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    Mac Pmss BF May2014 Copyright

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    vaishnavi

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    © All Rights Reserved
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    Mac Pmss BF May2014 Copyright

    Uploaded by

    vaishnavi
    36 views1 page

    Original Title

    mac_pmss_bf_may2014_copyright

    Copyright

    © © All Rights Reserved

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    36 views1 page

    Mac Pmss BF May2014 Copyright

    Uploaded by

    vaishnavi

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Name or Initials:_______________________ McMaster Premenstrual and Mood Symptom Scale (MAC-PMSS) Month/Year:_______________________

    1. Please fill out this form once a day starting the day you received it. Please mark “x” alongside the level of severity which corresponds to your mood symptoms. If you have manic and
    depressive symptoms on the same day you may mark both.
    Day of Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
    Disruptive behaviour;
    Severe completely incapacitated,
    hospitalized
    Unable to focus, significant
    Moderate- impairment in goal-
    Mania

    High directed activity, impulsive


    behaviour
    Unusually energetic, less
    Moderate- productive, noticeable
    Low impairment
    Elevated mood, more
    Mild energized & little or no
    functional impairment

    Stable (I feel fine)


    Minimal or transient
    Mild depression with little or
    no functional impairment
    Depression

    Persistent low mood, less


    Moderate- productive, noticeable
    Low impairment
    Pervasive
    M low mood,
    Moderate- significant impairment in
    High goal directed activity,
    unable to cope, passive/
    fleeting suicidal thoughts
    Severe Completely incapacitated
    or hospitalized
    2. Record the severity of your symptoms according to the following scale: 1- not at all, 2- minimal, 3- mild, 4- moderate, 5- severe, 6- extreme.
    Emotional lability (sudden mood changes or
    increased sensitivity to rejection)

    Anger, irritability or interpersonal conflicts

    Depressed mood, feelings of hopelessness


    or self-depreciating thoughts
    Anxiety, tension, feelings of being keyed up
    or on edge
    Less interest in usual activities (work,
    school, friends/loved ones, hobbies)
    Difficulty concentrating

    Lethargic, tired, fatigued; low energy

    Marked change in appetite (more or less)

    Slept significantly more or less than usual


    Feeling more overwhelmed or out of
    control than usual
    Physical symptoms such as breast
    tenderness or swelling, joint or muscle pain,
    sensation of “bloating” or weight gain
    Please indicate (S) if you are
    spotting or (B) if you are bleeding 
    Day of Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

    Total hours slept previous night

    Life Events (Including alcohol/drug use)

    Copyright © 2014 McMaster University, Hamilton, Ontario, Canada. Contact the McMaster Industry Liaison Office at McMaster University, email: [email protected] for licensing details.

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