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Psychosis Test

In the past month, have you had the following thoughts, feelings, or experiences? Check “yes” or “no” for each item.

Do not include experiences that occur only while under the influence of alcohol, drugs or medications that were not prescribed to you.

If you answer “YES” to an item, also indicate how distressing that experience has been for you.

Multipage

(e.g. brighter or duller, larger or smaller, or changed in some other way)

Survey Questions
Before you get to your results, please take a moment to answer the following optional questions. If you aren’t comfortable sharing any or all of the information, you can click “submit” right away. Otherwise, your answers will help us better understand how we can achieve our mission. Don’t worry; we won’t be able to identify you based on this information.
Check all that apply.
Check all that apply.
Check all that apply.
Please note that we cannot respond if you entered “other.” If you are in crisis, please call 911 or the National Suicide Prevention Hotline at 1-800-273-TALK or go immediately to the nearest emergency room.

Disclaimer
Screenings with missing answers cannot be scored. A positive score on the Prodromal Questionnaire-Brief Version (PQ-B) suggests the need for further evaluation by a qualified health (M.D., R.N.) or mental health (Ph.D., Psy.D., LCSW) professional who is trained in recognizing the early signs of psychosis.  The PQ-B is designed to test for Prodrome or Ultra high-risk of Psychosis and is considered the first step in a two-stage screening process.

500 Montgomery Street, Suite 820
 Alexandria, VA 22314

Phone (703) 684.7722

Toll Free (800) 969.6642

Fax (703) 684.5968

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