Los Angeles symptom checklist (LASC)

Introduction

List of 43 problems rated on a scale of 0 to 4, with

0 = not a problem

1 = a slight problem

2 = a moderate problem

3 = a serious problem

4 = an extreme problem

• difficulty falling asleep
• abusive drinking
• severe headaches
• restlessness
• nightmares
• difficulty finding a job
• difficulty holding a job
• irritability
• pervasive disgust
• momentary blackouts
• abdominal discomfort
• management of money
• trapped in an unsatisfactory job
• physical disabilities or medical problems. Explain

___________________________________________

• hostility/violence
• marital problems
• easily fatigued
• drug abuse
• inability to express feelings
• tension & anxiety
• no leisure activities
• suicidal thoughts
• vivid memories of unpleasant prior experience
• excessive eating
• difficulty concentrating
• dizziness/fainting
• sexual problems
• waking during the night
• difficulty with memory
• marked self-consciousness
• depression
• inability to make & keep same sex friends
• inability to make & keep opposite sex friends
• excessive jumpiness
• waking early in the morning
• loss of weight/appetite
• heart palpitations
• panic attacks
• problems with authority
• avoidance of activities that remind you of prior unpleasant experiences
• trouble trusting others
• loss of interest in usual activities
• feeling emotionally numb

How long have you been bothered by these symptoms ? ___________