PPHS

1. Patient ID:
2. Name:
3. Who provided the information:
a. Patient and relative
b. Relative alone
c. Patient alone
4. Has patient died since last assessment:
a. No
b. Yes
c. No information
5. Current mental status(Last 3 months):
a. Non-psychotic
b. Psychotic
c. Impossible to assess
d. No information/not known
6. Remission(symptom free for 30 days) since last assessment:
a. No
b. Yes
c. Impossible to assess
d. Patient still in an episode of inclusion
e. No information/not known
7. Duration( in months) for remission of first episode:
8. Number of discrete episodes since first assessment:
a. Presently in remission from episode of inclusion
b. Still in episode of inclusion
c. Not known/impossible to assess
9. Current treatment status:
a. Not on any form of treatment
b. In-patient
c. Outpatient
d. Partial hospitalization in medical psychiatric facility
e. Ambulatory treatment from religious/traditional healer
f. Partial or complete confinement in religious/traditional healer place
g. Others
h. More than one of the above, specify
10. Pattern of course since first assessment:
a. Complete/near complete recovery without relapse/exacerbation of psychotic symptoms
b. No relapse/exacerbation, but with residual personality change
c. One/more relapse/exacerbation, full/near full remission, no marked personality change
d. One/more relapse/exacerbation and marked personality change
 e. Continuous psychotic illness
f. Others
g. Impossible to assess
11. Number of suicide attempts since first assessment:
a. None
b. No information/not known
12. Pattern of alcohol consumption since first assessment:
a. Does not drink at all
b. Only occasional social drinking
c. Moderate alcohol use
d. Serious alcohol problem suspected
e. Clear evidence of serious alcohol problem
f. No information/not known
13. Any alcohol related problems since first assessment:
a. No
b. Yes
c. Yes, only once
d. Yes, more than once
e. Problem suspected, impossible to judge frequency and extent
f. Not applicable(patient does not take alcohol)
g. No information/not known
14. Work related and financial problems related to alcohol:
a. No
b. Yes
c. Yes, only once
d. Yes, more than once
e. Problem suspected, impossible to judge frequency and extent
f. Not applicable(patient does not take alcohol)
g. No information/not known
15. Social and legal problems related to alcohol:
a. No
b. Yes
c. Yes, only once
d. Yes, more than once
e. Problem suspected, impossible to judge frequency and extent
f. Not applicable(patient does not take alcohol)
g. No information/not known
16. Household and family problems related to alcohol:
a. No
b. Yes
c. Yes, only once
d. Yes, more than once
 e. Problem suspected, impossible to judge frequency and extent
f. Not applicable(patient does not take alcohol)
g. No information/not known
17. Personal and medical problems related to alcohol:
a. No
b. Yes
c. Yes, only once
d. Yes, more than once
e. Problem suspected, impossible to judge frequency and extent
f. Not applicable(patient does not take alcohol)
g. No information/not known
18. Illicit drug use and/or licit drug abuse since first assessment:
a. Not at all
b. Less than ones a month
c. Frequent/regular use suspected
d. Regular/frequent intake definitely present
e. Periodic binges
f. Drug-taking definite, but impossible to assess frequency
g. No information/not known
19. Specify nature of drug use/abuse:
a. Morphine/heroin
b. Opium/derivatives
c. Amphetamines/derivatives
d. Hashish/marijuana
e. Hallucinogens
f. Cocaine
g. Barbiturates
h. Non-barbiturate sedatives and tranquilizers
i. Others
20. Type of living arrangements:
a. Living alone
b. Living with spouse and/or children in nuclear family
c. With parents, nuclear family
d. Extended family, at least three generation together
e. Joint family, at least two brother/two sister along with child
f. With other relatives
g. With unrelated persons
h. Supervised accommodation
i. Mental hospital/other medical facilities
j. No information/not known/impossible to assess
k. Not applicable, wandering patient/no stable living arrangement
21. Number of members in household(including patient):
 a. Patient living alone
b. Patient in hospital/supervised accommodation
c. Patient is a vagrant with no stable household
d. No information/not known
22. Change in patient’s marital status since first assessment:
a. Single
b. Married or common law marriage
c. Engaged to be married/marriage has been arranged
d. Broken engagement/marriage arrangement
e. Divorced
f. Separated
g. Widowed
h. Other, specify
i. More than the above, specify
j. No information/not known
23. Location of residence:
a. Urban
b. Semi urban
c. Rural
24. Overall change in household socioeconomic status since first assessment:
a. No change
b. Change for the better
c. Change for the worse
d. Impossible to assess
e. Not applicable( patient has no household of his/her own)
f. No information/not known
25. Family’s perceived dangerousness of patient:
a. No one thinks patient is dangerous
b. All/some members think patient might be dangerous
c. All/ some are convinced that patient is dangerous
d. Not applicable
e. No information/not known
26. Dangerous behavior by patient:
a. No
b. Yes
c. Overt acts or behaviors suspected, but informant’s information unclear
d. No information/not known
27. Any changes since first assessment in the avoidance by household members:
a. No change
b. No change, some/much avoidance practiced
c. Some increase as noticed by one/more household embers
d. Some decrease as noticed by one/most of household members
 e. Mixed situation
f. Impossible to assess
g. Not applicable
h. No information to assess
28. Current employment(paid job) status(in last 30 days):
a. No
b. Yes
c. No information to assess
29. Specify reason, if not employed(paid job):
a. Student
b. Housewife
c. Worker in unpaid family concern
d. Patient’s mental illness
e. Physical disability or illness
f. General employment situation
g. More than one, specify
h. Others, specify
i. Not applicable
j. No information/not known
30. Life time employment(paid job) status since first assessment(excluding last 30 days):
a. One or more episode of unemployment lasting more than one month
b. Has been working properly practically all the time
c. Not applicable(patient never had a job)
d. Not known
31. If unemployed(excluding last 30 days) in life time, specify reason:
a. Patient’s mental illness
b. Physical illness or disability
c. General employment situation
d. Others
e. Combination of the above
f. Not applicable, patient was not unemployed
g. Not known
32. Number of job changes by the patient:
a. No change
b. Patient full time student, housewife, or unpaid worker in family concern
c. Not applicable, continuously hospitalized since first assessment
d. No information available
33. Patient’s level of earned income since first assessment:
a. No change
b. Some improvement
c. Marked improvement(more than 20% increase)
d. Some decline(less than 20% decline)
 e. Marked decline(more than 20% decline)
f. Not applicable
g. Not known/no information
34. Patient’s overall job performance since first assessment:
a. No impairment
b. Some impairment
c. Severe impairment
d. Not applicable
e. Not known
35. Overall level of socioeconomic difficulties:
a. No economic difficulties
b. Minor economic difficulties
c. Intermittent serious difficulties
d. Continuous serious difficulties
e. No information
36. Has the patient being doing all the household work:
a. No
b. Helps out around house when needed
c. Has a number of regular assigned work
d. Works full/almost full time at housework
e. Not applicable
f. No information/not known
37. Changes in the patient’s house work performance since first assessment:
a. No change, average/excellent performance
b. No change, poor performance
c. Some deterioration
d. Marked deterioration
e. Some improvement
f. Marked improvement
g. Impossible to assess
h. Not applicable
i. No information/not known
38. Has the patient continued education since first assessment:
a. No
b. Yes
c. No information
39. Has the patient discontinued education since first assessment:
a. No
b. Yes
c. No information
40. Has the patient completed education since first assessment:
a. No
 b. Yes
c. No information
41. Patient’s current social network status:
a. None
b. Yes
c. Not applicable, patient continuously hospitalized
d. No information/not known