Psychiatry
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Per caregivers, the patient has been experiencing the following dementia-related symptoms:
[checkbox name="gerdelusions" value="persecutory delusions|delusional beliefs that others are stealing|delusional beliefs that others are planning to harm in some way"]
[textarea name="descrDel" default="-"][checkbox name="gerhallucinations" value="visual hallucinations|auditory hallucinations"]
[textarea name="descrHall" default="-"] [checkbox name="geragitation" value="agitated behaviors|resistance to help from others|uncooperative with care|uncooperative with medications|resistance to redirection|episodes of verbal aggression|episodes of physical aggression|threatening behaviors|combativeness"]
[textarea name="descrag" default="-"] [checkbox name="gerdisinhibition" value="disinhibited behaviors|impulsivity|overly familiar conversation|sexually inappropriate behaviors|making sexually inappropriate comments|making rude comments|making offensive comments|inappropriately disrobing|urinating in public|appearing in public partially undressed"]
[textarea name="descrgerdisinh" default="-"][checkbox name="germood" value="depressed mood|sad mood|low mood|dysphoric mood|episodes of distinctly elevated mood|episodes of euphoria|appears excessively happy at times|apathy|seems indifferent to things previously cared about|decreased interest in usual activities|decreased interest in the activities and plans of others"]
[textarea name="descrgermood" default="-"] [checkbox name="geranx" value="increased anxiety|becomes upset when separated from caregiver|signs of nervousness such as:|shortness of breath|sighing|being unable to relax|muscle tension|tense facial expressions"]
[textarea name="descrgeranx" default="-"] [checkbox name="gerirritability" value="irritability|mood lability|difficulty coping with delays|impatience|difficulty waiting for planned activities"]
[textarea name="descrgerirritability" default="-"][checkbox name="germotordist" value="engages in repetitive behaviors|psychomotor agitation|pacing around the house|folding items repetitively"]
[textarea name="descrgermotordist" default="-"][checkbox name="gersleepdist" value="irregular sleep pattern|rising too early in morning|excessive napping|days and nights mixed up|symptoms are worse at night
[textarea name="descrgersleepdisturn" default="-"]
[checkbox name="gerappdist" value="decreased appetite|increased appetite|hyper oral|increased cravings of sugary foods|change in favorite foods|dislike of previously favorite foods|c/o that food doesn't taste good|weight loss|weight gain"]
[textarea name="descrgerappdist" default="-"]

Include severity of symptom to patient and distress that symptom causes caregiver
1. Delusions: Does the patient believe that others are stealing from him/her or planning to harm him/her in some way__.
2. Hallucinations: Does the patient hearing voices or does he/she talk to people who are not there__.
3. Agitation/Aggression: Is the patient stubborn or resistive of help from others__.
4. Depression/Dysphoria: Does the patient act as if he/she were sad or in low spirits__.
5. Anxiety: Does the patient become upset when separated from you__. Does he/she have any other signs of nervousness such as shortness of breath, sighing, being unable to relax, or feeling excessively tense__.
6. Elation/Euphoria: Does the patient appear to feel too good or act excessively happy__.
7. Apathy/Indifference: Does the patient seem less interested in his/her usual activities and in the activities and plans of others__.
4
8. Disinhibition: Does the patient seem to act impulsively, for example, talking to strangers as if he/she knows them, or saying things that may hurt people's feelings__.
9. Irritability/Lability: Is the patient impatient and cranky__. Does he/she have difficulty coping with delays or waiting for planned activities__.
10. Motor Disturbance: Does the patient engage in repetitive activities such as pacing around the house, handling buttons, wrapping string, or doing other activities repeatedly__.
11. Nighttime behaviors: Does the patient awaken you during the night, rise too early in the morning, or take excessive naps__.
12. Appetite: Has the patient lost or gained weight, or had a change in the type of food he/she likes__.
Per caregivers, the patient has been experiencing the following dementia-related symptoms:












Include severity of symptom to patient and distress that symptom causes caregiver
1. Delusions: Does the patient believe that others are stealing from him/her or planning to harm him/her in some way__.
2. Hallucinations: Does the patient hearing voices or does he/she talk to people who are not there__.
3. Agitation/Aggression: Is the patient stubborn or resistive of help from others__.
4. Depression/Dysphoria: Does the patient act as if he/she were sad or in low spirits__.
5. Anxiety: Does the patient become upset when separated from you__. Does he/she have any other signs of nervousness such as shortness of breath, sighing, being unable to relax, or feeling excessively tense__.
6. Elation/Euphoria: Does the patient appear to feel too good or act excessively happy__.
7. Apathy/Indifference: Does the patient seem less interested in his/her usual activities and in the activities and plans of others__.
4
8. Disinhibition: Does the patient seem to act impulsively, for example, talking to strangers as if he/she knows them, or saying things that may hurt people's feelings__.
9. Irritability/Lability: Is the patient impatient and cranky__. Does he/she have difficulty coping with delays or waiting for planned activities__.
10. Motor Disturbance: Does the patient engage in repetitive activities such as pacing around the house, handling buttons, wrapping string, or doing other activities repeatedly__.
11. Nighttime behaviors: Does the patient awaken you during the night, rise too early in the morning, or take excessive naps__.
12. Appetite: Has the patient lost or gained weight, or had a change in the type of food he/she likes__.

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