Overall Mental Well-being?

Do you have little interest or pleasure in doing things?

Are you feeling down, depressed, or hopeless?

Are you feeling more irritated, grouchy, or angry than usual?

Are you sleeping less than usual, but still have a lot of energy?

Are you starting lots more projects than usual or doing more risky things than usual?

Are you feeling nervous, anxious, frightened, worried, or on edge?

 Are you feeling panic or being frightened?

Are you avoiding situations that make you anxious?

Are you having unexplained aches and pains (e.g., head, back, joints, abdomen, legs)?

Do you feel that your illnesses are not being taken seriously enough?

Are you having thoughts of actually hurting yourself?

Are you feeling unexplained numbness or tingeing (e.g., hands, arms, back, legs, feet)?

When your eyes are open and/or shut, do you see flashes of lights, shapes, dots, specks, patterns, lines,  grids, zigzags, checkerboards, swirling vortexes,  delayed motion or trails, or a faint white glow around people and objects?

Do you ever hear unexplained sounds, music, or voices while falling a sleep or while waking up?

Do you ever hear tones, buzzing, static, or other similar sounds that come and go and seem to follow you wherever you go?

Are you having problems with sleep that affected your sleep quality over all?

Are you having problems with memory (e.g., learning new information) or with location (e.g., finding your way home)?

Are you having unpleasant thoughts, urges, or images that repeatedly enter your mind?

Are you feeling driven to perform certain behaviors or mental acts over and over again?

Are you feeling detached or distant from yourself, your body, your physical surroundings, or your memories?

Do you feel like you do not know who you really are or what you want out of life?

Do you feel like you are not close to other people or enjoying your relationships with them?

Do you drink at least 4 drinks of any kind of alcohol in a single day?

Do you smoke any cigarettes, a cigar, or pipe, or using snuff or chewing tobacco?

Do you drink a least 4 cups of coffee a day?

Are you using any of the following medicines ON YOUR OWN, that is, without a doctor’s prescription, in greater amounts or longer than prescribed [e.g., painkillers (like Vicodin), stimulants (like Ritalin or Adderall), sedatives or tranquilizers (like sleeping pills or Valium), or drugs like marijuana, cocaine or crack, club drugs (like ecstasy), hallucinogens (like LSD), heroin, inhalants or solvents (like glue), or methamphetamine (like speed)]?