Medical History for Bipolar Syndrome (Part 4)

FAMILY HISTORY
Description

FAMILY HISTORY

Number of siblings:
Description

Number of siblings:

Data type

integer

Date of birth male sibling(s)
Description

Date of birth male sibling(s)

Data type

integer

Date of birth female sibling(s)
Description

Date of birth female sibling(s)

Data type

integer

Number of children
Description

Number of children

Data type

integer

Date of birth son(s)
Description

Date of birth son(s)

Data type

integer

Date of birth daughter(s)
Description

Date of birth daughter(s)

Data type

integer

Patient is adopted and has no knowledge of biological relatives
Description

Patient is adopted and has no knowledge of biological relatives

Data type

boolean

ASK ACTIVE but not necessary to ignore everything
Description

ASK ACTIVE but not necessary to ignore everything

Type of Disease
Description

Type of Disease

Data type

text

Mother
Description

Mother

Data type

integer

Father
Description

Father

Data type

integer

Sister 1
Description

Sister 1

Data type

integer

Sister 2
Description

Sister 2

Data type

integer

Sister 3
Description

Sister 3

Data type

integer

Brother 1
Description

Brother 1

Data type

integer

Brother 2
Description

Brother 2

Data type

integer

Brother 3
Description

Brother 3

Data type

integer

Daughter 1
Description

Daughter 1

Data type

integer

Daughter 2
Description

Daughter 2

Data type

integer

Daughter 3
Description

Daughter 3

Data type

integer

Son 1
Description

Son 1

Data type

integer

Son 2
Description

Son 2

Data type

integer

Son 3
Description

Son 3

Data type

integer

ASK ACTIVE but not necessary to ignore everything
Description

ASK ACTIVE but not necessary to ignore everything

Mother's side: Grandmother
Description

Mother's side: Grandmother

Data type

integer

Mother's side: Grandpa
Description

Mother's side: Grandpa

Data type

integer

Mother´s side: Aunt 1
Description

Mother´s side: Aunt 1

Data type

integer

Mother's side: Uncle 1
Description

Mother's side: Uncle 1

Data type

integer

Mother's side: Cousin 1
Description

Mother's side: Cousin 1

Data type

integer

Mother's side: Cousin 2
Description

Mother's side: Cousin 2

Data type

integer

Father's side: Grandmother
Description

Father's side: Grandmother

Data type

integer

Father´s side: Grandfather
Description

Father´s side: Grandfather

Data type

integer

Father's Side: Aunt 1
Description

Father's Side: Aunt 1

Data type

integer

Father's Side: Uncle 1
Description

Father's Side: Uncle 1

Data type

integer

Father's Side: Cousin 1
Description

Father's Side: Cousin 1

Data type

integer

Father´s side: Cousin 2
Description

Father´s side: Cousin 2

Data type

integer

TREATMENT HISTORY
Description

TREATMENT HISTORY

Has the patient ever previously received patient education for bipolar disorder, systematic psychological treatment and / or neuropsychological investigation? *
Description

Has the patient ever previously received patient education for bipolar disorder, systematic psychological treatment and / or neuropsychological investigation? *

Data type

integer

Specification of patient education: bipolar syndrome (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 for managing everyday symptoms and opportunity for exchange of experience)
Description

Specification of patient education: bipolar syndrome

Data type

boolean

Specification of patient education psychological treatment (eg psychodynamic, dialectic-behavioral, interpersonal, cognitive or cognitive-behavioral therapy)
Description

Specification of patient education psychological treatment

Data type

boolean

Specification of patient education Neuropsychological investigation (investigation with standardized tests that measure cognitive functions as attention, memory function, concentration ability, learning ability)
Description

Specification of patient education Neuropsychological investigation

Data type

boolean

If yes, the patient has received patient education for bipolar disorder in the past 12 months, systematically psychologically treatment and / or neuropsychological investigation?
Description

If yes, the patient has received patient education for bipolar disorder in the past 12 months, systematically psychologically treatment and / or neuropsychological investigation? *

Data type

integer

Specification of patient education: bipolar syndrome (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 for managing everyday symptoms and opportunity for exchange of experience)
Description

Specification of patient education: bipolar syndrome

Data type

boolean

Specification of patient education: systematic treatment (eg psychodynamic, dialectic-behavioral, interpersonal, cognitive or cognitive-behavioral therapy)
Description

Specification of patient education: systematic treatment

Data type

boolean

Specification of patient education: Neuropsychological investigation (investigation with standardized tests that measure cognitive functions as attention, memory function, concentration ability, learning ability)
Description

Specification of patient education: Neuropsychological investigation

Data type

boolean

Has the patient ever been treated with ECT before?
Description

Has the patient ever been treated with ECT before?

Data type

integer

If yes, the number of treatment series during life
Description

If yes, the number of treatment series during life

Data type

integer

If yes, estimate outcomes for the latest treatment series:
Description

If yes, estimate outcomes for the latest treatment series:

Data type

integer

If yes, has the patient been treated with ECT over the past 12 months?
Description

If yes, has the patient been treated with ECT over the past 12 months?

Data type

integer

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

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

Data type

integer

DRUG THERAPY HISTORY
Description

DRUG THERAPY HISTORY

Tax treatment effects according to CGI-I. Compared with the patient's condition before treatment, how much has he / she changed? Dial the appropriate option.
Description

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

Data type

integer

Mood stabilizers
Description

Mood stabilizers

Treatment with carbamazepine
Description

Treatment with carbamazepine

Data type

boolean

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

integer

Drug side effect that prevented the use of the drug?
Description

Drug side effect that prevented the use of the drug?

Data type

boolean

Treatment with clonazepam
Description

Treatment with clonazepam

Data type

boolean

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

integer

Drug side effect that prevented the use of the drug?
Description

Drug side effect that prevented the use of the drug?

Data type

boolean

Treatment with Lamotrigin
Description

Treatment with Lamotrigin

Data type

boolean

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

integer

Treatment with Litium
Description

Treatment with Litium

Data type

boolean

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

integer

Drug side effect that prevented the use of the drug?
Description

Drug side effect that prevented the use of the drug?

Data type

boolean

Treatment with oxcarbazepine
Description

Treatment with oxcarbazepine

Data type

boolean

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

text

Drug side effect that prevented the use of the drug?
Description

Drug side effect that prevented the use of the drug?

Data type

boolean

Treatment with topiramate
Description

Treatment with topiramate

Data type

boolean

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

text

Drug side effect that prevented the use of the drug?
Description

Drug side effect that prevented the use of the drug?

Data type

boolean

Treatment with valproate
Description

Treatment with valproate

Data type

boolean

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

integer

Drug side effect that prevented the use of the drug?
Description

Drug side effect that prevented the use of the drug?

Data type

boolean

Other
Description

Other

Data type

boolean

If other, please specify
Description

If other, please specify

Data type

text

How long was the treatment going on, estimate the number of years
Description

How long was the treatment going on, estimate the number of years

Data type

float

Response to treatment
Description

Response to treatment

Data type

text

Drug side effect that prevented the use of the drug?
Description

Drug side effect that prevented the use of the drug?

Data type

boolean

Similar models

Medical History for Bipolar Syndrome (Part 4)

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
FAMILY HISTORY
Number of siblings:
Item
Number of siblings:
integer
Date of birth male sibling(s)
Item
Date of birth male sibling(s)
integer
Date of birth female sibling(s)
Item
Date of birth female sibling(s)
integer
Number of children
Item
Number of children
integer
Date of birth son(s)
Item
Date of birth son(s)
integer
Date of birth daughter(s)
Item
Date of birth daughter(s)
integer
Patient is adopted and has no knowledge of biological relatives
Item
Patient is adopted and has no knowledge of biological relatives
boolean
Item Group
ASK ACTIVE but not necessary to ignore everything
Type of Disease
Item
Type of Disease
text
Mother
Item
Mother
integer
Father
Item
Father
integer
Sister 1
Item
Sister 1
integer
Sister 2
Item
Sister 2
integer
Sister 3
Item
Sister 3
integer
Brother 1
Item
Brother 1
integer
Brother 2
Item
Brother 2
integer
Brother 3
Item
Brother 3
integer
Daughter 1
Item
Daughter 1
integer
Daughter 2
Item
Daughter 2
integer
Daughter 3
Item
Daughter 3
integer
Son 1
Item
Son 1
integer
Son 2
Item
Son 2
integer
Son 3
Item
Son 3
integer
Item Group
ASK ACTIVE but not necessary to ignore everything
Mother's side: Grandmother
Item
Mother's side: Grandmother
integer
Mother's side: Grandpa
Item
Mother's side: Grandpa
integer
Mother´s side: Aunt 1
Item
Mother´s side: Aunt 1
integer
Mother's side: Uncle 1
Item
Mother's side: Uncle 1
integer
Mother's side: Cousin 1
Item
Mother's side: Cousin 1
integer
Mother's side: Cousin 2
Item
Mother's side: Cousin 2
integer
Father's side: Grandmother
Item
Father's side: Grandmother
integer
Father´s side: Grandfather
Item
Father´s side: Grandfather
integer
Father's Side: Aunt 1
Item
Father's Side: Aunt 1
integer
Father's Side: Uncle 1
Item
Father's Side: Uncle 1
integer
Father's Side: Cousin 1
Item
Father's Side: Cousin 1
integer
Father´s side: Cousin 2
Item
Father´s side: Cousin 2
integer
Item Group
TREATMENT HISTORY
Item
Has the patient ever previously received patient education for bipolar disorder, systematic psychological treatment and / or neuropsychological investigation? *
integer
Code List
Has the patient ever previously received patient education for bipolar disorder, systematic psychological treatment and / or neuropsychological investigation? *
CL Item
Yes (Specify which / which * Multiple answer options can be specified) (1)
CL Item
No (2)
CL Item
Data not available (3)
Specification of patient education: bipolar syndrome
Item
Specification of patient education: bipolar syndrome (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 for managing everyday symptoms and opportunity for exchange of experience)
boolean
Specification of patient education psychological treatment
Item
Specification of patient education psychological treatment (eg psychodynamic, dialectic-behavioral, interpersonal, cognitive or cognitive-behavioral therapy)
boolean
Specification of patient education Neuropsychological investigation
Item
Specification of patient education Neuropsychological investigation (investigation with standardized tests that measure cognitive functions as attention, memory function, concentration ability, learning ability)
boolean
Item
If yes, the patient has received patient education for bipolar disorder in the past 12 months, systematically psychologically treatment and / or neuropsychological investigation?
integer
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?
CL Item
Yes (Specify which / which * Multiple answer options can be specified) (1)
CL Item
No (2)
CL Item
Data not available (3)
Specification of patient education: bipolar syndrome
Item
Specification of patient education: bipolar syndrome (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 for managing everyday symptoms and opportunity for exchange of experience)
boolean
Specification of patient education: systematic treatment
Item
Specification of patient education: systematic treatment (eg psychodynamic, dialectic-behavioral, interpersonal, cognitive or cognitive-behavioral therapy)
boolean
Specification of patient education: Neuropsychological investigation
Item
Specification of patient education: Neuropsychological investigation (investigation with standardized tests that measure cognitive functions as attention, memory function, concentration ability, learning ability)
boolean
Item
Has the patient ever been treated with ECT before?
integer
Code List
Has the patient ever been treated with ECT before?
CL Item
Yes  (1)
CL Item
No (2)
CL Item
Data not available  (3)
If yes, the number of treatment series during life
Item
If yes, the number of treatment series during life
integer
Item
If yes, estimate outcomes for the latest treatment series:
integer
Code List
If yes, estimate outcomes for the latest treatment series:
CL Item
0 (not assessed) (1)
CL Item
1 (Very much improved) (2)
CL Item
2 (much improved) (3)
CL Item
3 (minimally improved) (4)
CL Item
4 (no change) (5)
CL Item
5 (minimally worse) (6)
CL Item
6 (much worse) (7)
CL Item
7 (very much worse) (8)
Item
If yes, has the patient been treated with ECT over the past 12 months?
integer
Code List
If yes, has the patient been treated with ECT over the past 12 months?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Data not available (3)
Item
Estimate the treatment effect according to CGI-I. Compared with the patient's condition before treatment, how much has he / she changed? Dial the appropriate option.
integer
Code List
Estimate the treatment effect according to CGI-I. Compared with the patient's condition before treatment, how much has he / she changed? Dial the appropriate option.
CL Item
0 (not assessed) (1)
CL Item
1 (Very much improved) (2)
CL Item
2 (much improved) (3)
CL Item
3 (minimally improved) (4)
CL Item
4 (no change) (5)
CL Item
5 (minimally worse) (6)
CL Item
6 (much worse) (7)
CL Item
7 (very much worse) (8)
Item Group
DRUG THERAPY HISTORY
Item
Tax treatment effects according to CGI-I. Compared with the patient's condition before treatment, how much has he / she changed? Dial the appropriate option.
integer
Code List
Tax treatment effects according to CGI-I. Compared with the patient's condition before treatment, how much has he / she changed? Dial the appropriate option.
CL Item
0 (not assessed) (1)
CL Item
1 (Very much improved) (2)
CL Item
2 (much improved) (3)
CL Item
3 (minimally improved) (4)
CL Item
4 (no change) (5)
CL Item
5 (minimally worse) (6)
CL Item
6 (much worse) (7)
CL Item
7 (very much worse) (8)
Item Group
Mood stabilizers
Treatment with carbamazepine
Item
Treatment with carbamazepine
boolean
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
integer
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Drug side effect that prevented the use of the drug?
Item
Drug side effect that prevented the use of the drug?
boolean
Treatment with clonazepam
Item
Treatment with clonazepam
boolean
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
integer
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Drug side effect that prevented the use of the drug?
Item
Drug side effect that prevented the use of the drug?
boolean
Treatment with Lamotrigin
Item
Treatment with Lamotrigin
boolean
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
integer
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Treatment with Litium
Item
Treatment with Litium
boolean
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
integer
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Drug side effect that prevented the use of the drug?
Item
Drug side effect that prevented the use of the drug?
boolean
Treatment with oxcarbazepine
Item
Treatment with oxcarbazepine
boolean
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
text
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Drug side effect that prevented the use of the drug?
Item
Drug side effect that prevented the use of the drug?
boolean
Treatment with topiramate
Item
Treatment with topiramate
boolean
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
text
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Drug side effect that prevented the use of the drug?
Item
Drug side effect that prevented the use of the drug?
boolean
Treatment with valproate
Item
Treatment with valproate
boolean
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
integer
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Drug side effect that prevented the use of the drug?
Item
Drug side effect that prevented the use of the drug?
boolean
Other
Item
Other
boolean
If other, please specify
Item
If other, please specify
text
How long was the treatment going on, estimate the number of years
Item
How long was the treatment going on, estimate the number of years
float
Item
Response to treatment
text
Code List
Response to treatment
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
5 (6)
CL Item
6 (7)
CL Item
7 (8)
Drug side effect that prevented the use of the drug?
Item
Drug side effect that prevented the use of the drug?
boolean