Advanced Certificate 6.0 Course in Management of Addictive Disorders (ACCMAD) 6.0

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Dear Psychiatrist/Resident Psychiatry,

Greetings from Virtual Knowledge Network (VKN)ECHO, Centre for Addiction Medicine (CAM), Dept of Psychiatry NIMHANS, Bengaluru, and Department of Addiction Medicine (DAM) LGBRIMH, Tezpur.

What is unique about VKN NIMHANS ECHO?

NIMHANS Tele-ECHO: Hub & Spoke Model for Addiction Medicine

🔵 THE HUB: Centre for Addiction Medicine, NIMHANS & Dept of Addiction Medicine LGBRIMH Tezpur

🔴 THE SPOKES:
- Practicing Psychiatrists
- MD Psychiatry Residents
- DPM Psychiatry Residents
- DNB Psychiatry Residents
- Psychiatry Residents
- Addiction Psychiatry Specialists/residents

How Tele-ECHO Works:
1. Case Presentations (every Friday from 2:30 PM to 4:00 PM, starting November 14th, 2025) - Participants present anonymized patient cases
2. Collaborative Discussion - Hub experts and peers provide guidance
3. Guided Practice - Real-time mentoring and knowledge sharing

"Learning from Each Other • Collaborative Knowledge Sharing"

Watch the video:
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Criteria for Certificate Accreditation?

The heart and soul of NIMHANS ECHO is a collaborative case discussion where participants learn from both hub experts and peers. Through weekly case-based mentoring, healthcare providers build confidence and skills to manage complex addiction cases in their own communities.

As a byproduct of this learning and knowledge transfer, the NIMHANS Digital Academy Board of Studies has kindly approved this as a "Certificate professional development course".

Please go through the curriculum carefully, and all the criteria have to be fulfilled. Now, if you find that at this point your work commitment does not allow this, you may explore nimhanselearning.org, a self-paced learning module.
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What type of clinical cases will be useful for this course and increase the chance of getting into this ECHO certificate program?

This is an advanced course and hence it is expected to have complex cases, for example, a patient with cannabis, opioids, stimulants, benzodiazepines, synthetic drugs, comorbid psychiatric conditions, special populations like adolescents, females, etc. Even any cases, where you have reviewed for long-term follow up can also be useful

These cases will make the discussion more meaningful for all of us in this "all teach and all learn model."
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Criteria for Accreditation?* This field is required.Kind request to go through this criteria carefully. These points below are elaborated in the main curriculum These will be followed as it is. If any doubt or concern, can email to vkn@vknnimhans.in
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💻 More than 75% Attendance (17/24 sessions) with VIDEO Presence
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📋 Submission and Presentation of one substance use complex case-related patient case summaries on Friday's weekly Tele-ECHO VKN clinic.
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✍️ Completion of four e-Assignments
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📊 Monthly reports of patients seen (November 2025 onwards till May 2026)
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✏️ Completion of pre-test and post-test.
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💻 More than 75% Attendance (17/24 sessions) with VIDEO Presence
📋 Submission and Presentation of one substance use complex case-related patient case summaries on Friday's weekly Tele-ECHO VKN clinic.
✍️ Completion of four e-Assignments
📊 Monthly reports of patients seen (November 2025 onwards till May 2026)
✏️ Completion of pre-test and post-test.
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Enrollment Process

This is a two-step process

Step 1: Case submission by filling out the form below. Just submitting case does not automatically qualify enrollment.

Step 2: Once your case submission gets selected, you will get confirmation to submit nominal fees of 5200 INR (4800+ 400 INR inclusive of GST) via a link to the Director of NIMHANS.

Step 3: Once 60 slots are over, the system will automatically close. At this point, we have limited faculty and resource person capacity to accommodate all.

You will be informed by email in two weeks' time if selected.

The course will commence on November 14th, 2025, weekly every Friday from 2:30 PM to 4:00PM and video presence is a must

Why fees?

All the hub team involved in this programme are donating their time and none of them have taken any money/remuneration for the same. The fees is to make the learning material available for you via LMS free, cost of technology like slido, LMS, AI, content creation, HIPAA-compliant Jotform for case submission, etc.

The Zoom telehealth (HIPAA-compliant) and iECHO are supported completely by the NIMHANS ECHO MOU.

The following documents should be kept ready and uploaded once you start filling the form (maximum size 100KB):

Highest Academic Qualification Certificate (proof of medical docctor), Proof of persuing or complete MD/DPM/DNB Psychiatry and a valid ID proof

Once you have submitted this case record form, our team will review all the information provided, including verification of the uploaded certificates and documents. Only after successful verification, you will receive a confirmation regarding your registration status for the course.

Regards,
Hub Centre for Addiction Medicine, NIMHANS Team
📧 nahma@vknnimhans.in

cc to vkn@vknnimhans.in
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Your name, please* This field is required.This e-consultation is between Health care providers and Addiction Experts (As per Telemedicine Guidelines RMP to RMP and Health worker to RMP)
Please provide your name. Never provide name of the patient.
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Email* This field is required.Please provide your working e-mail ID for communication purposes. We will never misuse it. All communications will be via email.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
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Your affiliation/qualification* This field is required.
Consultant Psychiatrist (MD/DNB/DPM)
Please Select
Consultant Psychiatrist (MD/DNB/DPM)
Psychiatry Resident (MD/DNB/DPM)
Please enter your qualification
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Please upload a copy of your medical registration MBBS registraion certificate (pdf/doc/image is fine)* This field is required.a proof of registered medical practioner
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please upload a copy of your pursuing MD/DPM/DNB Psychiatry or completed MD/DPM/DNB Psychiatry* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Reason for Case presentation (Can select multiple)* This field is required.This will help in focussed case discussion. Please be specific as it is helpful for specialists time
Help with Diagnostic Clarification
Help with Pharmacological Management
Help with Psychosocial Management
Confirm your approach to case management
Sharing for a learning experience
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Information taken from?* This field is required.
Please SelectPatient
Patient
Parents
Siblings
Neighbors
Other relatives
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Socio demographic profile of the patient* This field is required.This is regarding socio demographic profile of the patient
Please Select
Please Select
Male
Female
Gender
Age
Please Select
Please Select
Single
Married
Separated/Divorced
Widowed
Marital status
Please Select
Please Select
Upper
Middle
Lowe
Socio economic status
Please Select
Please Select
above Graduate
below Graduate
Education
Occupation of the patient
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Total duration of the illness.* This field is required.
Please enter a number
Please Select
Please Select
days
weeks
months
years
select from the options
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Current pateint is a case of* This field is required.Fill up the primary substance of abuse
Alcohol Use Disorder
Opioid Dependence
Cannabis Use Disorder
Benzodiazepine Use Disorder
Cocaine, Methamphetamine, and Amphetamine Type Substance
Emerging areas
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CHIEF COMPLAINTS* This field is required.Chief complaints with which the patient presented to you. List the complaints in chronological order. Include complaints regarding Substance Use, Behavioral, and Medical symptoms.
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CURRENT PATTERN OF SUBSTANCE USE* This field is required.Describe the pattern of use of various substances over the last ONE month. Mention about all the substances used by the patient.
Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
Frequency (Eg:Daily, Binging)
Last use (e.g.: 2 days back)
Tobacco
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Alcohol
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Cannabis
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Cocaine
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Amphetamine type stimulants
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Inhalants
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Sedatives
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Hallucinogens
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Opioids
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Other
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Tobacco
Alcohol
Cannabis
Cocaine
Amphetamine type stimulants
Inhalants
Sedatives
Hallucinogens
Opioids
Other
Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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Average Quantity/Day   (e.g.: units per day/joints per day/gm per day etc.)
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Route (e.g.: Drinking, Smoking, Injection, Chasing, Snuffing etc.)
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Frequency (Eg:Daily, Binging)
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Last use (e.g.: 2 days back)
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HISTORY OF PRESENT ILLNESS* This field is required.You can write in detail about each complaint mentioned in the previous cards, including the substances the patient has used separately. You can include information on each complaint, including how it began, how it progressed throughout the illness, and the current status of the problem. You can add details about how each criticism has affected the patient's social, occupational, personal, and biological functions. Please consider using Addiction Rx mobile app "Assessment" section .
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Other details about the case* This field is required.Precipitating events can be physical (fever, head trauma) or psychological (death/loss, etc.) Ascertain whether the events closely preceded the illness or were consequences of the disease. Associated disturbances include sleep (click here for history taking of sleep disturbances), appetite (click here for history taking of appetite loss), weight loss, sexual dysfunctions (click here for history taking of sexual history), and socio-occupational difficulties. Describe in detail the events from the patient's life pre-illness and post-illness.
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Complications from Substance Use* This field is required.Describe complications in Physical, Psychological, Socio-familial, Occupational, Financial, and Legal domains that can be attributed to substance use by the person. Note down any interventions that have been done to manage those complications.
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Ask the patient: In your life, which of the following substances have you ever used?* This field is required.CLICK HERE to access ASSIST v 3. CLICK HERE to access the manual for using ASSIST.
Please Select
No substance used ever
Tobacco products (cigarettes, chewing tobacco, cigars, etc.)
Alcoholic beverages (beer, wine, spirits, etc.)
Cannabis (marijuana, pot, grass, hash, etc.)
Amphetamine-type stimulants (speed, diet pills, ecstasy, etc.)
Inhalants (nitrous, glue, plant thinner, etc.)
Sedatives or Sleeping Pills (Valium, Serepax, Rohypnol, etc.)
Hallucinogens (LSD, acid, mushrooms, PCP, Special K, etc.)
Opioids (heroin, morphine, methadone, codeine, etc.)
Others- please specify in the next section if selecting this option
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If you selected 'Other' please specify the substance being used by the patient.* This field is required.
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The next few cards will only be about the substances used in only last THREE MONTHS and not for lifetime usage. Please ask patients the questions as they have been framed in their language.

The scores will be calculated for each substance the patient has used separately, using your inputs by the system. You don't need to calculate the scores. To know the details about the scale and the score you can refer to the links in the previous card.
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Ask the patient if they have used Tobacco products in the last THREE MONTHS* This field is required.CLICK HERE for a list of smokeless tobacco products
YESNO
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Ask the patient details of TOBACCO use in the last 3 months* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used tobacco?
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How often have you had a strong desire or urge to use tobacco?
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How often your tobacco use has lead to health, social, legal/ financial problems?
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Has a friend or relative or anyone else ever expressed concern about your tobacco use?
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Have you ever tried and failed to control, cut down or stop the tobacco use?
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How often have you used tobacco?
How often have you had a strong desire or urge to use tobacco?
How often your tobacco use has lead to health, social, legal/ financial problems?
Has a friend or relative or anyone else ever expressed concern about your tobacco use?
Have you ever tried and failed to control, cut down or stop the tobacco use?
Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Total of ASSIST score for tobacco* This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive treatment
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Ask the patient if they have used beverages with ALCOHOL in the last THREE MONTHS * This field is required.CLICK HERE for the type and percentage of alcohol
YESNO
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Ask the patient details of ALCOHOL use in last 3 months.* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used alcohol?
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How often have you had a strong desire or urge to use alcohol?
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How often your alcohol use has lead to health, social, legal/ financial problems?
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How often have you failed to do what is normally expected from you because of alcohol use?
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Has a friend or relative or anyone else ever expressed concern about your alcohol use?
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Have you ever tried and failed to control, cut down or stop alcohol use?
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How often have you used alcohol?
How often have you had a strong desire or urge to use alcohol?
How often your alcohol use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of alcohol use?
Has a friend or relative or anyone else ever expressed concern about your alcohol use?
Have you ever tried and failed to control, cut down or stop alcohol use?
Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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Never
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Once or Twice
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Monthly : 1 to 3 times/month
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Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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ASSIST score for Alcohol* This field is required.0-10 no intervention, 11-26 brief intervention, 27+ intensive treatment
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Ask the patient if they have used CANNABIS (natural or synthetic) in the last THREE MONTHS* This field is required.CLICK HERE for a list of cannabis products and modes of use.
YESNO
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Ask details of CANNABIS use in last 3 months* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used cannabis?
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How often have you had a strong desire or urge to use cannabis?
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How often your cannabis use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of cannabis use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your cannabis use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop cannabis use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used cannabis?
How often have you had a strong desire or urge to use cannabis?
How often your cannabis use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of cannabis use?
Has a friend or relative or anyone else ever expressed concern about your cannabis use?
Have you ever tried and failed to control, cut down or stop cannabis use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
Row 5, Column 3
Daily or Almost Daily : 5-7days/week
Row 5, Column 4
1 of 6
33
ASSIST score for Cannabis* This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive treatment
34
Ask if the patient has used COCAINE in the last THREE MONTHS.* This field is required.CLICK HERE for street name
YESNO
35
Ask details about the COCAINE in last 3 months* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used cocaine?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
How often have you had a strong desire or urge to use cocaine?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
How often your cocaine use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of cocaine use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your cocaine use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop cocaine use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used cocaine?
How often have you had a strong desire or urge to use cocaine?
How often your cocaine use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of cocaine use?
Has a friend or relative or anyone else ever expressed concern about your cocaine use?
Have you ever tried and failed to control, cut down or stop cocaine use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
Row 5, Column 3
Daily or Almost Daily : 5-7days/week
Row 5, Column 4
1 of 6
36
ASSIST score for COCAINE* This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive treatment
37
Ask the patient if they have used AMPHETAMINE TYPE STIMULANTS in the last THREE MONTHS.* This field is required.CLICK HERE for the street names of ATS.
YESNO
38
Ask in detail about AMPHETAMINE TYPE STIMULANTS use in last 3 months* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used  amphetamine type stimulants?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
How often have you had a strong desire or urge to use  amphetamine type stimulants?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
How often your  amphetamine type stimulants use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of  amphetamine type stimulants use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your  amphetamine type stimulants use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop amphetamine type stimulants use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used  amphetamine type stimulants?
How often have you had a strong desire or urge to use  amphetamine type stimulants?
How often your  amphetamine type stimulants use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of  amphetamine type stimulants use?
Has a friend or relative or anyone else ever expressed concern about your  amphetamine type stimulants use?
Have you ever tried and failed to control, cut down or stop amphetamine type stimulants use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
Row 5, Column 3
Daily or Almost Daily : 5-7days/week
Row 5, Column 4
1 of 6
39
ASSIST score for Amphetamine type stimulants* This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive treatment
40
Ask patient if they have used INHALANT in the last THREE MONTHS* This field is required.CLICK HERE to read more about the Inhalants
YESNO
41
Ask in detail about the INHALANT use in last 3 months* This field is required.Glue, Dendrite, Erazex, Petrol, etc
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used inhalant?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
How often have you had a strong desire or urge to use inhalant ?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
How often your inhalant use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of inhalant use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your inhalant use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop inhalant use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used inhalant?
How often have you had a strong desire or urge to use inhalant ?
How often your inhalant use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of inhalant use?
Has a friend or relative or anyone else ever expressed concern about your inhalant use?
Have you ever tried and failed to control, cut down or stop inhalant use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
Row 5, Column 3
Daily or Almost Daily : 5-7days/week
Row 5, Column 4
1 of 6
42
ASSIST score for Inhalant* This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive treatment
43
Ask the patient if they have used SEDATIVES or SLEEPING PILLS in the last THREE MONTHS.* This field is required.prescription abuse or self
YESNO
44
Ask in detail about the SEDATIVES use in last 3 months* This field is required.Glue, Dendrite, Erazex, Petrol, etc
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used sedative?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
How often have you had a strong desire or urge to use sedative ?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
How often your sedative use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of sedative use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your sedative use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop sedative use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used sedative?
How often have you had a strong desire or urge to use sedative ?
How often your sedative use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of sedative use?
Has a friend or relative or anyone else ever expressed concern about your sedative use?
Have you ever tried and failed to control, cut down or stop sedative use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
Row 5, Column 3
Daily or Almost Daily : 5-7days/week
Row 5, Column 4
1 of 6
45
ASSIST Score for Sedatives or Sleeping pills* This field is required.0-3 Low,4-26 Moderate,27+ High
46
Ask the patient if they have used HALLUCINOGENS in the last THREE MONTHS?* This field is required.LSD, acid, mushrooms, PCP, Ketamine, etc.
YESNO
47
Details of the use of HALLUCINOGENS in the last 3 months.* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used hallucinogen?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
How often have you had a strong desire or urge to use hallucinogen ?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
How often your hallucinogen use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of hallucinogen use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your hallucinogen use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop hallucinogen use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used hallucinogen?
How often have you had a strong desire or urge to use hallucinogen ?
How often your hallucinogen use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of hallucinogen use?
Has a friend or relative or anyone else ever expressed concern about your hallucinogen use?
Have you ever tried and failed to control, cut down or stop hallucinogen use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
Row 5, Column 3
Daily or Almost Daily : 5-7days/week
Row 5, Column 4
1 of 6
48
ASSIST Score for Hallucinogens* This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive intervention
49
Ask the patient if they have used OPIOIDS in the last THREE MONTHS.* This field is required.CLICK HERE for the street names of Opioid
YESNO
50
Ask details about the OPIOID use in the last 3 months* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used opioid?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
How often have you had a strong desire or urge to use opioid?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
How often your opioid use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of opioid use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your opioid use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop opioid use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used opioid?
How often have you had a strong desire or urge to use opioid?
How often your opioid use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of opioid use?
Has a friend or relative or anyone else ever expressed concern about your opioid use?
Have you ever tried and failed to control, cut down or stop opioid use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
Row 5, Column 3
Daily or Almost Daily : 5-7days/week
Row 5, Column 4
1 of 6
51
ASSIST score for Opioid* This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive intervention
52
Ask the patient if they have used the 'OTHER DRUG' in the last THREE MONTHS.* This field is required.
YESNO
53
Ask details about the 'OTHER DRUG' use in the last 3 months* This field is required.
Never
Once or Twice
Monthly : 1 to 3 times/month
Weekly: 1to 4times in week
Daily or Almost Daily : 5-7days/week
How often have you used 'Other Drug'?
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
How often have you had a strong desire or urge to use  'Other Drug'?
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
How often your  'Other Drug' use has lead to health, social, legal/ financial problems?
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
How often have you failed to do what is normally expected from you because of  'Other Drug' use?
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Has a friend or relative or anyone else ever expressed concern about your  'Other Drug' use?
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
Have you ever tried and failed to control, cut down or stop  'Other Drug' use?
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
How often have you used 'Other Drug'?
How often have you had a strong desire or urge to use  'Other Drug'?
How often your  'Other Drug' use has lead to health, social, legal/ financial problems?
How often have you failed to do what is normally expected from you because of  'Other Drug' use?
Has a friend or relative or anyone else ever expressed concern about your  'Other Drug' use?
Have you ever tried and failed to control, cut down or stop  'Other Drug' use?
Never
Row 0, Column 0
Once or Twice
Row 0, Column 1
Monthly : 1 to 3 times/month
Row 0, Column 2
Weekly: 1to 4times in week
Row 0, Column 3
Daily or Almost Daily : 5-7days/week
Row 0, Column 4
Never
Row 1, Column 0
Once or Twice
Row 1, Column 1
Monthly : 1 to 3 times/month
Row 1, Column 2
Weekly: 1to 4times in week
Row 1, Column 3
Daily or Almost Daily : 5-7days/week
Row 1, Column 4
Never
Row 2, Column 0
Once or Twice
Row 2, Column 1
Monthly : 1 to 3 times/month
Row 2, Column 2
Weekly: 1to 4times in week
Row 2, Column 3
Daily or Almost Daily : 5-7days/week
Row 2, Column 4
Never
Row 3, Column 0
Once or Twice
Row 3, Column 1
Monthly : 1 to 3 times/month
Row 3, Column 2
Weekly: 1to 4times in week
Row 3, Column 3
Daily or Almost Daily : 5-7days/week
Row 3, Column 4
Never
Row 4, Column 0
Once or Twice
Row 4, Column 1
Monthly : 1 to 3 times/month
Row 4, Column 2
Weekly: 1to 4times in week
Row 4, Column 3
Daily or Almost Daily : 5-7days/week
Row 4, Column 4
Never
Row 5, Column 0
Once or Twice
Row 5, Column 1
Monthly : 1 to 3 times/month
Row 5, Column 2
Weekly: 1to 4times in week
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Daily or Almost Daily : 5-7days/week
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ASSIST score for 'Other Drug' * This field is required.0-3 no intervention, 4-26 brief intervention, 27+ intensive intervention
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Ask the patient: Have you ever used any drug by injection (nonmedical use only)* This field is required.
No, never
Please Select
No, never
Yes , in the past 3 months
Yes , but not in the past 3months
56
Over the last two weeks, how often (your client)have you been bothered by any of the following problems?* This field is required.CLICK HERE for screening scales for menal health screening calculator
Not at all
Several days
More than half the days
Nearly everyday
Little interest or pleasure in doing things
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Feeling down, depressed, or hopeless
Row 1, Column 0
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Trouble falling or staying asleep, or sleeping too much
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Feeling tired or having little energy
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Poor appetite or overeating
Row 4, Column 0
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Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Row 5, Column 0
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Trouble concentrating on things, such as reading the newspaper or watching television
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Moving or speaking so slowly that other people could have noticed?
Row 7, Column 0
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Thoughts that you would be better off dead or of hurting yourself in some way
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Row 8, Column 3
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself — or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed?
Thoughts that you would be better off dead or of hurting yourself in some way
Not at all
Row 0, Column 0
Several days
Row 0, Column 1
More than half the days
Row 0, Column 2
Nearly everyday
Row 0, Column 3
Not at all
Row 1, Column 0
Several days
Row 1, Column 1
More than half the days
Row 1, Column 2
Nearly everyday
Row 1, Column 3
Not at all
Row 2, Column 0
Several days
Row 2, Column 1
More than half the days
Row 2, Column 2
Nearly everyday
Row 2, Column 3
Not at all
Row 3, Column 0
Several days
Row 3, Column 1
More than half the days
Row 3, Column 2
Nearly everyday
Row 3, Column 3
Not at all
Row 4, Column 0
Several days
Row 4, Column 1
More than half the days
Row 4, Column 2
Nearly everyday
Row 4, Column 3
Not at all
Row 5, Column 0
Several days
Row 5, Column 1
More than half the days
Row 5, Column 2
Nearly everyday
Row 5, Column 3
Not at all
Row 6, Column 0
Several days
Row 6, Column 1
More than half the days
Row 6, Column 2
Nearly everyday
Row 6, Column 3
Not at all
Row 7, Column 0
Several days
Row 7, Column 1
More than half the days
Row 7, Column 2
Nearly everyday
Row 7, Column 3
Not at all
Row 8, Column 0
Several days
Row 8, Column 1
More than half the days
Row 8, Column 2
Nearly everyday
Row 8, Column 3
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Score for PHQ-9* This field is required.0-4 is minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
58
PAST PSYCHIATRIC and MEDICAL HISTORY * This field is required.Describe details of past history of medical and mental illnesses.
0/1000
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CURRENT MEDICATIONS (if any)* This field is required.Mention aboout current medications that the patient is taking, its dose and duration.
60
FAMILY HISTORY* This field is required. Describe the family history of Substance use, psychiatric illness, or significant medical illnesses. The description can include the primary family unit, socio-economic condition, leadership pattern, role functions, communication styles within the family, social support, interpersonal relations, and the patient's living situation. If significant, caregiver burden, expressed emotions, ongoing family-related stressors, and the relationship between these factors and substance use may be mentioned in this section.
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Please upload a three-generation genogram if you have made for the case being presented.
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62
Personal History* This field is required.CLICK HERE for headings and details under which youcan take personal history
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Premorbid personality and Vulnerability* This field is required.In this section, our goal is to capture the individual's personality before the onset of the illness (mental illness, including substance use disorders). The description should ideally include their personality in several aspects, including work, family life, friendships, etc. Illustrative anecdotes and detailed statements may be included if deemed necessary. What we aim to achieve with this description is to picture the individual as holistically as possible. CLICK HERE for a collection of hints to help with the elicitation. Covering all the items listed during the first interview may not be possible. However, an attempt can be made, and more information may come to light in subsequent contacts. You can consider adding Externalizing or Internalizing symptoms. Moer about these at Addiction rx app Assess section
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Key findings: PHYSICAL EXAMINATION * This field is required.Write down the relevant details of physical examination. This would include the general physical examination, systemic examination findings including details of a particular system, if necessary.
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MENTAL STATUS EXAMINATION

A systematically conducted mental status examination is an important component of case-taking.

It is essential to record the observations correctly, and whenever positive findings are obtained, they should be described in detail.

It is inadequate to say `delusions present’ or `hallucinations.’

MSE has to be repeated several times during the illness to know the evolution of symptoms, the effectiveness of treatment, etc.

The time frame covered by the MSE is restricted to the hour of observation but extends longer. The finding of an MSE can be extended for a week.

While the following account highlights the major components of MSE, details should be obtained from other sources cited.

For a video demonstration on MSE, click on the links in the bracket (VIDEO 1, VIDEO 2, VIDEO 3). CLICK HERE for definitions related to various terms in MSE. CLICK HERE for MSE proforma.
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Key finidings of Mental Status Examinations* This field is required.
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General Appearance and Behavior* This field is required.Description as complete, accurate, and life-like as possible of the observations of ward staff and your own. The following points may be considered, though not exclusively. Inquiry about how to spend the day, eating, sleeping, cleanliness in general, self-care, hair, and dress. Behavior towards other patients, doctors, and nursing staff: does the patient look ill? Note whether the patient is fully conscious, stuporous, or comatose; is he in touch with his surroundings? Is the patient relaxed, tense, restless, slow, or hesitant? How does he respond to various requirements and situations? Are there abnormal responses to external events? Can his attention be held or diverted? Is the patient cooperative? Can adequate rapport be established? Does the patient maintain good eye contact? Does the patient’s behavior suggest that he is oriented/disoriented? Note the presence of any tics on mannerisms. Note the presence of any catatonic phenomena.
0/2000
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Psychomotor activity* This field is required.Comment with examples on the psychomotor activity of the patient. Increased, decreased, or no abnormality noted
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Speech of the patient* This field is required.Note here the form of utterances rather than the content: does the patient speak spontaneously or only in response to questions? Is the amount of speech little or excessive? Is it high-toned or low-toned? Is the tempo fast or slow? Is the reaction time increased or decreased? Is it relevant? Is it coherent? Describe under these headings: relevance, coherence, volume, tone, tempo, and reaction time.
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Thought: Form and Stream* This field is required. Please add verbatim statements of the patient reflecting your inferences. CLICK HERE for the TLC Scale by Nancy Andreason for details
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Thought Possession* This field is required.Obsessions and compulsions through alienation. Concerning obsession, elicit their natural ideas, doubts, imagery, impulses, and phobias. Similarly, clarify the nature of compulsive acts, such as checking, counting, or washing. Are these `controlling’ or yielding compulsions? If there is no finding, you may write "no abnormality detected".
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Thought Content* This field is required.Look for overvalued ideas and delusions before making an inference; a detailed description of the phenomenon must be given. Note whether the delusion is single or there are multiple delusions, the type of delusion (grandiose, persecutory, nihilistic, etc.), the exact content of the delusion, whether they are fleeting or fixed, whether they are well systematized or poorly systematized, and whether they are mood congruent or not; Enquire about worries and preoccupations, hypochondriacal and somatic symptoms. Depressive ideation, ideas of worthlessness, guilt, hopelessness, and suicidal ideas must be enquired and recorded. Please add verbatim statements of the patient reflecting the inferences you made.
0/5000
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Mood* This field is required.Both subjective reports and objective evaluations should assess this; the assessment should be longitudinal (mood) and cross-sectional (affect). The description should be given regarding the following components: the quality of affect (happiness, sadness, anxiety, etc.), the intensity or depth of emotional experience, the range of affective responses, reactivity (changes in emotion about environmental factors), diurnal variation, congruity (about thought processes) and appropriateness (about situations). Note any evidence of liability (rapid and extreme changes in emotion).
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Perception* This field is required.Record the presence of illusions and hallucinations. Inquiry should be made into the following modalities: vision, hearing, smell, taste, pain and deep sensations, vestibular sensations, and sense of presence; the record also the presence of unique varieties of hallucinations like functional hallucinations, reflex hallucinations, extra-campine hallucinations, synesthesia, and autoscopy. Detailed descriptions of the experience should be obtained, for example, concerning auditory hallucination inquiry whether the hallucinations are verbal or nonverbal, continuous or intermittent, single voice or multiple voices, familiar or unfamiliar voice, first person, second person or a third person; pleasant or unpleasant, if unpleasant, whether commanding, abusive or threatening; response to hallucinations; whether the mood is congruent. Distinguish hallucinations from imagery and pseudo-hallucinations. Other perceptual disturbances that must be investigated include heightened perception, dulled perception, and depersonalization/derealization experiences.
75
Cognitive Functions* This field is required.Clinical assessment includes the areas of 1. Orientation 2. Attention and concentration 3. Memory 4. Intelligence. CLICK HERE for HMSE
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Judgment* This field is required.Personal: Judgment is assessed by inquiries about the patient’s plans. Social: Judgment is evaluated by observing behavior in social situation. Test Judgment with two problems.
77
Insight* This field is required.For insight into the patient’s level of awareness of his illness, does he think he is not ill at all (without insight)? Does he recognize the presence of illness but explain it in physical terms (partial insight)? Does he fully realize the emotional nature of his illness and the cause of his symptoms (insight present)?
78
Stage of Motivation* This field is required.CLICK HERE for one-page-questionnaire to assess stage of motivation
Please Select
Please Select
Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Stage of motivation
Please Select
Please Select
Not Applicable
Internal locus of control
External locus of control
Locus of control
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Investigation Reports* This field is required.Mention any significant hematology, or biochemical findings from blood, urine, or other samples. Reports of any imaging study can also be submitted here.
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80
You can upload your patient's previous treatment or investigations detailslike previous Prescriptions, treatment details
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Optional
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81
You can upload an audio clip of an important conversationabout his understanding about substance use, motivation, or any associated psychopathology
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Max. file size: 10.3MB
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82
Summary- Please select the boxes that the patient fulfills* This field is required.Based on the below-mentioned DSM 5 criteria, you can specify which are present in the last year (Multiple answers can be selected). You can use similar questions as given in the bracket to ask the patients the following questions to check whether the criteria are being fulfilled.
Took substance in more significant amounts or over a more extended period than was originally intended. (Have you noticed that you are cannot stop consuming the substance once you start using it?)
Persistent desire to cut down or regulate substance with multiple unsuccessful attempts. (Have you tried to stop using the substance entirely, but due to some reason you restarted it?)
Spending much time obtaining the substance, using it, or recovering from its effects. (Have you noticed that activities related to the substance now occupy more amount of your time than before?)
Craving: intense desire or urge to use the drug. (Whether there has ever been a time when there were such strong urges to take the drug that you could not think of anything else?)
Failure to fulfill major roles. (Have you felt that you could not fulfill your work/school or home reponsibilities?)
Substance use despite persistent or recurrent interpersonal problems due to substance. (Are you facing problems in your relationships due to your substance use but still unable to stop the use?)
Decreased time in leisure activities. (Have you given up on important social, occupational, or recreational activities or have you reduced your time spent in these activities and hobbies to use substances?)
Risky use. (Have you used substances recurrently in situations which may be physically hazardous?)
Use despite harm. (Do you know what harm has the substance been causing you physically or psychologically? Despite knowing about it are you not able to stop substance use?)
Tolerance. (do you require a markedly increased dose of the substance to achieve the desired effect? Do you experience less of an effect when you consume the usual dose of substance?)
Withdrawal. (When you suddenly stop the use of a substance do you feel unpleasant sensations in your body?)
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PRIMARY DIAGNOSIS* This field is required.Suggest your primary substance use related diagnoses for the case according to DSM-5.
Mild
Moderate
Severe
Not Applicable
Alcohol Use Disorder
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Tobacco Use Disorder
Row 1, Column 0
Row 1, Column 1
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Row 1, Column 3
Opioid Use Disorder
Row 2, Column 0
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Row 2, Column 3
Cannabis Use Disorder
Row 3, Column 0
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Row 3, Column 3
Sedative/Hypnotic Use Disorder
Row 4, Column 0
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Row 4, Column 3
Stimulant Use Disorder
Row 5, Column 0
Row 5, Column 1
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Row 5, Column 3
Hallucinogen Use Disorder
Row 6, Column 0
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Row 6, Column 3
Inhalant Use Disorder
Row 7, Column 0
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Gambling Disorder
Row 8, Column 0
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Gaming Disorder
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Alcohol Use Disorder
Tobacco Use Disorder
Opioid Use Disorder
Cannabis Use Disorder
Sedative/Hypnotic Use Disorder
Stimulant Use Disorder
Hallucinogen Use Disorder
Inhalant Use Disorder
Gambling Disorder
Gaming Disorder
Mild
Row 0, Column 0
Moderate
Row 0, Column 1
Severe
Row 0, Column 2
Not Applicable
Row 0, Column 3
Mild
Row 1, Column 0
Moderate
Row 1, Column 1
Severe
Row 1, Column 2
Not Applicable
Row 1, Column 3
Mild
Row 2, Column 0
Moderate
Row 2, Column 1
Severe
Row 2, Column 2
Not Applicable
Row 2, Column 3
Mild
Row 3, Column 0
Moderate
Row 3, Column 1
Severe
Row 3, Column 2
Not Applicable
Row 3, Column 3
Mild
Row 4, Column 0
Moderate
Row 4, Column 1
Severe
Row 4, Column 2
Not Applicable
Row 4, Column 3
Mild
Row 5, Column 0
Moderate
Row 5, Column 1
Severe
Row 5, Column 2
Not Applicable
Row 5, Column 3
Mild
Row 6, Column 0
Moderate
Row 6, Column 1
Severe
Row 6, Column 2
Not Applicable
Row 6, Column 3
Mild
Row 7, Column 0
Moderate
Row 7, Column 1
Severe
Row 7, Column 2
Not Applicable
Row 7, Column 3
Mild
Row 8, Column 0
Moderate
Row 8, Column 1
Severe
Row 8, Column 2
Not Applicable
Row 8, Column 3
Mild
Row 9, Column 0
Moderate
Row 9, Column 1
Severe
Row 9, Column 2
Not Applicable
Row 9, Column 3
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SECONDARY DIAGNOSIS; IF ANY* This field is required.Note down any comorbid psychiatric or medical illness that you think is present.
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Pharmacological Management Plan* This field is required.Mention your locus of care, focus of care, clarifications you would like to make, investigations you would like to plan in the future, and choice of pharmacological treatment with reasons for your choices.
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Psychological Management* This field is required.Describe your psychosocial management plan for the patient. Your plan may include Psychoeducation, Brief Intervention, Motivational Interviewing, Relapse Prevention, CBT, DBT, Family therapy, Trauma focussed work, among others, based on what the patient may benefit from.
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Please review the curriculum and modules in advance of the presentation, so we can have a more interactive and engaging discussion during the session.
88
Appointment for Case Presentation* This field is required.
Should be Empty: