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FIRST EPISODE PSYCHOSIS

 

 

Medication Questionnaire

Please tick or write in the boxes as indicated



1. You may have been prescribed medication when you first became unwell

Please list below any medication prescribed (Do not worry if you cannot remember all the details)


Name of Medicine Prescribed Dose/Amount Who prescribed the medication? e.g. GP, Psychiatrist, etc.

 

 

 

 

    

 

2. Were you given any information about your medication?

YES   NO  




If Yes, by whom

Doctor  
Nurse
 
Pharmacist
 
Other
 



If Other please specify -------------------------------

Was the information:

Too much
Too little
About right
Helpful
Unhelpful
 

 

3.  Were possible side effects of the medication explained to you?

YES   NO  

 




4.  Were you involved in any discussion about the type and amount of medication prescribed?

YES   NO  




Please comment-----------------------------------       


          

5.  What information would you have liked to know about your medication at this time?

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6.  Which medicines (if any) are you taking now?

Name of Medicine Prescribed Dose/Amount Who prescribed the medication? e.g. GP, Psychiatrist, etc.

 

 

 

 

    

 

 

7.  Please note any side effects (of any of the medication) you have experienced

Name of Medication
Side Effects Experienced

 

 

 

 

  

 

Were you able to report these side effects to your doctor or other professional?

YES   NO  




Please comment ----------------------------------------    


           

8.  Have you reduced or stopped taking any medication?

YES   NO  

 



If YES please note the reason (use the codes to answer)

Name of Medication
Reason (code)

 

 

 

 

  

Code 1 = Unpleasant side effects

Code 2 = Medication not helping

Code 3 = After discussion with professionals

Code 4 = Concerned about the medication

Code 5 = Influenced by friend/family/other client to stop medication


Did you receive advice in reducing or stopping your medication?

YES   NO  

 



Please comment ----------------------------------------   



9.  Are there any medicines you take if you notice the early signs of illness?

Name of Medication
Dose & Instructions

 

 

 

 

  




10.   Please note if you have at any time bought medicines/drugs to help your symptoms. Please include illicit drugs (in confidence)

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11.   Any other comments

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THANK YOU FOR YOUR HELP!

 


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