Psychosis Test Psychosis Test TestQuestions DemographicInformation YourResults In the past month, have you had the following thoughts, feelings, or experiences? Check “yes” or “no” for each item. Do not include experiences that occur only while under the influence of alcohol, drugs or medications that were not prescribed to you. If you answer “YES” to an item, also indicate how distressing that experience has been for you.Do familiar surroundings sometimes seem strange, confusing, threatening or unreal to you?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q1):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you heard unusual sounds like banging, clicking, hissing, clapping or ringing in your ears?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q2):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo things that you see appear different from the way they usually do?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q3):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you had experiences with telepathy, psychic forces, or fortune telling?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q4):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you felt that you are not in control of your own ideas or thoughts?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q5):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you have difficulty getting your point across, because you ramble or go off the track a lot when you talk?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q6):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you have strong feelings or beliefs about being unusually gifted or talented in some way?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q7):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you feel that other people are watching you or talking about you?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q8):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you sometimes get strange feelings on or just beneath your skin, like bugs crawling?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q9):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you sometimes feel suddenly distracted by distant sounds that you are not normally aware of?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q10):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you had the sense that some person or force is around you, although you couldn’t see anyone?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q11):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you worry at times that something may be wrong with your mind?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q12):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you ever felt that you don't exist, the world does not exist, or that you are dead?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q13):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you been confused at times whether something you experienced was real or imaginary?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q14):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you hold beliefs that other people would find unusual or bizarre?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q15):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you feel that parts of your body have changed in some way, or that parts of your body are working differently?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q16):Strongly disagreeDisagreeNeutralAgreeStrongly agreeAre your thoughts sometimes so strong that you can almost hear them?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q17):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo you find yourself feeling mistrustful or suspicious of other people?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q18):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you seen unusual things like flashes, flames, blinding light, or geometric figures?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q19):Strongly disagreeDisagreeNeutralAgreeStrongly agreeHave you seen things that other people can't see or don't seem to see?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q20):Strongly disagreeDisagreeNeutralAgreeStrongly agreeDo people sometimes find it hard to understand what you are saying?*NoYesIf YES: When this happens, I feel frightened, concerned, or it causes problems for me (Q21):Strongly disagreeDisagreeNeutralAgreeStrongly agree Please take a moment to answer the following optional questions. Your answers are totally anonymous—we won't be able to identify you based on this information. Your answers help us provide better information and support for people like you. You can answer as many or as few questions as you would like. When you are done, scroll to the bottom of the survey and click "submit" to receive your screening results.About YouAge Range11-1718-2425-3435-4445-5455-6465+GenderMaleFemaleAnother GenderEnter GenderPlease check this box if you identify as transgender. Please check this box if you identify as transgender. Race/EthnicityAsian or Pacific IslanderBlack or African-American (non-Hispanic)Hispanic or LatinoNative American or American IndianWhite (non-Hispanic)More than one of the aboveOtherHousehold IncomeLess than $20,000$20,000 - $39,999$40,000 - $59,999$60,000 - $79,999$80,000 - $99,999$100,000 - $149,999$150,000+Which of the following populations describes you? Veteran or active duty military Caregiver of someone living with emotional or physical illness LGBTQ+ Student Trauma survivor New or expecting mother Healthcare worker Who are you caring for? My spouse or partner My parent My child Another relative Other Caring For - OtherAs a caregiver, what supports do you need? The person I'm helping is getting treatment but is getting worse (meds or therapy stopped working) The person I'm helping is getting treatment but also needs something else (side effects cause other problems, not sure what else to do) The person I'm helping is getting treatment but also needs something else (side effects cause other problems, not sure what else to do) The person I'm helping doesn't want treatment and I want to figure out how to help them I need help because the stress of caretaking is hard Other Caregiver Support - OtherWhich of the following best describes your sexual orientation? Lesbian Gay Bisexual Queer Pansexual Asexual Other Sexual Orientation - OtherAbout Your Mental HealthHave you ever been diagnosed with a mental health condition by a professional (doctor, therapist, etc.)?YesNoHave you ever received treatment/support for a mental health problem?YesNoAre you receiving treatment/support now?YesNoThink about your mental health test. What are the main things contributing to your mental health problems right now?Choose up to 3. Coronavirus Racism Relationship problems Past trauma Current events (news, politics, etc.) Loneliness or isolation Grief or loss of someone or something Financial problems Other… Mental Health Problems - OtherAbout Your HealthDo you currently have health insurance?YesNoDo you have any of the following general health conditions? Heart disease Diabetes Cancer Arthritis or other chronic pain COPD or other lung conditions Movement Disorders (involuntary tics, tardive dyskinesia) HIV/AIDS Other If 'Other' please specify (for general health conditions)Additional InformationStateI live outside the United StatesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingI live in a U.S. TerritoryZip/Postal CodeWhat country do you live in?AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsNameThis field is for validation purposes and should be left unchanged.
