Anxiety and Panic Attacks In Emphysema ... - Mind Publications
Anxiety and Panic Attacks In Emphysema ... - Mind Publications
Anxiety and Panic Attacks In Emphysema ... - Mind Publications
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
Name<br />
Date<br />
DR. SHARMA’S ANXIETY CHECKLIST<br />
(Adapted from DSM-IV, Beck, Burns <strong>Anxiety</strong> <strong>In</strong>ventories)<br />
Please rate each symptom by putting (x) mark to indicate how bothered (“none”, “mild”,<br />
“moderate”, or “severe”)<br />
you have been by these symptoms in the past 2 weeks, including today.<br />
SWEATING/COLD SWEAT/BREAK INTO SWEAT (not due to<br />
heat)<br />
TREMBLING/SHAKING<br />
HOT FLASHES/COLD CHILLS<br />
NAUSEA/ABDOMINAL DISTRESS/BUTTERFLIES<br />
PALPITATION/ HEART RACING OR POUNDING<br />
SHORTNESS OF BREATH/SMOTHERING/CAN’T GET AIR<br />
UNSTEADINESS/DIZZINESS/FAINTING/LIGHTHEADEDNESS<br />
TINGLING/NUMBNESS<br />
CHEST PAINS/TIGHTNESS/PRESSURE<br />
CHOKING<br />
FEELING OF UNREALITY<br />
FEEL THINGS CHANGE SIZE<br />
FEEL BODY CHANGES SIZE<br />
THINGS APPEAR STRANGE<br />
FEEL DETACHED FROM SELF<br />
FEAR OF DYING<br />
FEAR OF GOING CRAZY/LOSING CONTROL<br />
RINGING IN EARS<br />
VOICES FADING OR THINGS BECOMING DISTANT<br />
MUSCLE TENSION/ACHES/SORENESS<br />
RESTLESSNESS/JUMPINESS<br />
EASY FATIGUABILITY/FEELING WEAK/EASILY<br />
EXHAUSTED<br />
EXAGGERATED STARTLE RESPONSE<br />
FREQUENT URINATION<br />
TROUBLE SWALLOWING/”LUMP IN THROAT)<br />
DRY MOUTH/LIKE COTTON (Not due to medicine)<br />
FEELING KEYED UP/ ON EDGE”<br />
IRRITABILITY<br />
non<br />
e<br />
0<br />
mil<br />
d<br />
1<br />
moder<br />
ate<br />
2<br />
seve<br />
re<br />
3