CENTRAL NERVOUS SYSTEM DISORDER CHECKLIST

Use the following checklist to determine if you or someone you know is suffering from a nervous system disorder. If five or more of the following symptoms have lasted for more than two weeks, or if they interfere with your work and family life, tell a doctor as soon as possible.

__	Persistently sad, anxious, or “empty” mood
__	Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex, decreased energy, fatigue, being “slowed down”
__	Restlessness, irritability
__	Feelings of guilt, worthlessness, helplessness
__	Appetite and/or weight loss or overeating and weight gain
__	Insomnia, early morning awakening, or oversleeping
__	Feelings of hopelessness, pessimism
__	Difficulty concentrating, remembering, making decisions
__	Thoughts of death or suicide; suicide attempts
__	Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

__________ TOTAL

(Source: National Institute for Mental Health)