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PsychiatricUniversityHospitalZurich,P.O.Box1931,CH-8032Zurich,Switzerland27.12.2007©2004PsychiatricUniversityHospitalZurich,DivisionofClinicalPsychiatrySYMPTOMCHECKLISTSCL90L.R.Derogatis,R.S.Lipman,L.CoviSTUDY[____]1-4GROUP[__]5-6PATIENT[___]7-9RATINGDAY[___]10-12CARDNUMBER[__]13-14Sex(1=male,2=female)[_]15Birthday(dd.mm.yy)[__:__:__]16-21Dateofhospitalization(dd.mm.yy)[__:__:__]22-27Firstdiagnosis[___.__]28-32Seconddiagnosis[___.__]33-37Diagnosticsystem(1=ICD9,2=ICD10,3=DSM3-R,4=DSM4)[_]38Ageatonset[__]39-40Course(1=firstmanifestation,2=intermittent,3=progredient,4=chronic)[_]41DurationofCurrentEpisodePriortoHospitalization(days)[___]42-44MedicationPriortoHospitalization(0=none,1=antidepr.,2=neuroleptics,3=other)[_]45CurrentMedication(cf.listofcodes)[___]46-48Educationallevel(1=remedial,2=juniorhigh,3=high,4=college)[_]49DATE(dd.mm.yy)[__:__:__]50-55INTERVIEWER[___]56-58HOSPITAL[__]59-60PATIENTID(thehospital’sinternalPID)[____________]61-72PsychiatricUniversityHospitalZurich,P.O.Box1931,CH-8032Zurich,Switzerland27.12.20072Attachedisalistofproblemsandcomplaintsthatpeoplehave.Pleasereadeachonecarefully.Afteryouhavedoneso,pleasefillinthenumber(0to4,seebelow)whichbestdescribeshowmuchthatproblemhasbotheredordistressedyouduringthepast4weeksincludingtoday.Chooseonlyonenumberforeachproblemanddonotskipanyitems.Ifyouchangeyourmind,eraseyourfirstanswerandfillinthenewone.Allquestionnaireswillbetreatedconfidentially!0=notatall;1=alittlebit;2=moderately;3=quiteabit;4=extremely;Pleasefillintheappropriatenumberwithinthebrackets!1-12duplCardnumber[__]13-14Howmuchwereyoubotheredordistressedoverthepast4weeksby1Headaches[_]152Nervousnessorshakinessinside[_]163Unwantedthoughtsorideasthatwon’tleaveyourhead[_]174Faintnessordizziness[_]185Lossofsexualinterestorpleasure[_]196Feelingcriticalofothers[_]207Theideathatsomeoneelsecancontrolyourthoughts[_]218Feelingothersaretoblameformostofyourtroubles[_]229Troublerememberingthings[_]2310Worriedaboutsloppinessorcarelessness[_]2411Feelingeasilyannoyedorirritated[_]2512Painsinheartorchest[_]2613Feelingafraidinopenspacesoronthestreet[_]2714Feelinglowinenergyorsloweddown[_]2815Thoughtsofendinglife[_]2916Hearingvoicesthatotherpeopledonothear[_]3017Trembling[_]3118Feelingthatmostpeoplecannotbetrusted[_]3219Poorappetite[_]3320Cryingeasily[_]3421Feelingshyoruneasywiththeoppositsex[_]3522Feelingofbeingtrappedorcaught[_]3623Suddenlyscaredfornoreason[_]3724Temperoutburststhatyoucouldnotcontrol[_]38PsychiatricUniversityHospitalZurich,P.O.Box1931,CH-8032Zurich,Switzerland27.12.2007325Feelingafraidtogooutofyourhousealone[_]3926Blamingyourselfforthings[_]4027Painsinlowerback[_]4128Feelingblockedingettingthingsdone[_]4229Feelinglonely[_]4330Feelingblue[_]4431Worryingtoomuchaboutthings[_]4532Feelingnointerestinthings[_]4633Feelingfearful[_]4734Yourfeelingsbeingeasilyhurt[_]4835Otherpeoplebeingawareofyourprivatethoughts[_]4936Feelingothersdonotunderstandyouorareunsympathetic[_]5037Feelingthatpeopleareunfriendly[_]5138Havingtodothingsveryslowly[_]5239Heartpoundingorracing[_]5340Nauseaorupsetstomach[_]5441Feelinginferiortoothers[_]5542Sorenessofyourmuscles[_]5643Feelingthatyouarewatchedortalkedaboutbyothers[_]5744Troublefallingasleep[_]5845Havingtocheckanddoublecheckwhatyoudo[_]5946Difficultymakingdecisions[_]6047Feelingafraidtotravelonbuses,subwaysortrains[_]6148Troublegettingyourbreath[_]6249Hotorcoldspells[_]6350Havingtoavoidcertainthings,placesoractivities[_]6451Yourmindgoingblank[_]6552Numbnessortinglinginpartsofyourbody[_]6653Alumpinyourthroat[_]6754Feelinghopelessaboutthefuture[_]6855Troubleconcentrating[_]6956Feelingweakinpartsofyourbody[_]7057Feelingtenseorkeyedup[_]7158Heavyfeelingsinyourarmsorlegs[_]72PsychiatricUniversityHospitalZurich,P.O.Box1931,CH-8032Zurich,Switzerland27.12.200741-12duplCardnumber[__]13-1459Thoughtsofdeathordying[_]1560Overeating[_]1661Feelinguneasywhenpeoplearewatchingortalkingaboutyou[_]1762Havingthoughtsthatarenotyourown[_]1863Havingurgestobeat,injureorharmsomeone[_]1964Awakeningintheearlymorning[_]2065Havingtorepeatthesameactionssuchastouching,counting,washing[_]2166Sleepthatisrestlessordisturbed[_]2267Havingurgestobreakorsmashthings[_]2368Havingideasorbeliefsthatothersdonotshare[_]2469Feelingveryself-consciouswithothers[_]2570Feelinguneasyincrowdssuchasshoppingoratamovie[_]2671Feelingeverythingisaneffort[_]2772Spellsofterrororpanic[_]2873Feelinguncomfortableabouteatingordrinkinginpublic[_]2974Gettingintofrequentarguments[_]3075Feelingnervouswhenyouareleftalone[_]3176Othersnotgivingyoupropercreditforyourachievments[_]3277Feelinglonelyevenwhenyouarewithpeople[_]3378Feelingsorestlessyoucouldn’tsitstill[_]3479Feelingofworthlessness[_]3580Feelingthatfamiliarthingsarestrangeorunreal[_]3681Shoutingorthrowingthings[_]3782Feelingafraidyouwillfaintinpublic[_]3883Feelingthatpeoplewilltakeadvantageofyouifyouletthem[_]3984Havingthoughtsaboutsexthatbotheryoualot[_]4085Theideathatyoushouldbepunishedforyoursins[_]4186Feelingpushedtogetthingsdone[_]4287Theideathatsomethingseriousiswron