a report on pilot study of national mental health survey,...

A Report on

Pilot Study of National Mental Health Survey, Nepal

September, 2018

Government of Nepal Nepal Health Research Council

Kathmandu, Nepal

A Report on

Pilot Study of National Mental Health Survey, Nepal

Authors

Anjani Kumar Jha, Saroj Prasad Ojha, Sushma Dahal, Rajendra Kumar BC, Bijay Kumar Jha, Amita Pradhan, Sweta Labh, Meghnath Dhimal

Recommended Citation

Jha, AK; Ojha, SP; Dahal, S; BC, RK; Jha, BK; Pradhan, A; Labh, S; Dhimal, M (2018) A report on pilot study of national mental health survey, Nepal. Kathmandu: Nepal Health Research Council.

Pilot Study of National Mental Health Survey, Nepal I

ACKNOWLEDGMENTSWe would like to offer our sincere thanks to our research team who contributed from the conception to completion of the piloting phase of the national mental health survey. We would like to acknowledge the Governemnt of Nepal and WHO Country Office Nepal for providing financial support for the survey. Our sincere gratitude also goes to Prof. Dr. David Vincent Sheehan for providing the license to use the MINI tools and also for his continuous support and guidance during different phases of this study.

Our gratitude also goes to Dr. Meghnath Dhimal, Chief/Senior Research Officer; Ms. Sushma Dahal, Research Officer; Ms. Sweta Labh, Assistant Research Officer for their dedicated efforts to make this study possible. Furthermore, we would like to acknowledge the continuous effort of Mr. Bijay Kumar Jha on managing field related activities. We would also like to extend our sincere thanks to Prof. Dr. Gopalkrishna Gururaj for his advices and guidance. We would also like to acknowledge the efforts of the members of the steering committee, technical working group for their continuous efforts and contribution to make this study possible. Our sincere thanks also go to the experts who were involved in translation and validation of the data collection tools.

We are thankful to all the field supervisors and field data enumerators. Without their arduous efforts on the field, this study would not have been possible. Likewise, we would like to extend our sincere thanks to Ms Tamanna Neupane, Program Officer for her her during preparation of data entry format. Our thanks also goes to Assistant Research Officers Mr. Bishal Bhandari, Ms. Dipiksha Poudyal and Ms. Sweksha Shah for their support in data entry. We would also like to acknowledge Ms. Punam Gnawali, assistant Program Officer for her help with the Nepali typing during the initial phase of tools development. Lastly, our word of appreciation also goes to all the study participants and stakeholders whose support and co-operation made it all possible.

Prof. Dr. Anjani Kumar JhaExecutive ChairmanNepal Health Research Council

Pilot Study of National Mental Health Survey, Nepal II

EXECUTIVE SUMMARYMental health is an integral part of overall health and wellbeing. The prevalence and disease burden of mental disorders have remained incredibly high globally and the treatment gap is also huge with about four in five people with mental illness in low and middle-income countries receiving no effective treatment. It is estimated that in Nepal 20-30% population are at risk of suffering from one or more mentally ill conditions and the sporadic studies done in different parts of the country indicate an increasing prevalence. However, there are no any national level studies on mental disorders conducted in Nepal till date. So, the aim of the national mental health survey, Nepal is to assess the prevalence of mental disorders in Nepal; to identify the help seeking behavior and barriers in accessing care among people with mental disorders; and to assess the impact and disability due to mental disorders in the Federal Democratic Republic of Nepal.

The national mental health survey, Nepal has been designed to be implemented after series of works in different phases. In the first step, necessary works on translation and validation of data collection tools including the pretesting has been completed. In the second phase a pilot study has been completed that will subsequently be followed by the comprehensive national level study. In this report we are sharing the major works performed for translation and validation of tools and the findings of the pilot study. The major tools of data collection were Mini International Neuropsychiatric Interview (MINI) tools for adult and adolescents, version 7.0.2. For the pilot survey, a total of 1647 participants were included and the data were collected using face to face interview with population aged 13 years and above. Besides the disorders included in MINI tools, other questionnaire on disorders such as epilepsy, dissociative conversion disorders etc., were also included. Questionnaire on barriers in accessing care and help seeking behavior were also administered with the participants aged 18 years and above. Pilot survey was conducted in three districts: Dhanusha, Bhaktapur and Dolakha; one from each ecological region.

The analysis of data from 1647 participants (1371 adults above 17 years, 276 adolescents aged 13-17 years) showed that the current prevalence of any form of mental disorders was 12.9%. Current prevalence of any form of mental disorders was found to be 11.2% and 13.2% among 13-17-year-olds and above 17 year-olds respectively. Current major depressive disorder was found among 0.7%, adolescents. Similarly, 1.8% of adolescents had taken any substance in past 12 months but substance use disorder was present among 0.7% only. Similarly, among participants above 17 years age, some of the major disorders found were: Major depressive disorder (current) (3.4%), alcohol use disorder (3.4%), substance use disorder (7.3%), current psychotic disorder (1.1%) and dissociative conversion disorder (6.1%). Suicidality was found to be high in both the groups. Current suicidality among adolescents was 8.7% and 10.9% among adults.

Among those with any form of mental disorder, only 18.4% received the treatment in last 12 months. The major barriers in accessing and receiving care were related to the knowledge and attitude related barriers. For example, about 79.8% of the participants who did not receive treatment did so because they wanted to solve their problem on their own followed by the feeling that the problem would get better by itself. Similarly, about 63% thought that they did not have any problem.

Experiences and findings from the pilot survey will be used for making necessary modifications in the tools, as well as to plan the national level survey. Given the lack of nationally representative data on prevalence of mental disorders in Nepal, this study will help to estimate the prevalence, treatment gap and help-seeking behavior of the people of the Federal Democratic Republic of Nepal.

Pilot Study of National Mental Health Survey, Nepal III

TABLE OF CONTENTSACKNOWLEDGMENT ......................................................................................................... I

EXECUTIVE SUMMARY ...................................................................................................... II

LIST OF TABLES .............................................................................................................III

LIST OF INTERNATIONAL ADVISORS ...................................................................................... V

LIST OF STEERING COMMITTEE MEMBERS ............................................................................... V

LIST OF TECHNICAL WORKING GROUP MEMBERS ...................................................................... V

LIST OF TEAM MEMBERS INVOLVED IN THE SECOND PHASE OF MINI TOOLS TRANSLATION ......................VI

LIST OF ABBREVIATIONS ..................................................................................................VII

CHAPTER I ....................................................................................................................1

1.1 INTRODUCTION .........................................................................................................1

1.2 RATIONALE ...............................................................................................................2

1.3 OBJECTIVES .............................................................................................................2

CHAPTER II ...................................................................................................................3

METHODOLOGY ..............................................................................................................3

2.1 Study design .............................................................................................................3

2.2 Study site ................................................................................................................3

2.3 Study duration ..........................................................................................................3

2.4 Study population and unit of analysis ...............................................................................3

2.5 Sample size calculation ...............................................................................................3

2.6 Sampling technique ....................................................................................................3

2.7 Tools and techniques of data collection ............................................................................4

2.8 Validity and reliability .................................................................................................5

2.9 Pretesting ................................................................................................................6

2.10 Data management and analysis .....................................................................................6

2.11 Ethical considerations ................................................................................................6

2.12 Potential bias and limitations .......................................................................................7

CHAPTER III ..................................................................................................................8

FINDINGS .....................................................................................................................8

3.1 Socio-demographic information of the adolescents aged 13-17 years .........................................8

3.2 Mental disorders among adolescent participants aged 13-17 years .......................................... 10

3.3 Suicidality among adolescent participants aged 13-17 years.................................................. 11

3.4 Socio-demographic information of participants aged 18 years and above ................................. 11

3.5 Mental disorders among participants aged 18 years and above .............................................. 13

3.6 Suicidality among participants aged 18 years and above ...................................................... 13

Pilot Study of National Mental Health Survey, Nepal IV

3.7 Help seeking behavior ............................................................................................... 14

3.8 Barriers in accessing care ........................................................................................... 14

3.9 Other experiences ................................................................................................... 16

CHAPTER IV ................................................................................................................17

CONCLUSIONS AND RECOMMENDATION .................................................................................17

REFERENCES ...............................................................................................................18

ANNEX I: Informed consent form ....................................................................................... 20

ANNEX II: Informed assent form ........................................................................................ 21

ANNEX III: Questionnaire for adult participants ......................................................................22

ANNEX IV: Questionnaire for adolescent participants ...............................................................66

ANNEX V: Adverse event management protocol .................................................................... 116

ANNEX VI: Example of criteria for monitoring the translation of items in MINI tool ......................... 116

ANNEX VI: Detail on the ethnicity .................................................................................... 117

ANNEX VII: Photographs .............................................................................................. 118

LIST OF TABLESTable 1: List of mental disorders used in the survey................................................................. 5

Table 2. Socio-demographic information of adolescent participants .............................................8

Table 3. Status of mental disorders among adolescent participants ............................................ 10

Table 4. Status of suicidality among adolescent participants aged 13-17 years ............................. 11

Table 5. Socio-demographic information of the participants aged 18 years and above .................... 11

Table 6. Status of mental disorders among participants aged 18 years and above ..........................13

Table 7. Status of suicidality among participants aged 18 years and above ..................................14

Table 8. Mental health services received .......................................................................... 14

Table 9. Barriers in accessing care ................................................................................. 15

Pilot Study of National Mental Health Survey, Nepal V

LIST OF INTERNATIONAL ADVISORS1. Dr. David Vincent Sheehan, MD, MBA, Distinguished University Health Professor Emeritus, University of

South Florida, College of Medicine, USA

2. Dr. Gopalkrishna Gururaj, MD, FAMS, Senior Professor, Department of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety Promotion Centre for Public Health, National Institute of Mental Health & Neuro Sciences, India

LIST OF STEERING COMMITTEE MEMBERS1. Prof. Dr. Anjani Kumar Jha, Executive chairman, Nepal Health Research Council

2. Prof. Dr. Saroj Prasad Ojha, Head of Psychiatry department, Institute of Medicine, Tribhuwan University Teaching Hospital (TUTH)

3. Dr. Deependra Raman Singh, Division Chief, Public Health Administration, Monitoring and Evaluation Division, MoHP

4. Dr. Bibek Kumar Lal, Director, Epidemiology and Disease Control Division (EDCD), MoHP

5. Mr. Suraj Koirala, Executive manager, Transcultural Psychosocial Organization (TPO), Nepal

6. Dr. Mohan Raj Shrestha Lakhe, Director, Mental Hospital Lagankhel

7. Dr. Rabi Shakya, Associate Professor, Patan Academy of Hospital Sciences

8. Mr. Matrika Devkota, Director, KOSHISH National Mental Health Sef-help Organization

9. Dr. Pashupati Mahat, Clinical psychologist, Centre for Mental Health and Counselling-Nepal

LIST OF TECHNICAL WORKING GROUP MEMBERS1. Prof. Dr. Anjani Kumar Jha, Executive Chairman, NHRC

2. Prof. Dr. Saroj Ojha, Head of Psychiatry Department, Institute of Medicine, Tribhuwan University Teaching Hospital (TUTH)

3. Ms. Yeshoda Aryal, Public Health Administrator, Curative Service Division, MoHP

4. Dr. Phanindra Baral, Section Chief, NCD and Mental Health Section, EDCD, MoHP

5. Dr. Meghnath Dhimal, Chief, Research Section, NHRC

6. Ms. Sushma Dahal, Research Officer, NHRC

7. Dr. Kedar Marahatta, Mental Health Consultant, WHO

8. Mr. Devendra Lal Karanjit, Director, CBS

9. Mr. Suraj Shakya, Lecturer/Clinical Psychologist, TUTH

10. Mr. Nagendra Luitel, Research Manager, TPO

11. Dr. Pawan Sharma, Lecturer, Patan Academy of Health Sciences

12. Dr. Sagun Ballav Pant, Teaching Assistant, TUTH

13. Dr. Devrat Joshi, Psychiatrist, Mental Hospital

14. Mr. Ramesh Prasad Adhikari, Research Manager, Helen Keller International

15. Dr. Baikuntha Subedi, Ayurvedic Medical Officer, MoH

16. Mr. Shiva Lal Sharma, Statistics Officer, MoH

Pilot Study of National Mental Health Survey, Nepal VI

17. Dr. Basudev Karki, Psychiatrist, Mental Hospital Lagankhel

18. Ms. Khagi Maya Pun, Associate Professor, Lalitpur Nursing Campus

19. Ms. Kabita Khati, Associate Professor, Padma Kanya Campus

20. Ms. Sweta Labh, Program Officer, NHRC

LIST OF TEAM MEMBERS INVOLVED IN THE SECOND PHASE OF MINI TOOLS TRANSLATION

1. Mr. Prabhat Kiran Pradhan, Mental Health Network Orange, Mental Health and Dementia First Aid Instructor

2. Dr. Rachana Sharma, Psychiatrist, Grande Hospital

3. Dr. Ritesh Thapa, Director and Psychiatrist, Rhythm Neuropsychiatry Hospital

4. Ms. Sandhaya Budhathoki, Lecturer, Nobel College

5. Mr. Suraj Shakya, Lecturer/Clinical Psychologist, TUTH

6. Ms. Sushma Dahal, Research Officer, NHRC

7. Ms. Sweta Labh, Program Officer, NHRC

Pilot Study of National Mental Health Survey, Nepal VII

LIST OF ABBREVIATIONSBACE : Barriers in Accessing Care Evaluation

DALY : Disability Adjusted Life Years

DoHS : Department of Health Services

DSM : Diagnostic and Statistical Manual

EDCD : Epidemiology and Diseases Control Division

ERB : Ethical Review Board

FDCs : Field Data Collectors

LMICs : Low and Middle Income Countries

MINI : Mini International Neuropsychiatric Interview

NHRC : Nepal Health Research Council

PHCRD : Primary health care revitalization division

PPS : Probability Proportionate to Size

TPO : Transcultural Psychosocial Organization

TWG : Technical Working Group

TUTH : Tribhuwan University Teaching Hospital

WHO : World Health Organization

YLD : Years Lived with Disability

YLL : Years of Life Lost due to premature death

Pilot Study of National Mental Health Survey, Nepal VIII

Pilot Study of National Mental Health Survey, Nepal 1

CHAPTER 1

INTRODUCTION

Mental health is an integral part of overall health and wellbeing and is a foundation for effective functioning of an individual and community [1]. Mental disorders among population of any country are an important public health concern. Poor mental health among young population affects them not only during their childhood but also in the long run during their adulthood and later life due to factors such as poor academic achievement, substance abuse, poor performance in work, poor reproductive health etc.[2]. Mental health of parents also affects the mental health of their children [3] reflecting the intergenerational effect of mental disorders. However, the prevalence of mental disorders remains remained incredibly high globally. According to global burden of disease study 2010, mental, neurological and substance use disorders accounted for 10.4% of global Disability Adjusted Life Years (DALY), 2.3% of global Years of Life Lost due to premature death (YLL) and 28.5% of global Years Lived with Disability (YLDs)[4]. Among mental, neurological and substance use disorders, mental disorders accounted for the largest proportion of DALYs[4]. Projections estimate that neuropsychiatric conditions will account for 15% of disability worldwide by the year 2020 including the unipolar depression alone accounting for 5.7% of DALYs[4, 5].

The treatment gap for mental disorders is huge all over the world; for instance, between 76% and 85% of people with severe mental disorders receive no treatment for their mental health conditions in Low and Middle Income Countries (LMICs) [6]. It is estimated that four out of five people with mental illness in Low and Middle-Income Countries (LMICs) receive no effective treatment[7, 8]. Lack of mental health professional and access to mental health services is an important health system challenge in these settings. There is a huge gap in mental health workforce in many LMICs. According to the mental health atlas 2011, the median number of psychiatrists per 100,000 population in LMIC is 0.05 whereas this number is 8.59 in high-income countries [9]. In some developing countries the rate of unmet need for mental health services is even 100% [10].

In Nepal also the burden of mental health problems in terms of morbidity, disability and costs to individuals, families and societies are overwhelmingly high. For example, the first epidemiological field survey conducted in the Kathmandu valley in 1984 showed a high prevalence of mental illness around 14 percent [11]. Similarly, a mental health prevalence survey conducted in two small towns of the Western region of Nepal identified 35% psychiatry morbidity in the region[12]. Similarly, multi-sectoral action plan for the prevention and control of non-communicable diseases (2014-2020) estimated the 18 percent of the NCD burden is due to mental illness[13]. Similarly, suicide is a key public health concern in Nepal especially among women of reproductive age group[14]. Different factors such as easy availability of toxic pesticides facilitate suicide attempts and belief that suicide is illegal hinder those affected from seeking help[14].

Nepalese people are at increased risk of developing mentally ill health conditions due to factors such as the ten years long armed conflict and political unrest, low socioeconomic status, labour migration, gender based discrimination, high vulnerability to natural disasters such as earthquake, flood, landslide etc[15-18].However, mental health is still a neglected issue in Nepal. People suffering from mental disorders are often seen as threats to Nepalese society leading to denial for seeking treatment and stigmatization. Then, there are cultural beliefs, myths, and religious convictions around causes and consequences of mental disorders that further discourage people to seek service from the health facilities. People suffering from mental disorders and their families in Nepal seek help from traditional healers. Though Nepal is signatory of the International Convention on Mental Health and different periodic plans of Nepal have incorporated gradual implementation of hospital to community based mental health care service in the country, barriers in accessing mental health care is still huge in Nepal.


1.2 RATIONALE

Mental health problems are a major public health problem worldwide. According to the global burden of disease study 2010, overall mental and substance use disorders were the fifth leading disorder category in terms of DALYs[19]. With this recognition, in the past few decades, national and international epidemiological studies have been conducted in relation to the prevalence, correlates and impacts of mental disorders. Most of these studies have been done in developed countries [20-22]. However, evidence from developing countries is also growing [23-25]. In this context, we are aiming to conduct a national level survey of mental disorders in Nepal.

Nepal is a country with almost thirty million population with a high vulnerability to natural disasters such as earthquake, flood, landslide etc. and has faced ten years long armed conflict and political unrest. Nepal also faced a devastating earthquake of 7.8 magnitude and the subsequent aftershocks in 2015 that struck western, central and eastern regions of Nepal. The earthquake lead to 8,702 the deaths, 22,303 injury and 605,254 completely destroyed houses rendering thousands of people homeless [26, 27]. Data from previous studies done in different parts of Nepal indicate an increasing prevalence of mental disorders in Nepal [11-13]. However, these studies are based on limited population samples limiting the generalizability of the produced estimates. There are no any national level studies on mental disorders conducted in Nepal to date. There is also difficulty in conceptualizing and measuring the mental disorders in the field of psychiatric epidemiology [28] which applies in case of Nepal as well. This uncertainty about diagnostic categories, criteria and measurement also limits the generalizability of the previous findings and make the findings difficult to understand. This also explains the need of a national level study in Nepal using a highly valid and reliable diagnostic tool. Promoting mental health and well-being, and the prevention and treatment of substance abuse are integral parts of the Sustainable Development Goals (SDGs). However, many low and middle-income countries, including Nepal currently allocate less than 2 percent of the health budget to the treatment and prevention of mental disorders[29]. Nepal is the signatory of an international convention on mental health to be included in urgent health service category and mental health care services are gradually implemented from community to hospitals. However, the area of mental health literacy has been neglected in comparison to physical health. The views of people regarding mental health are less known. Thus, it is important to know the concepts of Nepalese people about the mental health, the unmet need, the help seeking behavior of people with mental disorders and the major barriers in accessing and receiving mental health care services. So, this study aims to conduct a pilot survey regarding the status of mental illness, the existing barriers to care and health service utilization in Nepal followed by a national epidemiological study of mental health in Nepal.

1.3 OBJECTIVES

The objectives of the pilot survey were:

• To assess the prevalence of mental disorders in the study areas

• To assess help seeking behavior of people with mental disorders in the study areas

• To identify barriers of seeking treatment for mental disorders in the study areas

• To assess the feasibility for the national mental health survey, Nepal

• To refine the tools to be used in the national mental health survey, Nepal

• To estimate the time, cost and human resource required for the national mental health survey, Nepal


The details about the methodology used in this study are described below:

2.1 Study design

This study was quantitative in nature with a cross-sectional design.

2.2 Study site

For the pilot survey, three purposively selected districts: Dhanusha, Bhaktapur and Dolakha representing Terai, Hill and Mountain region respectively were included.

2.3 Study duration

The study was conducted from September 2017 to September 2018. Data collection was done June 20, 2018 to July 20, 2018.

2.4 Study population and unit of analysis

There were two groups of study population for this study. First, adolescents aged 13 to 17 years and second, adult population aged 18 years and above. All the study participants were non-institutionalized Nepali population. The population who were not able or willing to respond were not included in the study. The unit of analysis were the individual children/adolescent and adult participants.

2.5 Sample size calculation

Given the lack of population-based data on mental health in Nepal, we used the data from recent mental health survey of India, 2015-16 [24]. This was because India and Nepal share similar socio-cultural practices. Similarly, the mental health survey of India also used the MINI tools. The India mental health survey found the prevalence of F10-F19- Mental and behavioral problems due to psychoactive substance use as 22.2%. Using this prevalence estimate, margin of error of 5%, design effect of 1.5 and non-response rate of 23% [30], the total sample size was calculated to be 6855. Similarly, for children and adolescents, using the prevalence value phobic anxiety disorder (3.6%) among 13-16-year-olds from India mental health survey, margin of error of 5%, design effect of 1.5 and non-response rate of 23%, the total sample size for 13-17-year-olds was calculated to be 1377. Thus, the total sample size for the main survey was estimated to be 8232. Of this sample, 20% was taken for the pilot survey making a total sample size of 1647 (1371 sample for adults and 276 for adolescents). The research team agreed that the sample size calculated as above for the main survey will be used for the purpose of pilot survey and based on the findings of the pilot survey necessary modifications will be made in the sample size and sampling technique during the national mental health survey, Nepal.

2.6 Sampling technique

Nepal is divided into 7 provinces and 77 districts. Each district is then divided to different urban and rural municipalities which then are divided into wards. For pilot survey, three districts: Dolakha, Bhaktapur and Dhanusha representing Mountain, Hill and Terai regions respectively were purposively selected from different provinces. In this study, sample size was proportionate to the total number of households in selected districts as per the census report of 2011 [31] and wards were considered the primary sampling units (PSUs). A probability proportionate to size method was applied to identify PSUs at district level. From the selected PSUs, the household listing was done and 30 households were randomly selected per PSU. In case of more than one eligible adult in the household, lottery method was used for selecting the participant. In case of adolescents, only 6 households were selected, given

CHAPTER 2

METHODOLOGY


the small sample size and the participants were recruited using same technique as in adults.

2.7 Tools and techniques of data collection

Mini International Neuropsychiatric Interview (MINI) Adult and MINI-Kid version 7.0.2 were used to collect the data from adults and adolescents respectively. The MINI is a short, structured diagnostic interview developed initially in 1990 by psychiatrists and clinicians in the United States and Europe for DSM-III-R and ICD-10 psychiatric disorders. MINI is the structured psychiatric interview of choice for psychiatric evaluation and outcome tracking in clinical psychopharmacology trials and epidemiological studies. The MINI is the most widely used psychiatric structured diagnostic interview instrument in the world, employed by mental health professionals and health organizations in more than 100 countries. The MINI has been translated and linguistically validated in over 70 languages. The version 7.0.2 of the MINI assesses the psychiatric disorders by using Diagnostic and Statistical Manual five (DSM-V) criteria [32]. In our pilot study, we have included a total of 15 mental disorders among adults and 23 disorders among adolescents (refer to table 1).

We also used Barriers to Accessing Care Evaluation (BACE) tool and questionnaire on help seeking behavior. These questionnaires were administered to the participants who were diagnosed with any form of mental disorders from the MINI interview. There is preliminary evidence demonstrating the reliability, validity and acceptability of the BACE tool which is a 30 item-questionnaire [33] with a particular focus on stigma-related barriers, as well as covering a comprehensive set of other types of barrier such as attitude related barriers, knowledge related barriers, structural barriers, and economic barriers. It can be used to ascertain key barriers to access to mental health care which may help to identify potential interventions to increase care seeking and service use [33]. In the questionnaire on help seeking behavior, the variable such as who was contacted by the participant after having the mental health problems, the type of services received, completion of course recommended by the service provider e.g. medicine, counseling or any other forms of treatment, total expenses on treatment etc. The questions on barriers in accessing care and help seeking behavior were asked to all the participants who had any form of mental disorders in the past 12 months.

Licensure was obtained for the use of MINI tools in this survey. Similarly BACE tool was also used after taking the consent from relevant body. Besides the disorders included in MINI standard and kid version 7.0.2, additional disorders that are important in the Nepalese context such as epilepsy and dissociative conversion disorder were also added in questionnaire for adults. Similarly, epilepsy, dissociative conversion disorder and intellectual disability were added in the questionnaire for adolescents. Questionnaire for these additional disorders were prepared by a team of psychiatrists and psychologists which was then reviewed and finalized by the technical working group (TWG).

Though MINI tool is an internationally validated tool to assess mental disorders, it has not been translated to Nepali language. So, NHRC worked with the team of experts and the owner of the tool Prof Dr. David Vincent Sheehan to translate and validate this tool into Nepali language. The details on tools translation has been provided in the validity/reliability section below. Other tools described above were also translated into Nepali language. The technique of data collection was face-to-face interview.


Table 1: List of mental disorders used in the survey

Mental disorders among adults Mental disorders among adolescents

Disorders from the MINI

1. Major depressive episode (current-2 weeks, past and recurrent)

2. Suicidality (current-past month and lifetime attempt)

3. (Hypo) manic episode (current and past)

4. Panic disorder (current-past month and lifetime)

5. Agoraphobia (current)

6. Social phobia (current-past month)

7. Obessive compulsive disorder (current-past month)

8. Post Traumatic Stress Disorder (current-past month)

9. Alcohol use disorder (past 12 months)

10. Substance use disorder (past 12 months)

11. Any psychotic disorder (current and lifetime)

12. Anorexia nervosa (current-past three months)

13. Bulimia nervosa (current-past three months)

14. Generalized anxiety disorder (current-past six months)

15. Antisocial personality disorder (lifetime)

Disorders from the MINI

1. Major depressive episode (current-2 weeks, past and recurrent)

2. Suicidality (current-past month and lifetime attempt)

3. (Hypo) manic episode (current and past)

4. Panic disorder (current-past month and lifetime)

5. Agoraphobia (current)

6. Separation anxiety disorder (current-past month)

7. Social phobia (current-past month)

8. Specific phobia (current-past month)

9. Obessive compulsive disorder (current-past month)

10. Post Traumatic Stress Disorder (current-past month)

11. Alcohol use disorder (past 12 months)

12. Substance use disorder (past 12 months)

13. Tourette’s disorder (current)

14. Attention Deficit Hyperactivity Disorder (ADHD) (past six months)

15. Conduct disorder (past 12 months)

16. Oppositional defiant disorder (past six months)

17. Any psychotic disorder (current and lifetime)

18. Anorexia nervosa (current-past three months)

19. Bulimia nervosa (current-past three months)

20. Binge eating disorder (current)

21. Generalized anxiety disorder (current-past six months)

22. Adjustment disorders (current)

23. Autism Spectrum Disorder

Other additional disorder (not from the MINI module)

16. Dissociative conversion disorder (lifetime)

• Conversion disorder

• Trance and possession disorder

• Somatic symptom disorder

17. Epilepsy (lifetime)

Other additional disorder (not from the MINI module)

24. Dissociative conversion disorder (lifetime)

• Conversion disorder

• Trance and possession disorder

• Somatic symptom disorder

25. Epilepsy (lifetime)

26. Intellectual disability

2.8 Validity and reliability

Validity and reliability of tools have been ensured during the tools translation phase. The guideline for the translation of tools was designed based on the available literature [34-37] Consultation with our international advisors Dr. David Vincent Sheehan, the copyright holder of the MINI tools and Dr. Gopalkrishna Gururaj was also done. The steps of tools translation and validation used were:

1. Translation of tool in Nepali language by bilingual speaker


2. Review of the translated version by a group of mental health experts (who used the monitoring forms and provided their comments or any other alternative translation)

3. Evaluation of translated item by face to face interview with the prospective participants.

4. Blind back translation (by those unfamiliar with the original version of the questions)

5. Verification of the translation (Nepali and blind back English translation) by a team of experts

6. Revision and necessary modification

While reviewing/examining the translation, following criteria were evaluated:

1. Comprehensibility (is the translation understandable to the local population?)

2. Acceptability (would certain participants be uncomfortable to answer that question directly, may need to be modified to acceptable word)

3. Relevance (Is this question relevant to the local culture? e.g. in some setting such as those without any electricity; questions asking entertainment through video games, mobile games, television may not be relevant; and it may need to include other entertainment methods relevant there)

4. Completeness (Will the back translation relate back to the same concepts and ideas as the original question?)

Experts were consulted during and after the translation. The final tools were also reviewed and revised as necessary by the members of technical working group and steering committee. Thirteen BPH graduates and BSc Nursing graduates selected for the data collection were comprehensively trained on the tools before they moved to pretesting in the field setting. The trainers for this training were trained by Dr. David Vincent Sheehan, the copyright holder of the tool via zoom webinar. Necessary modifications in the tools were made after getting the feedback from data enumerators and supervisors who participated in the pretesting.

2.9 Pretesting

For the pretesting, two villages within Kathmandu district: Tokha and Dhapasi were selected purposively. The total sample size was 168 i.e. 138 adults and 30 adolescents respectively. After pretesting necessary modifications in the Nepali translated tools were made.

2.10 Data management and analysis

A multidisciplinary study team was formed consisting of psychiatrists, psychologists, mental health experts and public health experts having experience in mental health research. BPH and BSc Nursing graduates were trained for data collection from the field. Data was collected using paper version of the tool. After completion of data collection, questionnaires were checked for completeness; the collected data were verified and coded daily.

Data were entered in EpiData 3.1. version with pre-set checks and controls commands. All the entered data were rechecked for any errors. The data was then exported to IBM SPSS Statistics 23 for quantitative analysis. Data were analyzed using descriptive statistics, frequency and percentages were calculated and presented in tables. To calculate the current prevalence on mental disorders, only disorders that are included in MINI modules (excluding autism spectrum disorder that could not be ruled out and suicidality) were used.

2.11 Ethical considerations

The ethical approval for the study was taken from Ethical Review Board at the Nepal Health Research Council (NHRC). Written informed consent was taken from the adult participants. In case of children and adolescents, assent form was used that was duly signed by their parent/guardian. We also developed adverse event management protocol that was used to take appropriate action during the process of data collection. The protocol was used if any individual with suicidal tendency and or severe form of mental disorder were found and needed a referral for health facility/service.

Participants were given the right to refuse to answer any question without providing the reason for their


decisions and were allowed to withdraw from the study at any time. The information provided by the research participants was dealt with highest confidentiality and used only for this study. Privacy of the participants was fully maintained during data collection, analysis and storage.

2.12 Potential bias and limitations

Since mental illness is a stigmatized issue in Nepal, there are possibilities of reporting bias by the families having person with mental illness. One of the limitations of this study is it does not include population residing in some institutional settings for example hospitalized population, imprisoned population etc. Similarly, this is a pilot study that was conducted including only three districts. So, the findings of this study are not generalizable to the adolescents and adult population of Nepal.

Wellbeing is also an important component of mental health. However, in this study wellbeing has not been measured. Similarly, we could not assess the interrater reliability of the field data collectors (FDCs) because of the feasibility related reasons. However, due care was given during the selection and training of the FDCs & the supervisors.


Findings of the study have been shown in tables below. Disorders for which no any cases were found are described only in the paragraph and not listed in the tables. The average duration of interview for adolescents was 36 minutes (SD:9, Minimum:18, Maximum:90) whereas for adults the average time for the interview was 35.9 minutes (SD: 12.3, Minimum:15, Maximum: 103). The total non response rate in the pilot survey was less than 1%. Of the total participants included in the study, 212 (12.9%) had any form of mental disorder.

3.1 Socio-demographic information of the adolescents aged 13-17 years

Out of the total 276 adolescents included, more than 50% were in age group 13-15 years. Most of them were female, Hindu, from disadvantaged non Dalit Terai caste, nuclear family, and those with secondary level education (Table 2). The average age of participants was 17 years and most of them were unmarried.

Table 2. Socio-demographic information of adolescent participants aged 13-17 years

Variables (n=276) Level Frequency Percentage

Completed age (in years) 13 47 17.0

14 53 19.2

15 53 19.216 55 19.917 68 24.6

Sex Male 103 37.3

Female 173 62.7

Marital status Unmarried 270 97.8Married 6 2.2

Religion

Hindu 243 88.0

Christian 3 1.1

Islamic 13 4.7

Buddhist 12 4.3

Others 5 1.8

Ethnicity

Dalit 41 14.9Disadvantage Janajati 25 9.1Disadvantaged non dalit Terai caste 93 33.7

Religious minorities 8 2.9

Relatively advantaged Janajatis 47 17.0Upper Caste groups 62 22.5

Family Type Single 162 58.7Joint/Extended 114 41.3

Participant’s Education

Illiterate 6 2.2

Informal Education 2 0.7

Lower Primary Education 2 0.7

Primary Education 19 6.9Lower secondary 80 29.0Secondary 131 47.5Higher Secondary 36 13.0

CHAPTER 3

FINDINGS


Father’s Education (n=263)

Illiterate 39 14.8Informal Education 29 11.0Lower Primary Education 16 6.1Primary Education 33 12.5Lower secondary 41 15.6Secondary 62 23.6Higher Secondary 43 16.3

Mother’s Education (n=267)

Illiterate 81 30.3

Informal Education 76 28.5

Lower Primary Education 12 4.5Primary Education 23 8.6Lower secondary 28 10.5Secondary 31 11.6

Higher Secondary 16 6.0

Spouse’s Education (n=6)

Lower secondary 2 33.3

Secondary 3 50.0

Higher Secondary 1 16.7

Participant’s Occupation

Housewife 4 1.4

Agriculture 1 0.4Business 1 0.4

Daily worker 5 1.8

Others 265 96.0

Father’s Occupation (n=261)

Agriculture 49 18.8

Service 36 13.8

Business 63 24.1

Daily worker 56 21.5

Foreign employment 49 18.8

Others 8 3.1

Mother’s Occupation (n=268)

Housewife 147 54.8Agriculture 57 21.3Service 14 5.2Business 36 13.4Daily worker 13 4.8Others 1 0.4

Spouse’s Occupation (n=7)

Housewife 1 14.3Agriculture 1 14.3Service 2 28.6Daily worker 1 14.3 Foreign employment 2 28.6

Death of family members in last 12 months (n=275)

Yes 15 5.5

No 260 94.2


Family member who died (n=15)

Aunt 1 6.2

Niece/Nephew 1 6.2Father 1 6.2Grandmother 5 37.5

Grandfather 6 37.5

Mother 1 6.2

*Details on ethnicity is provided in annex section

3.2 Mental disorders among adolescent participants aged 13-17 years

Out of total adolescents 31 (11.2%) currently had any form of mental disorders. Table 3 below gives the status of mental disorders among adolescents aged 13-17 years during the pilot survey. Current major depressive disorder was found among 0.7%, panic disorder among 0.4%, agoraphobia among 2.2%, separation anxiety disorder among 0.4%, social phobia among 0.4%, specific phobia among 1.1%, and obsessive compulsive disorder among 1.1%. Of the total participants 1.8% had taken any substance in past 12 months but substance use disorder was present among only 0.7%.

Current psychotic disorder, GAD, anorexia nervosa and lifetime epilepsy was present among 1.8% participants each. Autism spectrum disorder could not be ruled out in 5.8% of the participants whereas about 12% participants felt that they had less intellectual capacity than other children of their age.

We did not find any adolescents with conditions such as manic and hypomanic episode, post-traumatic stress disorder, alcohol use disorder, tourette’s disorder, attention deficit hyperactivity disorder, conduct disorder, bulimia nervosa, and binge eating disorder.

Table 3. Status of mental disorders among adolescent participants aged 13-17 years

Name of mental disorder (n=276) Level Frequency (percent)

Any mental morbidity Current 31 (11.2)

Major depressive disorder Current 2 (0.7)Past 5 (1.8)Recurrent 4 (1.4)

Panic disorderCurrent 1 (0.4)Lifetime 3 (1.1)

Agoraphobia Current 6 (2.2)Separation anxiety disorders Current 1(0.4)Social anxiety disorder (social phobia ) Current 1(0.4)Specific phobia Current 3 (1.1)Obsessive compulsive disorder Current 3 (1.1)

Substance use disorderCurrent 2 (0.7)Mild 1 (0.4)Moderate 1 (0.4)

Oppositional defiant disorder Current 2 (0.7)

Psychotic disorderCurrent 5 (1.8)Lifetime 12 (4.3)

Anorexia nervosa Current 5 (1.8)

Generalized anxiety disorder (GAD) Current

5 (1.8)

Adjustment disorder Current 1 (0.4)

Autism Autism Spectrum Disorder not ruled out

16 (5.8)


Dissociative identity disorder Current 1 (0.4)

Somatic symptom disorder Current 1 (0.4)

Conversion disorder Current 1 (0.4)

Dissociative conversion disorder Current 3 (1.1)

Epilepsy Lifetime 5 (1.8)

Intellectual disorder

Feeling having less intellectual capacity than other child

32 (11.6)

Able to live in society like other children

272 (98.6)

Can say ‘no’ to illegal or harmful work

275 (99.6)

3.3 Suicidality among adolescent participants aged 13-17 years

Current suicidality was present among 8.7% of adolescents. Most of the suicidality was low in severity. Table 4 below gives the status of suicidality among adolescent participants aged 13-17 years.

Table 4. Status of suicidality among adolescent participants aged 13-17 years

Name of suicidality (n=276) Level Frequency (percent)

Suicidality

Low 18 (6.5)Moderate 4 (1.4)High 4 (1.4)Current 24 (8.7)Lifetime attempt 1 (0.4)Likely in near future 3 (1.1)

3.4 Socio-demographic information of participants aged 18 years and above

Total 1371 adult participants aged 18 years and above were included in the study. Table 5 below shows the socio-demographic information of the participants. Majority of the participants were female, married, Hindu, from disadvantaged non Dalit Terai caste, and living in nuclear family. Most of them were housewife, followed by those involved in agriculture as major occupation. About 61% of the participants said that their income had fulfilled the family needs (Table 5). Mean age of the participants was 39.4 years (range: 18 to 85 years, SD: 15.04).

Table 5. Socio-demographic information of the participants aged 18 years and above

Variables Level Frequency Percent

Age group (in years) (n=1368)

18-24 271 17.6

25-33 322 23.534-48 424 3149-64 270 19.765-78 104 7.679-98 7 0.5


Sex (n=1364)

Male 462 33.9

Female 901 66.1

Others 1 0.1

Marital Status (n=1340)

Unmarried 127 9.5Married 1122 83.7Widow 81 6.0Divorced 10 0.7

Religion (n=1369)

Hindu 1216 88.7Christian 13 1.0Muslim 68 50Buddhist 42 3.1Others 30 2.2

Ethnicity(n=1334)

Dalit 192 14.4Disadvantaged Janajati 95 7.1Disadvantaged non Dalit Terai 450 33.7Religious minorities 42 3.1Relatively advanced Janajatis 246 18.4Upper caste groups 309 23.2

Family Type (n=1359)Single 730 53.7Joint/extended 629 46.3

Educational status (n=1351)

Illiterate 336 24.9Informal education 233 17.2Below primary education 42 3.1Primary level 122 9.0Lower secondary level 137 10.1Secondary level 256 18.9Higher secondary 225 16.7

Occupation(n=1222)

Housewife 482 39.4Agriculture 252 20.6Service 70 5.7Business 202 16.5Daily laborer 88 7.2Others 128 10.5

Occupation of spouse (n=1118)

Housewife 224 20.0Agriculture 227 20.3Service 135 12.1Business 177 15.8Daily laborer 161 14.4Foreign employment 126 11.3Others 68 6.1

Has income fulfilled family needs (n=1355)

Yes 832 61.4No 459 33.9

Don’t Know 64 4.7Family member death in last 12 months (n=1370)

Yes 86 6.3

No 1284 93.7*Details on ethnicity is provided in annex section


3.5 Mental disorders among participants aged 18 years and above

The current prevalence of any mental disorders among adult participants was calculated to be 13.2%. Table 6 below gives the status of mental disorders among adults aged 18 years and above. Major depressive disorder (current) was found among 3.4%. Though a total of 5.2% and 13.9% had 3 or more alcoholic drink within 3-hour period or on 3 or more occasion and had non-alcoholic substance in past 12 months respectively; only 3.4% and 7.3% had alcohol use disorder and substance use disorder respectively. Among those with substance use disorder most of them used tobacco and tobacco products. Similarly, current psychotic disorder was present among 1.1%, dissociative conversion disorder among 6.1% and epilepsy among 1% of the participants.

We did not find any cases of anorexia nervosa, bulimia nervosa and hypomanic episode in adults.

Table 6. Status of mental disorders among participants aged 18 years and above

Name of mental disorder (n=1371) Level Frequency (percent)

Any mental morbidity Current 181 (13.2)

Major depressive disorderCurrent 46 (3.4)

Past 61 (4.4)

Manic episodeCurrent 4 (0.3)

Past 3 (0.2)

Panic disorderCurrent 10 (0.7)

Lifetime 29 (2.1)

Agoraphobia Current 8 (0.6)

Social Anxiety Disorder Current 3 (0.2)

Obsessive compulsive disorder Current 4 (0.3)

Post traumatic stress disorder Current 2 (0.1)

Alcohol use disorder

Current 46 (3.4)

Mild 14 (1.0)

Moderate 13 (0.9)

Severe 17 (1.2)

Substance use disorder

Current 100 (7.3)

Mild 35 (2.6)

Moderate 35 (2.6)

Severe 29 (2.1)

Psychotic disorder Current 15 (1.1)

Lifetime 47 (3.4)

General Anxiety disorder Current 19 (1.4)

Antisocial personality disorder Lifetime 3 (0.2)

Dissociative identity disorder Current 20 (1.5)

Somatic symptom disorder Current 59 (4.3)

Conversion disorder Current 19 (1.4)

Dissociative conversion disorder Current 83 (6.1)

Epilepsy Lifetime 14 (1)

3.6 Suicidality among participants aged 18 years and above

Current suicidality was present among 10.9% of adults. Most of the suicidality was low in severity (9.2). Table 7 below gives the status of suicidality among participants aged 18 years and above.


Table 7. Status of suicidality among participants aged 18 years and above

Status of suicidality (n=1371) Level Frequency (percent)

Suicidality

Low 126 (9.2)Moderate 9 (0.7)High 19 (1.4)Current 150 (10.9)Lifetime attempt 5 (0.4)Likely in near future 10 (0.7)

3.7 Help seeking behavior

Among total 325 participants who had any form of mental disorders in past 12 months, 171 i.e. 52.6% talked about their problem with someone and only 69 (21.2%) searched for the treatment followed by only 58 (17.8%) who received complete treatment in last 12 months (Table 8). Among those who talked with someone about their mental health problem, majority of them talked with husband/wife followed by friends and other family members, health workers, dhami jhakri, and jyotist/priest. Among participants who took mental health services from different sources, all of them said that the service was helpful.

The median amount of money spent for the treatment was NPR 39,041 (minimum:0, maximum: 300,000) whereas the median amount of money spent for transportation was NPR 3,000 (minimum:5, maximum: 50,000). Out of the total participants who received complete treatment, 17 (29.3%) were admitted to the hospital.

Table 8. Mental health services received

Variable Level Frequency Percentage

Talked with someone (n=325)

Yes 171 52.6.3

No 153 47.1

Don’t know 1 0.3

Received treatment in last 12 months (n=315)

Yes 58 18.4No 255 81.0Yes but did not complete

2 0.6

Received treatment with (n=45)

Psychiatrist 15 33.3

Doctor 16 35.5

Paramedics 3 6.7

Dhami Jhakri 11 24.4

3.8 Barriers in accessing care

Among the participants who responded to the barriers related questions (n=263) were the ones who either did not receive any treatment or stopped receiving the treatment before completing the treatment. The following table shows 30 items representing the possible barriers to receiving care for these people with mental disorders. The major barriers found during the pretesting were related to attitude of the participants. Some of the them are: people with mental disorders wanting to solve their problem by themselves, thinking that the problem would get better by itself, and not liking to talk about their feelings and emotions with others (Table 9).


Table 9. Barriers in accessing care

SN Barriers Not at all A little Quite a lot A lot NA

1Being unsure where to go for care (n=263)

183 (69.6) 31 (11.8) 29 (11) 20 (7.6) -

2Wanting to solve the problem on my own (n=263)

53 (20.2) 79 (30) 47 (17.9) 84 (31.9) -

3Concern that others might think me weak (n=262)

221 (84.4) 31 (11.8) 7 (2.7) 3 (1.1) -

4Fear of being put in hospital against my will (n=262)

246 (93.9) 11 (4.2) 3 (1.1) 2 (0.8) -

5.Thinking it might harm my chances of getting job (n=261)

242 (92.7) 3 (1.1) 4 (1.5) 2 (0.8) 10 (3.8)

6 Problem with transport (n=261) 229 (87.7) 16 (6.1) 7 (2.7) 8 (3.1) 1 (0.4)

7Thinking the problem would get better by itself (n=263)

73 (27.8) 68 (25.9) 65 (24.7) 57 (21.7) -

8Thinking what my family would think/say/do/feel (n=260)

235 (90.4) 14 (5.4) 6 (2.3 5 (1.9) -

9Feeling embarrassed or ashamed (n=262)

231 (88.2) 26 (9.9) 1 (0.4) 4 (1.5) -

10Preferring to get alternative forms of care (n=262)

243 (92.7) 6 (2.3) 5 (1.9) 7 (2.7) 1 (0.4)

11Not able to afford the financial cost (n=262)

188 (71.8) 28 (10.7) 16 (6.1) 30 (11.5) -

12Concerns that I might be seen as ‘crazy’ (n=262)

250 (95.4) 6 (2.3) 1 (0.4) 5 (1.9) -

13Thinking that professional care would not help (n=262)

219 (83.6) 21 (8.0) 12 (4.6) 10 (3.8) -

14Concern that I might be seen as a bad parent (n=261)

235 (90.0) 17 (6.5) 4 (1.5) 1 (0.4) 4 (1.5)

15Professional from my ethnic group not available (n=261)

242 (92.7) 14 (5.4) 2 (0.8) 3 (1.1) -

16Being too unwell to ask for help (n=261)

247 (94.6) 7 (2.7) 3(1.1) 4 (1.5) -

17Concerns that people I know might find out (n=261)

242 (92.7) 13 (5.0) 2 (0.8) 4 (1.5) -

18Not like to talk about my feelings and emotions (n=261)

170 (65.1) 40 (15.3) 24 (9.2) 26 (10.0) 1 (0.4)

19Concerns that people might not take me seriously (n=261)

248 (95.0) 7 (2.7) 4 (1.5) 2 (0.8) -

20Concerns about the side effects of treatment (n=261)

250 (95.8) 10 (3.8) 1 (0.4) - -

21Didn’t want these problems to be recorded (n=261)

254 (97.3) 4 (1.5) 3 (1.1) - -

22Bad experiences with mental health care (n=262)

247 (94.3) 9 (3.4) 4 (1.5) 2 (0.8) -


23Preferring to get help from family/friends (n=261)

215 (82.4) 26 (10.0) 12 (4.6) 8 (3.1) -

24Concerns about children (loosing custody etc.) (n=261)

240 (92.0) 12 (4.6) 5 (1.9) 3 (1.1) 1 (0.4)

25Thinking I did not have problem (n=261)

96 (36.8) 65 (24.9) 26 (10.0) 74 (28.4) -

26Concerns about what friends might think/say/do (n=261)

244 (93.5) 9 (3.4) 3 (1.1) 5 (1.9) -

27Difficulty taking time off work (n=261)

225 (86.2) 26 (10.0) 3 (1.1) 7 (2.7) -

28Concerns about what people at work might think, say or do (n=261)

247 (94.6) 11 (4.2) 3 (1.1) - -

29Problems with childcare while I receive care (n=261)

239 (91.6) 16 (6.1) 2 (0.8) 3 (1.1) 1 (0.4)

30Having no one who could help me get care (n=261)

221 (84.7) 14 (5.4) 13 (5.0) 13 (5.0) -

*the numbers in the parenthesis are percentages

3.9 Other experiences

The research team also collected different experiences from the field that could be helpful in successful conduction of national level survey. We also created a list of local names for some technical terms in the questionnaire that will be utilized in the national level survey. For example local terai name for ‘atmahatya’ (suicide) was identified as ‘khudkhushi’, ‘nidra’ (sleep) as ‘neend’, ‘ausadhi’ (medicine) as ‘dabai’, ‘upachaar’ (treatment) as ‘ilaaj’ etc. Questions that were difficult to administer to the participants were marked for revision. We also identified questioned that the particpants were not willing to answer. We also realized that some of the questions in the 30-item BACE module were found to be assessing the similar constructs and those may be removed in the final questionnaire. We also realized that for administering some disorders such as alcohol use disorder and substance use disorder due care should be taken so that the participant will not be affected by the external influencing factors such as presence of other members during the interview. This survey also enhanced the capacity of the field level enumerators in local level coordination, social mapping, rapport building with the participants and administering the tools.

Some of the management/administrative problems were: difficult geography and problem in transportation, difficulty in coordinating due to lack of mobile phone network, some participants had expectation of rewards (cash/kind) for being involved in the study etc. All these experiences helped the research team to gather insights regarding the technical and feasibility related aspects that need to be worked on further for the national level survey.


The analysis of data from 1647 participants (1371 adults above 17 years, 276 adolescents aged 13-17 years) showed the current prevalence of any form of mental disorders to be 12.9% which was 11.2% among 13-17-year-olds and 13.2% among those aged 17 years and above. A total of 21% of adult participants with mental disorders sought for the treatment of their disorders in last 12 months whereas around 18% received the complete treatment. Among those who did not seek any treatment for their mental disorders, majority wanted to solve their problem on their own. There were also knowledge related barriers that prevented the participants with mental disorders in receiving the appropriate treatment. The findings from the pilot survey on current prevalence of mental disorders can be utilized for estimating the sample size for the large-scale survey.

From the experiences of the pilot survey the research team has realized that the national level mental health survey is feasible. We also identified the technical and management related aspects that the research team needs to work on for the effective and successful conduction of the national mental health survey. For example, we realized the need of providing more comprehensive training to the FDCs and field supervisors. Similarly, the analysis of time required for the field level coordination, local level transportation, average time of completion of interview, non response rate etc in the pilot survey will help us to estimate the time, cost and human resource required for the national mental health survey. The pilot survey also helped us in refining our tools and making it fit more in the local context. For example we realized that, for making the interview effective we need to add the bridging sentences before transitioning from one module to another. Similarly, we could also prepare a list of local names for some terminology in the questionnaire. This will be included in the final questionnaire in the national level survey.

Based on the experiences from the pilot survey, we recommend that for the national mental health survey, the tools should be refined after incorporating the feedback received from the FDCs and supervisors in the pilot survey. Similarly, comprehensive practice based training, including interviews with the real patients should be provided to the FDCs and supervisors before moving to the field for data collection. There were some disorders for which we did not find any cases during the pilot survey. This should be further discussed among the experts and the possible reasons for the results should be analyzed. We also recommend that providing the participants with leaflet or pamphlets with basic information about mental disorders, common symptoms, and their management along with the contact details of the nearby mental health service provider will be helpful for the participants. We also recommend that adequate time should be given for the effective coordination in the local level including coordination with the female community health volunteers.

CHAPTER 4

CONCLUSION AND RECOMMENDATIONS


REFERENCES1. World Health Organization, Promoting mental health: Concepts, emerging evidence, practice: Summary

report. 2004.

2. Patel, V., et al., Mental health of young people: a global public-health challenge. The Lancet, 2007. 369(9569): p. 1302-1313.

3. Dahal, S., M.H. Swahn, and M.J. Hayat, Association between neighborhood conditions and mental disorders among children in the US: evidence from the National Survey of Children’s Health 2011/12. Psychiatry journal, 2018. 2018.

4. Whiteford, H.A., et al., The global burden of mental, neurological and substance use disorders: an analysis from the Global Burden of Disease Study 2010. PloS one, 2015. 10(2): p. e0116820.

5. World Health Organization, The World health report: 2004: changing history. 2004.

6. Demyttenaere, K., et al., Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Jama, 2004. 291(21): p. 2581-2590.

7. Kohn, R., et al., The treatment gap in mental health care. Bulletin of the World health Organization, 2004. 82(11): p. 858-866.

8. Luitel, N.P., et al., Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal. PloS one, 2017. 12(8): p. e0183223.

9. WHO, Mental health atlas. 2011.

10. Verhulst, F.C., et al., Comparisons of problems reported by youths from seven countries. American Journal of Psychiatry, 2003. 160(8): p. 1479-1485.

11. Shrestha DM, A survey of Kathmandu Valley. Cited in: Wright C (1988) community mental health service in Nepal early experiences (Proceedings of the workshop on National Mental Health Planning) Kathmandu, Dec 30, 1987-Jan 1,1988.

12. KD Upadhyaya and K Pol, A mental health prevalence survey in two developing towns of western region. Journal of Nepal Medical Association, 2003. 42: p. 328-330.

13. Multisectoral Action Plan for the Prevention and Control of Non Communicable Diseases ( 2014-2020 ) 2014, Government of Nepal: World Health Organization Country Office for Nepal.

14. Marahatta, K., et al., Suicide burden and prevention in Nepal: the need for a national strategy. WHO South-East Asia journal of public health, 2017. 6(1): p. 45.

15. Kohrt, B.A., et al., Political violence and mental health in Nepal: prospective study. The British Journal of Psychiatry, 2012. 201(4): p. 268-275.

16. Risal, A., et al., Anxiety and depression in Nepal: prevalence, comorbidity and associations. BMC psychiatry, 2016. 16(1): p. 102.

17. Tol, W.A., et al., Political violence and mental health: a multi-disciplinary review of the literature on Nepal. Social science & medicine, 2010. 70(1): p. 35-44.

18. Kane, J.C., et al., Mental health and psychosocial problems in the aftermath of the Nepal earthquakes: findings from a representative cluster sample survey. Epidemiology and psychiatric sciences, 2018. 27(3): p. 301-310.

19. Whiteford, H.A., et al., Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet, 2013. 382(9904): p. 1575-1586.

20. Sawyer, M.G., et al., The mental health of young people in Australia: key findings from the child and adolescent component of the national survey of mental health and well-being. Australian & New Zealand Journal of Psychiatry, 2001. 35(6): p. 806-814.


21. Merikangas, K.R., et al., Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 2010. 49(10): p. 980-989.

22. Alonso, J., et al., Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta psychiatrica scandinavica, 2004. 109(s420): p. 21-27.

23. Noorbala, A., et al., Mental health survey of the adult population in Iran. The British Journal of Psychiatry, 2004. 184(1): p. 70-73.

24. Murthy, R.S., National mental health survey of India 2015–2016. Indian journal of psychiatry, 2017. 59(1): p. 21.

25. Karam, E.G., et al., Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey. The Lancet, 2006. 367(9515): p. 1000-1006.

26. A report on post disaster needs assessment and recovery plan of health and population sector. 2015, Health and population sector.

27. Benfleld, A., Nepal earthquake event recap report 2015.

28. Kessler, R.C., Psychiatric epidemiology: selected recent advances and future directions. Bulletin of the World health Organization, 2000. 78(4): p. 464-474.

29. Alwan, A., Global status report on noncommunicable diseases 2010. 2011: World Health Organization.

30. The World Mental Health Survey Initiative. WMH Cross National Sample. 2015 [cited 2019 21 February 2019]; Available from: https://www.hcp.med.harvard.edu/wmh/national_sample.php.

31. CBS, National Population and Housing Census 2011. 2012, Government of Nepal, National Planning Commission Secretariat, Central Bureau of Statistics: Kathmandu.

32. Harm Research Institute. Mini International Neuropsychiatric Interview (MINI) 7.0.2. 2018 2019/02/21]; Available from: http://harmresearch.org/index.php/product/mini-international-neuropsychiatric-interview-mini-7-0-2-2/

33. Clement, S., et al., Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. 2012. 12(1): p. 36.

34. Brislin, R.W., Research instruments. Field methods in cross-cultural research, 1986. 8: p. 137-164.

35. Kohrt, B.A., et al., Detection of depression in low resource settings: validation of the Patient Health Questionnaire (PHQ-9) and cultural concepts of distress in Nepal. BMC psychiatry, 2016. 16(1): p. 58.

36. Kohrt, B.A., et al., Validation of cross-cultural child mental health and psychosocial research instruments: adapting the Depression Self-Rating Scale and Child PTSD Symptom Scale in Nepal. BMC psychiatry, 2011. 11(1): p. 127.

37. Van Ommeren, M., et al., Preparing instruments for transcultural research: use of the translation monitoring form with Nepali-speaking Bhutanese refugees. Transcultural Psychiatry, 1999. 36(3): p. 285-301.


ANNEXUREANNEX I: Informed consent form

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cfb/0fLo ;xefuL…………………………………………

k[i7e'dL / p2]Zo

g]kfn :jf:Yo cg';Gwfg kl/ifb\ -:jf:Yo dGqfno_ af6 /fli6«o dg;+u ;DalGwt ;d:ofsf] cf/lDes ;j]{If0f x'g uO{/x]sf] 5 . g]kfndf dg;+u ;DalGwt :jf:Yo cj:yf kQf nufpg' g}s o; cg';Gwfgsf] p2]Zo xf] . o; cg';Gwfgn] g]kfn :jf:Yo cg';Gwfg kl/ifb, g]kfnsf] cfrf/ ;+lxtf ;ldltaf6 :jLs[lt k|fKt u/]sf] 5 . of] ;j]{If0f g]kfn :jf:Yo cg';Gwfg kl/ifb -:jf:Yo dGqfno_ af6 tflnd k|fKt :jf:YosdL{÷tYofÎ

;+snsx?åf/f ;~rfng ul/g]5 . tkfO{ o; ;e{]df randomly 5gf}6 x'g'ePsf] 5 . To;}n] tkfO{nfO{ o; ;e{]df ;xefuL x'gsf nflu cg'/f]w 5 .

uf]klgotf tkfOF{n] lbPsf tYofÍx? uf]Kotfsf ;fy o; cg';Gwfgdf dfq k|of]u ul/g]5 . tkfO{sf] gfd, 7]ufgf tyf cGo JolQmut ljj/0fx? o; k|ZgfjnLaf6 x6fO{ tkfO{Fsf] kl/rofTds sf]8 dfq k|of]u ul/g]5 . tkfO{nfO{ o; ;e{]If0fsf k|ltlglwn] cfjZos k/]sf] v08df ;e{]sf] ;dfofjwL e/ s'g} klg ;dodf e]6\g cfpg ;Sg]5g\ .

;xefuLtf o; ;e{]df tkfO{sf] :j]lR5s ;xefuLtf x'g]5 . tkfO{Fn] rfx]sf] v08df jf s'g} klg j]nf o; ;j]{If0faf6 cnlUug ;Sg' x'g]5 . o;/L cnlUug' eof] eg] klg tkfO{nfO{ s'g} Iflt x'g] 5}g, tkfOF{n] s'g} xhf{gf ltg'{ kg]{ 5}g, tyf cGo s'g} klg c;/ kg]{ 5}g . tkfO{nfO{ o; ;e{]sf] af/]df s'g} klg s'/fsf] lh1f;f ePdf h'g;'s} j]nfdf klg ;e{] 6f]nLnfO{ /fVg ;Sg'x'g]5 . cg';Gwfgsf] ;DaGwdf yk hfgsf/Lsf nflug]kfn :jf:Yo cg';Gwfg kl/ifb /fdzfx ky 6]lnkmf]g g+= )!–$@%$@@) df ;Dks{ /fVg ;Sg'x'g]5 jf o;cg';Gwfgsf cg';Gwfgstf{ 8f=d]3gfy lwdfnnfO{ (*%!!^&!(* df jf ;'ifdf bfxfnnfO{ (*$)$%^%(@ df jf :j]tf nfenfO{ (*^)!)%)!* df ;Dks{ ug{ ;Sg'x'g]5 .......................................................................................................

;xefuLsf] kl/ro gDa/ M

lnlvt dGh'/Lgfdf kq

dnfO{ o; ;j]{If0fsf] p2]Zo / cfwf/, cGt/jftf{ k|lqmof, cfkm\gf] el'dsfsf] af/]df k'"0f{ hfgsf/L 5 . lbO{Psf] hfgsf/Ldf d ;Gt'i6 5' . dnfO{ d]/f] :j]R5fn] s'g} klg a]nf of] cg';Gwfgaf6 cnu x'g ;Sg] s'/f hfgsf/L 5 . d}n] of] hfgsf/L kq cfkm}+n] k9]sf] -======_ jf cGtjftf{stf{n] k9]/ ;'gfP/ -=====_ hfgsf/L u/fpg'ePsf] 5 .

x:tfIf/ : d ;e{]df ;xefuL x'gsf nflu dGh'/ 5' .

cGt/jftf{ lng]sf] gfdy/ ==================================== cGt/jftf{ lng]sf] ;lx5fk====================================== ldlt ==================================================================

cGt/jftf{ lbg]sf] gfd y/ ============================cGt/jftf{ lbg]sf] ;lx5fk ============================ ldlt ==============================


ANNEX II: Informed assent form

g]kfn :jf:Yo cg';Gwfg kl/ifb/fdzfxky, sf7df08f}F

k|ZgfjnLsf] nfuL ;'rgf kmf/d tyf ;xdlt kq -gfafnssf] nflu_

cWoogsf] ljifo: dfgl;s :jf:Yo cj:yf g]kfn, cf/lDes ;j]{If0f

cfb/0fLo cleefjs…………………………………………

k[i7e'dL / p2]Zo

g]kfn :jf:Yo cg';Gwfg kl/ifb\ -:jf:Yo dGqfno_ af6 dfgl;s :jf:Yo cj:yfsf] cf/lDes ;j]{If0f x'g uO{/x]sf] 5 . g]kfndf dfgl;s :jf:Yo cj:yf kQf nufpg' g} o; cg';Gwfgsf] p2]Zo xf] . o; cg';Gwfgn] g]kfn :jf:Yo cg';Gwfg kl/ifb, g]kfnsf] cfrf/ ;+lxtf ;ldltaf6 :jLs[lt k|fKt u/]sf] 5 . of] ;j]{If0f g]kfn :jf:Yo cg';Gwfg kl/ifb -:jf:Yo dGqfno_ af6 tflnd k|fKt :jf:YosdL{÷ tYofÎ ;+snsx?åf/f ;~rfng

ul/g]5 . tkfO{sf] aRrf -!#–!& jif{ pd]/sf_ o; ;e{]df randomly 5gf}6 x'g'ePsf] 5 . To;}n] tkfO{nfO{ o; ;e{]df ;xefuL x'gsf nflu cg'/f]w 5 .

uf]klgotf tkfOF{n] lbPsf tYofÍx? uf]Kotfsf ;fy o; cg';Gwfgdf dfq k|of]u ul/g]5 . tkfO{sf] gfd, 7]ufgf tyf cGoJolQmut ljj/0fx? o; k|ZgfjnLaf6 x6fO{ tkfO{Fsf] kl/rofTds sf]8 dfq k|of]u ul/g]5 . tkfO{nfO{ o; ;e{]If0fsf k|ltlglwn] cfjZos k/]sf] v08df ;e{]sf] ;dfofjwL e/ s'g} klg ;dodf e]6g cfpg ;Sg]5g\ .

;xefuLtf o; ;e{]df tkfO{sf] :j]lR5s ;xefuLtf x'g]5 . tkfO{Fn] rfx]sf] v08df jf s'g} klg j]nf o; ;j]{If0faf6 cnlUug ;Sg' x'g]5 . o;/L cnlUug' eof] eg] klg tkfO{nfO{ s'g} Iflt x'g] 5}g, tkfOF{n] s'g} xhf{gf ltg'{ kg]{ 5}g, tyf cGo s'g} klg c;/ kg]{ 5}g . tkfO{nfO{ o; ;e{]sf] af/]df s'g} klg s'/fsf] lh1f;f ePdf h'g;'s} j]nfdf klg ;e{] 6f]nLnfO{ /fVg ;Sg'x'g]5 . cg';Gwfgsf] ;DaGwdf yk hfgsf/Lsf nflu g]kfn :jf:Yo cg';Gwfg kl/ifb, /fdzfxky 6]lnkmf]g g+= )!–$@%$@@) df ;Dks{ /fVg ;Sg'x'g]5 jf o; cg';Gwfgsf cg';Gwfgstf{ 8f=d]3gfy lwdfnnfO{ (*%!!^&!(*, ;'ifdf bfxfnnfO{ (*$)$%^%(@jf :j]tf nfenfO{ (*^)!)%)!* df ;Dks{ ug{ ;Sg'x'g]5 .......................................................................................................

lnlvt dGh'/Lgfdf kqcleefjssf] ?kdf

4 dnfO{ o; ;j]{If0fsf] p2]Zo / cfwf/, cGt/jftf{ k|lqmof, cfkm\gf] el'dsfsf] af/]df k'"0f{ hfgsf/L 5 . lbO{Psf] hfgsf/Ldf d ;Gt'i6 5' .

4 dnfO{ d]/f] :j]R5fn] s'g} klg a]nf of] cg';Gwfgaf6 cnu x'g ;Sg] s'/f hfgsf/L 5 . d}n] of] hfgsf/L kq cfkm}+n] k9]sf] -======_ jf cGtjftf{stf{n] k9]/ ;'gfP/ -=====_ hfgsf/L u/fpg' ePsf] 5 .

4 o; sfo{s|ddf ;xefuL x'g] d]/f] ;+/IfsTjdf /x]sf] afns÷aflnsf sf] tkm{af6 d}n] :jLs[tL lbPsf] ePtfklg s'g} klg

avt o; sfo{s|d kl/Tofu ug{ kfpg] d]/f] clwsf/sf] af/]df d ;'lrt 5' .;xefuLsf] kl/ro gDa/ M

x:tfIf/ : d]/f] ;+/IfsTjdf /x]sf] afns÷aflnsfnfO{ ;e{]df ;xefuL x'gsf nflu dGh'/ 5' .

cleefjssf] gfd y/============================cleefjssf] ;lx5fk =========================== ldlt ==============================

gfafnssf] gfd y/================================ldlt ================================

ANNEX III: Questionnaire for adult participants;fdfGo k|ZgfjnL M

k|.g+. k|Zgx? k|ltls|ofx? k|Zg ;f]Wg 5f8\g] / csf]{ k|Zgdf hfg]

!= ;fdfGo k|Zgx? M1.1 cGt{jftf{sf] ldtL lbg/ dlxgf / jif{

..…/…….../……..

1.2 lhNnfsf] gfd / sf]8 ………………..….……( sf]8………….….)

1.3 gUf/kflnsf/UffpF kflnsf sf] gfd / sf]8 …………………...……( sf]8………….….)

1.4 Jf8f g+=

1.5 k|ZgsTff{sf]gfd / x:TffIf/ gfd ………….………….

x:TffIf/………….……….

1.6 cGt{jftf{ Zf'? EfPsf] / :fdfKTf EfPsf]] :fdo

1.7 cGt{jftf{sf] Kfl/0ffd cGt{jftf{ k'/f eof]…………………….…01

cGt{jftf{ cf+lZfs ?kDff k'/f eof]…..02

s'g} k|ltls|ofx? 5}gg\…………….…....03

1.8 :f'k/EffO{h/sf] gfd / x:TffIf/ gfd ………….………….

x:TffIf/………….……….

@= pQ/bftfsf] hg;f+Ëlvs tyf ;fdflhs ljj/0fM2.1 gfd -clgjfo{ 5}g_

2.2 pd]/ (pd]/ k'/f ePsf] jif{) ………………….. jif{

2.3 j}jflxs l:YflTf cljjflxt ………………………………..……...01

ljjflxt …………………………………..………02

ljwjf ………………………………………….….03

;DaGw ljR5]b ePsf]/cnlUuP/ a;]sf]…..04

cGo (pNn]v ug{'xf];\)………………………..…..05

2.8

2.4 lnË k'?if ………………01

dlxnf …………...02

cGo …………….…03

2.6

2.5 slt k6s ue{jtL x'g'eof] / ue{jtL k'/f ePsf] xfnsf] dlxgf -ue{jtL 5 eg]_ stL xf] <

ue{jtL ePsf] k6s…………………………….

k'/f ePsf] dlxgf………………….…………....

2.6 clGtd aRrfsf] pd]/ …………………. jif{ …………………. dlxgf


2.7 5f]/f–5f]/Lsf] ;+Vof -lhljt_ 5f]/f ……………………………hgf

5f]/L …………………………..hgf

cGo …………………….……..hgf

2.8 WfDf{ lxGb' ……………………………………...01

O{;fO{ ………………………………..…...02

O{;nfd ……………………………….…..03

af}¢ wdf{jnDaL ………………..…….….04

cGo (pNn]v ug{'xf];\)…………..….…….05

2.9 pQ/bftfsf] hftL bnLt…………………………………..………..…01

lk5l8Psf hghftL ………………………..…….02

lk5l8Psf] t/fO{ hftL (bnLtafx]s)…………..03

wfld{s cNk;+Vos …………….…………......…04

t'ngfTds ?kdf kmfObfdf k/]sf hghftL…....05

dflyNnf] hflto ;d'x ……….……………….….06

2.10 Kfl/jf/sf] ls;LDf Psn …….…………………………………..……01

;+o'Qm/lj:tfl/t …………………………..…….02

2.11 Kfl/jf/sf] ;+Vof …………………. hgf

2.12 Kfl/jf/df !#–!& jif{ pd]/sf ;b:ox?sf] ;+Vof

…………………. hgf

2.13 pQ/bftfsf] z}lIfs of]Uotf clzlIft ………………………….…….………….01

cgf}krfl/s lzIff …………...................02

k|fylds lzIff eGbf sd ………………….….…03

k|fylds tx ……………………………….….…04

lgDg dfWolds (^-*)……………….……...…..05

dfWolds ((-!))………………………..……….06

pRr dfWolds / dfly………………….………..07

2.14 a'afsf] z}lIfs of]Uotf-cljjflxtsf] nfuL_ clzlIft …………………………….…..…..…...01

cgf}krfl/s lzIff …………...................02

k|fylds lzIff eGbf sd …………………..……03

k|fylds tx ……………….…................…04

lgDg dfWolds (^-*)……………………….……05

dfWolds ((-!))………………………………...06

pRr dfWolds / dfly……….………………..…07


2.15 cfdfsf] z}lIfs of]Uotf -cljjflxtsf] nfuL_ clzlIft …………………………………….….….01

cgf}krfl/s lzIff ………….......................02

k|fylds lzIff eGbf sd ………………………..03

k|fylds tx ……………….………………….....04

lgDg dfWolds (^-*)…………………………….05

dfWolds ((-!))…………………………….……06

pRr dfWolds/ dfly………………………...…07

2.16 klt÷kTgLsf] z}lIfs of]Uotf -ljjflxtsf] nfuL_ clzlIft …………………………………….….….01

cgf}krfl/s lzIff …………...................02

k|fylds lzIff eGbf sd ………………………..03

k|fylds tx ……………….………………….....04

lgDg dfWolds (^-*)…………………………….05

dfWolds ((-!))…………………………….……06

pRr dfWolds / dfly………………………...…07

2.17 pQ/bfTffsf] k]zf u[lx0fL …..………………………………….….…...01

s[lif ……………………………………………..…..02

;]jf …………………………………….…..……….03

Jofkf/ …………………………………….…..…….04

b}lgs sfdbf/…………………….………………….05

cGo (pNn]v ug{'xf];\)………………….…..….06

2.18 cfdfsf] k]zf -cljjflxtsf] nfuL_ u[lx0fL …..………………………………….….…...01

s[lif ………………………………………..…..…..02

;]jf …………………………………….…..……….03

Jofkf/ …………………………………….…..…….04

b}lgs sfdbf/…………………….………………….05

cGo (pNn]v ug{'xf];\)………………….…..….06

2.19 a'afsf] k]zf -cljjflxtsf] nfuL_ s[lif ……………….……………………….….…….01

;]jf ……………………………………………..…..02

Jofkf/ ………………………………….…………….03

b}lgs sfdbf/…………………………….………….04

cGo (pNn]v ug{'xf];\)…………………….…….05

2.20 klt÷kTgLsf] k]zf -ljjflxtsf] nfuL_ u[lx0fL …..………………………………….….…...01

s[lif ………………………………………..…..…..02

;]jf …………………………………….…..……….03

Jofkf/ …………………………………….…..…….04

b}lgs sfdbf/…………………….………………….05

cGo (pNn]v ug{'xf];\)………………….…..….06

2.21 kl/jf/sf] dfl;s cfDbfgL (g].?.) g].?.…………………………………

yfxf 5}g….………..……………..

2.22 tkfO{sf] dfl;s cfDbfgLn] kl/jf/sf] xfnsf cfwf/e't cfjZostfx? -ufF;, af;, skf;, :jf:Yo_ k'u]sf]] 5 h:tf] nfU5 <

nfU5 ….……….………….…………………...……..01

nfUb}g ….…………………………….……….……...02

yfxf 5}g….………..………………………………....03

2.22.1 lgDg ;'ljwfx?df tkfO{sf] 3/kl/jf/df pknAw 5g\ <

vfgf ksfpg] O{Gwg -uf]a/ Uof;,Uof; r'nf]_…..01

pko'Qm af;:yfg ….……….……………….……...02

lah'ln / ;f]nf/….…………………….….……...03

vfg]kfgL….…………………………………….……...04

/]l8of] ….……….…………………………….……...05

6]lnkmf]]g÷df]afO{n ….………………………….…...06

6L.eL. ….……….……………………………....07

;fO{sn ….…….………………..…………….....08

df]6/;fO{sn ….………………………….….……...09

2.23 uPsf] !@ dlxgfdf, tkfO{sf] kl/jf/df s;}sf] lgwg ePsf] lyof] <

lyof] ….……….……...01

lyPg ….……………..02

yfxf 5}g ….………...03

2.23.1

2.23.1 olb lyof] eg], slt jif{sf] pd]/df lgwg ePsf] lyof] <

...............................jif{

2.23.2 pQm JolQm;Fu tkfO{sf] gftf s] lyof] < ...............................

2.23.3 pxfsf] lgwgsf] d'Vo sf/0f s] lyof] < ...............................


M.I.N.I. k|Zgx? ;DalGw ;fdfGo lgb]{zgx?

cGt{jftf{ M

cGt{jftf{nfO{ hlt ;Sbf] 5f]6f] /fVg, pQ/bftfnfO{ tkfO{n] Ufg]{ cGt{jftf{df ;f]lwg] dgf]Jf}¡fflgs ;d:of ;DalGwk|Zgx?sf] pQ/ …5Ú jf …5}gÚ df cfpg] vfnsf 5g\ Efg]/ hfgsf/L lbg'xf];\ .

;fdfGo 9fFRff M

= M.I.N.I.nfO{ ljleGg 8foUgf]i6Ls df]8\o'Nfdf ljeflhTf Ufl/Psf] 5, Hf'Gf c+u|]hL cIf/x? -A-Z_ af6 klxrfg Ufg{ ;lsG5 .

= x/]s 8foUgf]i6Ls df]8\o'nsf] ;'?jftdf -s8f lsl;dsf] dfgl;s /f]u-;fO{sf]l6s l8:c8{/_afx]s _, /f]usf] d'Vo dfkb08sf] l:s|lgËk|Zg -x?_v}/f] /Ësf] aS;df lbOPsf 5g\ .

= x/]sdf]8\o'nsf] cGTodf, 8foUgf]i6LsaS;-x?_ n] k|Zgstf{nfO{ 8foUgf]i6Ls dfkb08 k'/f eof] jf ePg eg]/ ;+s]t ug]{ cg'dlt lbG5 .

d"Nofª\sg lgb]{zgx? M

;a} k|Zgsf] d"Nofª\sg ug'{kb{5 . k|To]s k|Zgsf] bflxg] kl§ …5Ú jf …5}gÚ df, uf]nf] 3]/f nufP/ d"Nofª\sg ul/G5 . k|ltls|of sf]8 ug{nfO{, k|Zgstf{n] g}bflgs lg0f{o (Clinical Judgement) k|of]u ug'{k5{ . k|Zg ;f]Wbf / k|ltls|of d"Nofªsg ug{, k|Zgstf{ ;f+:s[lts ?kdf ;+j]bglzn x'g'kb{5 . ;lx sf]l8ª ug{nfO{ ,cfjZostf cg';f/ pQ/bftfnfO{ pbfx/0fx? ;f]Wg'k5{ . pQ/bftfnfO{ ga'l´Psf÷:ki6 gePsf s'g} klg k|Zgx? ;f]Wg k|f]T;fxg ug'{xf];\ .

k|Zgstf{ lglZrt x'g'k5{ ls k|To]s k|Zgsf ulx/fOx?, pQ/bftfn] k|i6;+u a'´]sf] x'g'kb{5 -h:t}M ;do ;Ldf, cfj[[lQ÷af/Da/tf, ulDe/tf, /÷jf ljsNkx?_ .

zf/Ll/s sf/0f jf dlb/f ;]jg jf nfu"cf}iflwsf] ;]jgn] ubf{ x'g] nIf0fx?nfO{ M.I.N.I. df …5Úsf]8 ug'{x'b}g . M.I.N.I. df o:tf ;d:ofx? kQf nufpg] k|Zgx? 5g\ .

cGo lgb]{zgx? M

= 8foUgf]i6Ls dfkb08sf] d"Nofª\sgnfO{ u'0f:tl/o agfpg …;fdfGo lnlkÚ df n]lVfPsf JffSox?, n]lVfP cg';f/ g} k9\g'kb{5 .

= …af]N8Ú df n]lvPsf JffSox?, k|Zgstf{nfO{ lgb]{zg xf], / of] pQ/bftf ;dIf k9\g'kb}{g .

= …cG8/nfOgÚ ePsf jfSox?n] ;do ;Ldf hgfpFb5 . k|Zgstf{n] of]] w]/} h;f] cfjZostf cg';f/ k9\g'kb{5 .:sf]/sf] lx;fa ug{, lbO{Psf] ;dofjlwdf b]lvPsf nIf0fx? dfq ;dfj]z ug'{kb{5 .

= dfly …P/f]Ú - _ ePsf pQ/x?n], 8foUgf]l;;sf] s'g} Ps dfkb08 k'/f gePsf] hgfpFb5 . o:tf] dfdnfdf, k|Zgstf{ df]8\o'nsf] cGTolt/ hfg'kb{5, …5}gÚdf uf]nf] nufpg'k5{ / csf]{ df]8\o'ndf hfg'kb{5 .

= olb …:nof;n]Ú -÷_ 5'6\ofOPsf zAbx? 5g\ eg], pQ/bftfn] a'´g] nIf0fx? dfq k9\g'kb5{ .

= …sf]i7sf] jfSof+zx?Ú, nIf0fx?sf] g}bflgs pbfx/0f x'g\ . oL k|ZgnfO{ :ki6 kfg{, pQ/bftf;dIf k9\g'kb{5 .

A. Major depressive episode

(pbfl;gtfsf] /f]u)

- sf] dtna – lgbfgsf] aS;df-8foUgf]i6LsaS;_hfg], …5}gÚdf 3]/f nufpg], / csf{]df]8\o'ndf hfg] ._

sltko dfG5]nfO{ @ xKtf ;Dd, w]/} h;f] ;do, nueu x/]s lbg pbf;, jf b'lv, lg/fz, jf vfnLkg dx;'; x'g] ub{5,========

A1a. s] tkfO{n] lhjgdf slxNo} @ xKtf ;Dd, w]/} h;f] ;do, nueu x/]s lbg pbf; jf b'lv, lg/fz jf vfnLkg (z"Gotf_ dx;'; ug'{ePsf] lyof] < olb …5}gÚ eg], A1b df …5}gÚ df lrGx nufpg'xf];, …5Ú eg], ;f]Wg'xf];\ M

b. uPsf] @ xKtfdf, s] tkfO{n] w]/} h;f] ;do nueu x/]s lbg, pbf; jf b'lv, lg/fz jf vfnLkg dx;'; ug'{ePsf] lyof] <

A2a. s] tkfO{n] lhjgdf slxNo} @ xKtf ;Dd, w]/} h;f] ;do, w]/} h;f] sfd÷s'/fx?df klxn] eGbf sd OR5f÷?rL nfUg] cyjf klxn] cfkm' /dfpg] u/]sf] sfd s'/fdf /dfpg g;s]sf] dx;'; ug'{ePsf] lyof] < olb …5}gÚ eg], A2b df …5}gÚ df lrGx nufpg'xf];, …5Ú eg], ;f]Wg'xf];\ M

b. uPsf] @ xKtfdf, s] tkfO{n] w]/} h;f] ;do, w]/} h;f] sfd÷s'/fx?df klxn] eGbf sd OR5f÷?rL nfUg] cyjf klxn] cfkm' /dfpg] u/]sf] sfd s'/fdf /dfpg g;s]sf] dx;'; ug'{ePsf] lyof] <

s] A1a cyjf A2adf …5Ú df lrGx nfu]sf] 5 <

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

olb A1b cyjf A2b=…5Ú eg] M xfnsf] / ljutdf ;a}eGbf w]/} nIf0f b]lvPsf] cjlwsf] af/]df lj:t[t hfgsf/L lng'xf];\, cGoyf

olb A1b / A2b =…5}gÚ eg] M ljutdf ;a}}}eGbf w]/} nIf0f b]lvPsf]] cjlwsf] dfq lj:t[t hfgsf/L lng'xf];\ M

A3. tkfO{n] pbf; jf ?rL gePsf] dxz'; u/]sf] Tof] b'O{ xKtfsf] cjwLdf M ljutsf] @ xKtf ljutsf] cjlw

a. s] tkfO{sf] vfgfdf ?rL nueu x/]s lbg a9]sf] jf 36]sf] lyof] < s] tkfO{n] cfkm}n] k|of; gubf{ gub{} klg tkfO{sf] tf}n a9]sf] jf 36]sf] lyof] <

-h:t} M z/L/sf] tf}nsf] ±%Ü n] cyjf Ps dlxgfdf &) lsnf]sf] dfG5]sf] nflu ±#=% lsnf] n] _ s'g} Psdf 5 eg], …5Ú sf]8 ug'{xf];\.

b. s] tkfO{nfO{ nueu x/]s /ft lgGb|fdf -lgGbdf_ ;d:of ePsf] lyof] < -lgGb|f÷ lgGb_ kg{ ufx|f] x'g], dWo/ftdf÷cfwf/ftdf Ao'lemg], laxfg l5§} Ao'lemg], cyjf Psbd w]/} ;'Tg] ;d:of ._

c. s] tkfO{n] nueu x/]s lbg ;fdfGo eGbf w]/} ;':t rNg]÷af]Ng] -lx88'n÷sfdsfh jf af]lnrfln_ ug'{ePsf] cyjf 56k6L dx;'; ug'{ePsf] lyof]] cyjf Ps} 7fpFdf a:g'df ;d:of ePsf] lyof] < s] s;}n] of] s'/f Vofn÷ofb u/]sf] jf eg]sf] lyof]] <

d. s] tkfO{n] nueu x/]s lbg ylst jf sdhf]/ ePsf] dx;'; ug'{ePsf] lyof] <

e. s] tkfO{n] nueu x/]s lbg cfkm' d'Nolxg -a]sf/÷cy{lxg_ jf bf]ifL ePsf]

dx;'; ug'{ePsf] lyof] < olb …5Ú eg], pbfx/0fx? ;f]Wg'xf];\ .

lgDg lsl;dsf] e|d 5 ls x]g'{xf]; M

c;kmtfsf], ckof{Tttfsf], bf]ifsf] jf ;hfosf] cfjZostfsf] jf /f]u jf d[To'sf] jf z"Gotf (nihilistic) jf zf/Ll/s e|d (somatic delusion).

oL pbfx/0fx? e|fds ljrf/;Fu ldNb5g\ M

xfnsf] cjlw M 5}g 5

ljutsf] cjlw M 5}g 5

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

f. s] tkfO{nfO{ k|foh;f] x/]s lbg Wofg lbg -Psfu| x'g_, ;f]Rg jf lg0f{o

lng ufx|f] ePsf] lyof] <

g. s] tkfO{nfO{ af/Daf/ d[To'sf] af/]df -dg'{sf] 8/nfO{ o;df ;dfj]z gug{]_ ;f]r

cfPsf] lyof] cyjf cfkm'nfO{ dfg]{÷cfTdxTof -v'bv'zL_ ug]{ ljrf/ cfPsf] lyof] cyjf cfTdxTof÷v'bv'zL sf] dgzfo -p2]Zo_ lng'ePsf] lyof] jf To;sf] nflu of]hgf agfpg' ePsf] lyof] < s] tkfO{n] cfTdxTof÷v'bv'zL sf] k|of; ug'{eof] < olb s'g} Psdf …5Ú sf]8 ul/Psf] 5 eg] …5Ú df lrGx nufpg'xf];\.

-nfdf] ;f]Wbf pQ/ cfPg eg] k|ZgnfO{ 6'qmfP/ ;f]Wg'xf];\ . _

5}g

5}g

5

5

5}g

5}g

5

5

A 4 s] lo nIf0fx?n], tkfO{sf] b}lgsL h:t} 3/ kl/jf/, sfdsfh, k9fO{, ;dfh, ;DjGwx?, jf cGo dxTjk"0f{ tl/sfn] 7"n} tgfj jf ;d:of u/]sf lyP / s] o;n] ubf{ tkfO{sf] klxn]sf] / clxn]sf] sfddf s]xL leGgtf÷kl/jt{g cfPsf] 5 <

5}g 5 5}g 5

A 5. s'g} @ j6f pbfl;gtfsf] cjlwsf] lardf, slDtdf @ dlxgfsf] nflu pNn]vgLo

pbfl;gtfsf] nIf0f jf s'g} s'/fdf ?lr gePsf] s'g} cjlw lyof] < yfxf 5}g 5}g 5

s] Tof] ;dofjlwsf] nflu A1 – A3 sf] k|Zg dWo] % jf a9L pQ/ / A4 sf] pQ/ …5Ú, sf]8 ul/Psf] 5 <

/

s] pbfl;gtfsf] /f]usf] nIf0fx? lgtfGt zf/Ll/s sf/0fn] ePsf] xf]O{g eg]/ 5'6\ofOPsf]] 5 <

of] k|s/0f xfnsf] xf] jf ÷/ ljutsf] xf] v'nfpg'xf];\ .

olb A5 df …5Ú sf]8 ul/Psf] 5 eg] aNem]sf] nfO{ …5Ú sf]8 ug'{xf];\ .

\

A6 (a). tkfO{nfO{ lhjgdf clxn];Dd slt k6s pbfl;gtfsf] ;d:of -/f]u_ ePsf] 5 <.........

pbfl;gtfsf] cjlwsf] lardf s'g} pNn]vlgo pbfl;gtf gePsf] sd;]sd @ dlxgfsf] cjlw x'g' kb{5 .

B. Suicidality

(cfTdxTofk|j[lQ)cfhsn cfTdxTof÷v'bv'zL sf] 36gfx? w]/} ;'Ggdf cfO{/x]sf] 5 . w]/} dflg;x?n] o:tf] ljrf/ cfPsf] s'/fx? JoQm u/]sf 5g,……………

kl5Nnf] dlxgfdf M gDa/

B1. s] tkfO{sf] s'g} b'3{6gf ePsf] lyof] < o;df e'mlSsP/ -;Dof]ua;_ w]/} cf}ifwLx?sf] ;]jg ug'{ klg kb{5 . olb B1 df …5}gÚ pQ/ cfPsf] 5 eg], B2 df hfg'xf];\ . olb …5Ú eg] k|Zg B1a ;f]Wg'xf];\ .

B1a. s] tkfO{n] s'g} hf]lvd÷vt/f nfO{ a]jf:tf u/]/ cyjf hfgLhfgL s'g} 36gf u/fP/ cfkm'nfO{ xfgL k'¥ofpg vf]Hg' ePsf] jf of]hgf agfpg' ePsf] lyof] <olb B1a df …5}gÚ eg], B2 df hfg'xf];\ . olb …5Ú eg] k|Zg B1 b ;f]Wg'xf];\ .

B1b. s] tkfO{sf] s'g} b'3{6gfdf k/]/ dg]{] ljrf/÷rfxgf lyof] <

5}g

5}g

5}g

5

5

5

)

)

)

5}g 5

k|d'v pbfl;gtfsf] cjlw

xfnsf]

ljutsf]

aNem]sf]

B2. s] tkfO{n] -Ifl0fs ?kdf dfq eP klg_, cfkm' d/]sf] eP /fd|f] x'GYof] jf cfkm' dg{ kfP x'GYof] jf cfkm' dg}{kg{] eg]/ ;f]Rg'eof] <

5}g 5 !

B3. s] tkfO{n] -Ifl0fs ?kdf dfq ePklg_, cfkm'n] cfkm}nfO{ xfgL ug{] jf rf]6 k'¥ofpg] jf 3fOt] agfpg] af/] ;f]Rg'ePsf] lyof] <

To;sf] sf/0f cfkm' dg{ ;Dd ;Sg] p2]Zo jf hfgsf/Lsf ;fy ug'{ePsf] lyof] <

jf cfTdxTof÷v'bv'zL sf] af/]df ;f]r agfP/ ug'{ePsf] lyof] <

olb B2 + B3 df …5}gÚ pQ/ cfPsf] 5 eg], B4 df hfg'xf];\. cGoyf ;f]Wg'xf];\ M

slth;f] -lk|mSj]G;L_ slt s8f -OG6]g;L6L_

slxn]sfxL xNsf

k|foh;f] dWod

w]/} h;f] ulDe/÷Hofb}

5}g 5 ^

B4. s] tkfO{n] cfkm'n] cfk}mnfO{ ædfg'{k5{Æ eGg] h:tf] lgb]{zg lbg] cfjfh-x?_ ;'Gg'eof] < cyjf cfTdxTof÷v'bv'zL ;Fu ;DalGwt s'g} ;kgf b]Vg'eof] < olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\ .

s] of] cfjfh-x?_ lyof] <

s] of] ;kgf lyof] <

5}g 5 $

B5. s] tkfO{n] cfTdxTof÷v'bv'zL ug]{ s'g} tl/sfsf] af/]df -s;/L ug{]_ ;f]Rg'ePsf] lyof] < 5}g 5 *

B6. s] tkfO{n] cfTdxTof÷v'bv'zL ug{ k|of]u x'g] s'g} dfWodsf] af/]df -s] k|of]u u/]/ ug{]_ ;f]Rg'ePsf] lyof]<

5}g 5 *

B7. s] tkfO{n] cfTdxTof÷v'bv'zL sf] k|of; ug{sf] nflu s'g} 7fpFsf] af/]df -sxfF ug{]_ ;f]Rg'ePsf] lyof]<

5}g 5 *

B8. s] tkfO{n] cfTdxTof÷v'bv'zL sf] k|of; ug{sf] nflu s'g} lbg jf ;dosf] af/]df -slxn] ug{]_ ;f]Rg'ePsf] lyof] <

5}g 5 *

B9. s] tkfO{n] cfTdxTof÷v'bv'zL ug'{eGbf klxn] k'/f ug'{kg{] s'g} sfd-x?_ sf] af/]df ;f]Rg'ePsf] lyof] < -h:t} ;cfTdxTof÷v'bv'zL ;DjGwL gf]6÷lr¶L n]Vg] cflb ._

5}g 5 *

B10= s] tkfO{n] cfTdxTof÷v'bv'zL ug{] ;f]r cg'';f/ sfd ug{] ljrf/ ug'{ePsf] lyof] <

olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\:

s] tkfO{n] cfTdxTof÷v'bv'zL sf] ;f]r cfPsf] a]nf g} To;f] ug]{ ;f]Rg'ePsf] lyof]<

eljiodf s'g} a]nfdf To;f] ug{] ;f]Rg'ePsf] lyof] <

5}g 5 *

B11. s] tkfO{n] cfTdxTof÷v'bv'zL u/]/ g} -4f/f g}_ dg{] ljrf/ ug'{ePsf] lyof] < olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\:

s] tkfO{n] ToxL a]nf g} cfTdxTof÷v'bv'zL u/]/ dg]{ ljrf/ ug'{ePsf] lyof] <

eljiodf s'g} a]nfdf cfTdxTof÷v'bv'zL u/]/ dg]{ ljrf/ ug'{ePsf] lyof] <

5}g 5 *

B12. s] tkfO{nfO{ rf8f] eGbf rf8f] cfkm'nfO{ dfg'{kg{] jf dfg]{ of]hgf agfpg'kg]{ h?/L dxz'; ePsf] lyof] jf cfj]u cfPsf] lyof] < olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\:

s] of] cfkm'nfO{ dfg{sf] nflu lyof] <

s] of] cfkm'nfO{ dfg{] of]hgf agfpgsf nflu lyof] <

olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\

s] of] s'g} s'/fn] gpS;fO{sg}÷ge8\sfOsg} ePsf] lyof] <

s'g} s'/fn] pS;fP/÷e8\sfP/ ePsf] lyof] <

olb of] s'g} s'/fn] gpS;fPsf] xf] eGg] s'/f lgwf{/0f ug{, ;f]Wg'xf];\M æo:tf] vfnsf] cfj]u cfPsf] % ldg]6 cl3, s] tkfO{n] To:tf] cfj]u cfpnf eg]/ klxn} cg'dfg ug{ ;Sg'x'GYof] <Æ

olb …5}gÚ eg], B14 df hfg'xf];\ .

5}g 5 *

B13. s] tkfO{nfO{ o:tf] cfj]ux? /f]Sg ufx|f] ePsf] lyof] < 5}g 5 *

B14. s] tkfO{n] cfkm'nfO{ dfg{] dg;fo jf ljrf/n], cfTdxTof÷v'bv'zL sf] k|of;sf] tof/Lsf nflu s'g} ;ls|o sbd rfNg'eof] < -s] tkfO{n] s'g} s'/f hfg]/ jf ghfg]/ ug'{eof] h;n] ubf{ tkfO{ cfTdxTof÷v'bv'zL sf] k|of;sf] glhs k'Ug'eof] <_ o;df tkfO{n] cfkm'nfO{ dfg{ ;ls|o sbd rfln;s]sf] t/ tkfO{nfO{ xfgL k'Ug' cl3 g} s;}n] /f]s]sf] jf tkfO{ cfkm} /f]lsg' ePsf] cj:yfx? kb{5 .

olb B14 df …5}gÚ eg], B15 df hfg'xf];\. cGoyf B14a ;f]Wg'xf];\ M

B14 a. s] tkfO{n] cfkm'nfO{ dfg{] tof/Lsf] nflu cfjZos sbd rfln;Sg' ePsf] lyof] t/ cfTdxTof÷v'bv'zL sf] k|of; ;'? ug'{ePg<

b. s] tkfO{n] cfkm'nfO{ dfg]{ tof/Lsf] nflu cfjZos sbd rfln;Sg' ePsf] lyof] t/ cfkm'nfO{ xflg k'¥ofpg' l7s cufl8 cfkm'nfO{ /f]Sg'eof]<

c. s] tkfO{n] cfkm'nfO{ dfg]{ tof/Lsf] nflu cfjZos sbd rfln;Sg' ePsf] lyof] t/ cfkm'nfO{ xflg k'Ug' l7s cufl8 s;}n] jf s]xL s'/fn] tkfO{nfO{ /f]Sof] <

5}g

5}g

5}g

5}g

5

5

5

5

(

!)

!!

B15. s] tkfO{n] cfkm'nfO{ dfg{] dg;fo geO{sg kgL hfgL hfgL cfkm'nfO{ xfgL k'¥ofpg' eof]< -of] cfTdxTofk|j[lQ cGtu{t kb}{g ._

5}g 5 )

B16. s] tkfO{n] cfTdxTof÷v'bv'zL ug]{ k|of;÷sf]lzz ug'{eof] <

-B16 df 5}g eg], B17 df hfg'xf];\ ._

a. s] tkfO{n] cfTdxTof÷v'bv'zL ug{] k|of; z'? ug'{eof] t/ aLrd} To;nfO{ /f]Sg] lg0f{o ug'{eof] / cfTdxTofsf] k|of;nfO{ k'/f ug{'ePg <

b. s] tkfO{n] cfTdxTof÷v'bv'zL sf] k|of; z'? ug'{eof] t/ tkfO{nfO{ aLrd} /f]sfj6 ePsf]n] Tof] k'/f ug{'ePg <

c. s] tkfO{n] cfkm'n] tof/L u/]sf] h:t} u/L cfTdxTof÷v'bv'zLsf] k"0f{ k|of; ug'{eof] -cfkm'nfO{ dfg{_ < cfTdxTof÷v'bv'zL sf] k|of; eGgfn]] yf]/} ePklg cfkm'nfO{ dfg{] dgzfon] u/]sf] s]xL sfd h;df tkfO{nfO{ rf]6k6s÷xfgL x'g ;SYof]_<

B16c df …5}gÚ pQ/ cfPsf] 5 eg], B17 df hfg'xf];\M

s] Tof] a]nf tkfO{n] s;}n] arfcf]; eGg] jf cfkm' afFRg] cfz

ug'{ePsf] lyof] <

dl/G5 g} eGg] nfu]sf] lyof] jf dg]{ dgzfo /fVg' ePsf] lyof] <

5}g

5}g

5}g

5}g

5

5

5

5

!@

!#

!$

B17. Pslbgdf tkfO{n] cfTdxTof÷v'bv'zL ;DjGwL cfj]ux?÷;f]rx? jf ;f] ;DalGw lqmofsnfkx?df slt ;do latfpg' eof] <

cf};t ;do k|lt lbg =============== 306f=============== ldg]6

slDtdf =============== 306f=============== ldg]6

al9df =============== 306f=============== ldg]6

o;/L klg ;f]Wg'xf];\ M

slth;f] -lk|mSj]G;L_

slxn]sfxLF

k|foh;f]

w]/} h;f]

B 18 lhjgdf clxn] ;Dd M

s] tkfO{n] slxNo} cfTdxTof÷v'bv'zL sf] k|of; ug'{ePsf] lyof] -cfkm'nfO{ dfg{] k|of;_ <

olb …5Ú eg],slt k6s <============

olb …5Ú eg],kl5Nnf] k6s -ljutdf_ slxn] ug'{ePsf] lyof] <

uPsf] !@ dlxgfdf

!@ b]lv @$ dlxgfsf] lardf

@$ dlxgf eGbf cuf8L

cfTdxTofsf] k|of; eGgfn] yf]/} eP klg dg]{ dg;fo /fv]/ ul/Psf] cfTd3ftjf cfkm"nfO{ rf]6÷xfgL gf]S;fgL k'¥ofpg] Jojxf/÷lqmofsnfk a'lemG5 . pbfx/0fsf] nflu o;nfO{ o;/L klg a'em\g ;lsG5 ls of] s]an Ps b'3{6gf dfq geO{ JolQmn] dg]{ dgzfo JoQm gu/]tf klg p;sf] nflu of] 3fts x'g;S5 eGg] yfxf x'bfFx'b} klg ul/Psf] Ps k|of; xf] .

5}g 5 $

B19. ca cfpg] # dlxgfdf, tkfO{n] cfkm'n] cfkm}nfO{ dfg{] k|of; ug]{ sltsf] ;Defjgf 5 < )–!))Ü ;Ddsf] dfqfdf eGg'xf];\ . ============= Ü

)Ü eGbf al9 ePdf, B19 df …5Ú sf]8 ug'{k5{ .

o;/L klg ;f]Wg'xf];\ M

ca cfpg] # dlxgfdf, tkfO{n] cfkm'n] cfkm}nfO{ dfg{] k|of; ug]{ sltsf] ;Defjgf 5< != 5}g

@= yf]/}÷clnslt

#= w]/}

$= Psbd w]/}

5}g 5 !#

dflysf k|Zgx? dWo] sDtLdf ! j6fdf -B1 afx]s_ …5Ú sf]8 ul/Psf] 5 <

olb 5 eg],B1 - B19 ;Dddf …5Ú sf]8 ul/Psf

pQ/x?af6 s'n c+s hf]8\g'xf]; /

cfTdxTofk|j[lQsf] jlu{s/0f ug'{xf];\ .

xfnsf]: -B1a af6 B16c ;Dd s'g} pQ/ …5Ú cfPdf

jf B17 df s]xL ;do vr{ u/]sf] ePdf ._

lhjgsfndf clxn] ;Dd: -B18 df …5Ú sf]8 ul/Psf] ._

lgs6 eljiodf: -B19df …5Ú sf]8 ul/Psf] ._

pQ/bftfsf] xfnsf] jf kl5Nnf]] cfTdxTof

k|of; ;DjGwL s'g} cGo hfgsf/L tn n]Vg'xf];\ M

C. Manic and hypomanic episode

(pGdfb / sd pGdfbsf] /f]u)- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS;_ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

s] tkfO{sf] kl/jf/df s;}nfO{ pGdfb jfpbfl;gtfsf] /f]u÷afOkf]nf/ /f]u ePsf] lyof] cyjf kl/jf/sf] sf]xL ;b:onfO{ dg kl/jt{g eO{/fVg] -slxn] cToflws v'zL, slxn] cToflws b'vL jf cToflws l/;fpg]_ ;d:ofsf] pkrf/ lnlyod h:tf] cf}ifwLn] u/fO{Psf] lyof] <of] k|Zg afOkf]nf/ /f]usf] nflu dfkb08 xf]Og t/ afOkf]nf/ /f]usf] hf]lvd k|lt k|Zgstf{sf] ;ts{tf a9fpg ;f]lwPsf] xf] .

olb …5Ú eg], sf] xf] k|i6 kfg'{xf];\M========================

5}g

5

5}g 5

cfTdxTofk|j[lQ

!–* c+s Go"g

(–!^ c+s dWod

!& c+s jf a9L pRr

xfnsf]

lhjgsfndf clxn] ;Dd

lgs6 eljiodf

C1a. s] tkfO{nfO{ lhjgdf slxNo}, cfkm' cgfjZos ?kdf÷lagfsf/0f w]/} g} km'lt{nf] ePsf] jf w]/} tfut cfPsf] dx;'; ePsf] 5 h;n] ubf{ tkfO{ cfkm' cˆ7\of/f cj:yfdf kg'{ePsf] 5 jf tkfO{nfO{ dflg;x?n] c;fdfGo ?kdf lnPsf lyP <-dfbs kbfy{ / nfu'cf}ifwLsf] cToflws ;]jg u/]sf] cj:yf o; leq kb}{g ._

olb pQ/bftfn] tkfO{n] eGg vf]Hg'ePsf] s'/f a'emg'ePg eg] – lgDg t/Lsfn] a'emfpg'xf];\ :

d}n] eGg vf]h]sf] M ==================

lagfsf/0f÷cgfjZos ?kdf cToflws dfqdf v'l; ePsf], km'lt{nf] jf ;lqmo ePsf], yf]/} dfq ;'t] k'Ug],lbdfudf w]/} / l56f]]] ;f]]]rfO{÷ljrf/÷of]hgf cfpg], cgfjZos ?kdf lqmofsnfk÷pTkfbgl;ntf a9]sf], k|]l/t ePsf], /rgfTds ePsf], cfj]uk"0f{ sfo{ a9]sf]; w]/} kmf]g rnfpg], w]/} sfd ug]{] jf w]/} k};f vr{ ug]{ ePsf] 5 < olb …5}gÚ eP, C1b df …5}gÚ df lrGx nufpg'xf];\ . olb …5Ú eg],;f]Wg'xf];\ M

b. s] tkfO{n] clxn] cgfjZos ?kdf tfut cfPsf] jf km'lt{nf] ePsf] h:tf] dx;'; ug'{ePsf] 5 <

C2a. s] tkfO{nfO{ lhjgdf slxNo}, w]/} lbg ;Dd, nuftf/ ;fgf] ;fgf] s'/fdf l/; pl7/fVg] ePsf] 5, h;n] ubf{ tkfO{sf] ax; -egfeg_ jf emu8f -df}lvs jf zf/Ll/s_ k/]sf] jf cfˆgf] kl/jf/ eGbf aflx/sf] dfG5];Fu tkfO{ s/fpg' ePsf] 5 <tkfO{n] cfkm"n] To:tf] Jojxf/ ug'{ l7s ePsf] dx;'; u/]tfklg, s] c? s;}n] tkfO{nfO{ ;fdfGo eGbf a9L g} ;fgf]–;fgf] s'/fdf emsL{g] jf w]/} k|ltls|of lbg]] eg]/ ofb÷Vofn u/]sf 5g\ < olb …5}gÚ eg], C2b df …5}gÚ df lrGx nufpg'xf];\ . olb …5Ú eg] ;f]Wg'xf];\ M

b. s] tkfO{ clxn] cfkm" nuftf/ emsf]{ dfGg] ePsf] dx;'; ul//xg' ePsf] 5 <

s] C1a jf C2a …5Ú sf]8 ul/Psf] 5 <

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

C3.olb, C1b jf C2b Ö …5Ú eg] M xfnsf] cjlw/ To;kl5 ljutsf] ;a} eGbf w]/} nIf0f ePsf] cjlwsf] af/] ljit[t hfgsf/L lng'xf];\ .

olb, C1b / C2bÖ …5}gÚ eg] M ljutsf]] w]/} nIf0f ePsf]÷b]lvPsf] cjlwsf] lj:t[t hfgsf/L lng'xf];\ .

xfnsf] cjlwsf] lj:t[t hfgsf/L lnbfF, x/]s k|ZgnfO{ o:tf] tl/sfn] ;f]Wg'xf];\ M

cfh ;lxt ljutsf s]xL lbgx?df, ha tkfO{n] w]/} phf{ ePsf dx;'; ug'{ePsf] lyof], s] tkfO{n]============?

klxn]sf] cjlwsf] lj:t[t hfgsf/L lnbfF, x/]s k|ZgnfO{ o:tf] tl/sfn] ;f]Wg'xf];\ M

ljutsf s]xL lbgx?df, ha tkfO{n] w]/} phf{ ePsf] dx;'; ug'{ePsf] lyof], s] tkfO{n] ==========================?

xfnsf] cjlw ljutsf] cjlw

a. cfkm'nfO{ Psbd dxTjk"0f{ JolQm ePsf] / c?n] ug{ g;Sg] sfo{ cfkm'n] ug{ ;S5' h:tf] dx;'; ug'{eof] <olb …xf]Ú eg], pbfx/0fx? ;f]Wg'xf];\.

s] pQ/bftfn] lbPsf pQ/x? e|fds ljrf/;Fu ldN5 <

xfnsf] cjlw 5}g 5

klxn]sf] cjlw 5}g 5

b.yf]/} dfq ;'t] k'Ug] -s]xL 306fdf g} lgGb|f k'/f x'g]_ dx;'; ug'{eof] <

c.g/f]lssg nuftf/ w]/} af]Ng'ePsf] jf af]Ng} kg{] bafj dx;'; ug'{eof] <

d.s] tkfO{sf] lbdfudf w]/} s'/f cfO{/fVg] jf ljrf/x? Ps af6 csf]{df l56f]–l56f] kl/jt{g ePsf] dx;'; ug'{eof] <

e. ;fgf] cj/f]w÷afwf÷/f]sfj6 n] klg Psbd ;lhn};Fu s'g} sfd–s'/faf6 Wofg x6\g] dx;'; eof] <

f. 3/df, sfddf, ljBfnodf, ;fdflhs sfo{df sfd ug{] O{R5f Psbd w]/} ePsf] <cyjf of}g OR5f tLa| ePsf] cyjf zf/Ll/s jf dfgl;s ?kdf w]/} :yL/ gePsf] dx;'; ug'{eof] < of] tLa| sfd ug{] rfx s'g} sf/0fjz cyjf s'g} sf/0f lagf g} ePsf] klg x'g ;S5 .

g. cfgGbdo lqmofsnfkdf olt w]/} ;xefuL x'g'eof] ls tkfO{n] To;;Fu} x'g] hf]lvdnfO{ gh/cGbfh ug'{eof] -h:t} : cgfjZos ?kdf cToflws k};f vr{ ug]{, nfk/jfX tl/sfn] uf8L rnfpg] jf nfk/jfX tl/sfn] of}g lqmofsnfkdf ;+nUg x'g] . _

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

C3 ;f/f+z M xfnsf] cjlwnfO{ d"NofÍg ubf{ M

olb C1b df…5}gÚ eg], s] C3 (C3f ;lxt) sf] $ j6f jf a9L pQ/ …5Ú cfPsf] 5 <

olb C1bdf …5Ú eg], s] C3 (C3f ;lxt) sf] # j6f jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

klxn]sf] cjlwnfO{ d'Nof+sg ubf{ M

olb C1adf …5}gÚ eg], s] C3 (C3 f ;lxt) sf] $ jf a9L pQ/ …5Ú cfPsf] 5 <

olb C1a df …5Ú eg], s]C3 (C3f ;lxt) sf] # j6f jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

olb dfyLsf # jf a9L nIf0fx? Pp6} ;dodf b]lvPsf eP dfq …5Ú sf]8 ug'{xf];\ .

lgod M cToflws v'zL jf v'zLsf] Jofkstfsf] nflu C3 sf] # j6f nIf0f x'g'kb{5 eg] l56f]–l56f] l/;fpg]sf] nflu C3 sf] $ j6f nIf0f x'g'kb{5 .

5}g 5 5}g 5

C4= o:tf] nIf0fx? a9Ldf slt nfdf] ;do ;Dd /x]sf lyP -Ps lbgdf k|foh;f] ;do cyjf x/]s lbg_<

nIf0f ;'? ePb]lv cGTo ;Ddsf] ;dofjlwsf] d"NofÍg ug'{xf];\, Psbd pRr ePsf] cjwL dfq xf]Og_

a. nuftf/ # lbg cyjf sd

b. $, % jf ^ lbg nuftf/ jf a9L

c. nuftf/ & lbg jf a9L

C5 s] tkfO{ of] ;d:ofx?sf] nflu c:ktfndf egf{ x'g'ePsf] lyof] <

olb lyof] eg], Tof] ;dofjwLsf] nflu pGdfb /f]usf] k|s/0fx?df …5Údf lrGx nufpg'xf];\ / C7 df hfg'xf];\ .

5}g 5 5}g 5

C6 s] lo nIf0fx?n], tkfO{sf] b}lgsL h:t} 3/ kl/jf/, sfdsfh, k9fO{, ;dfh, ;DaGwx? jf cGo dxTjk"0f{ tl/sfn] 7"n} tgfj jf ;d:of u/]sf lyP / s] o;n] ubf{ tkfO{sf] klxn]sf] / clxn]sf] sfddf s]xL leGgtf÷kl/jt{g cfPsf] 5 <

5}g 5 5}g 5

C7 s] tkfO{sf] klxn]sf] sfd u/fO{ jf tkfO{ ;fdfGotof h:tf] x'g'x'G5 Tof] eGbf 5n{Ë b]lvg] ul/ ePsf] leGgtf oL nIf0fx?;Fu ;DjlGwt 5g\ <

5}g 5 5}g 5

s] C3 ;f/f+z / C7 / (C4c jf C5 jf C6 jf K1 b]lv K8 ;Dddf) s'g} 5}g 5

pGdfb /f]usf] cjlw

xfnsf]

klxn]sf]

dfgl;s c;Gt'ngtfsf] nIf0f df …5Ú sf]8 ul/Psf] 5 <

/

s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn] ( O2 ;f/f+z )

ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 <

of] cjlw clxn]sf] xf] sL -/÷jf_ klxn]sf] xf] pNn]v ug'{xf];\ .

s] C3 ;f/fz+ df …5Ú / C5 / C6 df …5}gÚ /C7 df …5Ú / s] C4b jf C4c df sd pGdfb /f]usf] cjlw

xfnsf] 5}g 5

klxn]sf] 5}g 5

ljit[t hfgsf/L glnPsf]

…5Ú sf]8 ul/Psf] 5 <

/

O2;f/fz+df …5Ú sf]8 ul/Psf] 5 <

/

K1 b]lv K8 ;Dddf ePsf ;a} dfgl;s c;Gt'ngtfdf …5}gÚ sf]8 ul/Psf] 5 <

xfnsf] cjlw xf] jf klxn]sf] xf] :ki6 kfg'{xf];\ .

– xfnsf] pGdfb /f]usf] cjlwdf …5Ú eP, xfnsf] sd pGdfb /f]usf] cjlwdf …5}gÚ nufpg'xf];\ .

– klxn]sf] pGdfb /f]usf] cjlwdf …5Ú eP klxn]sf] pGdfb /f]usf] cjlwdf ljit[t hfgsf/L glnPsf]df lrGx nufpg'xf];\ .

s] C3 ;f/fz+ / C4a df …5Ú / C5 df …5}gÚ sf]8 ul/Psf] 5 < sd pGdfb /f]usf] cjlw

xfnsf] 5}g 5

klxn]sf] 5}g 5

ljit[t hfgsf/L glnPsf]

xfnsf] cjlw xf] jf klxn]sf] xf] :ki6 kfg'{xf];\ .

– xfnsf] pGdfb jf sd pGdfb /f]usf] cjlwdf …5Ú eP, xfnsf] sd pGdfb /f]usf] nIf0fdf …5}gÚ nufpg'xf];\ .

– klxn]sf] pGdfb jf sd pGdfb /f]usf] cjlwdf …5Ú eP, klxn]sf] sd pGdfb /f]usf] nIf0fdf …5}gÚ nufpg'xf];\ .

5}g

5}g

5}g

5

5

5

C8 a. ljutsf] jf s'g} Ps pGdfb /f]usf] cjlwdf …5Ú pQ/ cfPdf, ;f]Wg'xf];\ M

– clxn] ;Dddf, s] tkfO{nfO{ & lbg jf Tof] eGbf nfdf] ;do ;Dd -C4c_ /x]sf lt nIf0fx? -pGdfb /f]u_ sf] cjlw, @ jf @ k6s eGbf a9L ePsf] 5, -xfnsf] cjlwnfO{ klg ;dfj]z ul/sg_ <

b. olb xfnsf] jf klxn]sf] dWo] s'g} Pssf] pGdfb cyjf sd pGdfb /f]usf] cjlwdf …5Ú sf]8 ul/Psf] 5 eg], ;f]Wg'xf];\ M

– clxn] ;Dddf, s] tkfO{nfO{ $ lbg jf Tof] eGbf nfdf] ;do ;Dd -C4b_/x]sf lt nIf0fx? -sd pGdfb /f]u_ sf] cjlw,@ jf @ k6s eGbf a9L ePsf] 5, -xfnsf] cjlwnfO{ klg ;dfj]z ul/sg_ <

c. olb klxn]sf] ……sd pGdfb/f]usf]nIf0fx?dfÚÚ,…5Ú sf]8 ul/Psf] 5 eg], ;f]Wg'xf];\M

clxn] ;Dddf, s] tkfO{nfO{ !-# lbg;do ;Dd dfq -C4a_ /x]sf, sd pGdfb /f]usf] nIf0fx?, @ jf @ k6s eGbf a9L ePsf] 5, -xfnsf] cjlwnfO{ klg ;dfj]z ul/sg_ <

D. Panic disorder

(dgf]qf;sf] /f]u)- sf] dtna – lgbfgsf] aS;df - 8foUgf]i6Ls aS; _hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

D1a. s] tkfO{nfO{ Ps eGbf a9L To:tf] cj:yfx? cfPsf] 5, hxfF tkfO{ crfgs w]/} 8/fPsf], w]/} cflQPsf]], ;xh gePsf]÷cˆ7\of/f] ePsf] 5, h'g cj:yfdf c? dflg; ;fdfGo ?kdf 8/fpb}gg\ <

b. s] Tof] cj:yf ;'? ePsf] !) ldg]6leq g}, tkfO{nfO{ Psbd ufx|f]÷lbSst ePsf] lyof]<

5}g

5}g

5

5

D2 ljutsf] s'g} ;dodf, s] tL dWo] s'g} cflQg] cj:yf crfgs ;f]Rb} g;f]r]sf] tl/sfn] jf ck|Toflzt tl/sfn] jf s'g} sf/0f lagf -gpS;fO{sg_ g} ePsf lyP<

5}g 5

D3 s] tkfO{nfO{ lhjgdf slxNo}, s'g} To:tf] cflQg] cj:yf ePsf] lyof], h;kl5sf] Ps jf a9L dlxgf ;Dd klg To:t} cj:yf cfpF5 ls eGg] af/] / To;sf] kl/0ffdsf] af/] nuftf/ w]/} lrGtf nflu /x]sf] lyof] < cyjf s] tkfO{n] To:tf cj:yfsf] sf/0fn] cfˆgf] Jojxf/df s]xL pNn]vlgo kl/jt{g Nofpg' eof] < -h:t}:ckl/lrt kl/l:ylt af6 6f9f /xg] jf 3/ g5f]8\g] jf lsgd]n ug{ PSn} ghfg] jf dgf]qf;÷dg/f]usf] cj:yf x'g] s'/faf6 6f9f /xg] jf 8fS6/sf]df hfg] cyjf cfsl:ds sIfdf af/Daf/ hfg] ._

5}g 5

D4 tkfO{nfO{ ofb eP ;Ddsf] ;a}eGbf ufx|f] -lbSst_ ePsf] cj:yfdfM

a. s] tkfO{sf] d'6' w]/} hf]8n] w8\s]sf] jf d'6'sf] w8\sg /f]lsP h:tf] -d'6' lr;f] eP h:tf]_ dx;'; ePsf] lyof] <

b. s] tkfO{nfO{ k;Lgf cfPsf]] jf xft leh]sf] lyof] <

c. s] tkfO{sf] xftv'§f÷hLp sfKg] ePsf] lyof] <

d. s] tkfO{nfO{ ;fF; km]g{ ufx|f] ePsf],;fF; gk'u]sf] h:tf] jf ps';d's'; dx;'; ePsf] lyof]<

e. s] tkfO{nfO{ lg;fl:;Psf] jf 3f6Ldf s]xL c8\s]sf] h:tf] dx;'; ePsf] lyof] <

f. s] tkfO{nfO{ 5ftL b'v]sf], ef/L ePsf] jf cK7\of/f] -lbSst_ dx;'; ePsf] lyof] <

g. s] tkfO{nfO{ jfsjfsL nfUg] -pN6L h:tf] x'g]_, k]6sf] ;d:of jf PSsf;L emf8fkvfnf nfu]sf] lyof] <

h. s] tkfO{nfO{ l/+u6f nfUg], c:yL/ x'g], lbdfu xNsf -vfnL_ ePsf] h:tf] jf a]xf]zxf]nf ls h:tf] dx;'; ePsf] lyof] <

i. s] tkfO{sf] z/L/ PSsf;L /GsLP/ cfpg] -udL{ x'g]_ jf lhp l;l/Ë x'g] -lr;f] x'g]_ dx;'; ePsf] lyof] <

j. s] tkfO{nfO{ z/L/df emdemd x'g] jf nf6f] x'g] -s]xL rfn gkfpg]_ dx;'; ePsf] lyof] <

k. s] tkfO{nfO{ cfkm' jl/k/Lsf] s'/fx? c;fdfGo, sfNklgs, ckl/lrt, cnu ePsf] jf s] tkfO{n] cfkm' cfˆgf] k'/} z/L/ jf s'g} efuaf6 cnu ePsf] h:tf] nfu]sf] lyof] <

-cgf}7f], cfˆgf] z/L/ cfˆgf] xf]Og h:tf], cfkm" cfkm" xf]Og h:tf ] ._

l. s] tkfO{nfO{ cfˆgf] lgoGq0f jf lbdfusf] ;Gt'ng u'dfp5' ls eGg] s'/fsf] 8/ nfu]sf] lyof]<

m. s] tkfO{nfO{ cfkm' dl/G5 ls eGg] s'/fsf] 8/ nfu]sf] lyof] <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

5

5

5

5

5

5

D5 s] D3 / D4 df, $ jf ;f] eGbf a9L pQ/x?df …5Ú sf]8 ul/Psf] 5 < 5}g

5 -lhjgsfndf clxn];DdePsf] dgf]qf;sf] /f]u_

D6 kl5Nnf] dlxgfdf, s] tkfO{nfO{ km]/L To:tf] cflQg] cj:yf cfpg] af/]] / To;sf] kl/0ffdsf] af/] nuftf/ w]/} lrGtf nflu/x]sf] lyof], h;sf] sf/0fn] cfˆgf] Jojxf/ s'g} g s'g} tl/sfn] kl/jt{g ug'{ePsf] lyof] <

5}g 5

-xfndf ePsf] dgf]qf;sf] /f]u_

s] D5 / D6 dWo] s'g}df …5Ú sf]8 ul/Psf] 5 <

/



of] cjlw xfnsf] xf] jf lhjgsfndf clxn];Ddsf] xf], :ki6 kfg'{xf];\ .

5}g 5

dgf]qf;sf] /f]u

lhjgsfndf clxn];Dd

xfnsf]

E. Agoraphobia -Puf]/fkmf]laof_

- sf] dtna – lgbfgsf] aS;df - 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

E1 s] tkfO{nfO{ To:tf] kl/l:ytLdf cflQg] jf ;xh gePsf] dxz'; x'G5, hxfF tkfO{nfO{ dgf]qf;÷dg/f]u sf] cj:yf jf crfgs 8/fpg] l:ytL jf nfhdbf]{ dxz'; ug]{ cj:yf cfof] eg] ;lhn};Fu d2t kfpg jf ToxfFaf6 lg:sg cˆ7\of/f] x'G5 < h:t} M

– nfO{gdf plebf jf le8df x'Fbf ,– v'Nnf 7fpFdf x'Fbf jf k'n tbf{ ,– aGb 7fpFdf x'Fbf ,– PSn} 3/af6 6f9f x'Fbf jf 3/df PSn}x'Fbf ,– uf8L, a;, /]ndf, xjfO{hxfh jf ;fj{hlgs oftfoftdf ofqf ubf{ .

5}g 5

s] E1sf] @ jf @ eGbf a9L cj:yfx?df …5Ú sf]8 ul/Psf] 5 <

5}g 5

E2 s] o:tf] cj:yfx?df x'Fbf jf o:tf] cj:yfx?n], k|fo ;w} h;f] tkfO{nfO{ 8/fpg] jf cflQg] agfpF5< 5}g

5

E3 s] oL cj:yfx? b]lv olt w]/} 8/ nfU5 ls tkfO{n] o;af6 aRg vf]Hg' x'G5 jf lk8f ;xg'kg]{ x'G5 jf oL cj:yfsf] ;fdgf ug{ tkfO{nfO{ ;fyL rflxG5 <

5}g

5

E4s] tkfO{sf] of] 8/ / cflQg] k|j[lQ, tL cj:yfdf kg{'sf] jf:tljs vt/f eGbf w]/} u'0ff a9L 5 < 5}g

5

E5s] of] 8/fpg], cflQg] / efUg] k|j[lQ sDtLdf ^ dlxgf ;Dd /x]sf] lyof] < 5}g

5

E6s] lo nIf0fx?n], tkfO{sf] b}lgsL h:t} 3/ kl/jf/, sfdsfh, k9fO{, ;dfh, ;DjGwx? jf cGo dxTjk"0f{ tl/sfn] 7"n} tgfj jf ;d:of u/]sf lyP <

5}g

5

s] E6 df …5Ú sf]8 ul/Psf] 5 <5}g 5

xfnsf] Puf]/fkmf]laof

F. Social anxiety disorder (Social Phobia)

(;fdflhs kl/l:yltdf cflQg] /f]u -;fdflhs kl/l:yltsf] qf;_ )- sf] dtna – lgbfgsf] aS;df - 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

F1 uPsf] ! dlxgfdf, s] tkfO{nfO{ nuftf/ ?kdf c?n] cfkm"nfO{ x]5{ ls h:tf] -lgu/fgL /fv] h:tf]_ , cfkm" cfs{if0fsf] s]Gb| aG5' ls h:tf], jf ckdflgt÷nlHht x'G5' ls h:tf], jf c?n] cfkm'nfO{ cl:jsf/ u5{ ls h:tf] 8/ jf w]/} lrGtf nflu/x]sf] lyof] <

o;df ;fj{hlgs 7fpFdf af]Ng] jf vfg], c?;Fua;]/ vfg], c?n] x]l//xFbf n]Vg], c?sf] cuf8L k|:t'tL lbg] jf cGo ;fdflhs l:ytLdf x'g] h:tf] cj:yfx? kb{5 .

5}g 5

;fdflhs cj:yf÷lqmofsnfksf pbfx/0fx? :

– s'/fsfgL ;'? ug'{ jf ul//fVg' ,– ;fgf] ;d"xx?df efu lng' ,– 3'Dg hfg] -k|]dL–k|]ldsf;Fu_ ,– cfkm"n] cfbf/ ug'{kg]{÷dfGg' kg]{ JolQm;Fu s'/f ug'{ ,– ef]h et]/df hfg' ,– ;fj{hlgs 7fFpdf af]Ng',– c?sf] cuf8L vfg' ,– c?sf] cuf8L k|:t'tL lbg' ,– ;fj{hlgs zf}rfno k|of]u ug'{ cflb .

F2 s] o:tf ;fdflhs cj:yfx?n]] k|foh;f] tkfO{nfO{ 8/fpg] jf cflQg] agfpF5 < 5}g

5

F3 s] oL ;fdflhs kl/l:ytLx? b]lv olt w]/} 8/ nfU5 ls tkfO{n] tL cj:yfx?af6 aRg vf]Hg' x'G5 jf lk8f ;xg' kg]{ x'G5 jf oL cj:yfsf] ;fdgf ug{ tkfO{nfO{ ;fyL rflxG5 <

5}g

5

F4 s] of] ;fdflhs kl/l:ytLsf] 8/ jf cflQg] k|j[lt ljgf sf/0f jf ;fdfGo eGbf a9L xf] < 5}g

5

F5 s] of] ;fdflhs kl/l:ytL b]lv 8/fpg], cflQg] jf efUg] k|j[lQ÷afgL sDtLdf ^ dlxgf ;Dd /x]sf] lyof] <

5}g

5

F6 s] lo nIf0fx?n], tkfO{sf] b}lgsL h:t} 3/ kl/jf/, sfdsfh, k9fO{, ;dfh, ;DjGwx? jf cGo dxTjk"0f{ tl/sfn] 7"n} tgfj jf ;d:of u/]sf lyP <

5}g

5

s] F6 df …5Ú sf]8 ul/Psf] 5 <

/



k|Zgstf{nfO{ gf]6 M ;fj{hlgs 7fpFdf af]Ng] jf k|:t'lt lbg] 8/df dfq

l;ldt xf] ls, :ki6 kfg'{xf];\ .

5}g 5

;fdflhs kl/l:yltdf cflQg] /f]u -;fdflhs kl/l:yltsf] qf;_

xfnsf]

;fdflhs kl/l:yltdf cflQg] /f]u dfq

G. Obsessive-compulsive disorder (afWofTds dgf]u|:tLsf] /f]u)

- sf] dtna – lgbfgsf] aS;df - 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

G1a. uPsf] ! dlxgfdf, s] tkfO{nfO{ cˆ7\of/f] kfg]{, af/Daf/ Pp6} vfnsf] ;f]rfO{, cfj]z÷;f]rx? jf b[Zox? cfPsf lyP h'g tkfO{sf] O{R5f ljkl/t, tkfO{nfO{ dg gkg]{, plrt gePsf], x:tIf]k ug]{ jf lrGtfhgs lyP <

-h:t}M cfkm' kmf]xf]/L ePsf] h:tf], lhjf0f'÷ls6f0f'x?af6 ;+qmldt x'G5' ls jf c?nfO{ ;5{ ls eGg] 8/, c?nfO{ xfgL–gf]S;fgL k'¥ofpg] 8/, s'g} cfj]z÷;f]rx? df cfP/ s]xL unt u5{' ls eGg] 8/, cfˆgf] sf/0fn] s]xL g/fd|f] xf]nf ls eGg] af/] 8/ jf cGwljZjf;, of}g hGo ;f]rfO{, b[Zo jf cfj]z÷;f]rx? af/Daf/ cfO{/xg] jf wfld{s ;f]rfO{x? af/Daf/ cfO{/xg] .

b. uPsf] ! dlxgfdf, s] tkfO{n] s'g} ;f]r jfsfo{4f/f oL ;f]rx?, cfj]z÷;f]rx? jf b[Zox? bafpg -x6fpg_ jf ;fdfGoagfpgjfTo;sf] c;/nfO{ sd ug{ k|of; ug'{eof] < -o;df b}lgs lhjgdf x'g] jf:tljs ;d:ofx?sf] cToflws lrGtfnfO{ ;dfj]z gug'{xf];\ ._

5}g

G 3a df hfg]

5}g

G3adf hfg]

5

5

G2 tkfO{n] oL ;f]rx?nfO{ jf:tf gubf{ klg jf oL ;f]rx?af6 5'6sf/f k|fKt ug{ vf]Hbf klg, s] oL ;f]rx? af/Daf/ cfO/xg] ub{y] <

5}g 5

dgf]u|:tL

G3a. uPsf] ! dlxgfdf, s] tkfO{n] s'g} dgf]u|:tL jf s8f lgodn] ubf{ s'g} sfd af/Daf/ ul//xg'kg]{ jf bf]xf]¥ofO{ /fVg'kg{] dxz'; ePsf] lyof] < -h:t} M ;kmf ul//xg' kg{] jf wf]O{/fVg' kg]{, s'g} s'/fsf] af/Daf/ hfFr ul//fVg' kg{] jf luGtL ul//fVg' kg{] jf ;fdfg ldnfO{ /fVg'kg]{ jf s'g} cGo cGwljZjf;sf] ljlw ul//fVg' kg{] ._

b. s] oL ljlwx? tkfO{n] 8/ jf tgfj x'g glbg÷sd ug{ jf s'g} g/fd|f] s'/f x'g af6 /f]Sg ul/Psf lyP / s] tL cTolws jf lagf sf/0f lyP <

5}g

G 4

5}g

5

5

afWotf

s] (G1a/ G1b/ G2)jf(G3a/ G3b) df …5Ú sf]8 ul/Psf] 5 <

5}g 5

G4 uPsf] ! dlxgfdf, s] lo nIf0fx?n], tkfO{sf] b}lgsL h:t} 3/ kl/jf/, sfdsfh, k9fO{, ;dfh, ;DaGwx? jf cGo dxTjk"0f{ tl/sfn] 7"n} tgfj jf ;d:of u/]sf lyP jf oL ;f]r÷sfo{dflbgsf] Ps 306f eGbf a9L ;do latfpg' kg]{ ePsf] lyof] <

/



-s'g} ;+s|d0f ePsf] # xKtf leq s'g} afWofTds dgf]u|:tLsf] nIf0fx? ;'? ePsf] hfFr ug'{xf];\ . _

5}g 5

xfnsf] afWofTds dgf]u|:tLsf] /f]u

H.Post traumatic stress disorder

(cf3ft kl5 x'g] tgfjsf] /f]u)- sf] dtna – lgbfgsf] aS;df- 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

H1. s] tkfO{n] lhjgdf slxNo}, cToGt rf]6 k'¥ofpg] 36gf h:t} Hofg uPsf] jf Hofg hfg ;Sg] jf ulDe/ rf]6 jf of}ghGo lx+;fsf] cg'ej ug'{ePsf] 5 jf To:tf] 36gf cfkm'n] b]Vg'ePsf]] 5 <

-To:tf 36gfx?sf] pbfx/0fx? M ulDe/ b'3{6gf, of}ghGo jf zf/Ll/s xdnf÷cfqmd0f, cftGsjfbL xdnf, aGws agfOPsf], ckx/0f, cfunfuL, s;}sf] nf; e]6fPsf], o'4 jf k|fs[lts k|sf]k, sf]xL glhssf] dfG5]sf] crfgs jf lx+;fTds÷ljeT; d[To', Hofg} hfg ;Sg] /f]u. _

H 2. To:tf cf3ft kfg{] 36gf ePk5L, s] tkfO{n] grflxsg / lk8fbfoL tl/sfn] ToxL 36gf af/Daf/ dxz'; ug'{eof] <-h:t} M ToxL 36gf ;DaGwL;kgf af/Daf/ cfO{/xg], w]/} ;Demg] jf ofbx? cfpg] jf ToxL 36gf km]/L eO{/x]sf] cg'ej x'g]_ cyjf s] tkfO{nfO{ To:t} k|sf/sf 36gf ofb u/fpFbf jf To:t} vfnsf] 36gfsf] ;fdgf ubf{ zf/Ll/s jf dfgl;s ?kdf w]/}g} ufx|f] x'GYof] <

5}g

5}g

5

5

H3. uPsf] ! dlxgfdf M

a. s] tkfO{n] To:Tff]] 36gfsf] af/] g;f]Rg jf Tof] 36gfsf] af/] lk8f lbg] ofbx? jf Tof] 36gfk|ltsf] efjgfnfO{ a]jf:tf ug{, nuftf/ sf]lz; ug'{eof] <

b. s] tkfO{n] To:Tff]] 36gfsf] af/]df lk8f lbg] vfnsf s'/fx? ofb lbnfpg] dfG5], s'/fsfgLx?, 7fpFx?, cj:yfx?, sfdx?, jf j:t'x?af6 k/ efUg] nuftf/ sf]lz; ug'{eof] <

s] H3 sf] ! jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

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5}g

5}g

5

5

5

H4. uPsf] ! dlxgfdf M

a. s] tkfO{nfO{ Tof] 36gfsf] s]xL dxTjk"0f{ s'/fx? ofb ug{ uf¥xf] ePsf] lyof] <

-of] sl7gfO{ 6fpsf]df rf]6, dlb/fkfg, cf}ifwL jf nfu'kbfy{sf] ;]jgn] ubf{ ePsf] x'g' ePg_

b. s] tkfO{n] cfkm' jf c? jf ;+;f/sf] af/]df lg/Gt/ / lagfsf/0f gsf/fTds ;f]rfO{ /fVg' eof] <

c. s] tkfO{n] Tof] 36gfsf] nflu lg/Gt/ ?kdf cfkm'nfO{ jf c?nfO{ lagfsf/0f bf]if lbg'eof] <

d. s] tkfO{sf] efjgfx? ;w} gsf/fTds lyP -h:t} 8/÷qf;, l/;, UnfgL, nfh_ <

e. s] tkfO{nfO{ klxn] dxTjk"0f{ nfUg] sfdx?df clxn] sd ?rL nfUg yfn]sf]] 5 <

f. s] tkfO{n] c?af6 PSnLPsf] jf alx:sf/ ePsf] h:tf] cg'ej ug'{eof] <

g. s] tkfO{n] s'g} /fd|f] efjgf -h:t} v'zL, ;Gt'i6L, jf dfofsf efjgfx?_ cg'ej ug{ ;Sg' ePg <

s] H4 sf] @ jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

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5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

5

H5.uPsf] ! dlxgfdf M

a. s] tkfO{ ;fgf]–;fgf] sf/0fn] jf s'g} sf/0f lagf g} l/;fpg' jf lrl9g'ePsf] lyof] <

b. s] tkfO{ w]/} g} nfkaf{x jf w]/} g} cfTdljgfzsf/L -cfkm"nfO{ xfgL k'¥ofpg]_ x'g'ePsf] lyof] <

c. s] tkfO{ w]/} cflQg] jf lg/Gt/ ?kdf s]xL xf]nfls eg]/ ;t{s -;fjwfg_ x'g'ePsf] lyof] <

d. s] tkfO{ w]/} ;lhn} eml:sg' x'GYof] <

e. s] tkfO{nfO{ Wofg s]lGb|t ug{ w]/} ufx|f] x'GYof] <

f. s] tkfO{nfO{ lgbfpg w]/} ufx|f] x'GYof] <

s] H5 sf] @ jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

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5

5

5

5

5

5

5

H6. s] oL ;a} ;d:ofx? rf]6 k'¥ofpg] 36gf k5L ;'? ePsf x'g\ / s] oL ;d:of Ps dlxgf eGbf a9L ;do ;Dd /x]sf lyP <

5}g 5

H7. uPsf] ! dlxgfdf, s] lo nIf0fx?n], tkfO{sf] b}lgsL h:t} 3/ kl/jf/,

sfdsfh, k9fO{, ;dfh, ;DjGwx? jf cGo dxTjk"0f{ tl/sfn] 7"n} tgfj

u/]sf lyP jf tkfO{sf] sfd ug]{ Ifdtfdf x:tIf]k u/]sf lyP<

/

s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn]

( O2;f/f+z) ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 <

5}g 5

cf3ft kl5 x'g] tgfjsf] /f]u

xfnsf]

I. Alcohol use disorder (dlb/fkfgsf] nt)

- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

tkfO{sf] pd]/ ;d'xsf s]xL dflg;n] dlb/f÷/S;L ;]jg ug]{ kfO{Psf] 5 . s] tkfO{n] klg clxn] ;Dd slxNo}, dlb/f÷/S;L ;]jg ug'{ePsf] 5 ================================

I1.kl5Nnf] !@ dlxgfdf, tLg jf a9L cj;/df, s] tkfO{n] tLg 306fsf] cjlwdf, tLg jf a9L /S;Lsf] k]o lng'ePsf] lyof] <

lyPg lyof]

I2. kl5Nnf] !@ dlxgfdf Ma. tkfO{n] /S;L lkPsf] ;dodf, s] tkfO{n] cfkm'n] ;f]r]sf] eGbf a9L lkpg' eof] <b. s] tkfO{n] cfkmgf] dlb/f ;]jg 36fpg jf lgoGq0f ug{af/Da/ rfxg' eof] < s] tkfO{n]

cfˆgf] dlb/f ;]jg 36fpg jf lgoGq0f ug{ k|oTg ug'{eof], t/ c;kmn x'g'eof] <obL b sf] b'O{j6f k|Zg dWo] Ps df …5Ú pQ/ cfPdf …5Ú sf]8 ug{'xf];\ .

c. tkfO{n] dlb/f ;]jg u/]sf] lbgx?df, s] tkfO{n] dlb/f k|fKt ug{, lkpg, jf dlb/fsf] c;/af6 d'Qm x'g w]/} ;do latfpg' eof] <

d. s] tkfO{nfO{ dlb/f lkpg cToflws OR5f jf tntn x'GYof] <e. s] tkfO{sf] af/Da/ dlb/f ;]jgsf] sf/0fn] ubf{, tkfO{n] sfddf, :s'ndf jf 3/df

cfˆgf] lhDd]jf/L k'/f ug{ sd ;do lbg'eof] <f. s] tkfO{sf] dlb/f ;]jgsf] sf/0fn] ubf{, tkfO{sf] kl/jf/ jf c? dfG5];Fu ;d:of x'Fbf

klg, s] tkfO{n] dlb/f ;]jg ul/ /fVg'eof] <g. s] tkfO{ To:tf] cj:yfdf klg Ps eGbf a9L k6s /S;Ln] dfTg' ePsf] lyof], hxfF cfkm'

jf c?, zfl/l/s ?kdf hf]lvddfkg{ ;Sg] ;Defjgf lyof] < -h:t} M uf8L rnfpFbf, df]6/;fO{sn u'8fpFbf, d]lzg/L ;fwg rnfpFbf, 8'+uf rnfpFbf cfbL . _

h. tkfO{df dlb/f ;]jgsf] sf/0f dfgl;s jf zfl/l/s ;d:ofx? cfPsf] jf ;d:of emg\ v/fa ePsf]] eGg] :ki6 x'Fbf x'Fb} klg s] tkfO{n] dlb/f ;]jg hf/L /fVg'eof] <

i. tkfO{sf] dlb/f ;]jgsf] sf/0fn] ubf{ s] tkfO{n] dxTjk"0f{ sfd ug{ jf ;fdlhs tyf dgf]/GhgfTds sfo{s|dx?df hfg sd ug{'eof] jf 5f]8\g' eof] <

j. s] tkfO{n] z'?–z'?df /S;L ;]jg ubf{ ePsf] h:t} k|efj k|fKt ug{ w]/} /S;L lkpg' kYof]{ jf s] tkfO{n] nuftf/ TolQs} dfqfdf /S;L lkpbf sd dfq k|efj kYof]{ <

k1.cToflws dlb/f ;]jg jf nfdf] cjlw b]lvsf] dlb/f ;]jg sd ubf{, tkfO{nfO{ tn lbO{Psf dWo] s] s] s'/f ePsf lyP <

!= w]/} kl;gf aUg' jf d'6'sf] w8\sg a9\g'@= xft sfKg' jf xlNng'#= lgb|fdf ;d:of $= jfsjfsL nfUg' jf afGtf x'g'%= c?n] gb]v]sf jf g;'g]sf lrhx? b]Vg' jf ;'Gg' lagf sf/0f 5fnfdf s]lx ePsf] h:tf] cg'e"lt x'g'^= Aofs'n x'g' -czfGt, 56k6L, lr8lr8f kg_ &= cflQg' *= 5f/]÷ d[uL 5f]Kg]÷rl/kmfO{oL * dWo] @ jf a9Ldf lyof] pQ/ cfPsf] 5 eg] K1 nfO{ …5Ú sf]8 ug{'xf];\.

k2. s] tkfO{n] dlb/f ;]jg ug{ gkfpbfsf] c;/nfO{ 36fpg jf x6fpg jf xofË cf]e/ -dlb/f ;]jgsf] ef]nL kN6sf] c;/_ x'gaf6 aRg, dlb/f lkpg' eof] <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

5

5

5

5

5

I2k;f/f+z:

olb I2k1 jf I2k2,df 5 ePdf : …5Ú sf]8 ug{'xf];\ .

olb I2ab]lv I2k ;f/f+z;Dd -I2k1 / I2k2nfO{

Pp6f k|Zg dfGg]_, @ jf a9L pQ/ 5 cfPdf

dlb/fkfgsf] nt 5'6\ofpgsf] nfuL :

!@ dWo] @–# nIf0f: xNsf

!@ dWo] $–% nIf0f: dWod

!@ dWo] ^ jf a9L nIf0f: Hofb}

J. Substance use disorder (nfu"kbfy{sf] nt)

- sf] dtna – lgbfgsf] aS;df-8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

tkfOsf] pd]/ ;d'xsf s]xL dflg;n] nfu"kbfy{ ;]jg ug]{ kfO{Psf] 5 .s] tkfO{n] klg clxn] ;Dd slxNo}, nfu"kbfy{ ;]jg ug'{ePsf] 5 ===================================

J1 a. kl5Nnf] !@ dlxgfdf, s] tkfO{n], w]/} v';L x'g -pT;flxt dxz'; ug{_ jf cfˆgf] d'8÷dg kl/jt{g ug{, jf cToflws gzf k|fKt ug{ tkfO{n] /S;L afx]s c? s'g} nfu" cf}ifwL -h:t} M ufFhf, efË, wt'/f], clkmd jf c? s'g}_ Psk6s eGbf a9L k|of]u ug'{ ePsf] lyof] <

5}g

5

olb vfg'ePsf] eP, s] vfg' eof] <………….

Stimulants :…………….

Cocaine :…………….

Opiates :…………….

Hallucinogens :…………….

Dissociative Drugs :…………….

Inhalants :…………….

Cannabis :…………….

Sedatives, Hypnotics or anxiolyties :…………….

cGo ============

;a}eGbf a9L k|of]u ePsf nfu" cf}ifwLx?M…………….…………….

;a}eGbf a9L ;d:of pTkGg ug{] nfu" cf}ifwLM…………….…………….

;a}eGbf ;'?df a9L ;d:of pTkGg ug{] nfu" cf}ifwLsf] ju{sf] nflu dfkb08nfO{ lj:t[t ?kdf hfgsf/L lng'xf];\/ To:tf] nfu" cf}iflwsf] b'Jo{;gL sf] dfkb08 k'/f ug{ ;Sg] nfu" cf}ifwL 5'6\ofpg'xf];\ . olb w]/} nfu" cf}ifwL b'?kof]u ePsf] 5 eg] hlt ;Sbf] w]/} jf lgb]{lzsfn] dfu] cg';f/sf] lj:t[t ?kdf hfgsf/L lng'xf];\ .

J2. tkfO{n] k|of]u u/]sf] cf}ifwL / To;sf] ju{nfO{ Wofgdf /fVbf, kl5Nnf] !@ dlxgfdf M

5'6\ofpg'xf];\ M xNsf dWod Hofb}

5}g 5dlb/fkfgsf] nt

kl5Nnf] !@ dlxgfdf

a. tkfO{n] nfu" cf}ifwLsf] k|of]u u/]sf] ;dodf, s] tkfO{n] -cf}ifwLsf] gfd÷ju{_;f]Rg' ePsf] eGbf w]/} k|of]u ug'{eof] <

b. s] tkfO{n] af/Daf/ cf}ifwLsf] -cf}ifwLsf] gfd÷ju{_ k|of]u 36fpg jf lgoGq0f ug{ rfxg' eof] < s] tkfO{n] cfˆgf] cf}ifwLsf] k|of]u 36fpg jf lgoGq0f ug{ k|oTg ug'{eof] t/ c;kmn x'g'eof] <

olb b sf] b'O{ j6f k|Zg dWo] Psdf …5Ú cfPdf, …5Úsf]8 ug{'xf];\.

c. tkfO{n] nfu" cf}ifwLsf] -cf}ifwLsf] gfd÷ju{_ k|of]u u/]sf] lbgx?df, s] tkfO{n] nfu" cf}ifwL k|fKt ug{, vfg, jf nfu" cf}iflwsf] c;/af6 d'Qmx'g w]/} ;do latfpg' eof] <

d. s] tkfO{nfO{ nfu" cf}iflwsf] -cf}ifwLsf] gfd÷ju{_ k|of]u ug{ cToflws jf ltj| O{R5f -tntn_ x'GYof]<

e. s] tkfO{sf] af/Da/ nfu" cf}iflwsf] k|of]usf] -cf}ifwLsf] gfd/ju{_ sf/0fn] ubf{, tkfO{n] sfddf, :s'ndf jf 3/df cfˆgf] lhDd]jf/L k'/f ug{ sd ;do lbg'eof] <

f. nfu" cf}iflwsf]-cf}ifwLsf] gfd÷ju{_k|of]usf] sf/0fn] ubf{, tkfO{sf] kl/jf/ jf c? dfG5];Fu ;d:of x'Fbf klg, s] tkfO{n] nfu" cf}iflw k|of]u ul//fVg' eof] <

g. s] tkfO{ To:tf] cj:yfdf klg Ps eGbf a9L k6s nfu" cf}iflwn] -cf}ifwLsf] gfd / ju{_ dfTg' ePsf] lyof], hxfF cfkm' jf c?, zfl/l/s ?kdf hf]lvddf kg{ ;Sg] ;Defjgf lyof] < -h:t} M uf8L rnfpFbf, df]6/;fO{sn u'8fpFbf, d]lzg/L ;fwg rnfpFbf, 8'+uf rnfpFbf cfbL . _

h. tkfO{df nfu" cf}iflwsf] sf/0f -cf}ifwLsf] gfd÷ju{_ dfgl;s jf zf/Ll/s ;d:ofx? cfPsf] jf ;d:of emg\ v/fa ePsf]] eGg] :ki6 x'Fbf x'Fb} klg s] tkfO{n] nfu" cf}iflwsf] k|of]u -cf}ifwLsf] gfd÷ju{_ hf/L /fVg' eof] <

i. tkfO{sf] nfu" cf}iflwsf] -cf}ifwLsf] gfd÷ju{_ k|of]un] ubf{ s] tkfO{n] dxTjk"0f{ sfd ug{, jf ;fdlhs tyf dgf]/GhgfTds sfo{s|dx?df hfg sd ug{'eof] jf 5f]8\g' eof] <

j. s] tkfO{n] ;'?–;'?df nfu" cf}iflwsf] -cf}ifwLsf] gfd÷ju{_ k|of]un] ubf{ ePsf] h:t} k|efj k|fKt ug{ w]/} nfu" cf}iflw -cf}ifwLsf] gfd÷ju{_ k|of]u ug'{kYof]{ jf s] tkfO{n] nuftf/ TolQs} dfqfdf nfu" cf}iflw -cf}ifwLsf] gfd÷ju{_k|of]u ubf{ sd dfq k|efj kYof]{ <

olb of] cf}ifwL 8fS6/n] ;'emfj u/]sf] xf] / pko'Qm lrlsT;f ko{j]If0fdf k|of]u ul/Psf] xf] eg], of] dfkbG8nfO{ …5}gÚ pQ/ /fVg'xf];\ .

k1. cToflws nfu" cf}ifwLsf] k|of]usd ubf{ jf nfdf] cjlw b]lvsf] nfu" cf}ifwLsf] k|of]u sd ubf{, tkfO{nfO{ tn lbOPsf dWo] s]–s] s'/f ePsf lyP <

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5}g

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5}g

5}g

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5

5

5

5

5

5

5

5

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5

5

5

olb k|To]s ju{sf]nflu ck]lIft nfu" cf}iflw k|of]u ug{ gkfpbfsf] c;/sf] ;+Vofdf …5Ú cfPdf, J2K1 nfO{ …5Ú sf]8 ug{'xf];\ .

olb of] nfu" cf}ifwL 8fS6/n] ;'emfj u/]sf] xf] / pko'Qm lrlsT;f ko{j]If0fdf k|of]u ul/Psf] xf] eg], of] dfkbG8nfO{ …5}gÚ pQ/ /fVg'xf];\.

Sedatives, hypnotics or Anxiolytics -cf}ifwL k|of]u ug{ gkfpbfsf] @ jf a9L c;/x?_ M

!= w]/} kl;gf aUg' jf d'6'sf] w8\sg a9\g',

@= xft sfKg' jf xlNng',

#= lgb|fdf ;d:of ,

$= jfsjfsL nfUg' jf afGtf x'g' ,

%= c?n] gb]v]sf jf g;'g]sf lrhx? b]Vg'

jf ;'Gg', lagf sf/0f 5fnfdf s]lx ePsf]

h:tf] cg'e"lt x'g' ,

^= Aofs'n x'g' -czfGt, 56k6L, lr8lr8f kg_,

&= cflQg' ,

*= 5f/]÷d[uL 5f]Kg]÷rl/kmfO{

Opiates -cf}ifwL k|of]u ug{ gkfpbfsf] # jf a9Lc;/x?_M

!= pbf; dx;'; ug'{ ,

@= jfsjfsL nfUg' jf afGtf x'g' ,

#= df+;k]lzdf b'vfO{ -hLp b'Vg'_ ,

$= gfsaf6 kfgL aUg' jf cfvfF/;fpg' ,

%= cfvfFsf] gfgL km'lNng',/f}+ 7f8f] x'g', jf kl;gf cfpg' ,

^= emf8fkvnf x'g' ,

&= xfO{ cfpg' ,

*= z/L/ /GsLg'÷tftf] x'g' ,

(= lgb|fdf ;d:of .

Stimulants and Cocaine -cf}ifwL k|of]u ug{ gkfpbfsf] # jf a9L c;/x?_M

!= ysfO{ nfUg' ,

@= g/fd|f]÷clk|o ;kgfx? ,

#= lgb|f gkg'{ jf w]/} ;'Tg' ,

$=w]/} ef]s nfUg' ,

%= zf/Ll/s jf dfgl;s ?kdf ;':t ePsf] h:tf] b]lvg' jf dx;'; ug'{ .

Cannabis -cf}ifwL k|of]u ug{ gkfpbfsf] # jf a9L c;/x?_M

!= lrl9g', l/;fpg' jf cfs|fds x'g' ,

@= cflQg' ,

#= lgb|fdf ;d:of ,

$=vfgf g?Rg' jf tf}n 36\g' ,

%= 56k6L x'g' ,

^= pbf; x'g' ,

&= k]6 b'Vg], sDkg 5'6\g], kl;gf cfpg], hLp /GsLg], hLp

lr;f] x'g] / 6fpsf] b'Vg] ;d:ofx? dWo] Pp6fdf w]/} cK7\of/f] ePsf] .

k2.s] tkfO{n] nfu" cf}iflw k|of]u ug{ gkfpbfsf] c;/nfO{ 36fpg jf x6fpg cf}ifwLsf] k|of]u ug'{eof] <

J2k ;f/f+z MobL J2k1 jf J2k2, …5Ú ePdf;…5Ú sf]8 ug{'xf];\.

s] J2a b]vL J2k ;f/f+z;Dd (J2k1 / J2k2

nfO{ Pp6f k|Zg dfGg'xf];\_, @ jf a9L pQ/x? …5Ú sf]8 ul/Psf] 5 .

nfu"kbfy{sf] nt ljut !@ dlxgfsf] …5Ú sf]8 ug{'xf];\.

xNsf : J2 dWo] @–# nIf0f

dWod: J2 dWo] $–% nIf0f

Hofb}:J2 dWo] ^ jf a9L nIf0f

5}g 5

nfu"kbfy{sf] nt

-nfu"kbfy{sf] gfd jf ju{_

kl5Nnf] !@ dlxgfdf

5'6\ofpg'xf];\M

xNsf

dWod

Hofb}

K. Psychotic disorder and mood disorder with psychotic features (s8f lsl;dsf] dfgl;s /f]u -dfgl;s c;Gt'ngtf_)

…5Ú pQ/ cfPsf k|To]s k|Zgsf] nfuL pbfx/0f klg ;f]Wg'xf];\ . obL pbfx/0fx?n] :ki6 ?kdf larf/ / cg'e'ltdf s'g} lj?k0f-u8a8L_ b]vfPdf jf ;f+:s[lts ?kdf lt pQ/ pko'St gePsf] ca:yfdf dfq …5Ú sf]8 ug'{xf];\ .of] df]8o'nsf] p2]Zo s8f lsl;dsf] dfgl;s /f]u÷dfgl;s c;Gt'nGftfePsf la/fdLnfO{ kQf nufpg' xf] . of] df]8o'nsf] k|of]u ug{ cg'ej rflxG5.

ca d}n] tkfFO{nfO{ sf]xL dfG5]nfO{ x'g] c;fdfGo cg'ejsf] af/]df k|Zg ug{ uO/x]sf] 5' .

K1.a s] tkfO{n] slxNo},c? dfG5]n] tkfO{sf] lrof] rrf]{ ul//x]sf] 5 jf s;}n] tkfO{sf] la?4 if8oGq ul//x]sf] 5 jf tkfO{nfO{ xfgL k'¥ofpg vf]lh/x]sf] 5 eGg] s'/fdf ljZjf; ug'{ePsf] 5 <(tkfFO{nfO{ dfq To:tf] nfU5 sL c?nfO{ klg To:t} nfU5 < c?nfO{ klg To:t} nfU5 eg], o;sf] pt/ 5}g x'g ;S5 _

l6Kk0fL:;fFlRrs} lk5f ul//x]sf] xf] ls xf]Og eGg] s'/fnfO{ 7Dofpg pbfx/0fx? ;f]Wg'xf];\ .

b.obL…5Ú eg ] : s] tkfO{n] lt s'/fx?df clxn] klg Psbd ljZjf; ug'{x'G5 <

5}g

5}g

5

5

K2.a. s] tkfFO{n] slxNo}, c? dfG5]n] tkfO{sf] dg k9L /x]sf] 5 jf tkfO{sf] larf/ ;'Gg ;S5, jf tkfO{n] ;fFlRrs} c?sf] dg k9\g ;Sg'x'G5 jf c?n] ;f]r]sf] s'/f ;'Gg ;Sg'x'G5 eGg] s'/fdf ljZjf; ug'{ePsf] 5<

b.olb …5Úeg]: s] tkfO{n] lt s'/fx?df clxn] klg Psbd ljZjf; ug'{x'G5 <5}g

5}g

5

5

K3.a s] tkfO{nfO{ slxNo}, c? dfG5]n] jf s'g} afXo zlStn] tkfO{sf] dgdf To:tf] larf/ /flv lbPsf] h'g tkfO{sf] cfˆgf] xf]O{g jf slxNo} c? dfG5] jf afXo zlQmn] tkfO{sf] ;fdfGo :jefj eGbf km/s sfd ug{ nufof] eGg] s'/fdf ljZjf; ug'{ePsf] 5 < s] tkfO{n] slxn] cfkm' c?sf] clwgdf÷lgoGq0fdfePsf] cg'ej ug'{ePsf] 5 <

k|Zgstf{ : pbfx/0fx? ;f]Wg'xf];\ / dfgl;s c;Gt'ng;Fu ;DjlGwt gePsf s'/fnfO{ ;dfj]z gug'{xf];\ .

b.olb …5Ú eg]: s] tkfO{n] lt s'/fx?df clxn] klg Psbd ljZjf; ug'{x'G5 <

5}g

5}g

5

5

K4.a s] tkfO{n] slxNo}, l6=eL=, /]l8of],O{G6/g]6 ,kqklqsf jf lstfasf] dfWodaf6 s;}n] tkfO{nfO{ ljz]if ;Gb]z k7fPsf] jf tkfO{n] glrg]sf] JolStn] tkfO{ dfly ljz]if rf;f] lnPsf] eGg] s'/fdf ljZjf; ug'{ePsf] 5 <

b. obL …5Ú eg ] : s] tkfO{n] tL s'/fx?df clxn] klg ljZjf; ug'{x'G5 < pbfx/0fx? -s:tf] ;Gb]z k7fPsf] eGg] af/] cflb_ ;f]Wg'xf];\ / dfgl;s c;Gt'ng;Fu ;DjlGwt gePsf s'/fx?nfO{ ;dfj]z gug'{xf];\ .

5}g

5}g

5

5

K5.a s] tkfO{sf] gft]bf/ jf ;flyx?n] tkfO{sf] wf/0ffnfO{ c;fdfGo jf crDdsf] dfg]sf 5g\ <

k|Zgstf{: pbfx/0fx? ;f]Wg'xf];\ . obL pbfx/0fx? K1 b]lv K4 ;Dd g;f]lwPsf e|fds ljrf/x?df -delusional ideas) k5{g\ eGg] s'/f :ki6 5 eg] dfq …5Ú dflrGx nufpg] . pbfx/0fsf nflu: wd{, d[To', /f]u, tyf zf/Ll/se|dx? (somatic delusion), cf8+a/sf] -3d08_ e|d (delusion of grandiosity), O{iof{ jf bf]ifsf] e|d (jealousy or guilt), c;kmntf/ckof{Kttf (inadequacy),ljgfz (ruin), cefj (destitution), jf z"Gotf (nihilistic);DaGwL e|dx? .

b.obL …5Ú eg ] : s] pgLx?n] clxn] klg tkfO{sf] wf/0ffx? c;fdfGo jf crDdsf] dfG5g\ <

5}g

5}g

5

5

K6. a.s] tkfO{n] c? dfG5]x?n] g;'Gg]-g;'g]sf_ / tkfO{n] dfq ;'Gg] cfjfhx? ;'Gg' ePsf] 5 <

obL cfjfhsf] ldYofefif, xf] eg ]: s] Tof] cfjfhn] tkfO{sf] larf/x? jf Jojxf/df l6Kk0fL u/]sf] 5 jf s] tkfO{n] b'O{ cyjf a9L cfjfhx? Ps csf{;Fu s'/fsfgL u/]sf] ;'Gg' ePsf] 5 <

b.obL K6a df …5Ú cfPdf: s] tkfO{n] kl5Nnf] Ps dlxgfdf, klg To:t} lsl;dsf] cfjfhx? ;'Gg' ePsf] lyof] <

obL cfjfhsf] ldYofefif, xf] eg ]: s] Tof] cfjfhn] tkfO{sf] ljrf/x? jfJojxf/df l6Kk0fL u/]sf] 5 jf

s] tkfO{n] b'O{ cyjf a9L cfjfhx? Ps csf{;Fu s'/fsfgL u/]sf] ;'Gg'ePsf] 5 <

5}g

5}g

5}g

5}g

5

5

5

5

K7.a s] tkfO{n] glgbfPsf] -Jo'em]sf]_a]nfdf,c? dfG5]n] gb]Vg] / tkfO{n] dfq b]Vg] s'/fx? b]Vg' ePsf] 5<

k|Zgstf{: oL s'/fx? ;f+:s[lts ?kdf cg'lrt 5g\ ls 5}gg\ hfFr ug'{xf];\ .

b.obL…5Ú eg ]: s] tkfO{n] kl5Nnf] Ps dlxgfdf, o:tf s'/fx? b]Vg'ePsf] 5 <

k|Zgstf{sf] lg0f{o:

5}g

5}g

5

5

K8.as] la/fdLn] lautdf slxNo} cJojl:yt (disorganized), ga'lemg](incoherent), jf ljn'Kt

(derailed) efif0f/af]nL af]n]sf] jf s'g} a]d]n(marked loosening of association) b]vfPsf] 5 <

b.s] la/fdLn] xfn jf jt{dfgdf cJojl:yt (disorganized), ga'lemg](incoherent)jf ljn'Kt

(derailed)efif0f÷af]nL af]n]sf] jf s'g} a]d]n(marked loosening of association) b]vfPsf] 5 <

5}g

5}g

5

5

K9a.s] la/fdLn] lautdf slxn] cJojl:yt (disorganized)jf Sof6f6f]lgs-catatonic) Jojxf/

b]vfPsf] 5 <

b. s] la/fdLn] xfn jf jt{dfgdf slxn] cJojl:yt (disorganized)jf Sof6f6f]lgs-catatonic)

Jojxf/ b]vfPsf] 5<

5}g

5}g

5

5

K10 a= s] la/fdLn] slxNo} g]u]l6e nIf0fx? b]vfPsf] lyof] < h:t} M efjgfTds cleJolQmdf pNn]vlgo sdL

cfPsf], klxn] eGbf w]/} sd af]Ng] jf p2]Zod'n's lqmofsnfk z'? ug{ g;Sg] jf lg/Gt/tf lbg g;Sg] .

K10b. s] cGt{jftf{sf] ;dodfl;hf]km]/]lgofsf] g]u]l6e nIf0fx? k|d'v dfqfdf b]vfPsf] lyof] <(h:t} M efjgfTds cleJolQmdf pNn]vlgo sdL cfPsf], klxn] eGbf w]/} sd af]Ng] jf p2]Zo d'ns lqmofsnfk z'? ug{ g;Sg] jf lg/Gt/tf lbg g;Sg] .

5}g

5}g

5

5

K11a.s] K1a b]vL K7a ;Ddsf <a> k|Zgx? dWo] Ps jf a9L pQ/x? …5Ú sf]8 ul/Psf 5g\

/ o;sf ;fy},

k|d'v pbfl;gtfsf] cjlw, ( xfnsf] , ljutsf]jf aNem]sf] )

jf

pGdfb / pbfl;gtfsf] cjlw, ( xfnsf] jf ljutsf] )

/

pGdft / pbfl;gtfsf] cjlw stL ;do ;Dd rNof] <……………………………

s8f dfgl;s /f]usf] cjlw stL ;do ;Dd rNof] <……………………………

pGdfb / pbfl;gtfsf] cjlwePsf] v08df\, s8f dfgl;s /f]usf] nIf0fx?sf] xfn eO/x]sf] / afsLF /x]sfcjlw dWo] w]/} h;f] ;dodf pGdfb / pbfl;gtfsf] u8a8L 5 eg] dfq k|Zg gDa/ K11a nfO{ …5Úsf]8 ug'xf];\<xf]O{g eg] …5}gÚsf]8 ug'xf];\ .

obL k|Zg K11adf …5}gÚcfPdf M pGdft / pbfl;gtfsf] cjlwsf] s'n calw s8f dfgl;s /f]usf]

cjlwsf] calw eGbf sd cfPdf,pGdfb / pbfl;gtfsf] u8a8L;Fu s8f dfgl;s /f]usf] nIf0fx?sf]

g}bflgsaS;df …5}gÚ df uf]nf] nufpg'xf];\ / k|Zg K13 df hfg'xf];\ .

K11b.tkfO{n] c3L dnfO{ eGg' eof] ls tkfO{nfO{ klxn] s'g} a]nf pbf;

ePsf]÷w]/} tfut÷cgfjZos v';L÷nuftf/ ;fgf–;fgf s'/fdf l/; p7\g

;dofjlw x'g] uYof]{ eg]/ . tkfO{n] aofg u/]sf cg'ea÷wf/0ffx?

(k|ZgK1a-K7a df…5Ú sf]8 ul/Psf nIf0fx?)tkfO{n] klxn] s'g}

a]nf pbf; ePsf]÷w]/} tfut÷cgfjZos v';L÷nuftf/ ;fgf;fgf

s'/fdf l/; p7\g] cg'ea u/]sf] a]nfdf dfq x'Gy] <

obL pQ/bftf÷la/fdLn] klxn] s'g} a]nf pbf; ePsf]÷w]/} tfut÷

cgfjZos v';L÷nuftf/ ;fgf–;fgf s'/fdf l/; p7\g] dx;'; gu/]sf] ;dodf

slDtdf@ xKtf ;Dd, c3L aofg ul/Psf cg'ej wf/0ffx? cg'ej

u/]sf] 5 eg] lhjgdf clxn] ;Dd pGdfb / pbfl;gtfsf] u8a8L;Fu

s8f dfgl;s /f]usf nIf0fx?nfO{ …5}gÚsf]8 ug'{xf];\ .

5}g

k13

5

5}g 5

pGdfb / pbfl;gtfsf] u8a8L;Fu s8f dfgl;s /f]usf] nIf0fx?

lhjgdf clxn];Dd

lhjgdf clxn] ;Dd pGdfb / pbfl;gtfsf] u8a8L;Fu s8f dfgl;s

/f]usf nIf0fx?.

obL of] /f]usf] ;d"xsf] pQ/ …5}gÚ cfPsf] 5 eg]K12df klg …5}gÚ

df uf]nf] nufpg] / k|Zg K13 df hfg'xf];\.

K12a.s] K1b b]lv K7b ;Ddsf k|Zgx? dWo] Ps jf a9L

pQ/x? …5Ú sf]8 ul/Psf 5g\ <

/

xfnsf] pbfl;gtfsf] cjlw / pGdfbsf] cjlw dWo] s'g}df …5Ú

sf]8 ul/Psf] 5 <

obL of] /f]u lhjge/sf] jf clxn]sf] pQ/ …5Ú sf]8 ul/Psf]

5 eg], K13 / K14 nfO{ …5}gÚ sf]8 ug'{xf];\ clg csf]{ df]8o'ndf

hfg'xf];\ .

K13.s] K1b b]vL K8b ;Ddsf k|Zgx? dWo] Ps jf a9L


/

s] K1b b]vL K10b ;Ddsf k|Zgx? dWo] b'O jf a9L


/

s] s8f dfgl;s /f]usf] nI0fx? dWo] slDtdf @ j6f nIf0fx?

ToxL Ps dlxgfsf] calwdf b]lvPsf] lyof] <

/ s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn]

(O2;f/f+z) ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 <

K14.s] K13 …5Ú sf]8ul/Psf] 5 <

jf

s]K1a b]vL K8a ;Ddsf<a> k|Zgx? dWo] Ps jf

a9L pQ/x? …5Úsf]8 ul/Psf 5g\ <

/ s] K1a b]vL K10a ;Ddsf <a> k|Zgx? dWo] @ jf

a9L pQ/x? …5Ú sf]8 ul/Psf 5g\ <

/ s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s

sf/0fn] ePsf] xf]Ogeg]/ 5'6\ofOPsf] 5 <

5}g 5


xfnsf]

5}g 5

s8f dfgl;s /f]u

xfnsf]

5}g 5

s8f dfgl;s /f]u

lhjgdf clxn] ;Dd

L. Anorexia nervosa(Pgf]/]S;Lof gef]{;f)

- sf] dtna – lgbfgsf] aS;df- 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

L1 a. tkfO{sf] prfO{ slt 5 < lkm6 OGr

;]=dL=

b. kl5Nnf] # dlxgfdf, tkfO{sf] ;a} eGbf sd tf}n slt lyof] < kfp08

lsnf]

c. s] pQ/bftfsf] tf}n tn lbO{{Psf] tf}n / prfO{sf] tflnsf cg';f/ 5}g 5

sd jf a/fa/ 5 < -tnsf] tflnsf x]g{' xf]nf .

kl5Nnf]] # dlxgfdfM

L2 tkfO{sf] sd tf}nsf] afjh'b klg, s] tkfO{n] tf}n a9fpg] k|of; ug'{ ePg jf l;ldt dfq vfg]s'/f vfg] ug'{eof] <

5}g

5

L3 tkfO{ sd tf}nsf] ePtf klg, s] tkfO{nfO{ df]6f] x'g] jf w]/} tf}n a9\g] af/] Psbd 8/ nfu]sf] lyof] <

5}g

5

L4 a. s] tkfO{ cfkm'n] cfkm}nfO{ jf cfˆgf] z/L/sf] s'g} cË Psbd 7"nf] jf df]6f] ePsf] h:tf] nfU5 <

b.s] tkfO{sf] tf}n jf zfl/l/s agfj6n] tkfO{sf] cfkm" k|ltsf] wf/0f÷;f]rnfO{ c;/ u/]sf] 5 <

c.s] tkfO{n] cfˆgf] xfnsf] sd tf}nnfO{ ;fdfGo jf cToflws ePsf] h:tf] ;f]Rg'eof] <

5}g

5}g

5}g

5

5

5

L5 s] L4 sf] ! jf ! eGbf a9L a'Fbfdf …5Ú sf]8 ul/Psf] 5 <

5}g 5

s] L5 df …5Ú sf]8 ul/Psf] 5 <

5}g 5

Pgf]/]S;Lof gef]{;f

xfnsf]

M.Bulimia nervosa (Ao"nLldof gef]{;f)

- sf] dtna – lgbfgsf] aS;df - 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

M1. kl5Nnf] ltg dlxgfdf, s] tkfO{n] Psbd w]/} vfg] jf @ 306fsf] cjwL leq g} cToflws dfqfdf vfg'ePsf] lyof] <-Psbd w]/} vfg] eGgfn] l56f]–l56f] vfg], cˆ7\of/f] x'g] u/L vfg], ef]s gnfu] klg vfg] a'l´G5 ._

M2. o:tf] Psbd w]/} vfPsf] a]nf, Tof] v'jfO{ tkfO{sf] cfˆgf] lgoGq0f eGbf aflx/ ePsf] dx;'; ePsf] lyof] <

5}g

5}g

5

5

kl5Nnf] # dlxgfdf:

M3.s] tkfO{nfO{ o:tf] Psbd w]/} vfg] k|j[lQ slDtdf xKtfsf] Ps k6s h:tf] ePsf] lyof] <

5}g 5

M4. s] tkfO{n] To;sf] c;/ sd ug{ jf jhg÷tf}n a9\g af6 /f]Sg jfGtf ug{], s]xL gvfO{ a:g] -j|t a:g]_, Jofofd ug{], kvfnf nufpg] jf cGo s'g} cf}iflwx? k|of]u ug'{ePsf] lyof] < s] tkfO{n] oL sfo{x? cS;/ xKtfsf] Ps k6s h:tf] ug'{eof] <

a. o:tf c;/ sd ug]{, cg'lrt sfdx? Ps xKtfdf slt k6s h:tf] ug'{eof] <b. o:tf c;/ sd ug]{, cg'lrt sfdx? Ps xKtfdf slt lbg h:tf] ug'{eof] <

5}g

5

M 5 s] tkfO{sf] tf}n jf zf/Ll/s agfj6n] tkfO{sf] cfkm" k|ltsf] wf/0ffnfO{ c;/ u/]sf] lyof]<

5}g

5

M6 s] pQ/bftfsf] nIf0fx? Pgf]/]S;Lof gef]{;f;Fu d]n vfG5<

5}g

M8 df hfg]

5

M7 s] oL w]/} vfg] k|j[lQx? tkfO{sf] tf}n ========= lsnf] eGbf tn÷sd x'Fbf dfq x'g] ub{y]<

k|Zgstf{ M dflysf] sf]7fdf pQ/bftfsf] tf}n cg';f/sf] prfO{ lbOPsf] tflnsf cg';f/ n]Vg'xf];\ .

5}g 5

M8 M5 df / M6 jf M7 df …5Ú sf]8 ul/Psf] 5 <

vfg';Fu ;DalGwt /f]ux?sf ljlgb{]zsx?:xNsf= dfyL elgPsf To:tf cg'lrt Jojxf/sf !–# cjlwx?dWod= $–& cjlwx?uDeL/ = *–!# cjlwx? cToflws uDeL/ -Hofb}_= !$ jf ;f] eGbf a9L cjlwx?

5}g 5

Ao"nLldof gef]{;f

xfnsf]

5'6\ofpg'xf];\ M

xNsf

dWod

uDeL/

cToflws uDeL/ -Hofb}_

N. Generalized anxiety disorder

(;fdfGos[t cflQg] /f]u)- sf] dtna–lgbfgsf] aS;df-8foUgf]i6Ls aS;_ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

N1 a. kl5Nnf] ^ dlxgfdf, s] tkfO{nfO{ lgoldt sfd s'/fx?sf] af/]df Psbd w]/} cflQg]÷lrGtf nfUg] ePsf] 5 < olb lj/fdL÷pQ/bftfn] a'em]gg\ eg], k|i6 kf/]/ ;f]Wg'xf];\ .

s] tkfO{nfO{ c?n] w]/} lrGtf lnG5 jf cflQG5 eg]/ eGb5g\ <

b. s] of] lrGtf÷cflQg] k|j[lQ k|foh;f] x/]s lbg /xg] ub{5<

s] lj/fdL÷pQ/bftfsf] lrGtfx? jf cflQg] k|j[lQ cl3 ;f]lwPsf /f]ux?df l;ldt 5g\ jf lt /f]ux?n] /fd|/L j0f{g ub{5g\ <

5}g

5}g

5}g

5

5

5

N2. s] tkfO{nfO{ lt lrGtfx? nfO{ lgoGq0f ug{ ufx|f] x'G5 < 5}g 5

N3 olb, nIf0fx? o; cuf8Lsf] jf klxn]sf] /f]ux?df dfq l;ldt 5g eg], lgDg a'Fbfx?sf] nflu …5}gÚ df lrGx nufpg'xf];\M

kl5Nnf] ^ dlxgfdf, ha tkfO{ Psbd lrlGtt jf cflQg] x'g'eof], ta s] tkfO{n] w]/} h;f] ;do M

a= 56k6L dxz'; ug'{eof],s]xL g/fd|f] e}xfN5 ls eg]/ cToflws cflQg' eof] <

b. df+zk]zLx?df tgfa ePsf] dxz'; ug'{eof]<

c. Psbd} sdhf]/ jf ;lhn} ylst dxz'; ug'{eof] <

d. s'g} sfd–s'/fdf Wofg lbg ufx|f] ePsf] jf lbdfu vfnL ePsf] dxz'; ug'{eof] <

e. emls{g] x'g' eof] <

f.;'Tg÷lgbfpg ufx|f] eof] -lgbfpg g;Sg], dWo/ftdf Ao'lemg], ljxfg l5§} Ao'lemg] jf w]/} ;'lt/fVg]]_

s] N3 df # jf # eGbf a9L a'Fbf df …5Ú sf]8 ul/Psf] 5 <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

N. Generalized anxiety disorder

(;fdfGos[t cflQg] /f]u)- sf] dtna–lgbfgsf] aS;df-8foUgf]i6Ls aS;_ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

N1 a. kl5Nnf] ^ dlxgfdf, s] tkfO{nfO{ lgoldt sfd s'/fx?sf] af/]df Psbd w]/} cflQg]÷lrGtf nfUg] ePsf] 5 < olb lj/fdL÷pQ/bftfn] a'em]gg\ eg], k|i6 kf/]/ ;f]Wg'xf];\ .

s] tkfO{nfO{ c?n] w]/} lrGtf lnG5 jf cflQG5 eg]/ eGb5g\ <

b. s] of] lrGtf÷cflQg] k|j[lQ k|foh;f] x/]s lbg /xg] ub{5<

s] lj/fdL÷pQ/bftfsf] lrGtfx? jf cflQg] k|j[lQ cl3 ;f]lwPsf /f]ux?df l;ldt 5g\ jf lt /f]ux?n] /fd|/L j0f{g ub{5g\ <

5}g

5}g

5}g

5

5

5

N2. s] tkfO{nfO{ lt lrGtfx? nfO{ lgoGq0f ug{ ufx|f] x'G5 < 5}g 5

N3 olb, nIf0fx? o; cuf8Lsf] jf klxn]sf] /f]ux?df dfq l;ldt 5g eg], lgDg a'Fbfx?sf] nflu …5}gÚ df lrGx nufpg'xf];\M

kl5Nnf] ^ dlxgfdf, ha tkfO{ Psbd lrlGtt jf cflQg] x'g'eof], ta s] tkfO{n] w]/} h;f] ;do M

a= 56k6L dxz'; ug'{eof],s]xL g/fd|f] e}xfN5 ls eg]/ cToflws cflQg' eof] <



d. s'g} sfd–s'/fdf Wofg lbg ufx|f] ePsf] jf lbdfu vfnL ePsf] dxz'; ug'{eof] <

e. emls{g] x'g' eof] <

f.;'Tg÷lgbfpg ufx|f] eof] -lgbfpg g;Sg], dWo/ftdf Ao'lemg], ljxfg l5§} Ao'lemg] jf w]/} ;'lt/fVg]]_

s] N3 df # jf # eGbf a9L a'Fbf df …5Ú sf]8 ul/Psf] 5 <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

N4 s] of] lrGtf÷cflQg] k|j[lQn]], tkfO{sf] b}lgsL h:t} 3/

kl/jf/, sfdsfh, k9fO{, ;dfh, ;DjGwx? jf cGo

s'/fx?df 7"n} tgfj jf ;d:of u/]sf lyP <

/

s] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn] ePsf] xf]Og

eg]/ 5'6\ofOPsf] 5 <

O. dfgl;s nIf0fx? lgtfGt zf/Ll/s jf s'g} cf}ifwLsf] sf/0fn] ePsf] xf] ls xf]Og eg]/ 5'6\ofpg'xf];\M

olb pQ/bftf÷lj/fdLn] s'g} klg xfnsf] /f]u jf pbfl;gtfsf] cjlw jf pGdfbsf] cjlwdf …5Ú pQ/ sf]8 u/]df, ;f]Wg'xf];\ M

nIf0fx? ;'? x'g'eGbf l7s cuf8L :

O1as] tkfO{n] s'g} cf}ifwL÷nfu"kbfy{ lnb} ug'{ePsf] lyof] jf s'g} 5}g 5 clglZrt cf}ifwL÷nfu"kbfy{ vfg gkfpbfsf] c;/ ePsf] cj:yfdf x'g'x'GYof] <

O1bs] tkfO{nfO{ s'g} cGo zf/Ll/s /f]u nfu]sf] lyof] < 5}g 5 clglZrt

O 2 olb O1a cyjf O1b df …5Ú sf]8 ul/Psf] 5 eg] 5}g 5 clglZrt k|Zgstf{sf] d"Nofs+gdf s] Tof] la/fdLdf b]lvPsf]

/f]usf]] k|ToIf sf/0f x'g ;Sg] ;Defjgf 5 < olb

cfjZostf k5{ eg], lj:t[t ?kdf ;f]Wg'xf];\ .

O2 ;f/f+z:s] cGo zf/Ll/s /f]u jf nfu"kbfy{ cf}iflw;Fu 5}g 5 clglZrt ;DalGwt sf/0fx? 5'6\ofOPsf] 5 <olb O2 df …5}gÚsf]8

ul/Psf] 5 eg], O2 ;f/f+zdf …5Ú x'G5 .

cGoyf, of] clglZrt x'G5 .

5}g 5

;fdfGos[t cflQg] /f]u

xfnsf]

P. Antisocial personality disorder

(c;fdflhs JolQmTjsf] /f]u)- sf] dtna–lgbfgsf] aS;df -8foUgf]i6Ls aS;_ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

P1 s] tkfO{n] cfkm' !% jif{ k'Ug' cl3 M

a. af/Daf/ :s'n ghfg] jf :s'naf6 efUg] ug'{eof] jf /fte/L 3/ af6 efUg'eof] jf cfdf afa'sf] cg'dtL lagf /ftL aflx/ a:g' eof] <

b. af/Daf/ em'6 af]Ng'eof], a]OdfgL sfd ug'{eof], c?nfO{ 7Ug'eof] jf rf]g'{ eof] jf unt p2]Zon] s;}sf] 3/ jf uf8Ldf k:g' eof] <

c. emu8f ;'? ug'{eof] jf c?nfO{ wDSofpg], 8/fpg], t;f{pg] jf xf]Rofpg] ug'{eof] <d. hflghfgL rLh÷a:t'x? laufg]{ -gi6 ug{]_ jf cfuf] nufpg] ug'{eof] <e. hflghfgL hgfj/ jf dfG5]nfO{ rf]6 k'¥ofpg' eof]<

s;}nfO[33]g ultljlwdf nfUg afWo ug'{eof] < s] P1 sf] k|Zgx? dWo] @ jf a9L pQ/x? "5" sf]8 ul/Psf 5g\ <

obL tn lbOPsf Jojxf/x? ljz]if u/L /fhgLlts jf wfld{s ?kdf pTk]|l/t 5g eg]"5" sf]8 gug'{xf];\ .

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

P2. s]] tkfO{n] cfkm' !% jif{ k'lu;s] k5L M

a. cj}w÷sfg'g ljkl/t sfdx? jf tkfO{{ ks|fpdf gk/]tfklg, ks|fpdf kfg{ ;Sg] vfnsf sfdx? ug'{ePsf] 5, oblk tkfO{ ks|fp kg'{ ePg -pbfx/0fsf] nflu M ;Dklt gi6 ug{], rf]/L ug{], ;fdfg rf]g{], nfu'cf}ifwLx? a]Rg], jf s'g} 3f]/ ck/fw u/]sf] <

b. k|foh;f] k};f kfpg jf /dfO{nf]sf] nflu c?nfO{ em'7 af]Ng] jf 7Ug] ug{'ePsf] 5 <

c. l5§} cfj]udf cfpg] / ;f]Rb} g;f]rL -lagf of]hgf_ s'g} sfd ug]{ ug'{ePsf] 5 <

d. c?;Fu af/Daf/ emu8f -s'6fs'6_ ug'{eof] jf c?nfO{ cfs|d0f ug'{eof] ->LdtL jf 5f]/f 5f]/L;Fu ePsf] zf/Ll/s emu8f ;lxt_ <

e. Vofn gu/]/ -;f]Rb} g;f]rL_ cfkm'nfO{ jf c?nfO{ vt/fdf kfg'{eof] <

f. To:Tff sfdx? af/Daf/ ug'{x'G5 h'g c?n] x]bf{ u}/–lhDd]jf/ b]lvG5 <h:t}M(pwf/f] gltg]{, cfj]udf cfpg] jf hfgLhfgL s]xL sfd gu/L a:g] .)

g. c?nfO{ b'v -rf]6_ lbPkl5, b'Jo{jxf/ u/]kl5, em'6f] af]n]kl5 jf c?sf] s]xL rf]/]kl5 jf ;DklQsf] Iflt k'¥ofPkl5 klg cfkm'nfO{ bf]ifL -cfTdUfnfgL_ dxz'; ug'{ePg <

s] P2sf] k|Zgx? dWo] # jf a9L pQ/x? "5"

sf]8 ul/Psf 5g\ <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

5}g 5

c;fdflhs JolQmTjsf] /f]u

lhjgdf clxn];Dd

Q. Dissociative (Conversion) disorder (ljlqmt dgf]zf/Ll/s tyf tgfjsf] /f]u)

Q1. Dissociative identity disorder (l8;f];LPl6e cfO{8]g6L6L l8;c8{/)

Q1a. kl5Nnf] ! jif{df, s] tkfO{n] slxNo} z/L/df s]xL r9]sf] jf 5f]k]sf] h:tf] (dftf r9]sf], xfjf nfu]sf], cfTdf r9]sf] cflb) cg'ej ug'{ePsf] lyof] < Tolta]nf s] tkfO{sf] Jojxf/, af]nL, :d/0f zlQm, ;f]Rg ;Sg] Ifdtf -;f]rfO{_ of zf/Ll/s lqmofsnfkdf s]xL kl/jt{g cfPsf] h:tf] dx;'; ug'{ePsf] lyof] jf s;}n] tkfO{nfO{ eg]sf] lyof] < Q1a df…5}gÚ pQ/ cfPdf, Q2 df hfg'xf];\M

Q1b. s] oL nIf0fx?n] ubf{ tkfO{sf] b}lgsL, h:t} M :s'ndf jf 3/df jf ;dfhdf jf ;fyLx?;Fu jf sfdsfhdf jf cGo s'g} dxTjk"0f{ lqmofsnfkx?df ;d:of ePsf] lyof]<

Q1bdf…5}gÚ pQ/ cfPdf, Q2 df hfg'xf];\M

Q1c. s] o:tf] ultljlw tkfO{sf] ;dfhdf÷wd{÷;+:s[tL df dfGo 5 -c?n] ;dfg ?kdf lnG5g\ ls lnb}gg\_ <

Q1 sf] x/]s pQ/df 5 cfPdf dfq,Q1 nfO{ …5Ú sf]8 ug'{xf];\ .

5}g

5}g

5}g

5}g

5

5

5

5

Q2.Somatic symptom disorder (;f]Dof6Ls l;Dk6d l8;c8{/ )

Q2a. kl5Nnf] !jif{df, s] tkfO{nfO{ Ps jf a9L zf/Ll/s nIf0fx? -;d:of_ 5g\ , h;n] ubf{ tkfO{sf] b}lgs lhjgdf c;/ ePsf] 5 <-pbfx/0fdf M zf/Ll/s nIf0f eGgfn] z/L/sf] s'g} efu nuftf/ b'vL /fVg], xft v'§f emdemd ug]{, kf]n]sf] h:tf] x'g], rSs/ nfUg], af8'nL nfUg], k]6 km'n]sf] h:tf] x'g] cflb kb{5g\ ._Q2a df…5}gÚ pQ/ cfPdf, Q3 df hfg'xf];\M

Q2b. s] oL nIf0fx?sf] ulDe/tfsf] af/]dftkfO{nfO{ cgfjZos ?kdf jf nuftf/ cToflws tgfj÷lrGtf lbg] vfnsf] ;f]rx? cfO/xG5 <Q2b df…5}gÚ pQ/ cfPdf, Q3 df hfg'xf];\M

Q2c. s] tkfO{sf] w]/}h;f] ;do oL zf/Ll/s ;d:ofx?sf] af/]df ;f]r]/} laTg] ub{5 <Q2c df…5}gÚ pQ/ cfPdf, Q3 df hfg'xf];\M

Q2d. s] lo ;d:ofx? tkfO{nfO{ ^ dlxgf jf a9L ;do;Dd nuftf/ ?kdf ePsf lyP <

Q2 sf] x/]s pQ/df 5 cfPdf dfq,Q2nfO{ …5Ú sf]8 ug'{xf];\ .

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

Q3. Conversion disorder(sGe/;g l8;c8{/)

Q3a. kl5Nnf] ! jif{df, s] tkfO{nfO{ tn lbOPsf dWo] Ps jf a9L nIf0fx? 5g\ <= xft v'§fsf] sdhf]/L x'g] jf grNg] .= c;fdfGo ?kdf xft v'§f rNg], ˆofFsg], sfKg], xNnLg] cflb .= lgNg jf af]Ng ufx|f] x'g] . = 5f/] /f]u h:t} a]xf]; x'g] jf d'5f{ kg]{ -9Ng]_ . = z/L/sf] s'g} c+udf 5f]Psf] yfxf gx'g] -nf6f] x'g]_ .

Q3b. s] oL nIf0fx?n] ubf{ tkfO{sf] b}lgsL, h:t} M :s'ndf jf 3/df jf ;dfhdf jf ;fyLx?;Fu jf sfdsfhdf jf cGo s'g} dxTjk"0f{ lqmofsnfkx?df ;d:of ePsf] lyof] <

Q3c. s] oL nIf0fx?sf] af/]df tkfO{n] lrlsT;snfO{ b]vfpg' ePsf] 5 jf s'g} hfFr u/fpg' ePsf] 5 <olb …5Ú eg] s] oL nIf0fx? lgtfGt zf/Ll/s sf/0fn] ePsf] xf]Og eg]/ lrlsT;sn] eGg'ePsf] 5 <

olbQ3a / Q3b df …5Ú cfPdf, Q3 nfO{ …5Ú sf]8 ug'{xf];\ .

Q3;f/fz+:Q1, Q2jf Q3dWo] s'g} Psdf …5Ú sf]8 ul/Psf] 5 eg], ljlqmt dgf]zf/Ll/s tyf tgfjsf] /f]u(Dissociative÷Conversion disorder) nfO{ …5Ú sf]8 ug{'xf];\.

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

R. Epilepsy (5f/] /f]u)

R.a. s] tkfO{ slxNo} a]xf]; jf d'5f{ kg]{ x'g' ePsf] 5 <

R.b. a]xf]; ePsf] a]nfdf tn lbOPsf dWo] s'g} Ps jf a9L ultljlw ePsf lyP <= 6fpsf] jf d'v Psflt/ afª\uLg] .= bfx|f ls6\g] .= d'vaf6 lkmh cfpg] .= xft uf]8f s8f x'g] of sfKg] .= lha|f] 6f]Sg] . = cfFvf dfyL kN6fpg] . = Tof] a]nfdf lb;f, lk;fa sk8fd} x'g] -lgoGq0f ug{ g;Sg]_ .

Z. R.c.s] dfyL lbOPsf nIf0fx? PSn} x'bfF, /ftL ;'t]sf] a]nfdf jf s'g} klg cj:yfdf ePsf 5g\ <

R.d.s] o:tf nIf0fx?n] ubf{ tkfO{nfO{ z/L/df d'Votof ljz]ifu/L 6fpsf]df rf]6 nfu]sf] 5 <

5}g

5}g

5}g

5}g

5

5

5

5

R(a),R(b)/R(c) df …5Ú ePdf, …RÚ df …5Ú sf]8 ug'{xf];\ . 5}g 5

5f/] /f]u


dfu{ / pkRff/sf] b'/L ;+u ;DalGWft k|Zgx? M

ca d}n] tkfOnfO{ tkfOn] cl3 eGg' ePsf ;d:ofx?sf] pkrf/ ;+u ;DalGwt k|Zgx? ;f]Wg uO/x]sf] 5'|.

k|Zg g+=

k|Zgx? pQ/x? k|Zg ;f]Wg 5f8\g] / csf]{ k|Zgdf hfg]

1. uPsf] !@ dlxgfdf, tkfO{n] cfkm'n] ef]u]sf] s]lx ;d:ofx? cg'ej u/]sf] atfpg' eof] .

uPsf] !@ dlxgfdf, tkfO{n] …………… -/f]usf]nIf0f _ sf] af/]df s;};+u s'/f ug'{ePsf] lyof] ?

lyPg 0 3

lyof] 1

yfxf 5}g 888

2. olb lyof] eg], sf] ;+u s'/f ug'{ePsf] lyof] ?-nfu" x'g] ;a}df uf]nf] 3]/f nufpg'xf];\ ._

;fly÷l5d]ls 1

klt÷klTg 2

kl/jf/sf cGo ;b:ox? 3

sd{rf/L÷;xsdL{ 4

Hof]ltif, k'/f]lxt 5

:jf:Yo ;]jf sd{rf/L -h:t}M 8fS6/, g;{, ljz]if1 cflb_

6

wfdL–´fFls| 7

cGo -v'nfpg]_ 8

3. uPsf] !@ dlxgfdf, s] tkfO{n] …………… -/f]usf] nIf0f_ sf] s'g} pkrf/ vf]Hg'ePsf] lyof] ?

olb lyof] eg], s] lyof] pNn]v ug'xf];\ .

lyPg 0

lyof] 1

yfxf 5}g 888

4. uPsf] !@ dlxgfdf, s] tkfO{n]………… -/f]usf] nIf0f_ sf] s'g}pkrf/ ;]jf lng'ePsf] lyof] ?

lyPg 0 ^ df hfg] / csf]{ df]8\o'nsf] BACE k|Zg klg ;f]Wg]

lyof] 1

lnPsf] lyof] t/ lard} 5f8]sf]

2 ^ df hfg] / csf]{ df]8\o'nsf] BACE k|Zg klg ;f]Wg]

yfxf 5}g 888 6

5. olb pkrf/ ;]jf lng'ePsf] lyof] eg], tnsf] tflnsf eg'{xf];\ .

:jf:YosdL{ slt k6s e]6]sf] -;+Vof_

pkrf/sf] ljlw

;Nnfx lbP cg';f/ pkrf/sf] sf]if{ k'/f u/]sf]

pkrf/n] k'¥ofPsf] ;xof]u


5.1 dgf]lrlsT;s cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4.........

– cf}iflw k'/f u/]sf]

1 slQ klg ;xof]u k'¥ofPg

1

– clxn] klg cf}iflw lnO{/fv]sf]

2 s]lx ;xof]u k'¥ofof] 2

– cf}iflw k'/f gu/]sf]

3 w]/} ;xof]u k'¥ofof] 3

– k/fdZf{ k'/f u/]sf]

4 yfxf 5}g 888

– clxn] klg k/fdZf{ lnO{/fv]sf]

5

– k/fdZf{ k'/f gu/]sf]

6

– yfxf 5}g 7

– cGo 8

5.2 dgf]j}1flgs cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4.........



1






4 yfxf 5}g 888


5


6

– yfxf 5}g 7

– cGo 8


5.3 dgf]j}1flgs k/fdZf{bftf

cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4.........



1


2 s]lx ;xof]u k'¥ofof]2




4 yfxf 5}g 888


5


6

– yfxf 5}g 7

– cGo 8

5.4 8fS6/ cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4

.........



1






4 yfxf 5}g 888


5


6

– yfxf 5}g 7

– cGo 8


5.5 kf/fd]l8S; -g;{, :jf:Yo ;xfos cflb_

cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4

.........



1






4 yfxf 5}g 888


5


6

– yfxf 5}g 7

– cGo 8

5.6 dlxnf :jf:Yo :jod\ ;]ljsf

cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4

.........



1






4 yfxf 5}g 888


5


6

– yfxf 5}g 7

– cGo 8


5.7 wfdL emfFqmL cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4

.........



1






4 yfxf 5}g 888


5


6

– yfxf 5}g 7

– cGo 8

5.8 cGo -v'nfpg]_

pbfx/0f- k'g{:yfkgf ;]jf (rehab_

cf}iflw-1

k/fdZf{-2

b'a}-3

cGo-v'nfpg]_-4

.........



1






4 yfxf 5}g 888


5


6

– yfxf 5}g 7

– cGo 8


6. tkfO{n] uPsf]] !@ dlxgfdf,…………… -/f]usf] nIf0f_ sf] pkrf/sf]

nflu slt vr{ ug{'eof]] ?

pkrf/ vr{ cGbfhL ======================== ?k}of

oftfoft vr{ cGbfhL =======================?k}of

cGo vr{ -vfg] a:g] cflb_==================?k}of

7. s] tkfO{ slxNo} …………… sf] pkrf/sf] s|ddf c:ktfndf egf{ x'g'ePsf] lyof]]] ?

7.1 olb lyof] eg], slt k6s ?

7.2 slt ;do cjlwsf] nflu ?

lyPg===================0lyof] =================== 1yfxf 5}g =================888

=============k6s

==============dlxgf / ==============lbg

Barriers to Access to Care Evaluation scale (BACE)

ca xfdL tkfOn] cl3 eGg' ePsf h:tf ;d:ofx?sf] pkrf/ lng jf lg/Gt/tf lbgnfO{ /f]Sg], l9nf ug]{ jf lg?T;flxt ug]{ ljleGg sf/0fx?sf] af/]df 5nkmn ug]{5f}+ . o:tf :jf:Yo ;]jf lbg] JolQm eGgfn] oxfF 8fS6/, dgf]lrlsT;s, dgf]ljdz{stf{, dgf]j}1flgs, dfgl;s :jf:Yo g;{ jf dfgl;s :jf:Yo sfo{stf{nfO{ a'emfpF5 . d ca tkfO{sf] ;fd' ljleGg sf/0fx? / t]:sf ;+efljt pQ/x? klg k9\5' . tkfOnfO{ s'g sf/0fn] o]:tf ;]jfx? lng jf ;]jfnfO lg/Gt/tf lbg af6 afwf k'of{Psf] 5 jf lyof] s[kofdnfO{atfOlbg'xf]nf.

sf/0f slQ klg xf]Og

cln cln xf]

w ] / } xf]

Psbd} xf]

c;fGble{s

H1 o:tf :jf:Yo ;]jf ;'ljwf sxfF kfOG5 eGg] s'/fyfxf gePsfn]

० १ २ ३

H2 cfˆgf] ;d:ofsf] ;fdfwfg cfkm} ug{ rfx]sfn] ० १ २ ३

H3 dgsf] ;d:of 5 eg]/ yfxf kfPdf c? dflg;x?n]sdhf]/ JolQm 7fG5g eg]/

० १ २ ३

H4 cfˆgf] OR5f ljk/Lt c:ktfndf egf{ ul/ lbG5g eGg] 8/n]

० १ २ ३

H5 hflu/ vf]Hg] qmddf s'g} ;d:of k5{ls eGg] sf/0fn] ० १ २ ३ ६६

H6 hfg cfpg oftfoft ;fwgsf] c;'ljwfn] ubf{ ० १ २ ३

H7 ;d:of cfkm}+ ;dfwfg x'G5 eg]/ ० १ २ ३

H8 dgsf] ;d:of 5 eGg] yfxf kfPdf cfˆg} 3/kl/jf/n]klg s] eGnfGeg]/

० १ २ ३

H9 dgsf] ;d:of 5 eGg] s'/fn] cfkm}+ nlHht x'g ]sf/0fn] (Probe) c?;Fu dgsf] s'/f v'n]/ ug{ g;Sg]=

० १ २ ३

H10 cGo s'g }j}slNks ;]jfx?af6 g} 7Ls x'G5 eg]/ -h:t}Mkm'skmfs u/]/, wfdL emfqmL+nfO{ b]vfP/ cflb_

० १ २ ३

H11 pkrf/ ubf{ nfUg] vr{ h'6fpg g;s]sf] sf/0fn] ० १ २ ३

H12 ;a}n] af}nfxf kfun eg]/ lrG5g eGg ]lrGtfsf] sf/0fn] ० १ २ ३


H13 :jf:Yo ;]jf ;'ljwf lnP klg s]lx ;'wf/ x'b}+g eGg] ;f]rfOsf] sf/0fn]

० १ २ ३

H14 ;d'bfosf c? dflg;x?n] g/fd|f] cleefjssf] ?kdflnG5g eg]/

० १ २ ३६६

H15 cfˆg} hft -hftL, wd{, ;Fl:qmtL leq dfgl;s ;d:ofsf]pkrf/ cyjf ;]jf ;'ljwf pknAw gePsf] sf/0fn] (Probe) cfˆgf] hft hflt leqsf] pkrf/_

० १ २ ३

H16 PSbd} w]/ }lj/fdL eP/ ;xof]u dfUg} g;s]sf ]sf/0fn] ० १ २ ३

H17 cfkm"nfO{ lrGg] JolQmx?n] yfxf kfpF5g eg]/ ० १ २ ३

H18 cfˆgf] dgsf] s'/f-efjgf jf ljrf/ lk/, lrGtf, 8/_ s;}nfO{ eGg dgg nfu]/

० १ २ ३

H19 dgsf] :jf:Yo ;DalGw ;]jf ;'ljwf lnPsf]yfxf kfPdf ;d'bfosf dflg;x?n] sd dxTj lbG5g eg]/

० १ २ ३

H20 pkrf/ lnbfF gs/fTds c;/x? k5{ eg]/-Probe: PnhL{ x'g], w]/} df]6fpg], w]/} lgG›f nfUg]_

० १ २ ३

H21 dgsf] ;d:of ePsf] s'/f s'g} klg d]l8sn /]s8{df -c:ktfndf_ g/xf];\ eg]/

० १ २ ३

H22 :jf:Yo ;]jf lbg ]JolQm;Fusf] tLtf] -g/fd|f]_ cg'ejsf]sf/0fn]

० १ २ ३

H23 cfˆgf] kl/jf/ jf ;fyLx?af6 g} pkrf/sf] nfuL ;xof]u k|fKt ug]{ rfxgfn]

० १ २ ३

H24 cfˆgf] afnaRrfnfO{ cfkmgf] OR5f ljkl/t g} c? s;}n]x]/rfx ug{ n}hfG5g cfkm'af6 6f9f n}hfG5g eGg]sf/0fn]

० १ २ ३६६

H25 cfkm'nfO{ To:tf] s'g} klg ;d:of 5}g eGg] ;f]rfO{sf]sf/0fn]

० १ २ ३

H26 o:tf] ;d:of 5 eGg] yfxf kfPdf ;fyLefO{x?n] s]eG-nfg\, s] ;f]Rnfg jf s] unf{g eg]/

० १ २ ३

H27 sfdaf6 km';{b lgsfNg ufx|f] eP/ ० १ २ ३

H28 o:tf] ;d:of 5 eGg] yfxf kfPdf ;Fu} sfd ug]{ ;fyL -;xsdL{_x?n] s] eGnfg\, s] ;f]Rnfg\ jf s] unf{g eg]/

० १ २ ३ ६६

H29 :jf:Yo ;]jf ;'ljwf lnbfF, lng hfbf 3/df afnaRrfnfO{ x]/rfx ug{ ;d:of eP/

० १ २ ३ ६६

H30 :jf:Yo ;]jf ;'ljwf lng] rfxgf / dg x'bfF x'b}+ klg ;xof]u ug]{ sf]lx klg geP/

० १ २ ३

ANNEX IV: Questionnaire for adolescent participants

;fdfGo k|ZgfjnL M

k|.g+. k|Zgx? k|ltls|ofx?

1. ;fdfGo k|Zgx? M1.1 cGt{jftf{sf] ldtL lbg/ dlxgf / jif{

..…/…….../……..

1.2 lhNnfsf] gfd / sf]8 ………………..….……( sf]8………….….)

1.3 gUf/kflnsf/UffpF kflnsf sf] gfd / sf]8 …………………...……( sf]8………….….)

1.4 Jf8f g+=

1.5 k|ZgsTff{sf]gfd / x:TffIf/ gfd ………….………….

x:TffIf/………….……….

1.6 cGt{jftf{ Zf'? EfPsf] / :fdfKTf EfPsf]] :fdo

1.7 cGt{jftf{sf] Kfl/0ffd cGt{jftf{ k'/f eof]………………………….…01

cGt{jftf{ cf+lZfs?kDffk'/f eof]……..…...02

s'g} k|ltls|ofx? 5}gg\…………………..…....03

1.8 :f'k/EffO{h/sf]gfd / x:TffIf/ gfd ………….………….

x:TffIf/………….……….

2. pQ/bftfsf]hg;f+Ëlvs tyf ;fdflhs laj/0fM2.1 gfd -clgjfo{ 5}g_

2.2 pd]/ (pd]/ k'/f ePsf] jif{) ………………….. jif

2.3 lnË k'?if ………………01

dlxnf …………...02

cGo …………….…03

2.4 j}jflxs l:YflTf cljjflxt ………………………………..……...01

ljjflxt …………………………………..………02

ljwjf ………………………………………….….03

;DaGw ljR5]b ePsf]/cnlUuP/ a;]sf]………..04

cGo (pNn]v ug{'xf];\)………………………..…..05

2.8

2.5 slt k6s ue{jtL x'g'eof] / ue{jtL k'/f ePsf] xfnsf] dlxgf -ue{jtL 5 eg]_ stL xf] <

ue{jtL ePsf] k6s…………………………….

k'/f ePsf] dlxgf………………….…………....


2.6 clGtd aRrfsf] pd]/ …………………. jif{ …………………. dlxgf

2.7 5f]/f–5f]/Lsf] ;+Vof -lhljt_ 5f]/f ……………………………hgf

5f]/L …………………………..hgf

cGo …………………….……..hgf

2.8 WfDf{ lxGb' ……………………………………...01

O{;fO{ ………………………………..…...02

O{;nfd ……………………………….…..03

af}¢ wdf{jnDaL ………………..…….….04

cGo (pNn]v ug{'xf];\)…………..….…….05

2.9 pQ/bftfsf] hftL bnLt…………………………….………..…01

lk5l8PsfhghftL ……………….…….02

lk5l8Psf] t/fO{ hftL (bnLtafx]s)….03

wfld{s cNk;+Vos …………….………..…04

t'ngfTds ?kdf kmfObfdf k/]sf hghftL…....05

dflyNnf] hflto ;d'x ……………….….06

2.10 Kfl/jf/sf] ls;LDf Psn …….……………………………..……01

;+o'Qm/lj:tfl/t …………………….…….02

2.11 Kfl/jf/sf] ;+Vof …………………. hgf

2.12 Kfl/jf/df !#–!& jif{pd]/sf ;b:ox?sf] ;+Vof …………………. hgf

2.12.1 efO{ alxgLsf] ;+Vof -!#–!& jif{pd]/sf nfO{ dfq ;f]Wg]_

…………………. efO{

…………………. alxgL

2.13 pQ/bftfsf]z}lIfs of]Uotf clzlIft ………………………….………….01

cgf}krfl/s lzIff ………….............02

k|fylds lzIff eGbf sd ……………….…03

k|fylds tx ………………………….….…04

lgDg dfWolds (^-*)……………....…..05

dfWolds ((-!))…………………..……….06

pRr dfWolds/ dfly…………….…….07


2.14 a'afsf]z}lIfs of]Uotf -cljjflxtsf] nfuL_ clzlIft ………………………….…….………….01

cgf}krfl/s lzIff ………….............02

k|fylds lzIff eGbf sd …………….…03

k|fylds tx ……………………….….…04

lgDg dfWolds (^-*)……….……...…..05

dfWolds ((-!))…………………..……….06

pRr dfWolds/ dfly……………………..07

2.15 cfdfsf]z}lIfs of]Uotf -cljjflxtsf] nfuL_ clzlIft ………………………….………….01

cgf}krfl/s lzIff …………..........02

k|fylds lzIff eGbf sd ……….…0 3

k|fylds tx …………………….….…04

lgDg dfWolds (^-*)…………..…..05

dfWolds ((-!))…………..……….06

pRr dfWolds/ dfly…………….………..07

2.16 klt÷klTgsf]z}lIfs of]Uotf -ljjflxtsf] nfuL_ clzlIft …………………….………….01

cgf}krfl/s lzIff ……...........02

k|fylds lzIff eGbf sd ……….…03

k|fylds tx …………………….….…04

lgDg dfWolds (^-*)………..…..05

dfWolds ((-!))…………..……….06

pRr dfWolds/ dfly……………………..07

2.17 pQ/bfTffsf]k]zf u[lx0fL …..………………….….…...01

s[lif ………………………………..…..02

;]jf ……………………………..……….03

Jofkf/ ……………………………..…….04

b}lgs sfdbf/………………………….05

cGo (pNn]v ug{'xf];\)…………..….06

2.18 cfdfsf] k]zf-cljjflxtsf] nfuL_ u[lx0fL …..………………….….…...01

s[lif ……………………………………..…..02

;]jf …………………………….…..……….03

Jofkf/ …………………………….…..…….04

b}lgs sfdbf/………………………………….05

cGo (pNn]v ug{'xf];\)…………….…..….06

2.19 a'afsf] k]zf-cljjflxtsf] nfuL_ u[lx0fL …..………………………….….…...01

s[lif ……………………………………..…..02

;]jf …………………………….…..……….03

Jofkf/ …………………………….…..…….04

b}lgs sfdbf/……………………………….05

cGo (pNn]v ug{'xf];\)…………….…..….06

2.20 klt÷klTgsf] k]zf-cljjflxtsf] nfuL_ u[lx0fL …..………………………….….…...01

s[lif ……………………………………..…..02

;]jf …………………………………..……….03

Jofkf/ ………………………………..…….04

b}lgs sfdbf/……………………………….05

cGo (pNn]v ug{'xf];\)…………………..….06

2.21 kl/jf/sf] dfl;scfDbfgL (g].?.) g].?.…………………………………

yfxf 5}g….………..……………..

2.22 tkfO{sf] dfl;s cfDbfgLn] kl/jf/sf] xfnsf cfwf/e't cfjZostfx? -ufF;, af;, skf;, :jf:Yo_ k'u]sf]] 5 h:tf] nfU5 <

nfU5 ….……….…………………...……..01

nfUb}g ….…………………….……...02

yfxf 5}g….………..……………………....03

2.22.1 lgDg ;'ljwfx?dftkfO{sf] 3/kl/jf/df pknAw 5g\ <

vfgfksfpg]O{Gwg-uf]a/ Uof;,Uof; r'nf]..01

pko'Qm af;:yfg ….……………...02

lah'ln / ;f]nf/….……..03

vfg]kfgL….………………...04

/]l8of] ….……….……...05

6]lnkmf]]g÷df]afO{n ….……...06

6L.eL. ….………………...07

;fO{sn ….…………….....08 df]6/ ;fO{sn ….…….……...09

2.23 uPsf] !@ dlxgfsf] ;dfofjlwdf, tkfO{sf] kl/jf/df s;}sf] lgwg ePsf] lyof] <

lyof] ….……….……...01

lyPg ….……………..02

yfxf 5}g ….………...03

2.23.1

2.23.1 olb lyof] eg], slt jif{sf] pd]/df lgwg ePsf] lyof] <

.........................jif{

2.23.2 pQm JolQm;Fu tkfO{sf] gftf s] lyof] < ...............................

2.23.3 pxfsf] lgwgsf] d'Vo sf/0f s] lyof] < ...............................

M.I.N.I. k|Zgx? ;DalGw ;fdfGo lgb]{zgx?

cGt{jftf{ M

cGt{jftf{nfO{ hlt ;Sbf] 5f]6f] /fVg, pQ/bftfnfO{ tkfO{n] Ufg]{ cGt{jftf{df ;f]lwg] dgf]Jf}¡fflgs ;d:of ;DalGwk|Zgx?sf] pQ/ …5Ú jf …5}gÚ df cfpg] vfnsf 5g\ Efg]/ hfgsf/L lbg'xf];\ .

;fdfGo 9fFRff M

• M.I.N.I.nfO{ ljleGg 8foUgf]i6Ls df]8\o'Nfdf ljeflhTf Ufl/Psf] 5, Hf'Gf c+u|]hL cIf/x? -A-Z_ af6 klxrfg Ufg{ ;lsG5 .

• x/]s 8foUgf]i6Ls df]8\o'nsf] ;'?jftdf -s8f lsl;dsf] dfgl;s /f]u-;fO{sf]l6s l8:c8{/_afx]s _, /f]usf] d'Vo dfkb08sf] l:s|lgËk|Zg -x?_v}/f] /Ësf] aS;df lbOPsf 5g\ .

• x/]sdf]8\o'nsf] cGTodf, 8foUgf]i6LsaS;-x?_ n]k|Zgstf{nfO{ 8foUgf]i6Lsdfkb08 k'/f eof] jf ePg eg]/ ;+s]t ug]{ cg'dlt lbG5 .

d"Nofª\sg lgb]{zgx? M

;a} k|Zgsf] d"Nofª\sg ug'{kb{5 . k|To]s k|Zgsf] bflxg] kl§ …5Ú jf …5}gÚ df, uf]nf] 3]/f nufP/ d"Nofª\sg ul/G5 . k|ltls|of sf]8 ug{nfO{, k|Zgstf{n] g}bflgs lg0f{o (Clinical Judgement) k|of]u ug'{k5{ . k|Zg ;f]Wbf / k|ltls|of d"Nofªsg ug{, k|Zgstf{ ;f+:s[lts ?kdf ;+j]bglzn x'g'kb{5 . ;lx sf]l8ª ug{nfO{ ,cfjZostf cg';f/ pQ/bftfnfO{ pbfx/0fx? ;f]Wg'k5{ . pQ/bftfnfO{ ga'l´Psf÷:ki6 gePsf s'g} klg k|Zgx? ;f]Wg k|f]T;fxg ug'{xf];\ .

k|Zgstf{ lglZrt x'g'k5{ ls k|To]s k|Zgsf ulx/fOx?, pQ/bftfn] k|i6;+u a'´]sf] x'g'kb{5 -h:t}M ;do ;Ldf, cfj[[lQ÷af/Da/tf, ulDe/tf, /÷jf ljsNkx?_ .

zf/Ll/s sf/0f jf dlb/f ;]jg jf nfu"cf}iflwsf] ;]jgn] ubf{ x'g] nIf0fx?nfO{ M.I.N.I. df …5Úsf]8ug'{x'b}g . M.I.N.I. df o:tf ;d:ofx? kQf nufpg] k|Zgx? 5g\ .

cGo lgb]{zgx? M

• 8foUgf]i6Lsdfkb08sf] d"Nofª\sgnfO{ u'0f:tl/o agfpg…;fdfGo lnlkÚ df n]lVfPsf JffSox?, n]lVfP cg';f/ g} k9\g'kb{5 .

• …af]N8Ú df n]lvPsf JffSox?, k|Zgstf{nfO{ lgb]{zg xf], / of] pQ/bftf ;dIf k9\g'kb}{g .

• …cG8/nfOgÚ ePsf jfSox?n] ;do ;Ldf hgfpFb5 . k|Zgstf{n] of]] w]/} h;f] cfjZostf cg';f/ k9\g'kb{5 .:sf]/sf] lx;fa ug{, lbO{Psf] ;dofjlwdf b]lvPsf nIf0fx? dfq ;dfj]z ug'{kb{5 .

• dfly …P/f]Ú - _ ePsf pQ/x?n], 8foUgf]l;;sf] s'g} Ps dfkb08 k'/f gePsf] hgfpFb5 . o:tf] dfdnfdf, k|Zgstf{ df]8\o'nsf] cGTolt/ hfg'kb{5, …5}gÚdf uf]nf] nufpg'k5{ / csf]{ df]8\o'ndf hfg'kb{5 .

• olb …:nof;n]Ú -÷_ 5'6\ofOPsf zAbx? 5g\ eg], pQ/bftfn] a'´g] nIf0fx? dfq k9\g'kb5{ .

• …sf]i7sf] jfSof+zx?Ú, nIf0fx?sf] g}bflgs pbfx/0f x'g\ . oL k|ZgnfO{ :ki6 kfg{, pQ/bftf;dIf k9\g'kb{5 .

A. Major depressive episode

(pbfl;gtfsf] /f]u)- sf] dtna_ lgbfgsf] aS;df -8foUgf]i6LsaS; _hfg], …5}gÚdf 3]/f nufpg], / csf{]df]8\o'ndfhfg] ._

sltko dfG5]nfO{ @ xKtf ;Dd, w]/} h;f] ;do, nueu x/]s lbg pbf; jf b'lv, lg/fz jf vfnLkg dx;'; x'g] ub{5,…….

A1a. s] tkfO{n] lhjgdf slxNo} b'MvL jf pbf; dx;'; ug'{ePsf] lyof] < vfnL–vfnL jf lg/fz dx;'; ug'{ePsf] lyof] < ;fgf]–;fgf] s'/fdf l/; p7\g] jf emsf]{ nfUg] -lrl9Psf]_ dx;'; ug'{ePsf] lyof] < s] tkfO{n] slDtdf @ xKTff ;Dd, w]/}h;f] ;do o:tf] dx;'; ug'{ePsf] lyof] <

olb s'g} Psdf …5Ú cfPdf, k|Zg ;f]Wg hf/L /fVg] . olb ;a}df …5}gÚ pQ/ cfPdf, A1a / A1bdf …5}gÚ sf]8 ug'{xf];\.

b. uPsf] b'O{ xKtfdf, s] tkfO{n] w]/} h;f] ;do, nueu x/]s lbg To:tf] dx;'; ug'{ePsf] lyof] <

A2a. s] tkfO{nfO{ lhjgdf slxNo}, w]/} lbSs nfUg] jf tkfO{nfO{ dgkg]{ s'/fx?df -h:t}M cfkm"nfO{ dgkg]{ v]n v]Ng_ sd OR5f÷?rL nfu]sf] lyof] < s] tkfO{ cfkm"nfO{ dg kg]{ s'/fx?df /dfO{nf] dfGg g;s]sf] dx;'; ug'{ePsf] lyof] < s] tkfO{n] slDtdf @ xKtf ;Dd, w]/} h;f] ;do To:tf] dx;'; ug'{eof] <

olb s'g} Psdf …5Ú 5 eg], k|Zg ;f]Wg hf/L /fVg], olb ;a}df …5}gÚ pQ/ cfPdf A2a / A2b df …5}gÚ sf]8 ug'{xf];\.

b b. uPsf] @ xKtfdf, s] tkfO{n] w]/} h;f] ;do,w]/} h;f] sfd÷s'/fx?df klxn] cfkm' /dfpg] u/]sf] sfd÷s'/fdf /dfpg g;s]sf] dx;'; ug'{ePsf] lyof] <

s] A1a cyjf A2a df …5Ú sf]8 ul/Psf] 5 <

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

olb A1b jf A2b df …5Ú sf]8 ul/Psf] 5 eg] M xfnsf] / ljutdf b]lvPsf] k|d'v nIf0fx?sf] af/]df dfq a'em\g'xf];\ , c G o y f olb A1b / A2b df …5}gÚ sf]8 ul/Psf] 5 eg] M ljutdf b]lvPsf]] k|d'v nIf0fx?sf] af/]df dfq a'em\g'xf];\ .

A3. uPsf] @ xKtfdf, tkfO{n] pbf;÷emsf]{ -lrl9Psf]_÷?rL gePsf] dx;'; ubf{ M

ljutsf] @ xKtf ljutsf] cjlw

a. s] tkfOnfO{ k|foMh;f] lbgx?df w]/} ef]s nfUg] jf yf]/} ef]s nfUg] ePsf] lyof] < s] tkfO{sf] k|of; lagf g} tf}n 36]sf] jf a9]sf] lyof] < -h:t}M uPsf] ! dlxgfdf,z/L/sf] tf}nsf] ±%Ü n] 36]sf] jf a9]sf]_ olb s'g} Psdf …5Ú pQ/ cfPdf, …5Úsf]8 ug'{xf];\.

b. s] tkfO{nfO{ k|foMh;f] /ftdf lgGb|fdf ;d:of ePsf] lyof]<-oxfF ;d:of eg]sf] lgGb|f -lgGb_ kg{ ufx|f] x'g], cfwf/ftdf Ao'lemg], laxfg l5§} Ao'lemg], cyjf Psbd w]/} ;'Tg] ;d:of . _

c. s] tkfO{n] c? a]nf eGbf la:tf/} af]Ng] jf lx8\g] ug'{ePsf] lyof] < s] tkfO{nfO{ x/]s lbg 56k6L jf Ps} 7fpFdf a:g g;Sg] ePsf] lyof] <s] s;}n] tkfO{sf] of] s'/f yfxf kfPsf] lyof]] < olb s'g} Psdf …5Ú pQ/ cfPdf, …5Úsf]8 ug'{xf];\.

d. s] tkfO{n] k|foMh;f] ysfO{ nfu]sf] dx;'; ug'{ePsf] lyof]<

e. s] tkfO{nfO{ w]/}h;f] ;do, cfˆgf] af/]df g/fd|f] nfUg] ePsf] lyof] < s] tkfO{n] w]/}h;f] ;do, cfkm"nfO{ bf]ifL jf uNtL u/]sf] h:tf] dx;"; ug'{ePsf]] lyof]< olb s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

olb …5Ú eg] pbfx/0fx? ;f]Wg'xf];\ .

lgDg lsl;dsf] e|d 5 ls x]g'{xf]; M c;kmtfsf], ckof{Ktfsf], bf]ifsf] jf ;hfosf] cfjZostfsf] jf /f]u jf d[To'sf] jf z"Gotf(nihilistic) jf zf/Ll/s e|d(somatic delusion).

oL pbfx/0fx? e|fds ljrf/;Fu ldNb5g\ M xfnsf] cjlw M 5}g 5 ljutsf] cjlw M 5}g 5

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f. s] tkfO{nfO{ nueu x/]s lbg, s'g} s'/fdf Wofg lbg jf ;f]Rg jf s'g} s'/fsf] nflu ;f]r agfpg ufx|f] ePsf] lyof]< olb s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

g. s] tkfO{nfO{ olt w]/} g/fd|f] nfUof] ls, cfkm" d/]sf] eP x'GYof] h:tf] nfu]sf] lyof] < s] tkfO{n] cfkm"nfO{ rf]6÷xfgL k'¥ofpg] af/] ;f]Rg'ePsf] lyof] < s] tkfO{nfO{ d[To' af/]df;f]rx? cfPsf lyP < s] tkfO{n] cfkm"nfO{ dfg]{ af/] ;f]Rg'ePsf] lyof]< olb s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .-dg'{sf] 8/nfO{ o;df ;dfj]z gug'{xf];\_ -nfdf] ;f]Wbf pQ/ cfPg eg] k|ZgnfO{ 6'qmfP/ ;f]Wg'xf];\ . _

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A4. s] tkfO{sf] of] b'MvL jf pbf; efjgfn] ubf{ 3/df<:s'ndf< ;flyx?;Fu< cGo JolQmx?;Fu< jfcGo s'g} dxTjk"0f{ tl/sfn] w]/} ;d:of ePsf] lyof] <

5}g 5 5}g 5

A5. pbfl;gtf /f]usf] cjlwx?sf] lardf, s] tkfO{n] slDtdf @ dlxgf hlt, pbf; yfxf 5}g 5}g 5

jf b'MvL gePsf] dx;'; ug'{ePsf] lyof] <

s] (A1 – A3) ;Ddsf k|Zgx? dWo], % jf ;f] eGbf a9L pQ/ / A 4sf] pQ/ …5Ú

sf]8 ul/Psf] 5 </

s] pbfl;gtfsf] /f]usf] nIf0fx? lgtfGt zf/Ll/s sf/0fn] ePsf] xf]O{g(W2;f/f+z) eg]/

5'6\ofOPsf]] 5 <

of] cjlw xfnsf] xf] jf ÷/ ljutsf] xf] :ki6 kfg'{xf];\ .

olb A5df…5Ú sf]8 ul/Psf] 5 eg] aNem]sf] nfO{ …5Ú sf]8 ug'{xf];\ .

A6(a).tkfO{nfO{ lhjgdf clxn];Dd slt k6s pbfl;gtfsf] ;d:of -/f]u_ ePsf] 5 <.............

pbfl;gtfsf] cjlwsf] lardf s'g} pNn]vlgo pbfl;gtf gePsf] sd;]sd @ dlxgfsf] cjlw x'g'kb{5 .

5}g 5

k|d'v pbfl;gtfsf] cjlw

xfnsf]

ljutsf]

aNem]sf]

B. Suicidality

(cfTdxTofk|j[lQ)cfh sn cfTdxTof÷v'bv'zL sf] 36gfx? w]/} ;'Ggdf cfO{/x]sf] 5 . w]/} dflg;x?n] o:tf] ljrf/ cfPsf] s'/fx? JoQm u/]sf 5g\ ,………….

uPsf] ! dlxgfdf M gDa/

B1. s] tkfO{sf] s'g} b'3{6gf ePsf] lyof]<-e'mlSsP/ w]/} cf}ifwL vfPsf] klg b'3{6gfdf kb{5_ olb B1 df …5}gÚpQ/ cfPsf] 5 eg], B2 df hfg'xf];\ . olb …5Ú eg] k|Zg B1a ;f]Wg'xf];\ .

B1a. s] tkfO{n] slxNo} cfkm"n] cfkm}nfO{ rf]6 k'¥ofpg] dgzfon] s'g} b'3{6gfsf] of]hgf agfpg'ePsf] lyof] jf cfzf /fVg'ePsf] lyof] jf cfkm"nfO{ rf]6 k'¥ofpg], lk8f x'g;Sg] kl/l:ytLdfk'¥ofpg' ePsf] lyof] < olb B1a df …5}gÚ eg],B2 df hfg'xf];\ . olb …5Ú eg] k|Zg B1b ;f]Wg'xf];\ .

B1b. s] tkfO{nfO{ s'g} b'3{6gfdf kl/ dg{ kfP x'GYof] eGg] nfu]sf] lyof] <

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B2. s] tkfO{n] cfkm' d/]sf] eP /fd|f] x'GYof] jf cfkm' dg{ kfP x'GYof] jf cfkm' dg}{kg{] eg]/ ;f]Rg'eof] <

5}g 5 !

B3. s] tkfO{n] cfkm" dg{;Dd ;Sg] ;Defjgf x'bfFx'b}klg, cfkm"nfO{ xfgL ug{] -rf]6 k'¥ofpg]_ jf cfTdxTof÷v'bv'zL sf] af/]df ;f]r agfpg'ePsf] lyof]<

olb B2 + B3df …5}gÚ pQ/ cfPsf] 5 eg], B4 df hfg'xf];\. cGoyf ;f]Wg'xf];\ M

slth;f] -lk|mSj]G;L_ slt s8f -OG6]g;L6L_slxn]sfxL xNsf k|foh;f] dWod

w]/} h;f] ulDe/÷Hofb}

5}g 5 ^

B 4 s] tkfO{n] cfkm'n] cfk}mnfO{ ædfg'k5{Æ eGg] h:tf lgb]{zg lbg] cfjfh-x?_ ;'Gg'eof]<cyjf cfTdxTof÷v'bv'zL ;Fu ;DalGwt s'g} ;kgf b]Vg'eof] <

olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\ . s] of] cfjfh-x?_ lyof] < s] of] ;kgf lyof] <

5}g 5 $

B5 s] tkfO{n] cfkm"nfO{ dfg]{ s'g} tl/sfsf] af/]df;f]Rg'ePsf] lyof]-s;/L dfg{]_< 5}g 5 *

B6 s] k|of]u u/]/ tkfO{n] cfkm"nfO{ dfg]{af/] ;f]Rg'ePsf] lyof]<

5}g 5 *

B7 sxfF uP/ tkfO{n] cfkm"nfO{ dfg]{ af/] ;f]Rg'ePsf] lyof]< 5}g 5 *

B8 s] tkfO{n] cfkm"nfO{ slxn] dfg]{ eg]/ ;f]Rg'ePsf] lyof] < 5}g 5 *

B9 s] tkfO{n] cfkm"nfO{ dfg'{ cl3 k"/f ug{ afFsL s]xL s'/fsf] af/]df ;f]Rg' ePsf] lyof] < -h:t} M cfTdxTof ;DjGwL gf]6jf lr¶L n]Vg] cflb ._

5}g 5 *

B10 s] tkfO{n] s'g} of]hgf cg';f/ cfkm"nfO{ dfg]{ af/] ;f]Rg'ePsf]] lyof] <olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\:

s] tkfO{n] ToxL ;dodf g}, To;f] ug]{ ljrf/ ug'{ePsf] lyof] <s] tkfO{n] eljiodf s'g} a]nf, To;f] ug]{ ljrf/ ug'{ePsf] lyof] <

5}g 5 *

B11 o;/L rf]6 k'¥ofpbf cfkm' dl/G5 ls eGg] nfu]sf] lyof] <olb …5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\:

s] tkfO{n] ToxL ;dodf g}, To;f] ug]{ ljrf/ ug'{ePsf] lyof] <s] tkfO{n] eljiodf s'g} a]nf, To;f] ug]{ ljrf/ ug'{ePsf] lyof] <

5}g 5 *

B 12 s] tkfO{nfO{ rf8f] eGbf rf8f] cfkm'nfO{ dfg'{kg{] jf dfg]{ of]hgf agfpg'kg]{ h?/L dxz'; ePsf] lyof] jf ;f]r÷cfj]z cfPsf] lyof] <

olb…5Ú eg], s'g} Ps jf b'a}df lrGx nufpg'xf];\: s] of] cfkm'nfO{ dfg{sf] nflu lyof] < s] of] cfkm'nfO{ dfg{] of]hgf agfpgsf nflu lyof] <

olb …5Ú eg],s'g} Ps jf b'a}df lrGx nufpg'xf];\. s] of] s'g}/fd|f] sf/0fsf] nflu lyPg < s] of] s'g} /fd|f] sf/0fsf] nflu lyof]< of] s'g} s'/fn] gpS;fPsf] xf] eGg] s'/f lgwf{/0f ug{, ;f]Wg'xf];\ M æo:tf]

vfnsf] cfj]u cfPsf] % ldg]6 cl3, s] tkfO{n] To:tf] cfj]u cfpnf eg]/ klxn] g} cg'dfg ug{ ;Sg'x'GYof] <ÆolbB12 df …5}gÚ pQ/ cfPdf, B14df hfg'xf];\.

5}g 5 *

B13s] tkfO{nfO{ o:tf] ;f]rx? /f]Sgufx|f] ePsf] lyof] < 5}g 5 *

B14 s] tkfO{n] cfkm'nfO{ dfg{ cfjZos tof/L ug'{eof] t/ cfkm"nfO{ xfgL -rf]6_ k'¥ofpg' l7s cl3 g} /f]lsg'eof] <

olb B14 df …5}gÚ eg] B15 df hfg'xf];\. cGoyf B14a df hfg'xf];\.

B14 a. s] tkfO{n] cfkm'nfO{ dfg{ cfjZos tof/L ug'{eof] t/ cfkm"nfO{ dfg]{ k|of; ;'? ug'{ePg <

b. s] tkfO{n] cfkm'nfO{ dfg{cfjZos tof/L ug'{eof] t/ cfkm"nfO{ xfgL k'¥ofpg' l7s cl3 cfkm"nfO{ /f]Sg'eof] <c. s] tkfO{n] cfkm'nfO{ dfg{cfjZos tof/L ug'{eof] t/ cfkm"nfO{ xfgL k'¥ofpg' l7s cl3 s;}n]÷s]lxn] tkfO{nfO{ /f]Sof]<

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!!

B15 s] tkfO{n] cfkm'nfO{ dfg{] dg;fo geO{sg klg hfgL hfgL cfkm'nfO{ xfgL k'¥ofpg' ePsf] lyof] <-of] cfTdxTofk|j[lQ cGtu{t kb}{g_

5}g 5 )

B16 s] tkfO{n] cfkm'nfO{ dfg]{ k|of;÷sf]lzz ug'{ePsf] lyof]< -B16df …5}gÚ eg], B17df hfg'xf];\_

a. s] tkfO{n] cfkm"nfO{ dfg]{ k|of; z'? ug'{eof] t/ ;lsg' eGbf cuf8Lg} /f]lsg'eof] <

b. s] tkfO{n] cfkm"nfO{ dfg]{ k|of; z'? ug'{eof] t/;lsg' eGbf cuf8Lg} s;}n] /f]Sg'eof] <

c. s] tkfO{n] cfkm'n] tof/L u/]sf] h:t} u/L cfkm"nfO{ dfg]{ k|of; ug'{eof] <

-cfTdxTofsf] k|of; eGgfn]] yf]/} ePklg cfkm'nfO{ dfg{] dgzfon] u/]sf] s]xL sfd h;df tkfO{nfO{ rf]6k6s÷xfgL x'g ;SYof]_ <

olb …5}gÚ pQ/ cfPsf] 5 eg],B17 df hfg'xf];\Ms] Tof] a]nf tkfO{n] s;}n] arfcf]; eGg] jf cfkm' afFRg] cfz ug'{ePsf]lyof]<dl/G5g} eGg] nfu]sf] lyof] jf dg]{ dgzfo /fVg' ePsf] lyof] <

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B17 Pslbgdf tkfO{n] cfkm"nfO{ dfg]{ ;DjGwL cfj]ux?÷;f]rx? jf ;f] ;DjGwL lqmofsnfkx?df slt ;do latfpg' eof] <cf};t ;do k|lt lbg =============== 306f=============== ldg]6 slDtdf =========== lbg =============== 306f=============== ldg]6al9df ==============lbg =============== 306f=============== ldg]6

o;/L klg ;f]Wg'xf];\ Mslth;f] -lk|mSj]G;L_ slxn]sfxLF k|foh;f] w]/} h;f]

B18 lhjgdf clxn] ;Dd M s] tkfO{n] slxNo} cfTdxTofsf] k|of; -cfkm"nfO{ dfg]{ k|of;_ ug'{ePsf] lyof]<

olb …5Ú eg], slt k6s <============olb …5Ú eg], kl5Nnf] k6s -ljutdf_ slxn] ug'{ePsf] lyof] <

uPsf] !@ dlxgfdf!@ b]lv @$ dlxgflardf@$ dlxgf eGbf cuf8L

cfTdxTofsf ]k|of; eGgfn] yf]/} eP klg dg]{ dg;fo /fv]/ ul/Psf] cfTd3ftjf cfkm"nfO{ rf]6÷xfgL gf]S;fgL k'¥ofpg] Jojxf/÷lqmofsnfk a'lemG5 . pbfx/0fsf] nflu o;nfO{ o;/L klg a'em\g ;lsG5 ls of] s]an Ps b'3{6gf dfq geO{ JolQmn] dg]{ dgzfo JoQm gu/]tf klg of] 36gf p;sf] nflu 3fts x'g ;S5 eGg] yfxf x'bfFx'b} klg ul/Psf] Ps k|of; xf] .

5}g 5 $

B19 ca cfpg] # dlxgfdf, tkfO{n] cfkm'n] cfkm}nfO{ dfg{] k|of; ug]{ sltsf] ;Defjgf 5 < )–!))Ü ;Ddsf] dfqfdf eGg'xf];\ . ============= Ü

)Ü eGbf al9 ePdf,B19 df …5Ú sf]8 ug'{k5{ .

o;/L klg ;f]Wg'xf];\ M ca cfpg] # dlxgfdf, tkfO{n] cfkm'n] cfkm}nfO{ dfg{] k|of; ug]{ sltsf]

;Defjgf 5< != 5}g @= yf]/}÷clnslt #= w]/} $= Psbd w]/}

5}g 5!#

dflysf k|Zgx? dWo] sDtLdf ! j6fdf -B 1afx]s_ …5Ú sf]8 ul/Psf] 5 < olb 5 eg],(B1 - B19);Dddf …5Ú sf]8 ul/Psf pQ/x?af6 s'n c+s hf]8\g'xf]; / cfTdxTofk|j[lQsf] jlu{s/0f ug'{xf];\ .

xfnsf]: B1a af6 B16c ;Dd- B17afx]s_ s'g} pQ/ …5Ú cfPdf jf B17df s]xL ;do vr{ u/]sf] ePdf .lhjgsfndf clxn] ;Dd: B18 df …5Ú sf]8 ul/Psf] .lgs6 eljiodf:B19df …5Ú sf]8 ul/Psf] .

pQ/bftfsf] xfnsf] jf kl5Nnf]] cfTdxTof k|of; ;DalGw s'g} cGo hfgsf/L tn n]Vg'xf];\ M

C. Manic and Hypomanic Episode

(pGdfb / sd pGdfb /f]usf cjlwx?)- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS;_ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

s] tkfO{sf] kl/jf/df s;}nfO{ pGdfb–pbfl;gtfsf] /f]u÷afOkf]nf/ /f]u ePsf] lyof] cyjf kl/jf/sf] sf]xL ;b:onfO{ dg kl/jt{g eO{/fVg] -slxn] cToflws v'zL, slxn] cToflws b'vL jf cToflws l/;fpg]_ ;d:ofsf] pkrf/ lnlyod h:tf] cf}ifwLn] u/fO{Psf] lyof]<of] k|Zg afOkf]nf/ /f]usf] nflu dfkb08 xf]Og t/ afOkf]nf/ /f]usf] hf]lvd k|lt k|Zgstf{sf] ;ts{tf a9fpg ;f]lwPsf] xf] . olb …5Ú eg], sf] xf] k|i6 kfg'{xf];\M========================

5}g 5

5}g 5cfTdxTofk|j[lQ

!–* c+s Go"g (–!^ c+s dWod !& c+s jf a9L pRr

xfnsf]

lhjgsfndf clxn] ;Dd lgs6 eljiodf

C1a. s] tkfO{ lhjgdf slxNo} olt w]/} v';L x'g'ePsf] 5 ls, tkfO{n] cfkm"nfO{ Psbd} km'lt{nf] ePsf]]÷w]/} tfut cfPsf] dx;'; ug'{ePsf] 5< d}n] eGg vf]h]sf] Psbd} /fd|f]÷/dfO{nf] dx;'; x'g', Psbd km"lt{nf]÷tfultnf] ePsf] dx;'; x'g], yf]/} dfq ;'t] k'Ug],lbdfudf w]/} / l56f]]] ;f]]]rfO{÷ljrf/÷of]hgf cfpg], gofF s'/fx? w]/} cfpg] eGg] a'em\g ;lsG5 <

s] tkfO{n] cfkm" Psbd ;lqmo ePsf] jf w]/} km'lt{nf] ePsf]÷w]/} tfut cfPsf] dx;'; ug'{ePsf] 5 <olb b'j} k|Zgsf] pQ/ …5Ú cfPdf dfq …5Ú sf]8 ug'{xf];\ . -cj:yfx? h:t} M dfbs kbfy{÷nfu"kbfy{ ;]jg u/]sf], afn–aflnsfx?nfO{ pT;flxt÷a9L

v';L agfpg] cj:yfx? h:t} hGd lbg, rf8kj{ cflbnfO{ o;df ;dfj]z gug'{xf];\ ._

olb pQ/bftfn] tkfO{n] eGg vf]Hg'ePsf] s'/f a'emg'ePg eg] – lgDg tl/sfn] a'emfpg'xf];\ :Psbd} km'lt{nf] ePsf]÷tfut cfPsf] eGgfn] d}n] eGg vf]h]sf] lagf sf/0f÷cgfjZos ?kdf cToflws dfqdf v'l; ePsf], km'lt{nf] jf ;lqmo ePsf], yf]/} dfq ;'t] k'Ug], lbdfudf w]/} / l56f]]] ;f]]]rfO{÷ljrf/÷of]hgf cfpg], cgfjZos ?kdf lqmofsnfk÷ pTkfbgl;ntf a9]sf], k|]l/t ePsf], /rgfTds ePsf], cfj]uk"0f{ sfo{ a9]sf]; w]/} kmf]g rnfpg], w]/} sfd ug]{] jf w]/} k};f vr{ ug]{ ePsf] 5 <

olb …5}gÚ eP, C1b df …5}gÚ df lrGx nufpg'xf];\ . olb …5Ú eg], ;f]Wg'xf];\ M

b. s] tkfO{n] clxn] ;fdfGo eGbf w]/} tfut cfPsf] / km'lt{nf] ePsf] h:tf] dx;'; ug'{ePsf] 5 <

C2a. s] tkfO{nfO{ lhjgdf slxNo} w]/} lbg ;Dd nuftf/ ;fgf] ;fgf] s'/fdf l/; pl7/fVg]÷emsf]{ nfUg]÷lrl9g] ePsf] 5, h;n] ubf{ tkfO{n] 3/ kl/jf/ aflx/sf] dflg;nfO{ a]:;/L s/fpg' ePsf] jf emu8f ug'{ePsf] 5 < tkfO{n] cfkm"n] To:tf] Jojxf/ ug'{ l7s ePsf] dx;'; u/]tfklg s] c? s;}n] tkfO{nfO{ ;fdfGo aRrfx? eGbf a9L ;fgf]– ;fgf] s'/fdf l/;fpg]÷lrl9g] eg]/ ofb÷Vofn u/]sf] 5 <-dfbs kbfy{÷nfu" kbfy{ k|of]u ePsf] cj:yfx? o;df ;dfj]z gug'{xf]nf ._

olb …5}gÚ eg], C2b df …5}gÚ df lrGx nufpg'xf];\ . olb …5Ú eg] ;f]Wg'xf];\ M

b. s] cfhsn tkfOnfO{ k|foh;f] ;fgf]–;fgf] s'/fdf l/;fpg]]÷lrl9g] h:tf] dx;'; ePsf] 5 <

s] C1a jf C2a df …5Ú sf]8 ul/Psf] 5 <

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5

5

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C3. olb, C1b jf C2b Ö …5Ú eg] M xfnsf] cjlw / To;kl5 ljutsf] ;a}eGbf w]/} nIf0f ePsf] cjlwsf] af/] ljit[t hfgsf/L lng'xf];\ .

olb, C1b / C2bÖ …5}gÚ eg] M ljutsf]] w]/} nIf0f ePsf]÷b]lvPsf] cjlwsf] lj:t[t hfgsf/L lng'xf];\ .

xfnsf] cjlwsf] lj:t[t hfgsf/L lnbfF, x/]s k|ZgnfO{ o:tf] tl/sfn] ;f]Wg'xf];\ M

cfh ;lxt ljutsf s]xL lbgx?df, ha tkfO{n] w]/} phf{ ePsf] dx:f':f ug'{ePsf] lyof], Tof] ;dodf, s] tkfO{nfO{:==================

klxn]sf] cjlwsf] lj:t[t hfgsf/L lnbfF, x/]s k|ZgnfO{ o:tf] tl/sfn] ;f]Wg'xf];\ M

ljutsf s]xL lbgx?df, ha tkfO{n] w]/} phf{ ePsf] dx:f':f ug'{ePsf lyof], Tof] ;dodf, s] tkfO{nfO{:==================

xfnsf] cjlw ljutsf] cjlw

a. c?n] ug{ g;Sg] sfd cfkm"n] ug{ ;S5' h:tf] nfUof]< s] tkfO{nfO{ cfkm" Psbd dxTjk"0f{ JolQm ePsf] dx;'; eof] <

olb …xf]Ú eg], pbfx/0fx? ;f]Wg'xf];\.s] pQ/bftfn] lbPsf pQ/x? e|fds ljrf/;Fu ldN5 <

xfnsf] cjlw 5}g 5 klxn]sf] cjlw 5}g 5

b. yf]/} dfq ;'Tbf klg lgGb«f k'u]sf] h:tf] ePsf] lyof] <

c. nuftf/ g/f]lssgaf]n]sf] af]No}, s'/f u/]sf] ug]{ ug{'ePsf] lyof] < olt l56f] af]Ng'eof] ls c? dflg;n] tkfO{n] af]Ng'ePsf] a'em]gg\ < nuftf/ w]/} af]Ng' ePsf] jf af]Ng} kg]{ bafa dx;'; ug'{eof] <

d.s] tkfO{sf] larf/x? l5g l5gd}, Ps ljifo÷s'/faf6 csf]{df uPsf], lbdfu l56f]–l56f] rn]sf] h:tf] dx;'; ug'{eof] <

e. ;fgf]–;fgf] s'/fn] klg Wofg csf]{ lt/ uPsf] lyof] <

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5}g

5}g

5}g

5}g

5}g

f. 3/, kl/jf/, ljBfno jf ;dfhsf] s'/f÷ljifox?df c? eGbf w]/} / rflxg] eGbf a9L ;+nUg x'g'ePsf] lyof] <s] tkfO{n] w]/} 56k6L dx;'; ug'{eof] <-cfˆgf] lqmofsnfkdf ePsf] of] kl/jt{g÷j[l4 s'g} sf/0fjz jf s'g} sf/0f ljgf g} klg x'g ;S5 ._

g. rf]6k6s nfU5 eGg] yfxf x'bfFx'b} klg s'g} /dfO{nf] sfdx? ug{ rfxg'eof] < To:tf sfdn] cˆ7\of/f]df kfg{ ;S5 eGg] yfxf x'bfFx'b} klg lt sfd ug{ rfxg'eof] <-h:t} : ca]/ ;Dd 3/ aflx/ a:g], :s'n ghfg], nfk/aflx tl/sfn] uf8L rnfpg], cToflws w]/} k};f vr{ ug]{ . _

olb s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

5}g

5}g

5

5

5}g

5}g

5

5

C3;f/f+z M xfnsf] cjlwnfO{ d"NofÍg ubf{ Molb C1b df …5}gÚ eg], s] C3 (C3f ;lxt) sf] $ j6f jf a9L pQ/ …5Ú cfPsf] 5 <olbC1b df …5Ú eg], s] C3 (C3f ;lxt) sf] # j6f jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

klxn]sf] cjlwnfO{ d'Nof+sg ubf{ M olb C1a df …5}gÚ eg], s] C3 (C3f ;lxt) sf] $ jf a9L pQ/ …5Ú cfPsf] 5 <olb C1adf …5Ú eg], s] C3 (C3f ;lxt)sf] # j6f jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

olb dfyLsf # jf a9L nIf0fx? Pp6} ;dodf b]lvPsf eP dfq …5Ú sf]8 ug'{xf];\ .

lgod M cToflws v'zL jf v'zLsf] Jofkstfsf] nfluC3sf] # j6f nIf0f x'g'kb{5 eg] l56f]–l56f] l/;fpg]sf] nflu C3 sf] $ j6f nIf0f x'g'kb{5 .

5}g 5 5}g 5

C4 o:tf] nIf0fx? a9Ldf slt nfdf] ;do ;Dd /x]sf lyP < nIf0f ;'? ePb]lv cGTo ;Ddsf] ;dofjlwsf] d"NofÍg ug'{xf];\, Psbd pRr ePsf] cjwL dfq xf]Og .

a. nuftf/ # lbg cyjf sdb. $, % jf ^ lbg nuftf/ jf a9Lc. nuftf/ & lbg jf a9L

C5 s] tkfO{ of] ;d:ofx?sf] nflu c:ktfndf egf{ x'g'ePsf] lyof] <olb …5Ú eg] Tof] ;dofjwLsf] nflu pGdfb /f]usf] k|s/0fx?df …5Ú df lrGx nufpg'xf];\ / C7 df hfg'xf];\ .

5}g 5 5}g 5

C6 s] oL nIf0fx?n]] ubf{ 3/df <:s'ndf< ;flyx?;Fu<cGo JolQmx?;Fu< cGos'g} dxTjk"0f{ tl/sfn]< w]/} ;d:of ePsf] lyof] <

5}g 5 5}g 5

C7 s] oL ;d:ofx? -Jojxf/x¿_ tkfO{ klxn] h:tf] x'g'x'GYof] To;sf] t'ngfdf km/s lyP < ;fdfGotof tkfO{ h:tf] x'g'x'G5 To;sf] t'ngfdf s] oL km/s 5g\ <

s'g} Psdf …5Ú cfPdf, …5Ú sf]8 ug'{xf];\ .

5}g 5 5}g 5

s] C3 ;f/f+z / C7 / (C4c jf C5 jf C6 jf s'g} Q1 jf Q1 b]lv Q8 ;Ddsf s'g} s8f vfnsf] dfgl;s /f]usf] nIf0f df …5Ú sf]8 ul/Psf] 5 </ s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn] (W2 ;f/f+z)ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 <

of] cjlw clxn]sf] xf] sL -/÷jf_ klxn]sf] xf] pNn]v ug'{xf];\ .

s] C3 ;f/fz+ df …5Ú / C5/C6df …5}gÚ /C7df …5Ú / s] C4b jf C4cdf …5Ú sf]8 ul/Psf] 5 </ s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn] (W2 ;f/f+z) ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 </Q1 b]lv Q8 ;Dddf ePsf ;a} dfgl;s c;Gt'ngtfdf …5}gÚ sf]8 ul/Psf] 5 <

xfnsf] cjlw xf] jf klxn]sf] xf] :ki6 kfg'{xf]; . – xfnsf] pGdfb /f]usf] cjlwdf …5Ú eP, xfnsf] sd pGdfb /f]usf]

cjlwdf …5}gÚ nufpg'xf];\ . - klxn]sf] pGdfb /f]usf] cjlwdf …5Ú eP, klxn]sf] pGdfb /f]usf]

cjlwdf ljit[t hfgsf/L glnPsf]df lrGx nufpg'xf];\ .

s] C3 ;f/fz+ / C4adf …5Ú /C5 df …5}gÚ sf]8 ul/Psf] 5 <

xfnsf] cjlw xf] jf klxn]sf] xf] :ki6 kfg'{xf]; . – xfnsf] pGdfb /f]u jf sd pGdfb /f]usf]] cjlwdf …5Ú eP xfnsf] sd pGdfb /f]usf] nIf0fx?df …5}gÚ nufpg'xf];\ .– klxn]sf] pGdfb /f]u jf sd pGdfb /f]usf cjlwdf …5Ú eP

klxn]sf] pGdfb /f]usf] nIf0fx?df lj:t[t hfgsf/L glnPsf]df lrGx nufpg'xf];\.

5}g 5

pGdfb /f]usf] cjlw

xfnsf]

klxn]sf]

sd pGdfb /f]usf] cjlw

xfnsf] 5}g

5

klxn]sf] 5}g

5

lj:t[t hfgsf/L glnPsf]

sd pGdfb /f]usf] cjlw

xfnsf] 5}g

5

klxn]sf] 5}g

5

5}g

5}g

5}g

5

5

5

C8 a. xfnsf] jfljutsf] s'g} Ps pGdfb /f]usf] cjlwdf …5Ú pQ/ cfPdf, ;f]Wg'xf];\ M

– clxn] ;Dddf, s] tkfO{nfO{ & lbg jf Tof] eGbf nfdf] ;do ;Dd(C4c) /x]sf] pGdfb /f]usf] cjlw @ jf @ k6s eGbf a9L ePsf] 5 <

b.olb xfnsf] jf klxn]sf] dWo] s'g} Pssf] pGdfbcyjf sd pGdfb /f]usf] cjlwdf …5Ú sf]8 ul/Psf] 5 eg], ;f]Wg'xf];\ M

clxn] ;Dddf, s] tkfO{nfO{ $ lbg jf Tof] eGbf nfdf] ;do ;Dd(C4b) /x]sf] sd pGdfb /f]usf] cjlw @ jf @ k6s eGbf a9L ePsf] 5 <

c. olb klxn]sf] …sd pGdfb /f]usf] nIf0fx?Ú df …5Ú sf]8 ul/Psf] 5 eg], ;f]Wg'xf];\M

clxn] ;Dddf, s] tkfO{nfO{ sd pGdfb /f]usf] nIf0fx? !–# lbg jf Tof] eGbf nfdf] ;do ;Dd (C4a) /x]sf] sd pGdfb /f]usf] cjlw @ jf @ k6s eGbf a9L ePsf] 5 <

D. Panic disorder

(dgf]qf;sf] /f]u)- sf] dtna lgbfgsf] aS;df -8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

D1a s] tkfO{ lhjgdf slxNo} s'g} sf/0f lagf g} Psbd 8/fpg]] jf cflQg] x'g'ePsf] 5 < jf ;fdfGotof c? aRrfx? g8/fpg] cj:yfdf klg 8/fpg' ePsf] 5÷lyof] <

s'g} Pssf] nflu …5Ú ePdf, …5Ú sf]8 ug'{xf];\ . b'j}df …5}gÚ eP, …5}gÚ sf]8 ug'{xf];\ .

b. s] o:tf] s'/f Psk6s eGbf a9L ePsf] lyof] <

c. s] o:tf] cflQg] cj:yf s]xL ;do leq g}, Psbd l56f] a9]sf] lyof] <

5}g

5}g

5}g

5

5

5

D2 s] o:tf] s'/f tkfO{n] ;f]Rb} g;f]r]sf] a]nf slxNo} ePsf] 5 < 5}g 5

D3a. o:tf]] 36gf eO{;s]kl5, s] tkfO{nfO{ o:tf] cj:yf÷36gfkm]/L x'g ;S5 ls eg]/ jf o:tf] cj:yf÷36gf sf] sf/0f s]xL g/fd|f] xf]nf ls eg]/ 8/ nfUof] <

s] o:tf] cj:yf÷36gf sf] sf/0fn] tkfO{n] cfkm'n] ug{] u/]sf] sfd÷Jojxf/ kl/jt{g ug'{eof]<-h:t} M sf]xL Ps hgf ;Fu dfq aflx/ lgl:sg], 3/ eGbf aflx/ glgl:sg], lrlsT;ssf] df af/Daf/ hfg] jf o:tf] cj:yf÷36gf af6 hf]lug s]xL sfo{ ug{] . _

b. s] tkfO{nfO{ o:tf lrGtfx? Ps dlxgf jf Tof] eGbf a9L ;dosf] nflu ePsf] lyof] <

D3 ;f/f+zMolb D3a / D3b b'a}df …5Ú eP, …5Ú df sf]8 ug'{xf];\ .

5}g

5}g

5}g

5

5

5

sd pGdfb /f]usf] nIf0fx?

xfnsf] 5}g

5

klxn]sf] 5}g

5

D4 s'g} pko'Qm sf/0f lagf g} tkfO{ Psbd w]/} 8/fpg' ePsf] jf cflQg] x'g'ePsf] ;dosf] af/] ;f]Rg'xf];\ :

a. s] tkfO{sf] d'6' Psbd l56f]–l56f] jf hf]8n] w8\s]sf]] lyof] <b. s] tkfO{ kl;gf kl;gf x'g'ePsf] lyof] < jf tkfO{sf] xftdf Psbd w]/} kl;gf

cfPsf] lyof] <s'g} Psdf …5Ú eP, …5Ú sf]8 ug'{xf];\ .c. s] tkfO{sf] xftx? jf z/L/ sfk]sf] lyof] <d. s] tkfO{nfO{ ;f; km]g{ ufx|f] ePsf] lyof] jf tkfO{n] lg:;fl;Psf] h:tf] dxz';

ug'{ePsf] lyof] < e. s] tkfO{nfO{ 3fF6Ldf s]xL c8\s]sf] h:tf] dxz'; ePsf]] lyof] < s] tkfO{nfO{ s]xL lgNg g;Sg] h:tf] dxz'; ePsf] lyof] < f. s] tkfO{nfO{ 5ftL b'v]sf] jf 5ftLdf s;}n] lyr]sf] h:tf] dxz'; eof] <

g. s] tkfO{nfO{ jfsjfsL -pN6L_ jf afGtf cfpnf h:tf] eof] < k]6 v/fj ePsf]] lyof] < s] tkfO{nfO{ emf8fkvfnf nfu]sf] lyof] <s'g} Psdf …5Ú eP, …5Ú sf]8 ug'{xf];\ .

h. s] tkfO{nfO{ l/+u6f nfu]sf] lyof] jf a]xf]; x'g'ePsf] lyof] <i. s] tkfO{nfO udL{ jf hf8f] dxz'; eof] <j. s] tkfO{sf] z/L/sf] s'g} cËx? emdemdfPsf] jf z"Go-nf6f]_ ePsf] dxz'; eof]<

k. s] tkfO{nfO{ jl/kl/ eO{/x]sf s'/fx? cgf}7f] -crDdsf]_ jf c;To h:tf] dxz'; eof] <s] tkfO{n] jl/kl/sf s'/fx?nfO{ Psbd 6f9f h:tf] b]Vg' jf dxz'; ug'{eof]< s] tkfO{nfO cfkm' g} cfˆgf] zl// eGbf aflx/ ePsf] jf 5'l§Psf] dxz'; eof]<

s'g} Psdf …5Ú eP, …5Ú sf]8 ug'{xf];\ . l. s] tkfO{nfO{ cfkm"n] cfˆgf]lgoGq0f u'dfp5' ls eGg] s'/fsf] 8/ nfUof] < s] tkfO{nfO{ cfˆgf] lbdfun] sfd ub}{g ls eGg] s'/fsf] 8/ nfUof] < s'g} Psdf …5Ú eP, …5Ú sf]8 ug'{xf];\ . m. s] tkfO{nfO{ cfkm' dl/G5 ls eGg] s'/fsf] 8/ nfu]sf] lyof]<

5}g5}g

5}g5}g

5}g

5}g

5}g

5}g

5}g

5}g5}g

5}g

5}g

55

55

5

5

5

5

5

55

5

5

D5 s] D3/ D4df $ jf ;f] eGbf a9L pQ/x?df …5Ú sf]8 ul/Psf] 5 <

5}g -lhjg sfndfclxn]

;DdePsf]dgf]qf;sf]

/f]u_

5

D6 a. uPsf] ! dlxgfdf, s] tkfO{nfO{ o:tf] ;d:ofx? Ps k6s eGbf a9L k6s-af/Daf/_ ePsf] lyof] < olb …5}gÚ eg,] D6 ;f/f+zdf …5}gÚ sf]8 ug'{xf];\, lgbfgsf] aS; k'/f ug'{xf];\ / E1 df hfg'xf];\ .

uPsf] ! dlxgfdf Mb.s] tkfO{nfO{ o:tf] cj:yf÷36gfkm]/L cfpnf ls eg]/ lrGtf nfUof]] <

c. s] o:tf] cj:yf÷36gfsf]sf/0f s]xL g/fd|f] xf]nf ls eg]/ lrGtf nfUof] <

d. s] o:tf] cj:yf÷36gfn] ubf{ tkfO{sf] nflu s]xL s'/f kl/jt{g eof] < -h:t}M sf]xL ;fly ePdf dfq aflx/ hfg], 3/ aflx/ hfg dg gnfUg], lrlsT;s sxfF af/Daf/ hfg] cflb._

D6;f/f+z: olb D6b, jf D6c, jf D6d df …5Ú eP, …5Ú sf]8 ug'{xf];\

5}g

5}g

5}g

5}g

5}g -xfndfePsf]

dgf]qf;sf]/f]u_

5

5

5

5

5

s]] D5 / D6 dWo] s'g}df …5Ú sf]8 ul/Psf] 5 <

/ s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn] ( W2 ;f/f+z )


of] cjlw xfnsf] xf] jf lhjgsfndf clxn];Ddsf] xf], :ki6 kfg'{xf];\ .

E. Agoraphobia

(Puf]/fkmf]laof)- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

E1 s] tkfO{nfO{ Psbd}}} 8/ nfUg ;Sg] 7fpF jf cj:yfdf, h:t} M le8df x'Fbf jf aGb 7fpFdf x'Fbf, nfO{gdf plebf, 3/df PSn} x'bfF, k'n tbf{ jf v'Nnf 7fpFdf x'Fbf,uf8L, a;, /]ndf, xjfO{hxfh jf ;fj{hlgs oftfoftdf ofqf ubf{ cˆ7\of/f] jf lrGtf jf 8/ nfu]sf] dx;'; ug'{x'G5 <

s'g} Psdf …5Ú eP, …5Ú sf]8 ug'{xf];\ .

5}g 5

s] E1sf] @ jf @ eGbf a9L cj:yfx?df, …5Ú sf]8 ul/Psf] 5 < 5}g 5

E2 s] o:tf cj:yfx?n] k|fo ;w} h;f], tkfO{nfO{ 8/fpg] jf cflQg] agfpF5 < 5}g 5

E3 s] tkfO{nfO{ oL s'/fx? af6 olt w]/} 8/ nfU5 ls tkfO{n] o:tf cj:yfaf6 6f9f /xg vf]Hg' x'G5< cyjf tkfO{;Fu c? sf]xL ;fyL eof] eg] dfq oL] cj:yfx?sf] ;fdgf ug{ ;Sg'x'G5 <

jf tkfO{n] of] cj:yfx?sf] ;fdgf PSn} ug'{x'G5 t/ tkfO{nfO{ Psbd ufx|f] x'G5 < s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

5}g 5

5}g 5

dgf]qf;sf] /f]u

lhjgsfndf clxn];Dd xfnsf]

E4 s] tkfO{ o:tf cj:yfx?df, tkfO{sf] h:t} pd]/sf c? aRrfx? eGbf w]/} 8/fpg' x'G5 < 5}g 5

E5. s] tkfO{ oL cj:yfx? b]lv 8/fPsf] / oL cj:yfx?af6 hf]lug vf]Hg' ePsf] slDtdf klg ^ dlxgf ePsf] 5 <

5}g 5

E6. s] oL cj:yfx?n] ubf{ tkfO{nfO{ 3/df, :s'ndf, sfddf, ;flyx?;Fu ;d:of ePsf] lyof], jf cGo s'g} dxTjk"0f{ tl/sfn] tkfO{nfO{ b'MvL agfPsf]] lyof] <

5}g 5

s] E6 df …5Ú sf]8 ul/Psf] 5 <

F. Separation anxiety disorder (cfkmGtaf6 5'l§g] lrGtfsf] /f]u )

- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

F1a. uPsf] ! dlxgfdf, s] tkfO{ cfkm";Fu sf]xL glhssf] -dgkg]{_ dfG5] 5'l§G5 ls, eg]/ 8/fpg' ePsf]] lyof] < jf tkfO{ cfkm"n] cfkm";Fu glhssf] -dgkg]{_ dfG5]nfO{ u'dfpg'knf{ ls, eg]/ 8/fpg' ePsf] lyof] < -h:t}M cfˆgf] cleefjs÷a'jf cfdf;Fu 5'l§g] -6f9f x'g]_ jf 5'l§bf pxfFx?nfO{ s]xL g/fd|f] x'g] ._ s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

b. tkfO{nfO{ sf] af6 5'l§g-6f9f x'g_ 8/ nfU5......................<

5}g 5

5}g 5

xfnsf] Puf]/fkmf]laof

F2 a. s] o:tf] 8/ olt w]/} k6s eof] ls ==============af6 6f9f x'Fbf tkfO{ Psbd pbf; x'g'eof] < s] =========== af6 6f9f x'g] af/]df ;f]Rbf dfq klg tkfO{ Psbd pbf; -lvGg_ x'g'eof] < s'g} Pssf] nflu …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

b. s] tkfO{ ==================== nfO{ u'dfp5' ls eg]/ Psbd lrlGtt x'g' eof] <s] tkfO{ ========= nfO{ s]xL g/fd|f] xf]nf ls eg]/ Psbd lrlGtt x'g'eof] <-h:t}M s'g} b'3{6gfdf kg]{ jf d[To' x'g] ._s'g} Pssf] nflu …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

a. s] tkfO{ =================== af6 5'l§G5' ls eg]/ Psbd lrlGtt x'g'eof] < -h:t} ckx/0f x'g], x/fpg] ._

d. s] ===========af6 6fl9g] 8/n] tkfO{:s'n hfg jf aflx/ st} hfg dfGg'ePg<

a. s] tkfO{ ==================;Fu} geP;Dd 3/df jf st} c? 7fpFdf a:g 8/fpg'eof] <

b. s] tkfO{ ====================;Fu} geP;Dd ;'Tg rfxg'ePg <

g. s] tkfO{n] =================== af6 5'l§g]÷5'l§Psf] af/] g/fd|f] ;kgf b]Vg' ePsf] 5 < s] o:tf] ;kgf Ps rf]6L eGbf a9L b]Vg'ePsf] 5 <b'a}df …5}gÚ eP, …5}gÚ df lrGx nufpg'xf];\ .

h. s] tkfO{ =================== af6 6f9f x'Fbf Psbd} la/fdL x'g'ePsf] 5 < -h:t} M 6fpsf] b'Vg], k]6 b'Vg], jfsjfsL nfUg], jfGtf x'g], l/+u6f nfUg], d'6' w]/} l56f] l56f] w8\lsg] ._

s] tkfO{ ================= af6 6f9f x'g] af/] ;f]Rbf dfq klg Psbd} la/fdL x'g'ePsf] 5 < s'g} Pssf] nflu …5Ú ePdf, …5Ú df lrGx nufpg'xf];\ .

F2 ;f/f+z: s] F2a b]lv F2h ;Dd slDtdf # j6f k|Zgdf …5Ú sf]8 ul/Psf] 5 <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

5

5

F 3 s] of] s'/f -lrGtf÷efjgf÷cj:yf_ sDtLdf $ xKtf ;Dd /x]sf] lyof]< 5}g 5

F 4 s] tkfO{sf] ================== af6 6f9f x'g] 8/n] tkfO{nfO{ Psbd lrlGtt agfPsf]] lyof]< s] tkfO{sf] of] efjgfn] ubf{ 3/df< :s'ndf< ;flyx?;Fu< jf cGo s'g} dxTjk"0f{ tl/sfn] w]/} ;d:of k/]sf] lyof]< s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

s] F1, F2 ;f/f+z, F3/ F4df …5Ú sf]8 ul/Psf] 5 <

5}g 5

5}g 5

cfkmGtaf6 5'l§g] lrGtfsf] /f]u-;]K/];g PghfO{6L l8;c8/_

G. Social anxiety disorder (Social Phobia)

(;fdflhs kl/l:yltdf cflQg] /f]u -;fdflhs kl/l:yltsf] qf;_ )- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

G1 uPsf] ! dlxgfdf, s] tkfO{nfO{ cfˆg} pd]/sf] c?n] x]bf{ 8/ nfu]sf] jf Psbd cK7\of/f]÷nfh nfu]sf] lyof] < s] c?n] lh:sfpnf eg]/ 8/ nfu]sf] lyof] < sIffdf cufl8 af]Ng 8/ nfu]sf] lyof] < jf c?sf] cuf8L vfg÷n]Vg jf s]xL sfd ug{ 8/ nfu]sf] lyof] <

s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

5}g 5

G2 s] oL ;fdflhs cj:yfx?n] k|fo ;w} h;f] tkfO{df 8/ jf lrGtf NofpF5< 5}g 5

G3 s] tkfO{nfO{ oL s'/fx? af6 olt w]/} 8/ nfU5 ls, tkfO{ of] cj:yfaf6 6f9} /xg sf]lz; ug'{x'G5 < jf c? sf]xL ;fyL tkfO{;Fu eP dfq oL sfdx? ug{ ;Sg'x'G5 < jf tkfO{ oL sfd ug'{x'G5 t/ tkfO{nfO{ Psbd ufx|f] x'G5 < s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

5}g 5

G4 s] tkfO{ o:tf cj:yfx?df tkfO{sf] h:t} pd]/sf c? aRrfx? eGbf w]/} 8/fpg' x'G5 < 5}g 5

G5 s] tkfO{ oL cj:yfx? b]lv 8/fPsf] / oL cj:yfx?af6 hf]lug vf]Hg' ePsf] slDtdf klg ^ dlxgf ePsf] 5 <

5}g 5

G6s] oL cj:yfx?n] ubf{ tkfO{nfO{ 3/df, :s'ndf, sfddf, ;flyx?;Fu ;d:of ePsf] lyof], jf cGo s'g} dxTjk"0f{ tl/sfn] tkfO{nfO{ b'MvL agfPsf]] lyof] <

5}g 5

s] G6df …5Ú sf]8 ul/Psf] 5 <

/

s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn] (W2;f/f+z)


k|Zgstf{nfO{ gf]6 M ;fj{hlgs 7fpFdf af]Ng] jf k|:t'lt lbg] 8/df

dfq l;ldt xf] ls, :ki6 kfg'{xf];\ .

5}g 5

;fdflhs kl/l:yltdf cflQg] /f]u -;fdflhs kl/l:yltsf] qf;_

xfnsf]

;fdflhs kl/l:yltdf dfq cflQg] /f]u

H. Specificphobia

(ljz]if kl/l:YftL;Fusf] 8/sf] /f]u)- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

H1 uPsf] ! dlxgfdf, tkfO{nfO{ s]xL s'/f b]lv Psbd w]/} 8/ nfu]sf] 5 ,h:t}M ;k{ jf ls/fx?< s's'/ jf c? hgfj/< prfO{< p8\g] b]lv< x'l/ jtf;< cWof/f]< jf /ut jf ;'O{ b]lv<

H2 ljz]if kl/l:YftL ;Fusf] 8/sf] /f]u pNn]v ug'{xf];\ M =============== k|Zgstf{ M of] s'/f :ki6 kfg'{xf];\ ls of] 8/sf] /f]udf dgf]qf;sf] /f]u, Puf]/fkmf]laof, cfkmGtaf6

5'l§g] lrGtfsf] /f]u -;]K/];g PghfO{6L l8;c8/_, afWofTds dgf]u|:tLsf] /f]u, cf3ft kl5 x'g] tgfjsf] /f]u jf;fdflhs kl/l:yltdf cflQg] /f]u ;fdflhs kl/l:yltsf] qf;sf] sf/0f x'g] 8/÷lrGtf jf arfp kb}{g .

5}g 5

H3 s] tkfO{nfO{================================================glhs hfg] lalts} Psbd 8/ nfU5 < 5}g 5

H4 s] tkfO{nfO{ =============== b]lv olt w]/} 8/ nfU5 ls tkfO{To;af6 6f9f /xg vf]Hg' x'G5 < jf tkfO{;Fu c? sf]xL ;fyL eof] eg] dfq ………….. sf] jl/kl/ hfg ;Sg'x'G5 < jf ======== sf] jl/kl/ /xg ;Sg'x'G5 t/ Tof] tkfO{sf] nflu Psbd ufx|f] x'G5 <s'g} Psdf …5Ú ePdf, …5Ú df lrGx nufpg'xf];\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ .

5}g 5

H5 s] tkfO{=============================================b]lv tkfO{sf] pd]/sf] c? aRrfx? eGbf w]/} 8/fpg' x'G5 <

5}g 5

H6 s] tkfO{nfO{ ================ b]lv 8/ nfu]sf] ^ dlxgf jf w]/} ePsf] 5 < 5}g 5

H7 s] of] 8/n] tkfO{nfO{ Psbd b' Mv lbPsf] 5 < s] of] 8/n] tkfO{sf] 3/df jf :s'ndf jf ;flyx?;Fu jf cGo JolQmx?;Fu w]/} ;d:of ePsf] lyof] < s] o;n] tkfO{nfO{ cfkm'n] rfx]sf] sfd ug{df afwf k'¥ofO/x]sf] 5 <s'g} Psdf …5Ú ePdf, …5Ú df lrGx nufpg'xf];\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ .

s] H7 df …5Ú sf]8 ul/Psf] 5 <

5}g 5

5}g 5

ljz]if kl/l:YftL ;Fusf] 8/sf] /f]u

xfnsf]

I. Obsessive-compulsive disorder (afWofTds dgf]u|:tLsf] /f]u)

- sf] dtna – lgbfgsf] aS;df -8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

I1a. uPsf] ! dlxgfdf, s] tkfO{nfO{ cfˆg} lbdfudf cfO{/xg] g/fd|f] s'/fx?af6 5'6sf/f kfpg g;s]sf] sf/0f Psbd lrGtf nfu]sf] 5 < h:t} g/fd|f] ;f]r jf cfj]u÷cfj]u < jf b[Zo <pbfx/0fsf] nfluM tkfO{n] grfx]tfklg, s] tkfO{n] s;}nfO{ 3fp jf rf]6k6s k'¥ofpg] af/] ;f]Rg'ePsf] 5 -of] ;f]rn] tkfO{nfO{ b'Mv÷lrGtf÷tgfj lbPtfklg_ <tkfO{n] ug'{ePsf] jf gug'{ePsf] s'g} s'/f÷sfdn] tkfO{nfO{ jf c?nfO{ xfgL k'¥ofp5 ls eg]/ tkfO{nfO{ 8/ nfu]sf] lyof] < s] tkfO{sf] z/L/ kmf]x/ x'g] jf ls6f0f' ;g]{÷;fg{] jf s'g} tl/sfn] c?nfO{ la/fdL kfg'{ x'G5 ls eGg] s'/fdf tkfO{nfO{ Psbd lrGtf nfu]sf] lyof] < s] tkfO{nfO{ cfkm'n] s'g} ck|Toflzt -g;f]r]sf]÷cf3ft x'g]_ 36gf 36fp5' ls eGg] 8/ nfu]sf] lyof] <s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

b. uPsf] ! dlxgfdf, s] tkfO{n] oL ;f]r÷ljrf/, cfj]z jf b[Zox?af6 6f9f /xg k|of; ug'{eof] jf c? s'g} ;f]r jf sfo{af6 lt ljrf/nfO{ bafpg k|of; ug'{eof] <


5}g

I3adf hfg]

5}g

I3adf hfg]

5

5

I2 s] lt ljrf/nfO{ jf:tf gug{ vf]Hbf jf To;af6 5'6sf/f kfpg vf]Hbf klg tkfO{sf] dgdf cfO{/xGy] <

5}g 5 dgf]u|:tL

I3.a. uPsf] ! dlxgfdf, s] tkfO{n] s'g} sfo{ -Jojxf/_af/Daf/ bf]xf]¥ofP/ ug{af6 cfkm"nfO{ /f]Sg ;Sg'ePg <-h:t} M af/Daf/ xft v'§f wf]O{/xg], n'uf wf]O/xg], s'g}} ;fdfg ldnfO/xg], s]xL s'/f l7s 5 ls 5}g x]l//xg], s]xL s'/f ulGt ul//fVg], s]xL s'/f af/Daf/ elg/xg] cflb ._


b. s]] oL sfo{ -Jojxf/_ x?tkfO{n] lrGtf sd ug{ jf s]xL g/fd|f] x'g af6 /f]Sgsf] nflu ug'{eof] < s] oL tkfO{s} pd]/sf h:t} c? aRrfx?nfO{ eGbf tkfO{nfO{ a9L x'G5<

b'a} k|Zgsf] nflu …5Ú eP dfq, …5Ú sf]8 ug'{xf];\ . aRrfx?n] of] sfd ug'{sf] sf/0fx? j0f{g ug{ c;Ifd x'g ;S5g\ .

5}g

5}g

5

5

afWotf

s] -I1a / I1b / I2_ jf -I3a / I3b_ df 5Ú sf]8 ul/Psf] 5 < 5}g 5

I4. uPsf] ! dlxgfdf, s] oL ljrf/x? jf ;f]rx?n] ubf{ tkfO{n] 3/df< :s'ndf < ;fyLx? ;Fu< x'g] s]xL sfd÷s'/f 5'6fpg' ePsf] lyof] <s] o;n] ubf{ c? dflg;x? ;Fu tkfO{sf] w]/} ;d:of ePsf] 5 < s] o:tf sfd jf ljrf/n] slDtdf lbgsf] Ps 306f eGbf a9L ;do lng] u/]sf 5g\ < s'g} Psdf …5Ú eP, …5Ú df sf]8 ug'{xf];\ .

/


(W2;f/f+z) ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 <

5}g 5

afWofTds dgf]u|:tLsf] /f]u

xfnsf]

J. Post traumatic stress disorder (cf3ft kl5 x'g] tgfjsf] /f]u)

- sf] dtna – lgbfgsf] aS;df-8foUgf]i6Ls aS;_ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

J1= s] tkfO{sf] lhjgdf slxNo}, s'g} Psbd} eofgs 36gf 36]sf] 5 < h:t}M af9L, xfjf x"/L jf e"sDkdf kg'{ <cfuf] jf s'g} Psbd} v/fa b'3{6gfdf kg'{ < s;}nfO{ df/]sf] jf g/fd|f];Fu rf]6 nfu]sf] b]Vg'< s] tkfO{ slxNo} s;}sf] cfs|d0fdf kg'{ePsf] 5 < -cf3ft kfg]{ 36gfx?sf] pbfx/0fx? M ulDe/ b'3{6gf, of}ghGo jf zf/Ll/s xdnf÷cfqmd0f,

cftGsjfbL xdnf, aGws agfOPsf], ckx/0f, cfunfuL, s;}sf] nf; e]6fPsf], o'4 jf k|fs[lts k|sf]k, sf]xL glhssf] dfG5]sf] crfgs jf lx+;fTds÷ljeT; d[To', Hofg} hfg ;Sg] /f]u . _

J2= uPsf] ! dlxgfdf, s] o:tf eofgs 36gf s'g} t/Lsfn] km]/L dx;'; ug'{ePsf] 5 <h:t}M To;sf] af/]df ;kgf b]Vg] jf s8f -lal;{g} g;Sg]_ ofbx?cfpg' jf To;nfO{ cfˆgf] z/L/df cg'ej ug'{ . aRrfx?df To:tf cf3ftx? ljleGg t/Lsf h:t} bf]xf]¥P/ v]n v]Ng], c:ki6 8/ nfUbf ;kgfx? b]Vg] cflbdf cleJoQm ePsf x'G5g\ .

5}g

5}g

5

5

J3. uPsf] ! dlxgfdf Ma. s] tkfO{n] Tof] 36gfsf] af/]df g;f]Rg jf s'/f gug{ k|of; ug'{eof] <b. s] tkfO{n] To:Tff]] 36gf ofb u/fpg] dfG5] jf j:t' -lrh_ x? af6 6f9f x'g] sf]lz; -k|of;_

ug'{eof] <

J3 ;f/f+z M s] J3sf] ! jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

5}g5}g

5}g

55

5

J4. uPsf] ! dlxgfdf M

a. s] tkfO{nfO{ Tof] 36gfsf] s]xL dxTjk"0f{ s'/fx? ofb ug{ sl7gfO{÷ufx|f] ePsf] lyof] <

b. s] tkfO{nfO{ cfkm' jf c? k|lt w]/} gsf/fTds wf/0ff÷ljrf/-h:t}M d g/fd|f] dfG5] x'F ,s;}nfO{ ljZjf; ug{ ;lsb}g\,;+;f/ c;'/lIft 5 cflb_ cfPsf] lyof] <

c. s] tkfO{n] Tof] 36gfsf] nflu lg/Gt/ ?kdf cfkm'nfO{ jf c?nfO{ bf]if lbg'eof] <

d. s] tkfO{n] cfkm"k|lt w]/} gsf/fTds efjgf -h:t}M bf]ifL, nHhLt ePsf], l/;fPsf] jf 8/fPsf]_ cg'ej ug'{eof] <

e. s] tkfO{sf] cfˆgf] ;fyLx? jf ;f}vx?df sd ?rL ePsf]] 5 <

f. s] tkfO{n] c? dfG5]af6 cfkm" cnUuLPsf] cg'ej ug'{ePsf] 5 <

g. s] tkfO{n] s'g} /fd|f] efjgf -h:t} v'zL_ cg'ej ug{ ;Sg'ePsf] lyPg<

J4 ;f/f+z: s] J4 sf] # jf a9L pQ/x? …5Ú sf]8ul/Psf] 5 <

5}g

5}g

5}g

5}g5}g

5}g5}g

5}g

5

5

5

55

55

5

J5. uPsf] ! dlxgfdf Ma. s] tkfO{ s'g} sf/0f lagf g} l/;fpg' jf lrl9g'ePsf] lyof] <

b. s] tkfO{n] w]/}hf]lvdk"0f{ s'/fx? jf tkfO{nfO{ xfgL x'g ;Sg] sfdx? ug'{ePsf] lyof] <

c. s] tkfO{ s]lx g/fd|f] s'/f xf]nfls eg]/ cflQg' eof] jf rgfvf] x'g'eof] <

d. s] tkfO{n] cfjfhx? ;'Gbf jf s]lx s'/f b]Vbf plkm|g' -eml:sg'÷tl;{g'_ x'GYof] <

e. s] tkfO{nfO{ s'g} s'/fdf Wofg lbg ;d:of ePsf] lyof]<

f. s] tkfO{nfO{ lgGb«fdf÷lgGbdf ;d:of ePsf] lyof]] <

J5;f/f+z M s] J5sf] @ jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

J6. s] oL ;a} ;d:ofx? rf]6 k'¥ofpg] 36gf kl5 ;'? ePsf x'g\ / s] oL ;d:of ! dlxgf eGbf a9L ;do ;Dd, /x]sf lyP <

5}g 5

J7.uPsf] ! dlxgfdf, s] oL ;d:ofx?n] tkfO{nfO{ w]/} b'MvL agfPsf 5g\<

s] lo ;d:ofn] tkfO{nfO{ :s'ndf< 3/df< sfddf< ;fyLx?;Fu< kl/jf/df<

jf cGo s'g} dxTjk"0f{ tl/sfn] tkfO{nfO{ w]/} ;d:of lbPsf 5g\ <

/s] s8f vfnsf] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn]

( W2 ;f/f+z ) ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 <

5}g 5

cf3ft kl5 x'g] tgfjsf] /f]u

xfnsf]

K. Alcohol use disorder (dlb/fkfgsf] nt)- sf] dtna – lgbfgsf] aS;df - 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._ tkfOsf] pd]/sf s]xL aRrfx?n] dlb/f÷/S;L÷bf? ;]jg ug]{ kfO{Psf] 5 .s] tkfO{n] klg clxn];Dd slxNo}, dlb/f÷/S;L÷bf? ;]jg ug'{ePsf] 5 ===================================

K1. s] tkfO{n] uPsf] !@ dlxgfdf, Ps lbgdf tLg jf ;f] eGbf a9L /S;Lsf] k]o÷l8«+S; lng'eof] <Tof] ;dodf, s] tkfO{n] ltg 306fsf] cjlwdf tLg jf ;f] eGbf a9L /S;Lsf] k]o÷l8«+S; lng'eof] <s] tkfO{n] uPsf] !@ dlxgfdf, tLg jf ;f] eGbf a9L k6s o:tf] ug'{eof] <s'g} Psdf …5}gÚ ePdf, …5}gÚ sf]8 ug'{xf];\ .

5}g 5

K2.uPsf] !@ dlxgfdf Ma. tkfO{n] /S;L÷bf? lkPsf] ;dodf, s] tkfO{n] cfkm'n] ;f]r]sf] eGbf a9L lkpg'eof] <b. s] tkfO{n] af/Daf/ cfˆgf] dlb/f ;]jg 36fpg jf lgoGq0f ug{ rfxg'eof] < s] tkfO{n]

cfˆgf] dlb/f ;]jg 36fpg jf lgoGq0f ug{ k|oTg ug'{eof], t/ c;kmn x'g'eof] < obL b sf] b'O{ j6f k|Zg dWo] Psdf …5Ú cfPdf, …5Ú sf]8 ug'{xf];\ .

c. s] tkfO{n] dlb/f ;]jg u/]sf] lbgdf, dlb/f ;]jgdf # 306f eGbf a9L ;do latfpg' eof] < o;df dlb/f kfpg, vfg jf dlb/fsf] c;/af6 ;Grf] x'g÷lgsf] x'g nfu]sf] ;dosf] luGtL ug'{xf];\ . =====================;do

d. s] tkfO{nfO{ dlb/f lkpg cToflws jf lta| OR5f -tntn_ x'GYof] <e. tkfO{sf] af/Daf/ dlb/f ;]jgn] ubf{, s] tkfO{n] :s'ndf, sfddf jf 3/df cfkm'n]

ug'{kg]{ sfdx? k'/f ug{ sd ;do lbg'eof] <f. tkfO{sf] dlb/f ;]jgsf] sf/0fn] ubf{, kl/jf/ jf c? dfG5];Fu ;d:of x'Fbf klg, s]

tkfO{n] dlb/f ;]jg ul//fVg'eof] <g. s] tkfO{ To:tf] cj:yfdf klg, Ps eGbf a9L k6s /S;Ln] dfTg' ePsf] lyof], hxfF

cfkm' jf c?, hf]lvddfkg{ ;Sg] ;Defjgf lyof] <-h:t} M uf8L rnfpFbf, df]6/;fO{sn rnfpFbf, d]lzg/L ;fwg rnfpFbf, 8'+uf rnfpFbf cfbL . _

h. dlb/f ;]jgn], s] tkfO{sf] :jf:Yo jf lbdfudf s'g} ;d:of Nofof] < dlb/fsf] sf/0fn] oL ;d:ofx? ePsf] jf ;d:of emg\ v/fa ePsf]] xf] eGg] :ki6 x'Fbf x'Fb} klg, s] tkfO{n] dlb/f ;]jg hf/L /fVg'eof]<b'a}df …5Ú eP, …5Ú df lrGx nufpg'xf];\ .

i. s] tkfO{sf] dlb/f ;]jgsf] sf/0fn] ubf{, tkfO{n] sfddf, :s'ndf, ;fdflhs jfcGo ultljlw÷lqmofsnfkdf hfg sd ug{'eof] jf 5f]8\g' eof] <

j. s] tkfO{n] z'?–z'?df /S;L ;]jg ubf{ ePsf] h:t} k|efj k|fKt ug{ w]/} /S;L lkpg' kYof]{ jf s] tkfO{n] nuftf/ TolQs} dfqfdf /S;L lkpbf sd dfq k|efj kYof]{ <

s'g}df …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

5

5

5

k1.tkfO{n] dlb/f ;]jg sd ubf{, tn lbO{Psf dWo] s] s] s'/f ePsf lyP < != w]/} kl;gf aUg' jf d'6'sf] w8\sg a9\g'@= xft sfKg' jf xlNng'#= lgb|fdf ;d:of $= jfsjfsL nfUg' jf afGtf x'g'%= c?n] gb]v]sf jf g;'g]sf lrhx? b]Vg' jf ;'Gg'''' , lagfsf/0f 5fnfdf s]lx ePsf] h:tf] cg'e"lt x'g'^= Aofs'n x'g' -czfGt, 56k6L, lr8lr8fkg_ &= cflQg' *= 5f/]÷d[uL 5f]Kg]÷rl/kmfO{

oL *dWo],@ jf a9Ldf …5Ú pQ/ cfPsf] 5 eg],k1 nfO{{ …5Ú sf]8 ug'{xf];\ .

k2.s] tkfO{n] dlb/f ;]jg ug{ gkfpFbfsf] c;/nfO{ 36fpg jf x6fpg jf xofË cf]e/ -dlb/f ;]jgsf] ef]nL kN6sf] c;/_ x'gaf6 aRg, dlb/f lkpg'eof] <K2k;f/f+z: olb K2k1jf K2k2df 5 ePdf,…5Ú sf]8 ug'{xf];\ .

olb K2a b]lv K2k ;f/f+z;Dd -K2k1 / K2k2 nfO{ Pp6f k|Zg dfGg]_, K2 sf @ jf a9L pQ/ …5Ú cfPdf,dlb/fkfgsf] nt nfO{ …5Ú sf]8 ug'{xf];\ .

dlb/fkfgsf] nt 5'6\ofpgsf] nfuL :xNsf:K2 sf@–# nIf0f

dWod:K2 sf $–% nIf0f

Hofb}:K2 sf ^ jf a9L nIf0f

5}g

5}g

5}g

5

5

5

L. Substance use disorder (Non-alcohol)

(nfu"kbfy{sf] nt)- sf] dtna – lgbfgsf] aS;df- 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

tkfO{sf] pd]/sf s]xL aRrfx?n] nfu"kbfy { ;]jg ug]{ kfO{Psf] 5 . s] tkfO{n] klg clxn];Dd slxNo},nfu"kbfy{ ;]jg ug'{ePsf] 5 ,……………..

L1. uPsf] !@ dlxgfdf, s] tkfO{n], w]/} v';L x'g -pT;flxt dxz'; ug{_ jf cfˆgf] d'8÷dg kl/jt{g ug{, jf cToflws gzf k|fKt ug{ tkfO{n] /S;L afx]s c? s'g} nfu"cf}iflw -h:t}M ufFhf, efË,wt'/f], clkmd jf c? s'g}_ Psk6s eGbf a9L k|of]u ug'{ePsf] lyof] <

5}g 5

olb k|of]u ug'{ePsf] eP, s] k|of]u ug'{ePsf] lyof] <……………..

Stimulants :…………….……………. Cocaine :…………………………..…

Opiates :………………………….…… Hallucinogens :…………….………

Dissociative Drugs :…………….. Inhalants :…………….…………….. Cannabis :…………….…………….. Sedatives, Hypnotics or anxiolytics :…………………………..

5'6\ofpg'xf];\MxNsfdWodHofb}

5}g 5

dlb/fkfgsf] nt

uPsf] !@ dlxgfdf

cGo =………….………………………... ;a}eGbf a9L k|of]u ePsf nfu"kbfy{x?M………….……………………

;a}eGbf a9L ;d:of pTkGg ug{] nfu"kbfy{M………….………………..…

;a}eGbf ;'?df a9L ;d:of pTkGg ug{] nfu"cf}ifwLsf] ju{sf] nflu dfkb08nfO{ lj:t[t ?kdf hfgsf/L lng'xf];\ / To:tf] nfu"cf}ifwLsf]] b'Jo{;gL sf] dfkb08 k'/f ug{ ;Sg] nfu"cf}ifwL 5'6\ofpg'xf];\ . olb w]/} nfu"cf}ifwLsf] b'?kof]u ePsf] 5 eg] hlt ;Sbf] w]/} jf lgb]{lzsfn] dfu] cg';f/sf] lj:t[t ?kdf hfgsf/L lng'xf];\ .

L2. tkfO{n] k|of]u u/]sf] cf}ifwL / To;sf] ju{nfO{ Wofgdf /fVbf, uPsf] !@ dlxgfdf M

a. tkfO{n] nfu"cf}ifwLsf] k|of]u u/]sf] ;dodf, s] tkfO{n] -cf}ifwLsf] gfd÷ju{_ ;f]Rg'ePsf] eGbf w]/} k|of]u ug'{eof] <

b. s] tkfO{n] af/Daf/ cf}ifwLsf] -cf}ifwLsf] gfd÷ju{_ k|of]u 36fpg jf lgoGq0f ug{ rfxg'eof] < s] tkfO{n] cfˆgf] cf}ifwLsf] k|of]u 36fpg jf lgoGq0f ug{ k|oTg ug'{eof] t/ c;kmn x'g'eof] <s'g} Psdf …5ÚcfPdf, …5Ú sf]8 ug'{xf];\.

c. s] tkfOsf] Ps lbgdfnfu"cf}ifwLdf# 306f eGbf a9L ;do laTYof] < o;df nfu"cf}ifwL kfpg, vfg jf To;sf] c;/af6 ;Grf] x'g nfu]sf] ;dosf] luGtL ug'{xf];\ .===========================;do

d. s] tkfO{nfO{ nfu"cf}iflwsf] -cf}ifwLsf] gfd÷ju{_ k|of]u ug{ cToflws jf ltj| O{R5f -tntn_ x'GYof]<

e. tkfO{sf] af/Daf/ nfu"cf}iflwsf] ;]jgn] ubf{, s] tkfO{n] sfddf jf :s'ndf jf 3/df cfˆgf] lhDd]jf/L k'/f ug{ sd ;do lbg'eof] <

f. s] tkfO{sf] nfu"cf}iflwsf] ;]jgn] ubf{, kl/jf/ jf c? dfG5];Fu ;d:of x'Fbf klg, tkfO{n] nfu" cf}iflw ;]jg ul/ /fVg'eof] <

g. s] tkfO{ To:tf] cj:yfdf klg Ps eGbf a9L k6s nfu"cf}iflwsf] ;]jgn] dfTg' ePsf] lyof], hxfF cfkm' jf c?, hf]lvddfkg{ ;Sg] ;Defjgf lyof] <-h:t} M uf8L rnfpFbf, df]6/;fO{sn rnfpFbf, d]lzg/L ;fwg rnfpFbf, 8'+uf rnfpFbf cfbL . _

h. nfu"cf}iflwsf] ;]jgn] ubf{, s] tkfO{sf] :jf:Yo jf lbdfudf s'g} ;d:of Nofof] <nfu"cf}iflw ;]jgn] oL ;d:ofx? ePsf] jf ;d:of emg\ v/fa ePsf]] xf] eGg] :ki6 x'Fbf x'Fb} klg, s] tkfO{n] nfu"cf}iflwsf] ;]jg hf/L /fVg'eof] <

i. s] tkfO{sf] nfu"cf}iflwsf] ;]jgn] ubf{, tkfO{n] sfddf, :s'ndf, ;fdflhs jf cGo ultljlw÷ lqmofsnfkdf hfg sd ug{'eof] jf 5f]8\g' eof] <

j. s] tkfO{n] z'?–z'?df nfu"cf}ifwL ;]jg ubf{ ePsf] h:t} k|efj k|fKt ug{ w]/} nfu"cf}iflwsf] ;]jg ug{'kYof]{ jf s] tkfO{n] nuftf/ TolQs} dfqfdf nfu"cf}iflwsf] ;]jg ubf{ sd dfq k|efj kYof]{ <s'g} Psdf …5ÚcfPdf, …5Úsf]8 ug'{xf];\.olb of] nfu"cf}ifwL 8fS6/n] ;'emfj u/]sf] xf] / pko'Qm lrlsT;f ko{j]If0fdf k|of]u ul/Psf] xf] eg], of] dfkbG8nfO{ …5}gÚ pQ/ /fVg'xf];\ .

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k1.tkfO{n] cfˆgf] nfdf] cjlwsf] jf cToflws dfqfdf nfu"cf}ifwLsf] k|of]usd ubf{, tn lbOPsf dWo] s]–s] s'/f ePsf lyP < olb k|To]s ju{sf] nflu ck]lIft -rflxPsf] hlt_ nfu" cf}iflw k|of]u ug{ gkfpbfsf] c;/sf] ;+Vofdf …5Ú cfPdf, L2k1 nfO{ …5Ú sf]8 ug'{xf];\. olb of] nfu"cf}ifwL 8fS6/n] ;'emfj u/]sf] xf] / pko'Qm lrlsT;f ko{j]If0fdf k|of]u ul/Psf] xf] eg], of] dfkbG8nfO{ …5}gÚ pQ/ /fVg'xf];\ .

Sedatives, Hypnotic or Anxiolytic-cf}ifwL k|of]u ug{ gkfpFbfsf] @ jf a9L c;/x?_ M!= w]/} kl;gf aUg' jf d'6'sf] w8\sg a9\g' . @= xft sfKg' jf xlNng' .#= lgb|fdf ;d:of .$= jfsjfsL nfUg' jf afGtf x'g' .%= c?n] gb]v]sf jf g;'g]sf lrhx? b]Vg' jf ;'Gg', lagf sf/0f 5fnfdf s]lx ePsf] h:tf] cg'e"lt x'g' . ^= Aofs'n x'g' -czfGt, 56k6L, lr8lr8f kg_.&= cflQg' .*= 5f/]÷d[uL 5f]Kg]÷rl/kmfO{Opiates -cf}ifwL k|of]u ug{ gkfpFFFFbfsf] # jf a9Lc;/x?_M!= pbf; dx;'; ug'{ .@= jfsjfsL nfUg' jf afGtf x'g' .#= df+;k]lzdf b'vfO{ . -hLp b'Vg'_ $= gfsaf6 kfgL aUg' jf cfvfF/;fpg' .%= cfvfFsf] gfgL km'lNng',/f}+7f8f] x'g', jf kl;gf cfpg'.^= emf8fkvnf x'g' .&= xfO{ cfpg' .*= z/L/ /GsLg' ÷tftf] x'g' .(= lgb|fdf ;d:of .Stimulants and Cocaine - cf}ifwL k|of]u ug{ gkfpFbfsf] @ jf a9L c;/x?_M!= ysfO{ nfUg' .@= g/fd|f]÷ clk|o ;kgfx? .#= lgb|f gkg'{ jf w]/} ;'Tg' .$=w]/} ef]s nfUg' .%= zf/Ll/s jf dfgl;s ?kdf ;':t ePsf] h:tf] b]lvg' jf dx;'; ug'{.Cannabis-cf}ifwL k|of]u ug{ gkfpFbfsf] # jf a9L c;/x?_M!= lrl9g', l/;fpg' jf cfs|fds x'g' .@= cflQg' .#= lgb|fdf ;d:of .$=vfgf g?Rg' jf tf}n 36\g' .%= 56k6L x'g'.^= pbf; x'g' .

5}g 5

&= k]6 b'Vg], sDkg 5'6\g], kl;gf cfpg], hLp /GsLg], hLplr;f] x'g] / 6fpsf] b'Vg] ;d:ofx? dWo] Pp6fdf w]/} cK7\of/f] ePsf] .

k2.s] tkfO{n] nfu"cf}iflw k|of]u ug{ gkfpFbfsf] c;/nfO{ 36fpg jf x6fpg cf}ifwLsf] k|of]u ug'{eof] <

L2k;f/f+z MobL L2k1 jf L2k2 df…5Ú cfPdf, …5Ú sf]8 ug'{xf];\.

s] L2 sf @ jf a9L pQ/x¿, L2a b]vL L2k ;Dd, …5Ú sf]8 u/LPsf 5g\ ?

(L2k1 / L2k2 nfO{ Pp6f k|Zg dfGg] ._

nfu"kbfy{sf] nt 5'6\ofpg'xf];\ M

xNsf: L2 sf @–# nIf0f

dWod:L2 sf $–% nIf0f

Hofb}: L2 sf ^ jf a9L nIf0f

M. Tic disorder

( l6s l8;c8{/ )- sf] dtna – lgbfgsf] aS;df-8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

M1a. s] tkfO{nfO{ lhjgdf slxNo},tkfO{sf] z/L/sf] s'g} efu rNg' h;nfO{ l6S; elgG5, ePsf] lyof] < z/L/sf] s'g} efu lgoGq0f ug{ ufx|f] x'g] ul/ crfgs l56f]–l56f] rNg'nfO{ l6S; elgG5 . af/Daf/ cfFvf lemDsg'-o;df cfFvf km/km/fpg' kb}{g_, cg'xf/sf] s'g} efu rNg', 6fpsf] em8\sg', Pp6} tl/sfn] xft jf sfFw xNnLg' l6s x'g;S5 .

olb …5}gÚ eg], M1b df …5}gÚsf]8 ug'{xf];\ .olb …5Úeg], M1b ;f]Wg'xf];\ . b. uPsf] ! dlxgfdf, s] tkfO{sf] z/L/sf] s'g} efu rNg' h;nfO{ l6S; elgG5, ePsf] lyof] <M2a. s] tkfO{nfO{ lhjgdf slxNo}, s'g} To:tf] l6seof] h;n] ubf{ tkfO{n] Pp6} zJb bf]xf]¥ofO /fVg'eof], Pp6} cfjfh lgsfnL /fVg'eof] / h;nfO{ /f]Sg ufx|f] ePsf] lyof] <h:t} M ?3f vf]ls gnfu]klg af/Daf/ vf]Sg], 3fF6L v;v;fPsf] a]nf h:tf] 3fF6L ;kmf ug]{, gfs aGb ePsf] a]nf h:tf] ;'s;'sfpg], gfsaf6 crDdsf] cfjfh lgsfNg] -h:t} M s's'/ e's]sf] h:tf] cfjfh lgsfNg]_, Pp6} zJb af/Daf/ bf]xf]¥ofpg] jf g/fd|f] zAb÷ufnL crfgs lgSng], klxn] ;'g]sf cfjfh lgsfNg] jf c?n] eg]sf s'/fx? bf]xf]¥ofpg] ._ b. uPsf] ! dlxgfdf, s] tkfO{nfO{ slxNo} s'g} To:tf] l6seof] h;n] ubf{ tkfO{n] Pp6} zJb bf]xf]¥ofO /fVg'eof], Pp6} cfjfh lgsfnL /fVg'eof] / h;nfO{ /f]Sg ufx|f] ePsf] lyof] < olb M1a / M2a b'j} …5}gÚ sf]8 ul/Psf] 5 eg], ;a}lgbfgsf] aS;df …5}gÚ df uf]nf] nufpg'xf];\/ …N1Ú df hfg'xf];\ . M3.klxnf] k6s l6S; cfPk5L,s] lt l6S; cfpg] hfg] ePtfklg ! jif{ jf a9L ;do ;Dd eO{/fv] <

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5'6\ofpg'xf];\M

xNsfdWodHofb}

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nfu"kbfy{sf] nt

-nfu"kbfy{sf] gfd_

uPsf] !@ dlxgfdf

M4. s] lt l6S; tkfO{n] s'g} cf}ifwL jf sf]s]g k|of]u u/]kl5 dfq x'Gy] <

M5. s] lt l6S; s'g} zf/Ll/s /f]usf] sf/0fn] ubf{ dfq} ePsf] lyof] <-h:t} M huntington's disease jf postviral encephalitis. _

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M6a. s] M1a+M2a+M3…5Ú sf]8 ul/Psf 5g\ < / M4+M5 …5}gÚ sf]8 ul/Psf 5g\ <6'/]6 l8;c8{/, xfnsf]jf lhjgdf clxn];Ddjf b'j}, pNn]v ug'{xf];\ .

olb M1a / M2a b'j}df…5Ú sf]8 ul/Psf] 5 eg], lhjgdf clxn];Ddsf]8ug'{xf];\ .olb M1b / M2b b'j}df…5Ú sf]8 ul/Psf] 5 eg], xfnsf] sf]8 ug'{xf];\ .

M6b. s] M1a+M3…5Ú sf]8 ul/Psf 5g\ </ M2a + M4 + M5…5Ú sf]8 ul/Psf 5g\ </M6a lhjgdf clxn];Dd …5}gÚ sf]8 ul/Psf] 5 <

k/l;:6]G6 df]6/ l6s l8;c8{/, xfnsf]jf lhjgdf clxn];Ddjf b'j}, pNn]v ug'{xf];\ .olb M1a …5Ú sf]8 ul/Psf] 5 eg], lhjgdf clxn];Dd sf]8 ug'{xf];\ .olb M1b …5Ú sf]8 ul/Psf] 5 eg], xfnsf] sf]8 ug'{xf];\ .

M6c. s] M2a+M3,…5Ú sf]8 ul/Psf 5g\ </ M1a+M4+M5 …5}gÚ sf]8 ul/Psf 5g\ </ s] M6a lhjgdf clxn];Dd…5}gÚ sf]8 ul/Psf] 5 <

k/l;:6]G6 -s|f]lgs_ ef]sn l6s l8;c8{/_,xfnsf]jflhjgdf clxn];Dd,jf b'j} pNn]v ug'{xf];\ .olb M2a …5Ú sf]8 ul/Psf] 5 eg], lhjgdf clxn];Dd sf]8 ug'{xf];\ .olb M2b …5Ú sf]8 ul/Psf] 5 eg], xfnsf] sf]8 ug'{xf];\ .

M6d. s] M1a jf M2a,…5Ú sf]8 ul/Psf 5g\ </ M3+M4+M5 …5}gÚ sf]8 ul/Psf 5g\ < /s] M6a / M6b / M6c lhjgdf clxn];Dd …5}gÚ sf]8 ul/Psf] 5 <k|f]lehgnl6s l8;c8{/, xfnsf] jf lhjgdf clxn];Ddjf b'j} pNn]v ug'{xf];\ .olb M1a jf M2a jf b'j} …5Ú sf]8 ul/Psf] 5 eg], lhjgdf clxn];Dd sf]8 ug'{xf];\ .olb M1b jf M2b jf b'j}…5Ú sf]8 ul/Psf] 5 eg], xfnsf] sf]8 ug'{xf];\ .

5}g 5 Tourette's Disorder

-6'/]6 l8;c8{/_,

xfnsf]

lhjgdf clxn];Dd

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Persistent Motor Tic disorder -k/l;:6]G6 df]6/ l6s l8;c8{/_,

xfnsf]

lhjgdf clxn];Dd

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Persistent (chronic) vocal tic disorder -k/l;:6]G6 -s|f]lgs_

ef]sn l6s l8;c8{/_,

xfnsf]

lhjgdf clxn];Dd

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Provisional Tic disorder -k|f]lehgnl6s l8;c8{/_ ,

xfnsf]

lhjgdf clxn];Dd

N. Attention-deficit/hyperactivitydisorder

(Wofg cefj tyf clt ;lqmo x'g] /f]u)- sf] dtna – lgbfgsf] aS;df- 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

# j6f /f]ux?sf] (Wofg cefj tyf clt ;lqmo x'g] /f]u, Jojxf/;Fu ;DjlGwt /f]ux? :sG8S6 l8:c8{{/, ckf]hL:gn 8]lkmPG6l8:c8{{/ ):s|Llg+u k|Zg M

N1. s] lhjgdf slxNo} s;}n] -h:t} M lzIfs, cfof -/]v b]v ug]{_,;fyL jf a'jf–cfdf_ tkfO{sf] afgL jf :s'ndf x'Fbf tkfO{sf] lqmofsnfksf] af/]df u'gf;f] u/]sf] 5 <olb of] k|Zgsf] pQ/ …5}gÚ sf]8 ul/Psf] 5 eg], Jojxf/;Fu ;DjlGwt /f]ux? (sG8S6 l8:c8{{/ , ckf]hL:gn 8]lkmPG6l8:c8{{/ )nfO{ …5}gÚ sf]8 ug'{xf];\ .

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uPsf] ^ dlxgfdf M N2

a. s] tkfO{n] w]/}h;f], ;fgf] ;fgf] s'/fdf kof{Kt Wofg lbg'ePg < jf :s'ndf w]/} nfk/jfx eP/ uNtLx? ug'{eof] <

b. s] tkfO{nfO{ w]/} h;f], v]Nbf jf :s'nsf] sfd ubf{ Wofg s]Gb«Lt u/L /fVg ;d:of ePsf] lyof] <

c. s] tkfO{nfO{ c?x?n] tkfO{;Fu s'/f ubf{ tkfO{n] s'/} g;'g]sf] eg]/ eg]sf 5g\ <

d. s] tkfO{nfO{ u/ elgPsf] sfd eg] cg'?k -lgb]{zg cg';f/_ ug{ ufx|f] x'GYof] -h:t}M :s'nsf] sfdx? jf 3/sf] sfdx?_<tkfO{n] s] ug]{ eGg] s'/f a'em\bf a'em\b} klg Tof] sfd ug{ ufx|f] x'GYof] < s] tkfO{n] grfxbf grfxb} klg o:tf] x'GYof]] <

oL dWo] s'g}df …5}gÚ pQ/ cfPsf] 5 eg], …5}gÚ sf]8 ug'{xf];\ .

e. s] cfkm'nfO{ Jojl:yt /fVg -h:t}M ;dodf sfd ;sfpg], ;fdfgx¿ ldnfP/ /fVg], JolQmut ;/;kmfOdf Wofg lbg] cflb_ tkfO{nfO{ k|fo M ;d:of x'GYof]<

f. s] tkfO{n] cfkm'n] Psfu| eP/ Wofg lbg' kg]{ jf w]/} ;f]Rg' kg]{ sfd -h:t} M :s'nsf] sfd_gug{] jf To:tf sfdaf6 efUg] jf 6f9f /xg]_ sf]lz; ug'{eof] < s] tkfO{nfO{ o:tf sfdx? dg kb}{g<s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

g. s] tkfO{n] cfkm'nfO{ cfjZostf x'g] lrhx? -h:t} u[xsfo{, snd jf v]nf}gf_ k|fo M x/fpg' ePsf] jf la;{g' ePsf] 5 <

h. s] ;fgf] s'/fx?n] -h:t} M cfjfhx?, sf]7f aflx/sf ;fdfgx?_ ubf{ tkfO{sf] Wofg k|fo M ;lhn} eË x'G5<

i. s] tkfO{n] k|To]s lbg ug'{kg]{ sfdx? k|foM ug{ la;{g' x'G5 -h:t} M skfn sf]g{ jf bfFt dfem\g, s'g} ug'{kg]{ sfdx? ug{ lal;{g] _ <

N2 ;f/fz+ M s] N2 sf] ^ jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 .

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uPsf] ^ dlxgfdf M N3

a. s] tkfO{nfO{ l:y/ -zfGt_ eP/ a:g g;s]/ k|foh;f] cfˆgf] xft, v'§f rnfO{/fVg'kg]{ ePsf] 5 jf cfkm" a;]sf] 7fpFdf d8fl/ /fVg'kg]{ -r6\k6fO{ /fVg'kg]{_ ePsf] 5 <

s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\.

b. s] tkfO{ sIff sf]7fdf l:y/ -zfGt_ eP/ a:g'kg]{ ;dodf klg k|fo M cfˆgf] 7fpFaf6 p7\g], lx8\g], rNg] ug'{ ePsf] 5 <

c. s] tkfO{ ug{ gx'g]÷gldNg] cj:yfdf klg k|fo M otfptL bf}8g] jf hxfkfof] ToxL,r9\g] ug{'ePsf] 5 < s] tkfO{ otfptL bf}8g] jf hxfkfof] ToxL r9\g gu/]tf klg To:tf] ug{ dg nfUYof] <s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

d. s] tkfO{nfO{ zfGt eP/ v]Ng k|foM ufx|f] ePsf] 5 <

e. s] tkfO{nfO{ cgfjZos ?kdf …s]lx g s]lx u/L/fVg'kg]{ x'GYof] <

f. s] tkfO{nfO{ k|foh;f] cgfjZos ?kdf w]/} af]nL/fVg'kg]{ ePsf] 5 <

g. s] tkfO{n] lzIfs jf c? dfG5]n] k|Zg ;f]w]/ ;Sg' cl3 g} k|fo M pQ/ e// lbg'ePsf] 5 <

h. s] tkfO{nfO{ cfˆgf] kfnf] s'g{ k|foM ufx|f] ePsf] 5 <

i. s] tkfO{n] c? dfG5]nfO{ k|fo M lardf /f]Sg] -l8:6j{_ ug'{ePsf] 5 <h:t} M c? dfG5] s'/f ul//x]sf] a]nfdf jf plgx? Jo:t ePsf] a]nfdf jf kmf]gdf s'/f ul//x]sf] a]nfdf afwf k'¥ofpg'ePsf] 5 <

N3 ;f/f+z M s] N3 sf] ^ jf a9L pQ/ …5Ú sf]8 ul/Psf] 5 .

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5

N4.s] tkfO{nfO{ cfkm' !@ jif{ eGbf ;fgf] x'Fbf s]lx s'/fdf Wofg lbg ;d:of x'g], cgfjZos ?kdf clt ;ls|o (5's5's), rln /fVg'kg]{ jf cfj]udf -ODknl;e_cfpg] ;d:oflyof] <

5}g 5

N5.s] tkfO{sf] of] afgLn] ubf{ :s'ndf< 3/df< kl/jf/df< ;flyx?;Fu< ;d:of ePsf] lyof]< olb @ jf a9L pQ/ …5Ú cfPdf, …5Ú sf]8 ug'{xf];\.

s] N2 / N3 ;f/f+z …5Ú sf]8 ul/Psf] 5 <

/ Wofg cefj tyf clt ;lqmo x'g] /f]usf nIf0fx¿ lgtfGt cGo dfgl;s /f]usf] nIf0fx¿sf] sf/0fn] dfq x'g'ePg?

s] N2 ;f/f+z …5Ú sf]8 ul/Psf] 5 /N3 ;f/f+z …5}gÚ, sf]8 ul/Psf] 5 <hgfpg nIf0fx?_

/ Wofg cefj tyf clt ;lqmo x'g] /f]usf nIf0fx¿ lgtfGt cGo dfgl;s /f]usf] nIf0fx¿sf] sf/0fn] dfq x'g'ePg?

s] N2 ;f/f+z …5}gÚ sf]8 ul/Psf]] 5 / N3;f/f+z …5Ú sf]8 ul/Psf]]] 5 </ Wofg cefj tyf clt ;lqmo x'g] /f]usf nIf0fx¿ lgtfGt cGo dfgl;s /f]usf] nIf0fx¿sf] sf/0fn] dfq x'g'ePg?

5}g 5

O. Conduct disorder

(Jojxf/;Fu ;DjlGwt /f]u-sG8S6 l8:c8{{/)- sf] dtna lgbfgsf] aS;df- 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

:s|Llg+uk|ZgM

O 1. olb Wofg cefj tyf clt ;lqmo x'g] /f]usf] k|Zg N1 sf] pQ/ …5}gÚ sf]8 ul/Psf] 5 eg],sG8S6 l8:c8{{/ nfO{ …5}gÚ sf]8 ug'{xf];\ . olb N1 klxn]g} ;f]lwPsf] 5}g eg] tnsf] k|Zg ;f]Wg'xf];\ M

s] lhjgdf slxNo} s;}n] -h:t} M lzIfs, cfof -/]vb]v ug]{_,;fyL jf a'jf–cfdf_ tkfOsf] afgL jf :s'ndf x'Fbf tkfO{sf] lqmofsnfksf] af/]df u'gf;f] u/]sf] 5<

5}g

5

5}g 5

Wofg cefj tyf clt ;lqmo x'g] /f]u

b'Oj6} /f]usf] nIf0f ePsf]

5}g 5

Wofg cefj tyf clt ;lqmo x'g] /f]u

Predominantly inattentive presentation

-d'Votof Wofg cefjhgfpg] nIf0fx?_

O2. uPsf] !@ dlxgfdf M

a. s] tkfO{n] c? dfG5]x?nfO{ -cfˆgf] efO{÷alxgL afx]s_ wDsfpg] jf t;f{{pg] ug'{ePsf] 5 <b. s] tkfO{n] c?;Fu -cfˆgf] efO{÷alxgL afx]s_ emu8f ;'? ug'{ ePsf] 5 <

c. s] tkfO{n] s;}nfO{ rf]6 k'¥ofpg s'g} xltof/sf] -h:t} M 5'/L, aGb's, aNnf-bat_, jf c? j:t' _ k|of]u ug'{ ePsf] 5 <

d. s] tkfO{n] hfgL hfgL s;}nfO{ -cfˆgf] efO{÷alxgL afx]s_ zf/Ll/s ?kdf rf]6 k'¥ofpg' ePsf] 5<

e. s] tkfO{n] hfgL hfgL hgfj/x?nfO{ rf]6 k'¥ofpg' ePsf] 5 <

f. s] tkfO{n] an k|of]u u/]/ s]xL s'/f rf]g'{ ePsf] 5 < h:t} M xltof/ k|of]u u/]/ s;}nfO{ n'6\g' jf s;}sf] s]lx vf]:g' -h:t}M k;{ l5Gg'_ .

g. s] tkfO{n] s;}nfO{ cfkm';Fu of}g;Dks{ /fVg ha/h:tL ug'{ eof] <

h. s] tkfO{n] lrh j:t'x? gi6 ug{sf nflu hfgL hfgL cfuf] nfpg] ug'{ePsf] 5 <

i. s] tkfO{n] c?sf] lrh j:t'x? hfgL hfgL gi6 ug'{ePsf] 5 <

j. s] tkfO{ s;}sf] 3/ jf uf8Ldf ha/h:tL k:g'ePsf] 5 <

k. s] tkfO{n] dfG5]x?;Fu s]lx lng jf s'g} s'/faf6 klG5g\\ w]/} k6s em'6f] af]Ng' ePsf] 5 < jf s;}nfO{ cfˆgf] dg nfu]sf] sfd u/fpg em'Sofpg' ePsf] 5 <s'g} Pssf] pQ/ …5Ú cfPdf, …5Ú sf]8 ug'{xf];\.

l. s] tkfO{n] k};f kg]{ rLhx? rf]g'{ePsf] 5 < -h:t} Mk;naf6 ;fdfg rf]g]{ jf gSsnL r]s agfpg]_<

m. s] tkfO{ k|foh;f] cfˆgf] a'jf–cfdfn] cg'dlt lbg] ;do eGbf w]/} ca]/;Dd aflx/ a:g' ePsf] 5< s] lo s'/fx? tkfO{ !# aif{ k'Ug' eGbf c3Lg} z'? eP <

olb s'g} Pssf] pQ/ …5}gÚ cfPdf, …5}gÚ sf]8 ug'{xf];\ .

n. s] tkfO{ @ jf a9L k6s ;Dd 3/af6 efUg' ePsf] 5 <

o. s] tkfO{n] k|fo M :s'n 5f]8\g' ePsf] 5 < s] of] tkfO{ !# jif{ k'Ug' eGbf c3Lg} z'? eof] < olb s'g} Pssf] pQ/ …5}gÚ cfPdf, …5}gÚ sf]8 ug'{xf];\ .

O2 ;f/f+z M s] O2 sf] # jf a9L pQ/ h; dWo] slDtdf Pp6f uPsf] ^ dlxgfdf b]lvPsf] lyof], …5Ú sf]8 ul/Psf] 5 <

5}g

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5}g

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5}g

5}g

5}g

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

5

O3 M s] tkfO{sf] of] afgLn] ubf{ :s'ndf< 3/df< kl/jf/df< jf ;flyx?;Fu<

7"n} ;d:of ePsf] lyof] <olb s'g} ! df …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

sG8S6 l8:c8{{/ sf] klxnf] nIf0f z'? ePsf] pd]/pNn]v ug'{xf];\ .

!) jif{ eGbf cuf8L= aRrf–cj:yfdf z'? ePsf] .

!) jif{ eGbf k5L =lszf]/f–cj:yfdf z'? ePsf] .

z'? ePsf] pd]/ yfxf gePsf]= s'g} -gtf]lsPsf]_ cj:yfdf z'? ePsf]

P.Oppositionaldefiantdisorder

-Jojxf/;Fu ;DjlGwt /f]u—ckf]hL:gn 8]lkmPG6 l8:c8{{/_

- sf] dtna – lgbfgsf] aS;df- 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] . ;fjwfgL M olb sG8S6 l8:c8{{/df …5Ú pQ/ cfPsf] 5 eg], lgbfgsf] aS;df…5}gÚ df lrGx nufpg'xf];\ / csf]{ df]8\o'ndf hfg'xf];\ .

:s|Llg+u k|ZgM

P1= olb Wofg cefj tyf clt ;lqmo x'g] /f]usf] N1 df …5}gÚ eP …5}gÚ df lrGx nufpg'xf];\ .

olb N1 ;f]lwPsf] lyPg eg], lgDg k|Zg ;f]Wg'xf];\ .

(s] lhjgdf slxNo} s;}n] -h:t} M lzIfs, cfof -/]v b]v ug]{_,;fyL jf a'jf÷cfdf_ tkfOsf] afgL jf :s'ndf x'Fbf tkfO{sf] lqmofsnfksf] af/]df u'gf;f] u/]sf] 5<)

5}g 5

P2. uPsf] ^ dlxgfdf, xKtfsf] sDtLdf Ps k6s M

a. s] tkfO{nfO{ k|fo M Psbd w]/} l/; p7\g] u/]sf] 5 <

b. s] tkfO{ k|fo M …;+j]bglznÚ x'g' ePsf] jf c?b]lv Psbd emls{g]÷lrl9g] x'g'ePsf] 5 <

c. s] tkfO{nfO{ k|foh;f] c? b]lv l/; p7\g] jf dfG5];Fu ck|;Gg x'g] ePsf] 5 <

d. s] tkfO{ k|foh;f] cfkm" eGbf 7"nf] dfG5];Fu ax; ug]{ ug'{ePsf] 5 <

e. s] tkfO{n] k|foh;f] cfkm" eGbf 7"nfn] eg]sf] dfGg] ug'{ePsf] 5}g < jf lgodx? kfngf ug'{ePsf] 5}g <s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

f. s] tkfO{n] k|foh;f] hfgL hfgL c?nfO{ lr9fpg' ePsf]÷l/; p7fpg' ePsf] 5 <

g. s] tkfO{n] k|foh;f] cfˆgf] uNtL jf g/fd|f] Jojxf/sf] nflu c?nfO{ bf]if nufpg] ug'{ePsf] 5 <

h. s] tkfO{ k|foh;f] cfkm"nfO{ g/fd|f] Jojxf/ ug]{ dfG5] k|lt 4]if jf rf8f] …abnfÚ lng] efjgf /fVg] ug'{ePsf] 5 < uPsf] ̂ dlxgfdf, s] tkfO{n] @ jf @ k6s eGbf a9L o:tf] ug'{ePsf] 5 < olb b'j}df …5Ú cfPdf, …5Ú sf]8 ug'{xf];\ .

P2;f/f+z M s] P2 sf $ jf $ eGbf a9L pQ/x? …5Ú sf]8 Ufl/Psf 5g\ <

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5

5

5

5

5

5

5

5

5

5}g 5

sG8S6 l8:c8{{/ xfnsf]

aRrf–cj:yfdf z'? ePsf]

lszf]/f–cj:yfdf z'? ePsf]

s'g}–cj:yfdf z'? ePsf]

P3.s] o:tf] Jojxf/x? sDtLdf ^ dlxgf ;Dd /x]sf lyP <

5}g 5

P4.s] o:tf] Jojxf/ cfˆgf] bfh'efO{ jf lblbalxgL afx]s c?;Fu klg ePsf] 5 <

5}g 5

P5.s] tkfO{sf] of] afgLn] ubf{ :s'ndf< 3/df< kl/jf/df< jf ;flyx?;Fu< ;d:of ePsf] lyof]< s'g} Psdf …5Ú ePdf, …5Ú sf]8 ug'{xf];\ .

s] P2 ;f/f+z+ P3+P4+P5df …5Ú sf]8 Ufl/Psf] 5 <

ckf]hL:gn 8]lkmPG6l8:c8{{/nfO{ c? dfgl;s /f]u,

h:t} dgsf] /f]u, nfu"kbfy{sf] nt,

s8f lsl;dsf] -vfnsf]_ dfgl;s /f]un]

j0f{g÷JofVof÷;Daf]wg ub{}g / To;df l;ldt /xb}g /

pQ/bftfnfO{ l8;/kl6e d'8 /]Uf'n]Zg l8:c8{{/ ePsf] x'b}g .

5}g

5

Q. Psychotic disorder and mood disorder with psychotic features

(s8f lsl;dsf] -vfnsf]_ dfgl;s /f]u -dfgl;s c;Gt'ngtf_/ dgsf]/f]u ;+u} s8f lsl;dsf] -vfnsf]_ dfgl;s /f]usf nIf0fx?)

…5Ú pQ/ cfPsf k|To]s k|Zgsf] nfuL pbfx/0f klg ;f]Wg'xf];\ . obL pbfx/0fx?n] :ki6 ?kdf larf/ / cg'e'ltdf s'g} lj?k0f -u8a8L_ b]vfPdf jf ;f+:s[lts ?kdf lt pQ/ pko'St gePsf] ca:yfdf dfq …5Ú sf]8 ug'{xf];\ .

of] df]8o'nsf] p2]Zo s8f lsl;dsf] -vfnsf]_ dfgl;s /f]u÷dfgl;s c;Gt'nGftf ePsf la/fdLnfO{ kQf nufpg' xf] . of] df]8o'nsf] k|of]u ug{ cg'ej rflxG5 .

ca d}n] tkfFO{nfO{ sf]xL dfG5]nfO{ x'g] c;dfGo cg'ejsf] af/]df k|Zg ug{ uO/x]sf] 5' .

Q1a. s] tkfO{n] lhjgdf slxNo},c? dfG5]n] tkfO{nfO{ uf]Ko ?kdf -n's]/_ x]l//x]sf] 5 eGg] s'/f nfu]sf]] 5 < s] s;}n] tkfO{nfO{ rf]6 -hurt_ k'¥ofpg-g/fd|f] ug{_ vf]lh/x]sf] 5 eGg] s'/f nfu]sf] 5 < s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ . l6Kk0fL M ;fFlRrs} lk5f ul//x]sf] xf] ls xf]Og eGg] s'/fnfO{ 7Dofpg pbfx/0fx? ;f]Wg'xf];\ .

b. olb …5Ú pQ/ cfPdf M s] tkfO{n] clxn] of] s'/f ljZjf; ug'{x'G5 <

5}g

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5

5

Q2a. s] tkfO{n] lhjgdf slxNo}, c? dfG5]n] tkfO{sf] dg k9L /x]sf] 5 jf tkfO{sf] larf/ ;'Gg ;S5 , jf tkfO{n] ;fFlRrs} c?sf] dg k9\g ;Sg'x'G5 jf c?n] ;f]r]sf] s'/f ;'Gg ;Sg'x'G5 eGg] s'/fdf ljZjf; ug'{ePsf] 5<s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .


5}g

5}g

5

5

5}g 5

ckf]hL:gn 8]lkmPG6 l8:c8{{/

xfnsf]

Q3a. s] tkfO{nfO{ lhjgdf slxNo}, c? dfG5]n] jf s]lx s'/fn]] tkfO{sf] dgdf-lbdfu_ To:tf] larf/ /flv lbPsf] h'g tkfO{sf] cfˆgf] xf]O{g jf slxNo} c? dfG5] jf afXo zlQmn] tkfO{sf] ;fdfGo :jefj eGbf km/s sfd ug{ nufof] eGg] s'/fdf ljZjf; ug'{ePsf] 5 < s] tkfO{n] slxn] cfkm' c?sf] clwgdf÷ lgoGq0fdf ePsf] cg'ej ug'{ePsf] 5 < s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ . l6Kk0fL: pbfx/0fx? ;f]Wg'xf];\ / dfgl;s c;Gt'ng;Fu ;DjlGwt gePsf s'/fnfO{ ;dfj]z gug'{xf];\ .


5}g

5}g

5

5

Q4a. s] tkfO{n] lhjgdf slxNo}, l6=eL=, /]l8of], O{G6/g]6, kqklqsf, lstfa, v]nf}gf jf v]nsf] dfWodaf6 s;}n] tkfO{nfO{ ljz]if ;Gb]z k7fPsf] eGg] s'/fdf ljZjf; ug'{ePsf] 5 <s] tkfO{n] glrg]sf] JolStn] tkfO{ dfly ljz]if rf;f] lnof] eGg] s'/fdf ljZjf; ug'{ePsf] 5 <s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

b.olb …5Ú pQ/ cfPdf M s] tkfO{n] clxn] of] s'/f ljZjf; ug'{x'G5 <

5}g

5}g

5

5

Q5a.s] tkfO{sf] gft]bf/ jf ;flyx?n] tkfO{sf] wf/0ff-ljrf/_ nfO{ ;fdfGo gePsf] jf crDdsf] dfg]sf 5g\ < s[kof dnfO{ Pp6f pbfx/0f lbg'xf];\ .

k|Zgs{{tf{{ M pbfx/0fx? ;f]Wg'xf];\ . olb pbfx/0fx?, Q1 b]lv Q4;Dd g;f]lwPsf e|fds ljrf/x?df - delusional ideas)df k5{g\ eGg] s'/f :ki6 5 eg] dfq …5Ú sf]8 ug'{xf];\.

pbfx/0fsf] nflu M wd{, d[To', /f]u tyf zf/Ll/s e|dx? (somatic delusion), cf8+a/sf] -3d08_ e|d(delusion of grandiosity), O{iof{ jf bf]ifsf] e|d (jealousy or guilt),c;kmntf/ckof{Kttf (inadequacy),ljgfz (ruin), cefj (destitution),jf z"Gotf(nihilistic);DaGwL e|dx? .

b.olb …5Ú pQ/ cfPdf: s] pgLx?n] clxn] klg tkfO{sf] wf/0ffx? ;fdfGo gePsf] jf crDdsf] dfG5g\ <

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5

5

Q6a. s] tkfO{n] c? dfG5]x?n] g;'Gg] -g;'g]sf_ / tkfO{n] dfq ;'Gg] cfjfhx? ;'Gg'ePsf] 5 < olb …5Ú cfPdf M s] Tof] cfjfhn] tkfOsf] af/]df s'/f ul//x]sf] lyof] < s] lt cfjfhx¿ Ps csf{;Fu s'/f ul//x]sf lyP <

b. olb Q6adf …5Ú cfPdf M s] tkfO{n] uPsf] ! dlxgfdf lt WjgL÷cfjfhx? ;'Gg'ePsf] lyof] <

olb …5Ú cfPdf M s] tkfO{n] cfˆgf] af/]df s'/f ul//x]sf] cfjfh ;'Gg'eof]<s] tkfO{n] ! eGbf w]/} cfjfh Ps csf{;Fu s'/f ul//x]sf] ;'Gg'eof] <

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5

5

Q7a. s] tkfO{n] Jo'em]sf] a]nfdf c? dfG5]n] gb]Vg] / tkfO{n] dfq b]Vg] s'/fx? b]Vg'ePsf] 5 <

k|Zgs{{tf{{ M lo s'/fx? ;f+:s[lts ?kdf pko'Qm 5g\ ls 5}gg\ hfFr ug'{xf];\ .

b.olb …5Ú cfPdfM s] tkfO{n] uPsf] ! dlxgfdf, o:tf s'/fx? b]Vg'ePsf] lyof] <

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5

5

k|Zgs{{tfsf] lg0f{o M

Q8 a. s] la/fdLn] ljutdf slxNo} cJojl:yt (disorganized),ga'lemg](incoherent), jf ljn'Kt (derailed) efif0f/af]nL af]n]sf] jf s'g} a]d]n -marked loosening of association) b]vfPsf] 5 <

b.s] la/fdLn] xfn jf jt{dfgdf cJojl:yt (disorganized), ga'lemg] (incoherent) jf ljn'Kt (derailed) efif0f÷af]nL af]n]sf] jf s'g} a]d]n -marked loosening of association) b]vfPsf] 5 <

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5

5

Q9 a. s] la/fdLn] ljutdf slxn] cJojl:yt -disorganized_ jf Sof6f6f]lgs (catatonic) Jojxf/ b]vfPsf] 5 <

b. s] la/fdLn] xfn÷jt{dfgdf slxn]]]] cJojl:yt -disorganized_ jf Sof6f6f]lgs(catatonic) Jojxf/ b]vfPsf] 5 <

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5

5

Q10a.= s] la/fdLn] slxNo} g]u]l6e nIf0fx? b]vfPsf] lyof] < h:t} M efjgfTds cleJolQmdf pNn]vlgo sdL cfPsf], klxn] eGbf w]/} sd af]Ng] jf p2]Zod'n's lqmofsnfk z'? ug{ g;Sg] jf lg/Gt/tf lbg g;Sg] .

b. s] cGt{jftf{sf] ;dodf l;hf]km]/]lgofsf] g]u]l6e nIf0fx? k|d'v dfqfdf b]vfPsf] lyof] < h:t} M efjgfTds cleJolQmdf pNn]vlgo sdL cfPsf], klxn] eGbf w]/} sd af]Ng] jf p2]Zod'ns lqmofsnfk z'? ug{ g;Sg] jf lg/Gt/tf lbg g;Sg] .

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5

5

Q11a. s]Q1a b]lvQ7a ;Ddsf^a^k|Zgx? dWo],! jf a9L pQ/x? …5Ú sf]8 ul/Psf 5g\ < / o;sf ;fy},

pGdft / pbfl;gtfsf] cjlw stL ;do ;Dd rNof] <=================

s8f dfgl;s /f]usf] cjlw stL ;do ;Dd rNof] <=================

pGdfb / pbfl;gtfsf] cjlw ePsf] v08df\, s8f dfgl;s /f]usf] nIf0fx?sf] xfn eO/x]sf] / afsLF /x]sf cjlw dWo] w]/} h;f] ;dodf pGdfb / pbfl;gtfsf] u8a8L 5 eg] dfq k|Zg gDa/ Q11a nfO{ …5Ú sf]8 ug'{xf];\ . xf]O{g eg], …5}gÚ sf]8 ug'{xf];\ .

obL k|Zg Q11a df …5}gÚ cfPdf M pGdft / pbfl;gtfsf] cjlwsf] s'n calw s8f dfgl;s /f]usf] cjlwsf] calw eGbf sd cfPdf,pGdfb / pbfl;gtfsf] u8a8L;Fu s8f dfgl;s /f]usf] nIf0fx?sf] lgbfgsf] -8foUgf]i6Ls_ aS;df …5}gÚ df uf]nf] nufpg' xf];\ / k|Zg Q13df hfg'xf];\ .

Q11b.tkfO{n] c3L dnfO{ eGg' eof] ls tkfO{nfO{ klxn] s'g} a]nf pbf;

ePsf]÷w]/} tfut÷cgfjZos v';L÷nuftf/ ;fgf–;fgf s'/fdf l/;

p7\g] ;dofjlw x'g] uYof]{ eg]/ .

tkfO{n] aofg u/]sf cg'ea÷wf/0ffx?

(k|Zg Q1a-Q7a df …5Ú sf]8 ul/Psf nIf0fx?) tkfO{n]

klxn] s'g} a]nf pbf; ePsf]÷w]/} tfut÷cgfjZos v';L÷nuftf/

;fgf;fgf s'/fdf l/; p7\g] cg'ea u/]sf] a]nfdf dfq x'Gy] <

obL la/fdLn] klxn] s'g} a]nf pbf; ePsf]÷w]/} tfut÷cgfjZos

v';L÷nuftf/ ;fgf–;fgf s'/fdf l/; p7\g] dx;'; gu/]sf] ;dodf

slDtdf @ xKtf ;Dd, c3L aofg ul/Psf cg'ej wf/0ffx? cg'ej

u/]sf] 5 eg] lhjgdf clxn] ;Dd pGdfb / pbfl;gtfsf] u8a8L;Fu

s8f dfgl;s /f]usf nIf0fx?nfO{ …5}gÚ sf]8 ug'{xf];\ .

obL of] /f]usf] ;d"xsf] pQ/ …5}gÚ cfPsf] 5 eg] Q12 df klg …5}gÚ

df uf]nf] nufpg] / k|Zg Q13 df hfg'xf];\ .

5}g

Q13

5

5}g 5


lhjgdf clxn] ;Dd

Q12 s] Q1b b]lv Q7b ;Ddsf k|Zgx? dWo] ! jf a9L


/ o;sf ;fy}

pbfl;gtfsf] cjlw -xfnsf]_ jf pGdfbsf] cjlw -xfnsf] _

dWo] s'g}df …5Ú sf]8 ul/Psf] 5 <

obL of] /f]u lhjge/sf] jf clxn]sf] pQ/ …5Ú sf]8 ul/Psf] 5 eg],

Q13 / Q14 nfO{ …5}gÚ sf]8 ug'{xf];\ clg csf]{ df]8o'ndf hfg'xf];\ .

Q13.s] Q1b b]vL Q8b ;Ddsf k|Zgx? dWo] ! jf a9L pQ/x?

…5Ú sf]8 ul/Psf 5g\ <

/ s] Q1b b]vL Q10b ;Ddsf k|Zgx? dWo], @ jf a9L pQ/x?

…5Ú sf]8 ul/Psf 5g\ <

/ s] s8f dfgl;s /f]usf] nIf0fx? dWo] slDtdf, @ j6f nIf0fx? ToxL

! dlxgfsf] calwdf b]lvPsf] lyof] <

/


( W2 ;f/f+z )ePsf] xf]Og eg]/ 5'6\ofOPsf] 5 <

Q14. s] Q13 …5Ú sf]8 ul/Psf] 5 < jf s] Q1a b]vL Q8a ;Ddsf <a> k|Zgx? dWo] ! jf a9L pQ/x? …5Úsf]8 ul/Psf 5g\ </ s] Q1a b]vL Q10a ;Ddsf <a> k|Zgx? dWo] @ jf a9L pQ/x? …5Ú sf]8 ul/Psf 5g\ </

s] s8f dfgl;s /f]usf] nI0fx? dWo] slDtdf @ j6f nIf0fx?,

ToxL Ps dlxgfsf] calwdf b]lvPsf] lyof] <

/



5}g 5


xfnsf]

5}g 5

s8f dfgl;s /f]u

xfnsf]

5}g 5

s8f dfgl;s /f]u

lhjgdf clxn] ;Dd

R. Anorexia nervosa

(Pgf]/]S;Lof gef]{;f)- sf] dtna – lgbfgsf] aS;df - 8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndfhfg] ._

R1 a. tkfO{sf] prfO{ slt 5 < lkm6 O{{Gr

;]=dL=

b.uPsf] # dlxgfdf, tkfO{sf] ;a} eGbf sd tf}n÷jhg slt lyof] < kfp08

lsnf]

c. s] pQ/bftfsf] tf}n÷jhg tn lbO{{Psf] tf}n / prfO{sf] tflnsf cg';f/ 5}g 5

sd jf a/fa/ 5 <

-tnsf] tflnsf x]g{'xf]nf . _

d. uPsf] # dlxgfdf, s] tkfO{sf] @. # s].hL jf a9L tf}n÷jhg 36]sf] lyof] < 5}g 5

e. tkfO{ !$ jif{ eGbf sd pd]/sf] x'g'x'G5 eg], uPsf] # dlxgfdf, 5}g 5

s] tkfO{sf] s]xL tf}n÷jhg a9\g ;s]sf] lyPg <-olb ;xefuL !$ aif{

eGbf a9L pd]/sf] x'g'x'G5 eg], …5}gÚ sf]8 ug'{xf];\._

f.uPsf] # dlxgfdf, s] s;}n] tkfO{sf] jhg w]/} 36\of] eg]/ eg]sf] 5 < 5}g 5

olb R1cjf R1d jf R1e jf R1f df …5Ú sf]8 ul/Psf] 5 eg], 5}g 5

…5Ú sf]8 ug'{xf];\.

uPsf] # dlxgfdf,

R2. s] tkfO{n] cfˆgf] tf}n÷jhg a9gaf6 /f]Sg sf]l;; ug'{ePsf] lyof] jf vfgf vfg lgoGq0f ug'{ePsf] 5 < 5}g 5

R3.s] tkfO{ jhg a9\5 ls eg]/ 8/fpg'ePsf] lyof]<s] tkfO{nfO{ cfkm" w]/} df]6f] x'G5' eGg] 8/ nfu]sf] 5 < (olb s'g} Psdf …5Ú pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ ._

5}g 5

R4a. s] tkfO{n] cfkm'n] cfkm}nfO Psbd} df]6f] b]Vg'ePsf] 5 jf tkfO{nfO{ cfˆgf] zl//sf] s'g} efu cTolws df]6f] nfu]sf] 5< (olb s'g} Psdf …5Ú pQ/ cfPdf,…5Ú sf]8 ug'{xf];\._

b. s] tkfO{sf] cfˆgf] cfkm'k|ltsf] efj÷wf/0ffnfO{ w]/} xb;Dd tkfO{sf] jhgn] c;/ u/]sf] 5 < s] tkfOsf] cfˆgf] cfkm'k|ltsf] efj÷wf/0ffnfO{ w]/} xb;Dd tkfO{sf] zl//sf] cfsf/n] c;/ u/]sf] 5 < (olb s'g} Psdf 5 pQ/ cfPdf, …5Ú sf]8 ug'{xf];.\)

c.s] tkfO{n] cfˆgf] xfnsf] sd tf}nnfO{ ;fdfGo jf cToflws ePsf] ;f]Rg'eof] <

5}g

5}g

5}g

5

5

5

R5.s] R4sf] ! jf ! eGbf a9L a'Fbfdf …5Ú sf]8 ul/Psf] 5 <

s] R5df …5Ú sf]8 ul/Psf] 5 <

5}g 5

S. Bulimia nervosa

(Ao"nLldof gef]{;f)- sf] dtna – lgbfgsf] aS; - 8foUgf]i6Ls aS; _df hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

uPsf] # dlxgfdfM

S1.s] tkfO{n] cToflws vfg] ug'{ePsf] lyof] <

…cToflws vfg]Ú eGgfn] @ 306fdfcˆ7\of/f] x'g] u/L w]/} vfg' xf] .

S2.o:tf] Psbd w]/} vfPsf] a]nf, Tof] v'jfO{ tkfO{sf] cfˆgf] lgoGq0f eGbf aflx/ ePsf] dx;';

ePsf] lyof] <

5}g

5}g

5

5

uPsf] # dlxgfdfM

S3 s] tkfO{nfO{ o:tf] Psbd w]/} vfg] k|j[lQ slDtdf xKtfsf] Ps k6s h:tf] ePsf] lyof]] <

S4 s] tkfO{n] jhg a9\gaf6 /f]Sg s]xL pkfo ckgfpg' eof]< h:t}M jfGtf ug{] jf w]/} Jofofd ug]{< Ps jf w]/} lbg gvfO{ a:g]< kvfnf nufpg] cf}iflw k|of]u ug]{ jf tf}n a9\g glbg cGo s'g} cf}iflw vfg] ug'{eof]]]<(olb s'g} Psdf 5 pQ/ cfPdf,…5Ú sf]8 ug'{xf];\ .)

S4a. o:tf cg'lrt sfdx? Ps xKtfdf slt k6s h:tf] ug'{eof] <……………………..

o:tf cg'lrt sfdx? Ps xKtfdf slt lbg h:tf] ug'{eof] <……………………...

5}g

5}g

5

5

5}g 5

Pgf]/]S;Lof gef]{;f

xfnsf]

S5 s] tkfO{sf] cfˆgf] cfkm'k|ltsf] efj÷wf/0ffnfO{ w]/} xb;Dd tkfO{sf] jhgn] c;/ u/]sf] 5< s] tkfOsf] cfˆgf] cfkm'k|ltsf] efj÷wf/0ffnfO{ w]/} xb;Dd tkfO{sf] z/L/sf] cfsf/n] c;/ u/]sf] 5 < (olb s'g} Psdf 5 pQ/ cfPdf,…5Ú sf]8 ug'{xf];\ .)

5}g 5

S6.s] pQ/btfsf] nIf0fx? Pgf]/]S;Lof gef]{;f;Fu d]n vfG5< 5}g

S8 df hfg]

5

S7 s] oL w]/} vfg] k|j[lQx? tkfO{sf] tf}n ========= lsnf] eGbf tn÷sd x'Fbf dfq x'g] ub{y]<

k|Zgs{{tf M dflysf] sf]7fdf lj/fdLsf] tf}n========= cg';f/sf] prfO{ lbOPsf] tflnsf cg';f/ n]Vg'xf];\ . 5}g 5

S8 s] S5 df …5Ú sf]8 ul/Psf] 5 /S6 jf S7 …5}gÚ

sf]8 ul/Psf] 5<

S9 s] S7df …5Ú sf]8 ul/Psf] 5 <

s] pQ/bftfsf] nIf0fx? Pgf]/]S;Lof gef]{;fsf] dfkb08

cg'?ksf] 5 <

/

s] S2/ S4df …5}gÚ sf]8 ul/Psf] 5 <

vfg';Fu ;DalGwt /f]ux?5'6\ofpg'xf];\ M

M xNsf= dfyL elgPsf To:tf cg'lrt Jojxf/sf !–# cjlwx?

dWod= $–& cjlwx?

uDeL/ =*–!# cjlwx?

cToflws uDeL/ -Hofb}_= !$ jf ;f] eGbf a9L cjlwx?

5}g 5

Ao"nLldof gef]{;f

xfnsf]

5}g 5

Pgf]/]S;Lof gef]{;f

Binge eating/Purging Type

xfnsf]

5}g 5

Pgf]/]S;Lof gef]{;f

Restricting Type -/]l:6«S6LË 6fO{k_

xfnsf]

5'6\ofpg'xf];\ M

xNsf

dWod

uDeL/

T. Binge eating disorder

(laGh Ol6Ë l8:c8{{/)- sf] dtna – lgbfgsf] aS; - 8foUgf]i6Ls aS; _ df hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

T1. s] pQ/btfsf] nIf0fx? Pgf]/]S;Lof gef]{;f;Fu d]n vfG5 < 5}g 5

T2. s] pQ/btfsf] nIf0fx?Ao"nLldof gef]{;f;Fu d]n vfG5 < 5}g 5

T3. s] S2df …5Ú sf]8 ul/Psf] 5 <

5}g 5

T4. s] S3 df …5Ú sf]8 ul/Psf] 5 < 5}g 5

T5. s]]]]]]]]]]]]]]]] S4 df …5Ú sf]8 ul/Psf] 5 < 5}g 5

uPsf] # dlxgfdf, cToflws vfg] u/]sf] a]nf s] tkfO{ M

T6a. ;fdfGotof eGbf Psbd} l56f]–l56f] vfg'x'GYof] < 5}g 5

b. cˆ7\of/f] -ufx|f]_ gx'Gh]n ;Dd vfO{ /fVg'x'GYof] < 5}g 5

c.ef]s gnfu]sf] a]nfdf klg w]/} dfqfdf vfg'x'GYof] < 5}g 5

d. tkfO{sf] Tof] cToflws vfg] afgLn] ubf{, c?sf] cuf8L nfh x'G5 5}g 5

eg]/ PSn} vfg' x'G5 <

e. cToflws vfO{;s]kl5 bf]ifL -UnfgL÷a]sf/df vfP h:tf]_, pbf; jf 3[l0ft dx;'; ug'{eof] < 5}g 5

s] # jf a9L T6 k|Zgx?df …5Ú sf]8 ul/Psf] 5 < 5}g 5

T7. s] tkfO{sf] of] cToflws vfg] afgLn] tkfO{nfO{ lrlGtt agfof] < 5}g 5

T8. o:tf] cToflws vfg] xKtfdf slt k6s h:tf] ug'{eof] < ==================

o:tf] cToflws vfg] xKtfdf slt lbg h:tf] ug'{eof] < ==================

s] T7 df …5Ú sf]8 ul/Psf] 5 <

vfg';Fu ;DalGwt /f]ux? 5'6\ofpg'xf];\ M

M xNsf= dfyL elgPsf To:tf cg'lrt Jojxf/sf !–# cjlwx?

dWod= $–& cjlwx?

uDeL/ =*–!# cjlwx?

cToflws uDeL/ -Hofb}_= !$ jf ;f] eGbf a9L cjlwx?

5'6\ofpg'xf];\ M

xNsf

dWod

uDeL/


5}g 5

laGh Ol6Ë l8:c8{{/

xfnsf]

U. Generalized anxiety disorder (;fdfGos[t cflQg] /f]u)

- sf] dtna – lgbfgsf] aS;df-8foUgf]i6Ls aS; _ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

U1a. uPsf] ^ dlxgfdf, s] tkfO{ w]/} g} lrlGtt jf cflQg' ePsf] 5 <

s] tkfO{ w]/} s'/fdf lrlGtt jf cflQg] x'g'ePsf] 5 < -h:t} M :s'ndf, tkfO{sf] cfˆgf] :jf:Yo ;DaGwL jf s]xL g/fd|f] eO/x]sf] 5 ls eg]/ _ <

tkfO{ cfˆgf] pd]/ ;/xsf] c? aRrfx? eGbf w]/} g} lrlGtt x'gePsf] 5 <

olb s'g} Psdf 5 pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

b. s] tkfO{ k|foh;f] w]/} lbgx?df lrlGtt /xg'x'G5 <

s] la/fdL÷pQ/bftfsf] lrGtfx? jf cflQg] k|j[lQ cl3 ;f]lwPsf /f]ux?df l;ldt 5g\ jf lt /f]ux?n] /fd|/L j0f{g u5{g\ <

5}g

5}g

5}g

5

5

5

U2. s] tkfO{nfO{ Tof] lrGtfnfO{ /f]Sg ufx|f] x'G5 < s] Tof] lrGtfn] ubf{ tkfO{nfO{ cfkm"n] ub}{ u/]sf] sfddf Wofg lbg ufx|f] x'G5 <olb s'g} Psdf 5 pQ/ cfPdf, …5Ú sf]8 ug'{xf];\ .

5}g 5

U3 olb, nIf0fx? o; cuf8Lsf] jf klxn]sf] /f]ux?df dfq l;ldt 5g eg], lgDg a'Fbfx?sf] nflu …5}gÚ df lrGx nufpg'xf];\M lrlGtt ePsf] a]nfdf w]/} h;f] ;do, s] tkfO{ M

a. Ps} 7fpFdf a:g ufx|f] ePsf] h:tf] dx;'; eof] <



d. s] tkfO{nfO{ cfkm"n] ub}{ u/]sf] sfddf Wofg lbg ufx|f] x'G5< s] tkfO{sf] lbdfu vfnL÷z'Go ePsf] h:tf] x'G5<

e. emls{g] jf lrl9g] dx;''; ug'{eof] <

f. ;'Tg÷lgbfpg ufx|f] eof] -lgbfpg g;Sg], dWo/ftdf÷cfwf/ftdf Ao'lemg], ljxfg l5§} Ao'lemg], w]/} ;'Tg], lgGb|f nfUg]_ <

s] U3 sf ! jf a9L pQ/x? …5Ú sf]8 ul/Psf] 5 <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

U4 s] oL lrGtf jf cflQg] k|j[lQn] tkfO{sf] :s'ndf jf ;flyx?;Fu jf

3/df jf sfddf jf cGo JolQmx?;Fu w]/} ;d:of ePsf] lyof] <

/

s] dfgl;s nIf0fx? lgtfGt zf/Ll/s sf/0fn] -W2;f/f+z_ ePsf] xf]Og

eg]/ 5'6\ofOPsf] 5 <

5}g 5

;fdfGos[t cflQg] /f]u

xfnsf]

V. Adjustment disorder

(P8h;6d]G6 l8:c8{{/) - sf] dtna–lgbfgsf] aS;df-8foUgf]i6Ls aS;_ hfg], …5}gÚ df 3]/f nufpg], / csf{] df]8\o'ndf hfg] ._

klxn] ;f]lwPsf /f]ux?df …5}gÚ sf]8 ul/Psf] 5 eg] dfq oL k|Zgx? ;f]Wg'xf];\ M

tgfj hGo 36gfx? ePtf klg jf tgfjsf] sf/0f ;d:of ePtf klg, dfly cGo /f]ux?df …5Ú sf]8 ul/Psf] 5 eg], …P8h;6dG6 l8:c8{{/Ú sf] 8fPUgf]l;; glbg'xf];\ . lgbfgsf] aS;df NA uf]nf] lrGx nufpg'xf];\ / of] df]8\o'n 5f]8\g'xf];\ .

V1. s] tkfO{nfO{ s'g} s'/fsf] tgfj eO/x]sf] 5 < s] o;n] tkfO{nfO{ b'MvL÷lrlGtt agfPsf] 5 jf tkfO{sf] Jojxf/nfO{ emg v/fa agfPsf] 5 <olb s'g} Psdf 5}g pQ/ cfPdf, …5}gÚ sf]8 ug'{xf];\.

pbfx/0fx?df M cflQg]÷pbf;÷zf/Ll/s ;d:of; g/fd|f] Jojxf/ h:t} M emu8f, nfk/afx tl/sfn] uf8L rnfpg], :s'n ghfg], tf]8kmf]8 ug]{, csf{sf] clwsf/sf] xgg ug]{ jf u}x| sfg'gL lqmofsnfkdf ;+nUg x'g] .

klxrfg ul/Psf] tgfjsf] ;|f]t M =========================================== slxn] ;'? ePsf] M =========================================================

V2 s] lt ;d:ofx? tgfj x'g] lalQs} ;'? ePsf lyP < cyjf tgfj ;'? ePsf] # dlxgf leq g} lt ;d:ofx? ;'? ePsf lyP <olb s'g} Psdf 5}g pQ/ cfPdf, …5}gÚ sf]8 ug'{xf];\ .

V3 a. s] of] tgfjn] tkfO{nfO{ cfˆgf] pd]/ ;/xsf] c? aRrfx?nfO{ eGbf w]/} b'MvL agfPsf] xf] <

b= s] oL tgfj jf b'MvL efjgfn] tkfO{sf] 3/df< kl/jf/df< :s'ndf< ;fyLx?;+u< c? dflg;;+u<jf cGo s'g} dxTjk"0f{ tl/sfn]< ;d:of ePsf] 5 <

olb V3a df …5Ú jf V3b sf] s'g} efudf …5Ú cfPdf, …5Ú sf]8 ug'{xf];\ .

5}g

5}g

5}g

5}g

5

5

5

5

V4. oL efjgfTds Jojxf/;Fu ;DjlGwt nIf0fx? cfkm"n] dfof ug]{ dfG5]nfO{ u'dfPkl5 dfq cfPsf] xf] / oL nIf0fx?sf] ulDe/tf, logLx?n] k'¥ofpg] Ifltsf] dfqf / cjlw o:t} kl/l:ytLdf /x]sf c?sf] ef]ufO{;Fu ;dfg 5g\ eg] o;nfO{ zf]s elgG5 .

of] zf]s xf] ls xf]Og eg]/ 5'6\ofpg'xf];, olb zf]s xf]Og eg], V5 df hfg'xf];\ .

V5. s] tgfjsf] cj:yf ;lsPkl5 klg oL ;d:ofx?, ^ dlxgf jf a9L cjlw ;Dd /lx/x\of] < tn lbO{Psf dWo] s'g–s'g efjgfTds÷Jojxf/;Fu ;DjlGwt ;d:ofx? 5g\ M

a. pbfl;gtf, ?g dg nfUg] jf lg/fZff . b.cflQg] kg, ge{; x'g], lr8lr8fkg, lrGtf . c. g/fd|f] Jojxf/ h:t} M emu8f, nfk/afx tl/sfn] uf8L rnfpg], :s'n ghfg], tf]8kmf]8 ug]{, csf{sf]

clwsf/sf] xgg ug]{ jf u}x| sfg'gL lqmofsnfkdf ;+nUg x'g] .d.:s'n;Fu ;DjlGwt ;d:ofx?, zf/Ll/s ;d:ofx? jf ;dfh;Fu cnUuLg' .

5}g

5}g

5

5

olb V1 / V2 / -V3a jf V3b_df, …5Ú sf]8 ul/Psf] 5,

/ V5 df …5}gÚ sf]8 ul/Psf] 5 eg], P8h;6dG6 l8:c8{{/nfO{

…5Ú sf]8 ug'{xf];\.

5}g yfxf 5}g 5

P8h;6dG6 l8:c8{{/

W. dfgl;s nIf0fx? lgtfGt zf/Ll/s jf s'g} cf}ifwLsf] sf/0fn] ePsf] xf] ls xf]Og eg]/ 5'6\ofpg'xf];\M

olb pQ/bftf÷lj/fdLsf] s'g} klg xfnsf] /f]u jf pbfl;gtfsf] cjlw jf pGdfbsf] cjlwdf …5Ú pQ/ sf]8 ul/Psf] 5 eg], ;f]Wg'xf];\ M

nIf0fx? ;'? x'g'eGbf l7s cuf8L :

W1a.s] tkfO{n] s'g} cf}ifwL÷nfu"kbfy{ lnb} ug'{ePsf] lyof] jf s'g} 5}g 5 clglZrt

cf}ifwL÷nfu"kbfy{ vfg gkfpbfsf] c;/ ePsf] cj:yfdf x'g'x'GYof] <

W1b. s] tkfO{nfO{ s'g} cGo zf/Ll/s /f]u nfu]sf] lyof] < 5}g 5 clglZrt

W2. olb W1acyjf W1b df …5Ú sf]8 ul/Psf] 5 eg], 5}g 5 clglZrt

k|Zgstf{sf] d"Nofs+gdf s] Tof] la/fdLdf b]lvPsf]

/f]usf]] k|ToIf sf/0f x'g ;Sg] ;Defjgf 5 < olb

cfjZostf k5{ eg], lj:t[t ?kdf ;f]Wg'xf];\ .

W2 ;f/f+z:s] cGo zf/Ll/s /f]u jf nfu"kbfy{ cf}iflw;Fu 5}g 5 clglZrt

;DalGwt sf/0fx? 5'6\ofOPsf] 5 <

olb W2df …5}gÚ sf]8 ul/Psf] 5 eg], W2 ;f/f+zdf …5Ú x'G5 , cGoyf, of] clglZrt x'G5 .

X. Autism spectrum disorder

(cl6hd :k]s6«d l8:c{8/)cl6hd :k]s6«d l8:c{8/sf] ;d:of ePsf ;xefuLn] tn pNn]lvt Jojxf/x? klxrfg gug{ klg ;S5g\ .

kl/jf/sf ;b:ox?n] ;xefuLsf] pQm Jojxf/ lyof] lyPg /fd|/L atfpg ;Sg'x'G5 . tyflk, cGtjftf{sf] s|ddf ;s];Dd

;xefuLnfO{ pkl:ylt u/fpg' kb{5 .

X1. rf/ jif{sf] pd]/ b]lv s] tkfO{nfO{ ;fyL agfpg ;d:of x'GYof] < s] tkfO{ c¿;Fu 3'nldn x'g g;s]sf] -cfkm'd} l;ldt x'g]÷cfkm'd}/dfpg]_ sf/0f of] ;d:of ePsf] xf] <s] of]] ;d:of, tkfO{ nhfn' ePsf]n] jf c¿;Fu 3'nldn x'g g;Sg] sf/0fn] ePsf] xf] <olb s'g} Psdf 5 pQ/ cfPdf, …5Ú sf]8 ug'{xf];\.

X2. s] s;}n] tkfO{sf] cg'xf/df efj gePsf] eg]sf] 5 jf tkfO{nfO{ cGo tl/sfn] -Ozf/f, xfpefj_ ;+jfb ug{ ;d:of 5 eg]/ s;}n] eg]sf] lyof] <s] tkfO{sf] cg'xf/sf] efj jf zfl/l/s xfpefp x]/]/ tkfO{n] s] ;f]lr/fVg' ePsf] 5 eg]/ cGbfh ug{ lgs} sl7g x'G5 eg]/ s;}n] eg]sf] 5 <olb s'g} Psdf 5 pQ/ cfPdf, …5Ú sf]8 ug'{xf];\.

X3. s] tkfO{nfO{ cfˆgf] b}lgs jf lgoldt sfo{ Pp6} lsl;dn] ug'{kg]{ x'G5 <s] tkfO{nfO{ s'g} s'/fdf ljZf]if ?lr 5 h;n] c? lqmofsnfkdf afwf k'¥ofpF5 <olb s'g} Psdf 5 pQ/ cfPdf, …5Ú sf]8 ug'{xf];\.

X4. s] tkfO{n] cfkm'nfO{ zfGtkfg{ jf /fd|f] dxz''; ug{sf nflu, s'g} sfd bf]xf]¥ofP/ af/Daf/ -h:t} M bf]xf]¥ofP/ af]Ng]÷rNg] cflb_ ug'{eof] h'g tkfO{ cfkm" jf c? s;}n] Vofn u/]sf] 5<

X5. s] tkfO{n] cfjfh jf :kz{ jf b[Zo jf af:gf, :jfb, tfkqmd jf b'vfOsf] cg'ej k|lt sd k|ltls|of jf cToflws k|ltls|of lbg'x'G5 <

X6. s] c? aRrfx?n] tkfO{ Psbd} leGg jf 5'§} jf cgf}7f] ePsf] eg]/ u5{g\ <

X7. s] tkfO{ k|foh;f] c? aRrfx? ;Fu gv]n]/ cfkm' PSn} v]Ng'x'G5 <

5}g

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5

clglZrt

clglZrt

clglZrt

clglZrt

clglZrt

clglZrt

clglZrt

X 8.olb 'X' sf] ;a} pQ/x? 5}g cfPsf] 5 eg], …5}gÚsf]8 ug'{xf];\ .

olb ! jf ;f] eGbf a9L 'X pQ/x?', …5Ú jf …clglZrtÚ , sf]8 ul/Psf] 5

5 eg], sf]8 5'6\ofpg ;lsb}g <

*cl6hd :k]s6«d l8:c{8/ x'g ;Sg] ;Defjgf 5 t/Boardcertifiedchildpsychiatrist4f/f o;sf] dhfn] hfFr x'g' cfjZos 5 . dfly lbOPsf pQ/x?sf] cfwf/df ASD sf] lgbfg ug{ ;lsPg . The above screening is to rule out the diagnosis rather then to rule it in.

Y. Dissociative conversion disorder

(ljlqmt dgf]zf/Ll/s tyf tgfjsf] /f]u)

Y1. Dissociative identity disorder

(l8;f];LPl6e cfO{8]g6L6L l8;c8{/)

Y Y1a. uPsf] !@ dlxgfdf,s] tkfO{n] z/L/df s]xL r9]sf] jf 5f]k]sf] h:tf] (dftf r9]sf], xfjf nfu]sf], cfTdf r9]sf] cflb) cg'ej ug'{ePsf] lyof] < Tolta]nf s] tkfO{sf] Jojxf/, af]nL, :d/0f zlQm, ;f]Rg ;Sg] Ifdtf -;f]rfO{_ of zf/Ll/s lqmofsnfkdf s]xL kl/jt{g cfPsf] h:tf] dx;'; ug'{ePsf] lyof] jf s;}n] tkfO{nfO{ eg]sf] lyof] <Y1a df…5}gÚ pQ/ cfPdf, Y2 df hfg'xf];\ .

Y1b. s] oL nIf0fx?n] ubf{ tkfO{sf] b}lgsL, h:t} M :s'ndf jf 3/df jf ;dfhdf jf ;fyLx?;Fu jf sfdsfhdf jf cGo s'g} dxTjk"0f{ lqmofsnfkx?df ;d:of ePsf] lyof]<

Y1b df …5}gÚ pQ/ cfPdf, Y2 df hfg'xf];\ .Y1c. s] o:tf] ultljlw tkfO{sf] ;dfhdf÷wd{÷;+:s[tL df dfGo 5 -c?n] ;dfg ?kdf lnG5g\ ls

lnb}gg\_ < Y1 sf] x/]s pQ/df 5 cfPdf dfq,Y1nfO{ …5Ú sf]8 ug'{xf];\ .

5}g

5}g

5}g

5}g

5

5

5

5

5}g *5'6\ofpg ;lsb}g

cl6hd :k]s6«d l8:c{8/

Y2.Somatic symptom disorder

(;f]Dof6Ls l;Dk6d l8;c8{/ )

Y2a. uPsf] !@ dlxgfdf,s] tkfO{nfO{ Ps jf a9L zf/Ll/s nIf0fx? -;d:of_ 5g\, h;n] ubf{ tkfO{sf] b}lgs lhjgdf c;/ ePsf] 5 <

-pbfx/0fdfM zf/Ll/s nIf0f eGgfn] zl//sf] s'g} efu nuftf/ b'vL /fVg], xft v'§f emdemd ug]{, kf]n]sf] h:tf] x'g], rSs/ nfUg], af8'nL nfUg], k]6 km'n]sf] h:tf] x'g] cflb kb{5g\ ._

Y2a df …5}gÚ pQ/ cfPdf, Y3 df hfg'xf];\M

Y2b. s] oL nIf0fx?sf] ulDe/tfsf] af/]dftkfO{nfO{ cgfjZos ?kdf jf nuftf/ cToflws tgfj÷lrGtf lbg] vfnsf] ;f]rx? cfO/xG5< Y2b df …5}gÚ pQ/ cfPdf, Y3 df hfg'xf];\M

Y2c. s] tkfO{sf] w]/}h;f] ;do oL zf/Ll/s ;d:ofx?sf] af/]df ;f]r]/} laTg] ub{5 <

Y2c df …5}gÚ pQ/ cfPdf, Y3 df hfg'xf];\M

Y2d. s] lo ;d:ofx? tkfO{nfO{ ^ dlxgf jf a9L ;do;Dd nuftf/ ?kdf ePsf lyP <

Y2 sf] x/]s pQ/df 5 cfPdf dfq,Y2 nfO{ …5Ú sf]8 ug'{xf];\ .

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

Y3. Conversion disorder

(sGe/;g l8;c8{/)

ljutsf] @ xKtf ljutsf] cjlw

Y3a. uPsf] !@ dlxgfdf,s] tkfO{nfO{ tn lbOPsf dWo], Ps jf a9L nIf0fx? 5g\ <• xft v'§fsf] sdhf]/L x'g] jf grNg] . • c;fdfGo ?kdf xft v'§f rNg], ˆofFsg], sfKg], xNnLg] cflb .• lgNg jf af]Ng ufx|f] x'g] . • 5f/] /f]u h:t} a]xf]; x'g] jf d'5f{ kg]{ -9Ng]_ . • z/L/sf] s'g} c+udf 5f]Psf] yfxf gx'g] -nf6f] x'g]_ .

Y3b. s] oL nIf0fx?n] ubf{ tkfO{sf] b}lgsL h:t} M :s'ndf jf 3/df jf ;dfhdf jf ;fyLx?;Fu jf sfdsfhdf jf cGo s'g} dxTjk"0f{ lqmofsnfkx?df ;d:of ePsf] lyof] <

Y3c. s] oL nIf0fx?sf] af/]df tkfO{n] lrlsT;snfO{ b]vfpg'ePsf] 5 jf s'g} hfFr u/fpg'ePsf] 5 < olb …5Ú eg] s] oL nIf0fx? lgtfGt zf/Ll/s sf/0fn] ePsf] xf]Og eg]/ lrlsT;sn] eGg'ePsf] 5 <

olb Y3a / Y3b df …5Ú cfPdf, Y3 nfO{ …5Ú sf]8 ug'{xf];\ .

Y3;f/fz+: Y1, Y2 jf Y3 dWo] s'g} Psdf …5Ú sf]8 ul/Psf] 5 eg], / Y2 ;f/fz+df …5Ú sf]8 ul/Psf] 5 eg] ljlqmt dgf]zf/Ll/s tyf tgfjsf] /f]u (Dissociative÷Conversion disorder ) nfO{ …5Ú sf]8 ug{'xf];\ .

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

5}g

5}g

5}g

5}g

5}g

5}g

5

5

5

5

5

5

Z. Epilepsy

(5f/] /f]u)

Za. s] tkfO{ lhjgdf slxNo} a]xf]; jf d'5f{ kg]{ x'g'ePsf] 5 <

Zb. a]xf]; ePsf] a]nfdf tn lbOPsf dWo], s'g} Ps jf a9L ultljlw ePsf lyP <• 6fpsf] jf d'v Psflt/ afª\uLg] .• bfx|f ls6\g] .• d'vaf6 lkmh cfpg] .• xft uf]8f s8f x'g] of sfKg] .• lha|f] 6f]Sg] . • cfFvf dfyL kN6fpg] . • Tof] a]nfdf lb;f, lk;fa sk8fd} x'g] -lgoGq0f ug{ g;Sg]_ .

Z. Zc.s] dfyL lbOPsf nIf0fx? PSn} x'bfF, /ftL ;'t]sf] a]nfdf jf s'g} klg cj:yfdf ePsf 5g\ <

Zd.s] o:tf nIf0fx?n] ubf{, tkfO{nfO{ z/L/df d'Votof ljz]ifu/L 6fpsf]df rf]6 nfu]sf] 5 <

5}g

5}g

5}g

5}g

5

5

5

5

Z(a), Z(b) / Z(c) df …5Ú ePdf, …ZÚ df …5Ú sf]8 ug'{xf];\ .

AA. Intellectual disability

(af}l4s ckfËtf)

AA1. s] tkfO{df cfˆgf] pd]/ ;/xsf] c? aRrfx? eGbf tn lbO{Psf af}l4s Ifdtfdf sdL 5 < h:t} M –l;Sg] s'/fdf . –;lx unt 5'§ofpg] . –ts{ ug]{ Ifdtf . –of]hgf agfpg] Ifdtf . –k9\g n]Vg ;Sg] Ifdtf . –lx;fa lstfa ug{ jf /fVg ;Sg] Ifdtf .

AA2. s] tkfO{ cfˆgf] pd]/ ;/xsf] c? aRrfx? h:t} cfˆgf] kl/jf/sf ;b:ox? jf l5d]sL tyf ;fyLx?;Fu /fd|f] ;DaGw /fVg / ldlnh'nL a:g ;Sg'ePsf] 5 <

AA3. …ug{ gx'g]Ú jf vt/fk"0f{ 5 eg] /fd|f] yfxf kfPsf] sfd -h:t} M rf]/L, s;}nfO{ jf cfkm}nfO{ s'6\g], rf]6 kfg]{, ;fdfgx? lauf{g]_ c? s;}n] cx|fof] tyf l;sfof] eg] b[9tfk"j{s …gfO{Ú eGg ;Sg'x'G5 <

AA4. s] dfyL pNn]vLt ;d:ofx? ;fg} pd]/ b]vL -hGdhft_ b]vf k/]sf] xf] <

5}g

5}g

5}g

5}g

5

5

5

5

5}g 5

5f/] /f]u


ANNEX V: Adverse event management protocol

Adverse Events Reporting Form

Date Location Name of enumerator

Name and contact details of person to whom adverse event happened

Type of adverse event

1. Suicidality

2. Psychosis

3. Other (specify)….......

Description of the event

Action taken

Signature of the reporting staff member

………………………..

Signature of Immediate Supervisor

…………………………

Signature of Project Coordinator

…………………………

ANNEX VI: Example of criteria for monitoring the translation of items in MINI toolItem : BNumber: B

Comprehensibility ( Semantic Equivalence)

Is the translation understandable in the language known to the local population? Please comment on any difficulties.

Expert's view : Since question B is long, additional instruction has been added for enumerator that they can break the question while asking if need be.

Acceptability and other response set issues ( Technical Equivalence)

Would certain participants be uncomfortable to respond honestly to this question? Please explain.

Expert's view : To increase the response of the participants and to normalize the questions on suicidality, one additional sentence has been added before directly asking the question.

Relevance (Content Equivalence)

Is this question relevant in the local culture? If not, please explain.

Expert's view : Yes


Completeness ( Semantic, criterion, and conceptual equivalence)

Would the back-translation relate back to the same concepts and ideas as the original? If not, please explain.

Expert's view : Few questions mentioned in the comments below have been added in the original English questionnaire.

Comments (if necessary, use other side of the page)

• In B 17, additional question that asks about the frequency (sometimes, often, very often) of spending significant time per day has been added. The need of addition was felt because some participants may not be able to report the average time precisely.

• In B 19, additional question that asks about the probability of killing onself in the scale format (no, minimum, high, very high) has been added. The need of addition was felt because some participants may not be able to report this probability in percentage value.

• Visual graphic/pictures can be used to ask the questions that requires rating.

• The actions that will be taken if a respondent is found to be suicidal, need to be clarified in advance.

• In overall, enumerators (if they are not clinicians) need to be extensively oriented.

• There is our concern on applicability of this tool if it need to be used in the local context i.e for respondent using language other than Nepali (e.g Maithali, Tharu etc.).

ANNEX VI: Detail on the ethnicity

1. Dalit

• Hill: Kami, Damai, Sarkii, Gaine, Badi

• Terai: Chamar, Mushar, Dusah,Paswan, Tatma, Khatway, Bantar, Dom, Chiadimar, Dhobi, Halkhor

2. Disadvantaged Janajatis

• Hill: Magar, Tamang, Rai, Limbu, Sherpa, Bhote, Walung, Byansi, Hyolomo, Garrti/Bhujel, Kuuumal, Sunar, Baramu, Pahari, Yakkah, chhantal, Jirel, Drai, Dura, Majhi, Danuwar, Thami, Lepcha, Chaepang, Bote, Raji, Hayu, Raute, Kusunda

• Terai: Tharu, Dhanuk, Rajbansi, Tajpuria, Gangai, Dhimarl, Meche, Kisan, Munda, Santhal/Satar, Dhangad/Jhangad, Koche, Pattarkatta/Kusbadiay

3. Disadvantaged non dalit Terai caste groups

• Yadav, Teli, Kalwar, Sudhi, Sonar, Lohar, Koiri, Kurmi, Kanu, Haluwai, hajam/Thakur, Badhe, Badae, Rajba, Kewat, Mallah, Nuniya, Kumhar, Kahar, Lodhar, Bing/Banda, bhediyar, Mali, Kumar, Dhunia

4. Religious minorities

• Muslims, Churoute

5. Relatively Advantaged Janajatis

• Newar, Thakali, Gurung

6. Upper Caste groups

• Brahman (Hill), Chhetri, Thakuri, Sanyasi, Brahman (Terai), Rajput, Kayastha, Baniya, Marwadi, Jaine, Nuraang, Bengali


ANNEX VII: Photographs

a report on pilot study of national mental health survey,...

Documents