Isolation Assessment Questionnaire

Why: to determine if acute or chronic.

Why: e.g. inappropriate loss of interest or involvement, withdrawing from social contacts and situations, lack of available social supports.

Why: may assist in determining the type of depression that you have e.g. with endogenous depression symptoms are usually feel worse on waking in the morning; postnatal depression usually feel worse at end of day.

Why: it is important for the doctor to know if you are a suicide risk.

Why: e.g. severe loss, such as the death of a loved one, marital separation or financial loss. Note that causes of isolation and detachment may develop for no apparent reason.

Why: questions specifically about relationship, family, children, social support, occupation, general physical health and financial stresses.

Why: postnatal depression has its onset within 3 months, and possibly up to 6 months following childbirth and may present with detachment and a feeling of isolation.

Why: e.g. if elderly consider dementia and depression. Depression can have bizarre features in the elderly and may be misdiagnosed as dementia or psychosis. Agitated depression is the most frequent type of depression in the elderly. Other symptoms in the elderly may include histrionic behavior, delusions and disordered thinking and they can certainly appear detached and lose interest and involvement.

Why: medical illness is an important precipitant of depression, especially in the elderly. Depression with chronic fatigue syndrome may follow an illness such as glandular fever or influenza or may follow an operation or childbirth.

Why: Many mental illnesses may cause social withdrawal or isolation such as depression, generalized anxiety disorder, schizophrenia, bipolar disorder, personality disorders, panic disorder, agoraphobia, eating disorders.

Why: some medications may increase the risk of depression e.g. beta-blockers, anti-Parkinson drugs, corticosteroids, anti-cancer drugs, non-steroidal anti-inflammatory medications, combined oral contraceptive pill, progesterone-only contraceptives.

Why: may help in determining whether alcoholism is the cause of depression, dementia or dysthymia.

Why: may cause depression. Marijuana is well known to cause apathy. The social consequences of illicit drug use and secrecy about the abuse may cause social withdrawal and isolation.

Why: e.g. depression, schizophrenia, bipolar affective disorder, Alzheimer's disease, Huntington's disease.

Why: e.g. depressed mood, crying spells, anhedonia (loss of interest or pleasure), increase or decrease in appetite (usually decreased), weight loss or gain, insomnia or increased sleeping (usually early morning waking), fatigue, loss of energy, feelings of worthlessness, feelings of excessive guilt, poor concentration, difficulty making decisions, low libido, thoughts of death or suicide attempt - may present with social withdrawal and isolation.

Why: e.g. episodes of depression (often psychotic in intensity) and at other times episodes of psychotic excitement (mania or hypomania). Symptoms of psychotic excitement may include elevation of mood, increased activity, grandiose ideas, irritability, disinhibition (which affects social, sexual and financial behavior), rapid speech and racing thoughts, delusions (persecutory or grandiose) and sometimes hallucinations. The depression phase may present with detachment, social withdrawal and isolation.

Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination - may present with detachment, social withdrawal and isolation.

Why: e.g. hallucinations, delusions, disordered thought - may suggest schizophrenia, bipolar affective disorder, severe depression, dementia or delirium - all of which may present with detachment, social withdrawal and isolation.

Why: e.g. impaired memory, impaired judgement and thinking, impaired verbal fluency and impaired ability to perform complex tasks. Personality may change, impulse control may be lost and personal care deteriorates. People with dementia may also have psychiatric symptoms such as delusions, paranoid ideas, hallucinations, mood disturbance and behavioral disturbance - Dementia e.g. Alzheimer's disease, Huntington's disease, Pick's disease may present with detachment, social withdrawal and isolation.

Why: e.g. symptoms follow exposure to an unusual stress such as a battle, being attacked or raped or a natural disaster. Symptoms include recurrent and intrusive recollections of the stress, recurrent distressing dreams of the event, acting or feeling as if the event was recurring, intense distress on exposure to resembling events, persistent avoidance of events that symbolize or resemble the trauma, increased arousal symptoms such as insomnia, exaggerated startle response, poor concentration and moodiness - Post-traumatic stress disorder may present with detachment, social withdrawal and isolation.

Why: e.g. sudden, unexpected, short-lived episodes of intense anxiety. Panic disorder may present with detachment, social withdrawal and isolation.

Why: e.g. anxiety about being in a situation or place from which to escape may be difficult, or in which help may not be easily available should a panic attack occur. It is usually a complication of panic disorder which leads to avoidance of a variety of feared situations such as being alone away from home; being home alone; being in crowded areas; traveling in buses, trains, cars or planes; and being in an elevator or on a bridge.

Why: e.g. refusal to maintain normal body weight, loss of more than 25% of original body weight, intense fear of becoming fat, preoccupation with calorie counting, avoidance of all carbohydrate, fainting. May present with social withdrawal and isolation due to secrecy about the disorder.

Why: e.g. recurrent episodes of binge eating; preoccupation with food and weight changes; consumption of high calorie, easily digested food during the binge; termination of the binge by abdominal pain, sleep or vomiting; inconspicuous eating during a binge; repeated attempts to lose weight by frequent vomiting, fasting or use of laxatives or diuretics; frequent fluctuations of more than 4.5kg; awareness of abnormal eating pattern and fear of not being able to stop voluntarily; depressed mood after binge. May present with social withdrawal and isolation due to secrecy about the disorder.

Why: may cause social withdrawal or isolation due to embarrassment.