Symptom |
Description |
Score |
Agitation |
Excessive motor activity, restlessness, or irritability |
0-7 |
Anxiety |
Subjective distress, nervousness, or a feeling of unease |
0-7 |
Auditory disturbances |
Abnormal auditory experiences such as hearing sounds that are not present |
0-7 |
Headache |
Presence of a headache or pain in the head |
0-7 |
Nausea/vomiting |
Presence of nausea or vomiting symptoms |
0-7 |
Orientation and clouding of sensorium |
Level of consciousness, orientation to time and place, and clarity of thinking |
0-4 |
Paroxysmal sweats |
Sudden onset of sweating, not explained by external factors |
0-7 |
Tactile disturbances |
Sensory disturbances such as itching, tingling, or numbness |
0-7 |
Tremor |
Observable tremor of the outstretched hands |
0-7 |
Visual disturbances |
Visual hallucinations or other disturbances in vision |
0-7 |
Total |
Sum of scores for all criteria |
0-67 |