| Category
|
Select Score
|
| Nausea/Vomiting
|
1 None (0) Mild nausea (1) Intermittent nausea (4) Constant nausea/dry heaves/vomiting (7)
|
| Tremor (arms extended, fingers spread)
|
1 None (0) Not visible, can be felt (1) Moderate (4) Severe (7)
|
| Paroxysmal Sweats
|
1 None (0) Barely perceptible (1) Obvious beads of sweat (4) Drenching sweats (7)
|
| Anxiety
|
1 None (0) Mildly anxious (1) Moderately anxious (4) Acute panic (7)
|
| Agitation
|
1 Normal activity (0) Somewhat restless (1) Moderately fidgety (4) Constantly thrashes (7)
|
| Tactile Disturbances
|
1 None (0) Mild itch/burning/numbness (1) Moderate hallucinations (4) Continuous hallucinations (7)
|
| Auditory Disturbances
|
1 Not present (0) Mildly harshened (1) Moderate hallucinations (4) Continuous hallucinations (7)
|
| Visual Disturbances
|
1 Not present (0) Mild sensitivity (1) Moderate hallucinations (4) Continuous hallucinations (7)
|
| Headache/Fullness
|
1 Not present (0) Very mild (1) Moderate (4) Extremely severe (7)
|
| Orientation/Clouding
|
1 Oriented (0) Uncertain about date (1) Date uncertain >2 days (2) Disoriented (4)
|
| CIWA-Ar Total
|
/ 67
|
