Survey on psychiatric covariation

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Psychiatric diagnosis or self-diagnosis

Select most appropriate: Relative with diagnosis ADHD/ADD Asperger/PDD Low-functioning autism Other

Age

Age not given 0 - 9 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 +

Gender

Select gender Male Female

Age at death of:

Mothers mother: Alive - 60 60 - 69 70 - 79 80 - 89 90 - 99 100 +      Fathers mother: Alive - 60 60 - 69 70 - 79 80 - 89 90 - 99 100 +     Mothers father: Alive - 60 60 - 69 70 - 79 80 - 89 90 - 99 100 +      Fathers father: Alive - 60 60 - 69 70 - 79 80 - 89 90 - 99 100 +

Hemochromatosis

Own          Parent          Sibling          Relative

Cystic Fibrosis

Own          Parent          Sibling          Relative

Factor V Leiden

Own          Parent          Sibling          Relative

Huntington's Disease

Own          Parent          Sibling          Relative

Parkinson

Own          Parent          Sibling          Relative

Psoriasis

Own          Parent          Sibling          Relative

Fibromyalgia

Own          Parent          Sibling          Relative

Multiple Sclerosis

Own          Parent          Sibling          Relative

Crooked tooth or underbite

Own          Parent          Sibling          Relative

Flat-footed

Own          Parent          Sibling          Relative

Natural red or auburn hair color

Own          Parent          Sibling          Relative

Freckles

Own          Parent          Sibling          Relative

Rhesus (RH) negative

Own          Parent          Sibling          Relative

Comments