Current result of estimation on the GAF scale part scale for mental symptoms.
Descripción

The question is answered if the patient is 21 years of age or older. The GAF scale is a global function estimation scale for estimating psychological, social and professional functioning. Instruction: Note that the value 0 (insufficient information) should always be is stated when it is estimated that no clinical data can be obtained relevant estimation on the part scale. This can for example be the case when it is difficult to communicate with the patient that the symptom source can not clarified. (0 - 100)

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0017644
UMLS CUI [1,2]
C0004936
Specify the type of symptoms / function estimation.
Descripción

(The question is answered if the patient is 20 years and younger) One answer only.

Tipo de datos

text

Alias
UMLS CUI [1]
C0450973
If C-GAS, enter current value on C-GAS:
Descripción

Estimate the person's most impaired overall functional level during the specified time period by selecting the lowest level describing his / her functioning on a hypothetical continuum of health / illness. Also use intermediate levels (eg 35, 58, 62). The value "0" = insufficient information to be able to tax. C-GAS = Children's Global Assessment Scale. (0 - 100)

Tipo de datos

integer

Alias
UMLS CUI [1]
C3472495
If GAF, enter the current value of GAF Function:
Descripción

(0 - 100)

Tipo de datos

integer

Alias
UMLS CUI [1]
C0017644
If GAF, enter the current value of GAF Symptom:
Descripción

(0 - 100)

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0017644
UMLS CUI [1,2]
C1457887
CGI-S (Clinical Global Impression - Severity, Overall Clinical Impression of Disease Severity) * * Mandatory
Descripción

CGI-S (Clinical Global Impression - Severity, Overall Clinical Impression of Disease Severity) * * Mandatory

Alias
UMLS CUI-1
C3639708
CGI-S mania In view of the overall clinical experience of this patient population, to which extent is the patient manic?
Descripción

One answer only.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3639708
UMLS CUI [1,2]
C0024713
CGI-S depression In view of the overall clinical experience of this patient population, to which extent is the patient depressed?
Descripción

One answer only.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3639708
UMLS CUI [1,2]
C0011581
CGI-S TOTAL Set throughout life (can be high even if the patient is currently doing well) In view of your overall clinical experience of this particular patient population, how strongly is the patient affected by the mental disorder in a life perspective?
Descripción

Clinical Global Impression

Tipo de datos

text

Alias
UMLS CUI [1]
C3639708
Volver a la parte superior de la página

Similar models

Anamnesis

1 formularios
  1. StudyEvent: ODM
    1. Anamnesis
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
General Information
C1508263 (UMLS CUI-1)
Name
Item
Name
text
C1299487 (UMLS CUI [1])
Patient-ID
Item
Patient-No.:
text
C2348585 (UMLS CUI [1])
Code Number
Item
Code Number
text
C0805701 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Interviewer
Item
Interviewer
text
C1550483 (UMLS CUI [1])
Date of Report
Item
Date of Report
date
C1302584 (UMLS CUI [1])
Item Group
Medical History
C0262926 (UMLS CUI-1)
Investigator
Item
Medical history Protocol entered online by:
text
C2826892 (UMLS CUI [1])
Date of Medical History Taking
Item
Date:
date
C0025084 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Actual Medical History
Item
Actual Medical History:
text
C0262926 (UMLS CUI [1,1])
C0237400 (UMLS CUI [1,2])
Referral
Item
Referring from:
text
C0034927 (UMLS CUI [1])
Comment
Item
Comments:
text
C0947611 (UMLS CUI [1])
Item Group
Social Anamnesis
C0424945 (UMLS CUI-1)
Item
Enter the patient's main employment over the past 12 months.* * Mandatory
text
C0242271 (UMLS CUI [1])
Employment Status
Code List
Enter the patient's main employment over the past 12 months.* * Mandatory
CL Item
Skyddad verksamhet mer än 50 procent (Skyddad verksamhet mer än 50 procent)
CL Item
Skyddad verksamhet 50 procent eller mindre (Skyddad verksamhet 50 procent eller mindre)
CL Item
Sysselsättning motsvarande SOL:s definition (dagcenter, brukarklubbar, etc) (Sysselsättning motsvarande SOL:s definition (dagcenter, brukarklubbar, etc))
CL Item
Ingen sysselsättning (Ingen sysselsättning)
CL Item
Uppgift saknas (Uppgift saknas)
CL Item
Arbete/studier på öppna marknaden mer än 50 procent (Arbete/studier på öppna marknaden mer än 50 procent)
CL Item
Arbete/studier på öppna marknaden 50 procent eller mindre (Arbete/studier på öppna marknaden 50 procent eller mindre)
CL Item
Arbetslös/arbetsmarknadsåtgärd (Arbetslös/arbetsmarknadsåtgärd)
CL Item
Anpassad studieform (mål vidare studier/arbete) (Anpassad studieform (mål vidare studier/arbete))
CL Item
Arbetsrehabilitering (inkl. under utredning för klargörande av funktionsnivå) (Arbetsrehabilitering (inkl. under utredning för klargörande av funktionsnivå))
Item Group
Determine the number of affective episodes.
C1386525 (UMLS CUI-1)
Depressive Episodes
Item
Depressive episodes: Data not available?
boolean
C0349217 (UMLS CUI [1])
Number of Depressive Episodes
Item
Enter the total number of depressive episodes during the past 12 months:
float
C0349217 (UMLS CUI [1,1])
C4086638 (UMLS CUI [1,2])
Hypomanic Episodes
Item
Hypomanic episodes: Data not available?
boolean
C1396834 (UMLS CUI [1])
Number of Hypomanic Episodes
Item
Enter the total number of hypomanic episodes during the past 12 months:
float
C1396834 (UMLS CUI [1,1])
C4086638 (UMLS CUI [1,2])
Manic Episodes
Item
Manic episodes: Data not available?
boolean
C0349208 (UMLS CUI [1])
Number of Manic Episodes
Item
Enter the total number of manic episodes during the past 12 months:
float
C0349208 (UMLS CUI [1,1])
C4086638 (UMLS CUI [1,2])
Mixed Affective Episodes
Item
Mixed episodes: Data not available?
boolean
C4290107 (UMLS CUI [1])
Number of Mixed Affective Episodes
Item
Enter the total number of depressive episodes during the past 12 months:
float
C4290107 (UMLS CUI [1,1])
C4086638 (UMLS CUI [1,2])
Duration of Affective Episodes
Item
Enter the total number of weeks of affective episodes in the last 12 months. (0-52)
integer
C1386525 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Item
Have the patient during the last 12 months had at least a two-month period without affective episodes?
text
C0040223 (UMLS CUI [1,1])
C0332288 (UMLS CUI [1,2])
C1386525 (UMLS CUI [1,3])
Time without Affective Episodes
Code List
Have the patient during the last 12 months had at least a two-month period without affective episodes?
CL Item
 (Ja, med fullständig remission mellan skoven)
CL Item
 (Ja, utan fullständig remission mellan skoven)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item Group
Self-Injurious Behavior
C0085271 (UMLS CUI-1)
Item
Has the patient ever done self-injurious action without suicide?* * Mandatory
text
C3641595 (UMLS CUI [1])
Non-suicidal Self-injurious Behavior
Code List
Has the patient ever done self-injurious action without suicide?* * Mandatory
CL Item
 (Nej, har ej förekommit)
CL Item
 (Ja, vid enstaka tillfällen)
CL Item
 (Uppgift saknas, otillräcklig information)
CL Item
 (Ja, återkommande under en eller flera perioder)
Item
If yes, occasionally OR Yes, recurrent for one or more periods, has the patient in the past 12 months done self-harmful action without suicide?* * Mandatory
text
C3641595 (UMLS CUI [1,1])
C0439228 (UMLS CUI [1,2])
undefined item
Code List
If yes, occasionally OR Yes, recurrent for one or more periods, has the patient in the past 12 months done self-harmful action without suicide?* * Mandatory
CL Item
 (Nej (0 dygn))
CL Item
 (Ja, under 1-5 dygn)
CL Item
 (Ja, under 6-25 dygn)
CL Item
 (Ja, under 26-50 dygn)
CL Item
 (Ja, under 51-100 dygn)
CL Item
 (Ja, under 101-365 dygn)
CL Item
 (Uppgift saknas, otillräcklig information)
Item
Has the patient ever done any suicide attempt? * * Mandatory
text
C0038663 (UMLS CUI [1])
Suicide Attempt
Code List
Has the patient ever done any suicide attempt? * * Mandatory
CL Item
 (Nej)
CL Item
 (1-2 ggr)
CL Item
 (3 ggr eller fler)
CL Item
 (Uppgift saknas, otillräcklig information)
Item
In 1-2 times OR 3 times or more, has the patient been suicidal in the last 12 months? * * Mandatory
text
C0038663 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Number of Suicide Attempts
Code List
In 1-2 times OR 3 times or more, has the patient been suicidal in the last 12 months? * * Mandatory
CL Item
 (Nej)
CL Item
 (1-2 ggr)
CL Item
 (3 ggr eller fler)
CL Item
 (Uppgift saknas, otillräcklig information)
Item Group
Treatment History
C0814462 (UMLS CUI-1)
Item
Has the patient ever previously received patient education for bipolar disorder, systematic psychological treatment and / or neuropsychological investigation? * * Mandatory
text
C0005586 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Treatment for bipolar disorder
Code List
Has the patient ever previously received patient education for bipolar disorder, systematic psychological treatment and / or neuropsychological investigation? * * Mandatory
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
If YES, please specify (several answers are possible):* * Mandatory
text
C0005586 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Treatment for bipolar disorder
Code List
If YES, please specify (several answers are possible):* * Mandatory
CL Item
 (Patientutbildning för bipolär sjukdom)
CL Item
 (Systematisk psykologisk behandling)
CL Item
 (Neuropsykologisk utredning)
Item
If yes, the patient has received patient education for bipolar disorder in the past 12 months, systematically psychologically treatment and / or neuropsychological investigation? * * Mandatory
text
C0005586 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C2348792 (UMLS CUI [1,3])
undefined item
Code List
If yes, the patient has received patient education for bipolar disorder in the past 12 months, systematically psychologically treatment and / or neuropsychological investigation? * * Mandatory
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
If YES, please specify (several answers are possible):* * Mandatory
text
C0005586 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C2348792 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Treatment for bipolar disorder
Code List
If YES, please specify (several answers are possible):* * Mandatory
CL Item
 (Patientutbildning för bipolär sjukdom)
CL Item
 (Systematisk psykologisk behandling)
CL Item
 (Neuropsykologisk utredning)
Item
Has the patient ever been treated with ECT before?
text
C0013806 (UMLS CUI [1])
Electroconvulsive Therapy
Code List
Has the patient ever been treated with ECT before?
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Electroconvulsive Therapy: Number
Item
If yes, number of treatment series during life:
float
C0013806 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item
If yes, estimate outcomes for the latest treatment series:
integer
C0013806 (UMLS CUI [1,1])
C1547647 (UMLS CUI [1,2])
Electroconvulsive Therapy: Outcome
Code List
If yes, estimate outcomes for the latest treatment series:
CL Item
not assessed (0)
CL Item
very much improved (1)
CL Item
much improved (2)
CL Item
minimally improved (3)
CL Item
no change (4)
CL Item
minimally worse (5)
CL Item
much worse (6)
CL Item
very much worse (7)
Item
If yes, has the patient been treated with ECT over the past 12 months?
text
C0013806 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
Electroconvulsive Therapy: Last Treatment
Code List
If yes, has the patient been treated with ECT over the past 12 months?
CL Item
Ja (Ja)
CL Item
Nej (Nej)
CL Item
Uppgift saknas (Uppgift saknas)
Item Group
Ongoing Pharmacotherapy
C0013216 (UMLS CUI-1)
C0549178 (UMLS CUI-2)
Item
Mood stabilizing drug
text
C1533054 (UMLS CUI [1])
Mood stabilizing drug
Code List
Mood stabilizing drug
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
If Yes, please specify:
text
C1533054 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Mood Stabilizing Drug: Specification
Code List
If Yes, please specify:
CL Item
Karbamazepin (Karbamazepin)
CL Item
 (Lamotrigin)
CL Item
 (Litium)
CL Item
 (Valproat)
CL Item
 (Annat)
Lithium Therapy: Start Date
Item
If the patient is treated with lithium at present: What year was lithium inserted for the first time?
date
C3540800 (UMLS CUI [1,1])
C1531783 (UMLS CUI [1,2])
Lithium Measurement
Item
Enter the last value of S-Lithium, but not older than 12 months:
float
C0337452 (UMLS CUI [1])
Item
Have kidney function been investigated with regard to glomerular filtration rate (GFR) in the last 12 months?
text
C0232804 (UMLS CUI [1])
Renal Function
Code List
Have kidney function been investigated with regard to glomerular filtration rate (GFR) in the last 12 months?
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Creatinine
Item
Please specify: Creatinine. Enter the last value of Creatinine (not older than 12 months):
integer
Cystatin C
Item
Please specify: Cystatin C. Enter value. (Decimal digit with two decimal places)
float
C1619716 (UMLS CUI [1])
Iohexol Clearance
Item
Please specify: Iohexol Clearance. Enter value.
integer
C0017654 (UMLS CUI [1,1])
C0022005 (UMLS CUI [1,2])
Renal Function Test
Item
Please specify: Other method.
text
C0232804 (UMLS CUI [1,1])
C0022885 (UMLS CUI [1,2])
Item
Antipsychotic Agents * * Mandatory
text
C0040615 (UMLS CUI [1])
undefined item
Code List
Antipsychotic Agents * * Mandatory
CL Item
Ja (Ja)
CL Item
Nej (Nej)
CL Item
Uppgift saknas (Uppgift saknas)
Item
Antipsychotic Agents: Please specify:
text
C0040615 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
undefined item
Code List
Antipsychotic Agents: Please specify:
CL Item
Typiska antipsykotiska läkemedel (Typiska antipsykotiska läkemedel)
CL Item
Atypiska antipsykotiska läkemedel: Aripiprazol (Atypiska antipsykotiska läkemedel: Aripiprazol)
CL Item
Atypiska antipsykotiska läkemedel: Klozapin (Atypiska antipsykotiska läkemedel: Klozapin)
CL Item
Atypiska antipsykotiska läkemedel: Olanzapin (Atypiska antipsykotiska läkemedel: Olanzapin)
CL Item
Atypiska antipsykotiska läkemedel: Quetiapin (Atypiska antipsykotiska läkemedel: Quetiapin)
CL Item
Atypiska antipsykotiska läkemedel, annat (Atypiska antipsykotiska läkemedel, annat)
Item
Antidepressive Agents?* * Mandatory
text
C0003289 (UMLS CUI [1])
Antidepressive Agents
Code List
Antidepressive Agents?* * Mandatory
CL Item
Ja (Ja)
CL Item
Nej (Nej)
CL Item
Uppgift saknas (Uppgift saknas)
Item
Antidepressive Agents: Please specify. Tick one or more answers.
text
C0003289 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Antidepressive Agents: Specification
Code List
Antidepressive Agents: Please specify. Tick one or more answers.
CL Item
Agomelatin (Agomelatin)
CL Item
Amitryptilin (Amitryptilin)
CL Item
Bupropion (Bupropion)
CL Item
Citalopram (Citalopram)
CL Item
Duloxetin (Duloxetin)
CL Item
Escitalopram (Escitalopram)
CL Item
Fluoxetin (Fluoxetin)
CL Item
Fluvoxamin (Fluvoxamin)
CL Item
Imipramin (Imipramin)
CL Item
Klomipramin (Klomipramin)
CL Item
Lofepramin (Lofepramin)
CL Item
Maprotilin (Maprotilin)
CL Item
Mianserin (Mianserin)
CL Item
Mirtazapin (Mirtazapin)
CL Item
Moclobemid (Moclobemid)
CL Item
Nefazodon (Nefazodon)
CL Item
Nortryptilin (Nortryptilin)
CL Item
Paroxetin (Paroxetin)
CL Item
Phenelzin (Phenelzin)
CL Item
Reboxetin (Reboxetin)
CL Item
Sertralin (Sertralin)
CL Item
Tranylcypromin (Tranylcypromin)
CL Item
Trimipramin (Trimipramin)
CL Item
Venlafaxin (Venlafaxin)
CL Item
ev annat (ev annat)
Item
Medicine against ADHD * * Mandatory
text
C1263846 (UMLS CUI [1,1])
C0013216 (UMLS CUI [1,2])
ADHD Pharmacotherapy
Code List
Medicine against ADHD * * Mandatory
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
Medicine against ADHD: If YES, please specify.
text
C1263846 (UMLS CUI [1,1])
C0013216 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
ADHD Pharmacotherapy Specification
Code List
Medicine against ADHD: If YES, please specify.
CL Item
 (Atomoxetin)
CL Item
 (Centralstimulerande)
CL Item
 (Annat)
Item
Benzodiazepines and benzodiazepine-like drugs
text
C0005064 (UMLS CUI [1])
Benzodiazepines
Code List
Benzodiazepines and benzodiazepine-like drugs
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
Levothyroxine* * Mandatory
text
C1881373 (UMLS CUI [1])
Levothyroxine
Code List
Levothyroxine* * Mandatory
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
Has the patient during the past 12 months been given any drug side effects that caused withdrawal or drug change? * * Mandatory
text
C0041755 (UMLS CUI [1])
Adverse reaction to drug
Code List
Has the patient during the past 12 months been given any drug side effects that caused withdrawal or drug change? * * Mandatory
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Adverse reaction to drug: Preparation
Item
If Yes, specify the preparation:
text
C0041755 (UMLS CUI [1,1])
C1521827 (UMLS CUI [1,2])
Adverse reaction to drug: Specification
Item
If Yes, please specify the side effect:
text
C0041755 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item Group
Somatic Factors
C2986476 (UMLS CUI-1)
Item
Are there any of the following conditions in addition to bipolar disorder?
text
C2986476 (UMLS CUI [1])
Somatic Factors
Code List
Are there any of the following conditions in addition to bipolar disorder?
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
If Yes, please specify:
text
Somatic Factors: Specification
Code List
If Yes, please specify:
CL Item
Psoriasis (Psoriasis)
CL Item
 (Diabetessjukdom)
CL Item
 (Hjärt- och kärlsjukdom)
CL Item
 (Hypertoni)
CL Item
 (Njursjukdom)
CL Item
 (Thyroideasjukdom, hypothyreos)
CL Item
 (Thyroideasjukdom, hyperthyreos)
CL Item
 (Allergier/eksem)
CL Item
 (Graviditet)
CL Item
 (Amning)
CL Item
 (Reumatoid artrit, Osteoartrit)
CL Item
 (Migrän)
CL Item
 (Multipel skleros)
CL Item
 (Epilepsi)
CL Item
 (Alzheimers/annan demenssjukdom)
CL Item
 (Parkinsons sjukdom)
CL Item
 (Gastrit / Ulcus)
CL Item
 (Colon irritabile (IBS irritable bowel syndrom))
CL Item
 (Crohns sjukdom)
CL Item
 (Ulcerös colit)
CL Item
 (Hepatit)
CL Item
 (Annat tillstånd)
CL Item
 (Uppgift saknas)
Somatic Factors: Others
Item
If YES, please specify. If OTHER, please specify:
text
C2986476 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
HbA1c
Item
HbA1c - Data not available?
boolean
C0019018 (UMLS CUI [1])
HbA1c value
Item
Enter the current value of HbA1c.
integer
C0019018 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Systolic Blood Pressure
Item
Current Systolic Blood Pressure - Data not available?
boolean
C0871470 (UMLS CUI [1])
Systolic Blood Pressure Value
Item
Enter current systolic blood pressure.
integer
C0871470 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Diastolic Blood Pressure
Item
Diastolic Blood Pressure - Data not available?
boolean
C0428883 (UMLS CUI [1])
Diastolic Blood Pressure Value
Item
Enter current diastolic blood pressure.
integer
C0428883 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Body Weight
Item
Weight - Data not available?
boolean
C0005910 (UMLS CUI [1])
Body Weight Value
Item
Enter current weight.
float
Body Height
Item
Height - Data not available?
boolean
C0005890 (UMLS CUI [1])
Body Height Value
Item
Enter current height.
integer
C0005890 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Item Group
Substance Use Disorders
C0038586 (UMLS CUI-1)
Item
Nicotine Does the patient use nicotine as much as daily?* * Mandatory
text
C0376384 (UMLS CUI [1])
Nicotine
Code List
Nicotine Does the patient use nicotine as much as daily?* * Mandatory
CL Item
Ja (Ja)
CL Item
Nej (Nej)
CL Item
Uppgift (Uppgift)
Item
If Yes, please specify:
text
C0376384 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Nicotine Specification
Code List
If Yes, please specify:
CL Item
Röker (Röker)
CL Item
Snusar (Snusar)
CL Item
Nikotinersättning (Nikotinersättning)
Item
Alcohol AUDIT C is answered by the patient * * Mandatory 1.How often do you dring alcohol?
integer
C0001948 (UMLS CUI [1,1])
C0439603 (UMLS CUI [1,2])
Alcohol Use Frequency
Code List
Alcohol AUDIT C is answered by the patient * * Mandatory 1.How often do you dring alcohol?
CL Item
Aldrig (0)
CL Item
1 gång i månaden eller mer sällan (1)
CL Item
2-4 gånger i månaden (2)
CL Item
2-3 gånger i veckan (3)
CL Item
4 gånger per vecka eller mer (4)
Item
Alcohol AUDIT C is answered by the patient * * Mandatory 2. How many "glass" (see example) do you drink on a typical day when you drink alcohol?
integer
C0560578 (UMLS CUI [1])
Alcohol Use Frequency
Code List
Alcohol AUDIT C is answered by the patient * * Mandatory 2. How many "glass" (see example) do you drink on a typical day when you drink alcohol?
CL Item
1-2  (0)
CL Item
3-4  (1)
CL Item
5-6  (2)
CL Item
7-9  (3)
CL Item
10 eller fler  (4)
Item
Alcohol AUDIT C is answered by the patient * * Mandatory 3. How often do you (woman) 4 or (5) drink such "glasses" or more at the same time?
integer
C0001948 (UMLS CUI [1,1])
C0442802 (UMLS CUI [1,2])
Alcohol Use Frequency
Code List
Alcohol AUDIT C is answered by the patient * * Mandatory 3. How often do you (woman) 4 or (5) drink such "glasses" or more at the same time?
CL Item
Aldrig (0)
CL Item
Mer sällan än en gång i månaden (1)
CL Item
Varje månad (2)
CL Item
Varje vecka  (3)
CL Item
Dagligen eller nästan varje dag (4)
Alcohol Consumption Score
Item
AUDIT C Total Score:
integer
C0001948 (UMLS CUI [1,1])
C0449820 (UMLS CUI [1,2])
Item Group
Psychiatric comorbidity - Based on clinical interview, MINI interview or other instruments:
C0004936 (UMLS CUI-1)
Item
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory
text
C0004936 (UMLS CUI [1])
Psychiatric comorbidity
Code List
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory
CL Item
 (Ja)
CL Item
 (Nej)
CL Item
 (Uppgift saknas)
Item
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify:
text
C0004936 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Psychiatric comorbidity
Code List
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify:
CL Item
 (Annat)
CL Item
 (Emotionellt instabil/borderline personlighetsstörning (F60.3))
CL Item
 (Antisocial personlighetsstörning (F60.2))
CL Item
 (Agorafobi (F40.0))
CL Item
 (Social fobi (F40.1))
CL Item
 (Paniksyndrom (F41.0))
CL Item
 (Uppmärksamhetsstörning)
CL Item
 (Substansmissbruk)
CL Item
 (Generaliserat ångestsyndrom (F41.1))
CL Item
 (Tvångssyndrom (F42.0, F42.1, F42.2))
Item
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify: If Attention Deficit Disorder, please specify:
text
C0041671 (UMLS CUI [1])
Attention Deficit Disorder
Code List
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify: If Attention Deficit Disorder, please specify:
CL Item
 (Uppmärksamhetsstörning/hyperaktivitet, i kombination (F90.0) (Både A1 och A2 sidan 12))
CL Item
 (Uppmärksamhetsstörning/hyperaktivitet, huvudsakligen bristande uppmärksamhet (F98.8) (Bara A1 sidan 12))
CL Item
 (Uppmärksamhetsstörning/hyperaktivitet, huvudsakligen hyperaktivitet-impulsivitet (F90.0) (Bara A2 sidan 12))
CL Item
 (Uppmärksamhet/hyperaktivitet UNS (F90.9))
CL Item
 (Uppgift saknas)
Item
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify: If Substance Use Disorder, please specify:
text
C0038586 (UMLS CUI [1])
Substance Use Disorders
Code List
Are there any other current psychiatric diagnosis other than bipolar disorder? * * Mandatory If Yes, please specify: If Substance Use Disorder, please specify:
CL Item
 (Alkohol (F10.1/F10.2))
CL Item
 (Opiater (F11.1/F11.2))
CL Item
 (Cannabis (F12.1/F12.2))
CL Item
 (Sedativa (F13.1/F13.2))
CL Item
 (Kokain (F14.1/F14.2))
CL Item
 (Stimulantia inklusive koffein (F15.1/F15.2))
CL Item
 (Hallucinogener (F16.1/F16.2))
CL Item
 (Tobak (F17.1/F17.2))
CL Item
 (Lösningsmedel (F18.1/F18.2))
CL Item
 (Kombination (F19.1/F19.2))
CL Item
 (Uppgift saknas)
Global Assessment: Social Capacity
Item
Enter current value of GAF: sub-scale function: Current result of estimation on the GAF scale part scale for social and professional functional capacity.
integer
C0017644 (UMLS CUI [1,1])
C0814554 (UMLS CUI [1,2])
Global Assessment of Functioning: Mental Symptoms
Item
Enter current value of GAF: sub-scale symptom: Current result of estimation on the GAF scale part scale for mental symptoms.
integer
C0017644 (UMLS CUI [1,1])
C0004936 (UMLS CUI [1,2])
Item
Specify the type of symptoms / function estimation.
text
C0450973 (UMLS CUI [1])
Global Assessment
Code List
Specify the type of symptoms / function estimation.
CL Item
C-GAS (C-GAS)
CL Item
GAF (GAF)
Children's Global Assessment Scale
Item
If C-GAS, enter current value on C-GAS:
integer
C3472495 (UMLS CUI [1])
Global Assessment of Functioning
Item
If GAF, enter the current value of GAF Function:
integer
C0017644 (UMLS CUI [1])
Global Assessment of Functioning: Symptom
Item
If GAF, enter the current value of GAF Symptom:
integer
C0017644 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
Item Group
CGI-S (Clinical Global Impression - Severity, Overall Clinical Impression of Disease Severity) * * Mandatory
C3639708 (UMLS CUI-1)
Item
CGI-S mania In view of the overall clinical experience of this patient population, to which extent is the patient manic?
text
C3639708 (UMLS CUI [1,1])
C0024713 (UMLS CUI [1,2])
Clinical Global Impression: Mania
Code List
CGI-S mania In view of the overall clinical experience of this patient population, to which extent is the patient manic?
CL Item
 (Ej bedömt)
CL Item
 (Normal, inte alls sjuk)
CL Item
 (Gränsfall för psykisk sjukdom)
CL Item
 (Lindrigt sjuk)
CL Item
 (Måttligt sjuk)
CL Item
 (Påtagligt sjuk)
CL Item
 (Allvarligt sjuk)
CL Item
 (Bland de mest extremt sjuka patienterna)
Item
CGI-S depression In view of the overall clinical experience of this patient population, to which extent is the patient depressed?
text
C3639708 (UMLS CUI [1,1])
C0011581 (UMLS CUI [1,2])
Clinical Global Impression: Depression
Code List
CGI-S depression In view of the overall clinical experience of this patient population, to which extent is the patient depressed?
CL Item
 (Ej bedömt)
CL Item
 (Normal, inte alls sjuk)
CL Item
 (Gränsfall för psykisk sjukdom)
CL Item
 (Lindrigt sjuk)
CL Item
 (Måttligt sjuk)
CL Item
 (Påtagligt sjuk)
CL Item
 (Allvarligt sjuk)
CL Item
 (Bland de mest extremt sjuka patienterna)
Item
CGI-S TOTAL Set throughout life (can be high even if the patient is currently doing well) In view of your overall clinical experience of this particular patient population, how strongly is the patient affected by the mental disorder in a life perspective?
text
C3639708 (UMLS CUI [1])
Clinical Global Impression
Code List
CGI-S TOTAL Set throughout life (can be high even if the patient is currently doing well) In view of your overall clinical experience of this particular patient population, how strongly is the patient affected by the mental disorder in a life perspective?
CL Item
 (Ej bedömt)
CL Item
 (Normal, inte alls sjuk)
CL Item
 (Gränsfall för psykisk sjukdom)
CL Item
 (Lindrigt sjuk)
CL Item
 (Måttligt sjuk)
CL Item
 (Påtagligt sjuk)
CL Item
 (Allvarligt sjuk)
CL Item
 (Bland de mest extremt sjuka patienterna)
Volver a la parte superior de la página 

Contacto

Utilice este formulario para comentarios, preguntas y sugerencias.

Los campos marcados con * son obligatorios.

Ayuda

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial