September 2013
Intermediate to advanced
256 pages
5h 51m
English
Appendix C: The Maudsley Medical Questionnaire*
Read through the questions in Table C.1 and circle either Yes or No as it applies to you. Do not omit any item. It is important to be as honest as possible.
Table C.1 The Maudsley Medical Questionnaire
| 1. Do you have dizzy turns? 2. Do you feel palpitations or thumping in your heart? 3. Have you ever had a nervous breakdown? 4. Have you often been away from work because of sickness? 5. Do you often experience “stage fright”? 6. Do you find it difficult to get into conversations with strangers? 7. Have you ever been troubled by a stammer or stutter? 8. Have you ever been unconscious for two hours or more because of an accident or blow? 9. Do you worry too much about humiliating experiences? 10. Do you consider yourself to be a nervous person? 11. Are your feelings easily hurt? 12. Do you usually stay in the background on social occasions? 13. Are you subject to attacks of shaking or trembling? 14. Are you an irritable person? 15. Do ideas run through your head so that you cannot sleep? 16. Do you worry about possible misfortunes? 17. Are you rather shy? 18. Do you sometimes feel happy and sometimes depressed for no apparent reason? 19. Do you daydream a lot? 20. Do you seem to have less vitality than others? 21. Do you sometimes feel a pain over your heart? 22. Do you have nightmares? | Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes | No No No No No No No No No No No No No No No No No No No ... |
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