Повышение качества оказания специализированной медицинской помощи детям с урогенитальными инфекциями

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ПРИЛОЖЕНИЯ

Приложение 1

ВИЗИТ:

ПОЛ Муж. Жен.

Опросник выраженности Психопатологической симптоматики ( Simptom Check List - 90 - Revised - SCL - 90 - R )

 ИНСТРУКЦИЯ Ниже приведен перечень проблем и жалоб иногда возникающих у людей. Пожалуйста, читайте каждый пункт внимательно. Обведите кружком номер того ответа, который наиболее точно описывает степень Вашего дискомфорта или встревоженности в связи с той или иной проблемой в течение последней недели, включая сегодня. Обведите только один из номеров в каждом пункте (так, чтобы цифра внутри кружка была видна), не пропуская ни одного пункта. Если Вы захотите изменить свой ответ, сотрите резинкой Вашу первую пометку. Прежде чем начать, прочитайте нижеприведенный пример, и, если у Вас возникнут вопросы, задайте их инструктору.

Ф.И.О.:

Место жительства:

Образование: 

Дата рожд.
Мег,	День	Гол

Семейное положение:

НОМ

[ЕР

ВОЗРАСТ

 

Насколько сильно Вас тревожили:	Совсем нет	Немного	Умеренно	Сильно	Очень сильно
1	2	3	4	5	6
1 Головные боли	0	1	2	3	4
2 Нервозность или внутренняя дрожь	0	1	2	3	4
3 Повторяющиеся неприятные неотвязные мысли	0	1 •к	2	3	4 '
4 Слабость или головокружение	0	1	2	3	4
5 Потеря сексуального влечения или удовольствия	0	1	2	3	4
6 Чувство недовольства другими	0	1	2	3	4
7 Ощущение, что кто-то другой может управлять вашими мыслями	0	1	2	3	4
8 Ощущение, что почти во всех ваших неприятностях виноваты другие	0	1	2	3	4
9 Проблемы с памятью	0	1	2	3	4
10 Ваша небрежность или раздражение	0	1	2	3	4
11 Легко возникающая досада или раздражение	0	1	2	3	4
12 Боли в сердце или грудной клетке	0	1	2	3	4
13 Чувство страха в открытых местах или на улице	0	1	2	3	4
14 Упадок сил или заторможенность	0	*к 1	2	3	4
15 Мысли о том, чтобы покончить с собой	0	1	2	3	4
16 То, что вы слышите голоса, которых не слышат другие	0	1	2	3	4
17 Дрожь		1	2	3	4
18 Чувство, что большинству людей нельзя доверять	0	1	2	3	4 .
19 Плохой аппетит	0	1	2	3	4
20 Слезливость	0	1	2	3	4
21 Застенчивость или скованность в общении с лицами другого пола	0	1	2	3	4
22 Ощущение, что вы в западне или пойманы	0	1	2	3	4
23 Неожиданный и беспричинный страх	0	1	2	3	4
24 Вспышка гнева, которые вы не • смогли сдержать	0		2	3	• 4
25 Боязнь выйти из дома одному	0	1	2	3	4
26 Чувство, что вы сами во многом виноваты	0	1	2	3	4 *
27 Боли в пояснице	0	1	2	3	4
28 Ощущение, что что-то вам мешает сделать что-либо	0	1	2	3	4
29 Чувство одиночества	0	1	2	3	4
30 Подавленное настроение, хандра	0	1	2	3	4
31 Чрезмерное беспокойство по разным поводам	0	1	2	3	4