Glasgow Antipsychotic Side-effect Scale & Extra Questions

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Personal Details

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General Health Questions

Are you able to provide a blood pressure reading: *

If you do not have a blood pressure monitor at home, we have one in reception.

How to take an affective reading

Sit quietly for 5 mins
Take two readings more than one minute apart whilst seated
Record the second of the two readings below

Your systolic blood pressure is the top number on your reading

Your diastolic blood pressure is the bottom number on your reading

Are you able to provide your pulse/heart rate: *

Are you able to provide your current weight?: *

What unit of measurement are you using?: *

Conversion from Stones & Pounds to Kilograms

Are you a smoker? : *

What do you smoke?: *

Do you consume alcohol?: *

What 1 unit of alcohol looks like

Half pint of regular beer, lager or cider. 1 small glass of wine. 1 single measure of spirits. 1 single measure of aperitifs. 1 small glass of sherry.

Wine (all types)

Sparking wine tends to be less strong

750ml bottle (13% abv) = 10 units
175ml glass (13% abv) = 2.5 units
125ml glass (12% abv) = 1.5 units

Beer, ale, lager and cider

Watch out for high strength drinks, try a smaller serving. Some pubs offer one- and two-third servings as well as pints and halves

1 pint (4% abv) = 2.5 units
1 pint (5% abv) = 3 units
Half pint (7% abv) = 2 units
1 pint (7% abv) = 4 units

Spirits (with or without a mixer)

In England and Wales, a single is usually 25ml. But in Scotland and Northern Ireland it can be 25ml or 35ml

25ml single measure (40% abv) = 1 unit
35ml single measure (40% abv) = 1.5 units

Alcopops, ready-to-drink and pre-mixed drinks.

250ml bottle or can (4% abv) = 1 unit

Are you currently able to exercise? : *

Has a parent or sibling ever been diagnosed with angina: *

Has a parent or sibling under the age of 50 ever had a heart attack: *

Processing

Over the past week

I felt sleepy during the day: *

I find this distressing: *

I felt drugged or like a zombie: *

I find this distressing: *

I felt dizzy when I stood up and/or have fainted : *

I find this distressing: *

I have felt my heart beating irregularly or unusually fast : *

I find this distressing: *

My muscles have been tense or jerky: *

I find this distressing: *

My hands or arms have been shaky : *

I find this distressing: *

My legs have felt restless and/or I couldn’t sit still: *

I find this distressing: *

I have been drooling : *

I find this distressing: *

My movements or walking have been slower than usual: *

I find this distressing: *

I have had uncontrollable movements of my face or body: *

I find this distressing: *

My vision has been blurry: *

I find this distressing: *

My mouth has been dry: *

I find this distressing: *

I have had difficulty passing urine: *

I find this distressing: *

I have felt like I am going to be sick or have vomited: *

I find this distressing: *

I have had problems opening my bowels (constipation) : *

I find this distressing: *

I have wet the bed: *

I find this distressing: *

I have been very thirsty and/or passing urine frequently: *

I find this distressing: *

The areas around my nipples have been sore and swollen: *

I find this distressing: *

I have noticed fluid coming from my nipples: *

I find this distressing: *

I have had problems enjoying sex: *

I find this distressing: *

I have had problems getting an erection: *

I find this distressing: *

Over the last three months

I have noticed a change in my periods : *

I find this distressing: *

I have been gaining weight: *

I find this distressing: *

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Results

Thank you for completing the assessment, please submit this form and a clinician will review the results and may contact you if required.

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