a) Mark with F3 symptoms that you have experienced
in the last month.
|
( ) 1. Frequent diarrhea |
( ) 2. Sexual difficulties |
( ) 3. Insomnia (difficulty sleeping) |
( ) 4. Nausea |
( ) 5. Tics |
( ) 6. Continued hypertension (high blood
pressure) |
( ) 7. Continued skin problems |
( ) 8. Extreme appetite change |
( ) 9. Excessive gases |
( ) 10. Frequent dizziness |
( ) 11. Ulcer, colitis or other serious digestive
problem |
( ) 12. Heart attack |
Add 1 point for each F3 marked: F3 = ....... |
b) Mark with P3 symptoms that you have
experienced |
in the last month. |
( ) 13. Inability to work |
( ) 14. Frequent nightmare |
( ) 15. Feeling incompetent in all areas |
( ) 16. Desire to get away from everything |
( ) 17. Apathy, depression and prolonged rage |
( ) 18. Constant and excessive fatigue |
( ) 19. Constantly speaking and think on only one
subject |
( ) 20. Frequent irritability without apparent
cause |
( ) 21. Daily distress, anxiety, fear |
( ) 22. Emotional hypersensitivity |
( ) 23. Loss of sense of humor |
Add 1 point for each P3 marked: P3 = ........ |