First Name
Age Group
Zip Code
Marital Status
How many people share the living space with you?
21 or more
What is your highest level of formal education?
Bachelor Degree
What race/ethnicity do you belong to?
What is the frequency of your visits to the health care provider?
Every Month
Are you presently employed? If yes, what is your occupation?
Were you employed previously? If yes, when and where?
What conditions have you been diagnosed with? When? Where?
Bipolar 1 disorder in july of 2006, insomnia, psycotic episodes, self-harm
Have you ever been hospitalized? If yes, how many times? When was the last time that you were hospitalized?
No, refused to go
Please describe everything you know about your condition(s) and how you obtained such information?
i get infomation through books and the internet mental health websites via google normally.
Please illustrate your life before, during, and after learning of your condition(s) and engaging in therapies, if any?
my life before was very out going, full of fun, and stress free. things started to go bad after a bad case of major depression and post traumatic stress and a realisation that i wasnt reaching my full potenial. Now, well daily life is very up and down. The majority of the time i am unaware of what i am doing and very careless. i found sport is a great relief.
Please describe how you cope with your condition(s), if at all, and the effectiveness of each strategy?
Sport is a great strategy, so that you channel your anger and pain into competition. This also makes you tired so help me sleep better at night.
Does the state of your health impede in any way your everyday activities such as work, housework, studies and so on?
in terms of studies, my condition impeads me greatly when i comes to certain times where i forget nearly everything i know and struggle to concentrate for more than 10 seconds. On the up side, there are times where i seem to know everything and come up with great new theroies.
Does the state of your health impede in any way your social activities, such as inviting others to your residence, accepting invitations, going out with friends and so on?
pyscotic episodes definatly inpead social activities as i have to stay well clear of people.
How would you classify your daily interactions with people in general? (Comfortable, neutral, awkward, unpleasant) Please describe in detail.
they are generally comfortable, i enjoy people, but sometimes it becomes very difficult to approach friends if i am feeling down.
How do you envision your future?
very succssesful. I will over come what i have and become a person who will achieve great things
On the whole, I am satisfied with myself.
At times I think I am no good at all.
Strongly Disagree
I feel that I have a number of good qualities.
Strongly Agree
I am able to do things as well as most other people.
Strongly Agree
I feel I do not have much to be proud of.
I certainly feel useless at times.
Strongly Disagree
I feel that I'm a person of worth, at least on an equal plane with others.
I wish I could have more respect for myself.
All in all, I am inclined to feel that I am a failure.
I take a positive attitude toward myself.
I can always manage to solve difficult problems if I try hard enough.
Strongly Disagree
If someone opposes me, I can find the ways and means to get what I want.
Strongly Disagree
I am certain that I can accomplish my goals.
Strongly Disagree
I am confident that I could deal efficiently with unexpected events.
Strongly Disagree
Thanks to my resourcefulness, I can handle unforeseen situations.
Strongly Disagree
I can solve most problems if I invest the necessary effort.
Strongly Disagree
I can remain calm when facing difficulties because I can rely on my coping abilities.
Strongly Disagree
When I am confronted with a problem, I can find several solutions.
Strongly Disagree
If I am in trouble, I can think of a good solution.
Strongly Disagree
I can handle whatever comes my way.
Strongly Disagree
With my illness experience, I feel I am:
Often relaxed
Equally comfortable and uncomfortable
Often at ease
Often distraught
Often optimistic
Equally confident and unsure
Equally capable and helpless
Equally certain and uncertain
My relationships help me feel I am:
Almost always valued
Often comforted
Equally close and distant
Equally connected and isolated
Often included
More often blamed
More often criticized
Towards those who are emotionally close to me, I feel I am:
Almost always forgiving
Equally welcoming and unreceptive
Equally accepting and rejecting
More often encouraging
More often trusting
More often understanding
More often respectful
Universal beliefs and principles or a divine presence help me feel I am:
Almost always inspired
Almost always comforted
Almost always accepted
Almost always guided
Almost always embraced
Almost always in harmony
Almost always sustained
Towards universal beliefs and principles or a divine presence I feel I am:
More often listening
More often receptive
Almost always thankful
More often accepting
More often approaching
Almost always willing
More often connecting