This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD
Short Name:
PSQIA
Description:
Sleep disturbances reflect a core dysfunction underlying Posttraumatic Stress Disorder (PTSD). Specifically, disruptive nocturnal behaviors (DNB) may represent PTSD-specific sleep disturbances. The Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A) is self-report instrument designed to assess the frequency of seven disruptive nocturnal behaviors (DNB). References: Anne Germaina, Martica Halla, Barry Krakowb, M. Katherine Sheara, Daniel J. Buyssea, A brief Sleep Scale for Posttraumatic Stress Disorder: Pittsburgh Sleep Quality Index Addendum for PTSD http://dx.doi.org/10.1016/j.janxdis.2004.02.001
Disease:
General (For all diseases)
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2015-06-09
Version:
1.1
Date Created:
2015-05-08
Owner:
Number of Data Elements:
23
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Visit date   Actual interview or visit date VisitDate Recommended CDE
5 Site name   The name of the site for the study SiteName Recommended CDE
6 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
7 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
8 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

PSQIA (Repeat Infinitely)

# Title Short Description Variable Name Required? Type
1 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Hot flash scale  The scale to which the subject had hot flashes in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIAHotFlashScl Recommended CDE
2 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - General nervous scale  The scale to which the subject had feelings of nervousness in general in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIAGeneralNervousScl Recommended CDE
3 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Trauma memory nightmare scale  The scale to which the subject experienced trauma memory nightmares in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIATraumaMemNightmreScl Recommended CDE
4 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Unrelated trauma nightmare scale  The scale to which the subject had bad dreams, not related to traumatic memories in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIAUnrelateTrauNightmreScl Recommended CDE
5 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Unrelated trauma anxiety panic scale  The scale to which the subject had severe anxiety or panic, not related to traumatic memories in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIAUnrelateTrauAnxPanicScl Recommended CDE
6 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Terror scream during sleep scale  The scale to which the subject had episodes or terror or screaming during sleep in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIATerrorScreamSleepScl Recommended CDE
7 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Physical movement during dream scale  The scale to which the subject had physical movement during dreams in the past month, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIAPhysMoveDreamScl Recommended CDE
8 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Trauma memory nightmare anxiety scale  The scale to which the subject had anxiety in relation to memories/nightmares, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIATrauMemAnxMemoryScl Recommended CDE
9 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Trauma memory nightmare anger scale  The scale to which the subject had anger in relation to memories/nightmares, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIATrauMemNightmreAngScl Recommended CDE
10 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Memory nightmare time scale  The scale which represents the time of night in which most of the memories/nightmares occur, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIAMemNightmreTimeScl Recommended CDE
11 Pittsburgh Sleep Quality Index (PSQI) addendum PTSD - Global score  Global score, as part of the Pittsburgh Sleep Quality Index (PSQI) addendum for PTSD. PSQIAGlobalScore Recommended CDE

 Change History

 Administrative Change History