Panic Disorder Questionnaire

1. Click on the symptoms that you experienced and the frequency
 
1A. Heart palpitations or accelerated heart beat
  None   Daily   Weekly   Monthly
 
1B. Sweating
  None   Daily   Weekly   Monthly
 
1C. Trembling or shaking
  None   Daily   Weekly   Monthly
 
1D. Sensation of shortness of breath or smothering
  None   Daily   Weekly   Monthly
 
1E. Feeling of chocking
  None   Daily   Weekly   Monthly
 
1F. Chest pain or discomfort
  None   Daily   Weekly   Monthly
 
1G. Nausea or abdominal distress
  None   Daily   Weekly   Monthly
 
1H. Feeling dizzy, unsteady, lightheaded, or faint
  None   Daily   Weekly   Monthly
 
1I. A feeling of unreality or being detatched from oneself
  None   Daily   Weekly   Monthly
 
1J. Fear of losing control or going crazy
  None   Daily   Weekly   Monthly
 
1K. Fear of dying
  None   Daily   Weekly   Monthly
 
1L. Numbness or pins and needles feeling
  None   Daily   Weekly   Monthly
 
1M. Hot or cold flushes
  None   Daily   Weekly   Monthly
 
2. How many attacks have you had during the last 2 months?
0 1 2 3 or more
 
3. How often do you experience the fear of having another panic attack?
1 Week 1 Month Many Months 1 Year
 
4. Do these symptoms develop abruptly ?
No Yes

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