Kennedy Axis V

CHAPTER 7
COMPLETED KENNEDY
AXIS V SCORING SHEETS
7–1
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Completed Kennedy Axis V Scoring Sheets 7–3
COMPLETED KENNEDY AXIS V SCORING SHEETS

CONTENTS
I. Standard-Form Scoring Sheet ......................................................................................................... 7–5

II. Long-Form Scoring Sheet.............................................................................................................. 7–13
III. Computerized, Variable-Length Scoring Sheet ............................................................................ 7–18
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COMPLETED KENNEDY AXIS V SCORING SHEETS

I. Standard-Form Scoring Sheet
This form should allow you to quickly rate the K Axis and just as quickly enter some very brief clinical
information to support the ratings.
The following are samples of completed K Axis scoring sheets using the standard-form scoring
sheet.
7–6 Mastering the Kennedy Axis V
Kennedy Axis V: Scoring Sheet © 1986–2003
Name: Susan Anderson (Front Street Residence) #: 12341 Age: 34

Instructions: For each subscale, enter the rating followed by a brief description of the relevant symptoms and behaviors. Round off
intermediate codes, e.g., 43, 62, 78, to the nearest multiple of 5, e.g., 45, 60, 80. Enter NR if Not Rated. The numbers for deriving the
Dangerousness Level are located directly below the subscale scores and are automatically indicated as one checks each subscale score.
ÄÄ FUNCTIONAL DYSFUNCTIONAL ÅÅ
1. Psychological Impairment
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 X 25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Primarily (check one): Not Impaired___ Antisocially Impaired___ Other Impairment X Both___
Pt. hears command hallucinations and tends to follow them. She believes the voices are real.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. has few, if any, friends due to poor social skills. Interactions with others are usually somewhat awkward; however, she is
not grossly inappropriate in her social skills.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonviolent___ Violent to Self___ Violent to Others X Violent to Self and Others___
She made a serious assault on her mother 2 years ago. She is easily provoked. She often becomes angry and hostile during
conflicts with peers around food and other household issues. Some occasional thoughts that life is not worth living;
however, she is not seen as a risk for attempting suicide.
4. ADL–Occupational Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is able to cook fairly well and is able to do some basic housework. She cannot budget money. She is unable to drive a car.
She has some difficulty using public transportation, and she needs supervision when shopping for food.
5. Substance Abuse
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonabuser X Alcohol Abuser___ Drug Abuser___ Both___

Pt. has no significant problems with drugs or alcohol. She used to smoke. Occasional social drinker.
6. Medical Impairment
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 X 60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has non-insulin-dependent diabetes. Her compliance with her diabetic diet is poor. She takes an oral hypoglycemic agent
every day and has a FBS (fasting blood sugar) taken q 2 weeks.
7. Ancillary Impairment (optional)

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. is in an environment with moderately violent clients and neighbors. She, like others in this environment, is at risk of
being assaulted.
GAF Equivalent: #1 30 + #2 60 + #3 60 + #4 50 = 200 / 4 = 50

Dangerousness Level (indicate only the most dangerous rating): 50
Signature: James A. Kennedy, MD Date: 1/22/03
Name: Keith Brown (Lakeview State Hospital) #: 12342 Age: 55

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 X 25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is delusional, only partly oriented, and able to focus his attention for only a few minutes. He often talks to himself. He is very
socially withdrawn.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 X 40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. has no friends and virtually no peer relationships due to impaired social skills. Pt.’s verbalizations are often grossly
inappropriate. However, pt.’s interactions with others are very awkward but not grossly inappropriate.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 X 35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. often attempts to assault others and is felt to be in real danger of hurting someone if not supervised closely. He is generally
angry and verbally abusive. He also has some mild problems with being self-abusive (biting his arm and banging his head).
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 X 20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. needs assistance with his personal hygiene including bathing, dressing, and grooming. He has great difficulty focusing on any
vocational tasks, and his workmanship is very sloppy. Pt. has difficulty responding to a fire alarm. He has some difficulty finding
his way around the hospital
5. Substance Abuse
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5

Pt. has no history of abuse of drugs or alcohol. Pt. smokes cigarettes daily.
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has mild TD. Pt. has a hiatal hernia, which is well controlled with antacids. Otherwise, pt. has fairly good health.

100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has no more than minimal difficulty with his current living situation (i.e., chronic hospitalization). Staff has been very
effective in preventing him from assaulting others and vice versa.
GAF Equivalent: #1 30 + #2 45 + #3 40 + #4 25 = 140 / 4 = 35

Name: Helen Johnson (Friendly House Residence) #: 12343 Age: 62

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 X 35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has some impairment in reality testing, including being delusional at times. No hallucinations.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. has no friends; however, she has some peer relationships. Her social functioning is clearly impaired.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has mild problems with anger and irritability. She assaulted a neighbor more than 10 years ago.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 X 35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. completed the 11th grade. Pt. did housework in the neighborhood for many years; however, she has been unable to
work for many years. She now needs supervision to do even basic housework and other routine tasks of living, such as
shopping or using public transportation.
5. Substance Abuse
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5

No history of use of drugs or alcohol. She smokes cigarettes. She does not drink.
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Generally pt. has good medical health (i.e., few, if any, medical problems).

100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has some difficulty paying for her cigarettes, snacks, and other basic needs with her disability income. Pt.’s residence is
generally safe, except for some occasional mild violence.
GAF Equivalent: #1 40 + #2 50 + #3 70 + #4 40 = 200 / 4 = 50

Name: Albert Morgan (Lakeview Residence) #: 12344 Age: 24

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 X 35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has persistent persecutory delusions, thought broadcasting, and impaired judgment. He has moderate impairment in
motivation; however, he is cooperative with treatment programs and taking his meds.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
No obvious impairment in social skills. He has friends who are not clients. At times, females take advantage of him.
3. Violence
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonviolent X Violent to Self___ Violent to Others___ Violent to Self and Others___
Occasionally angry and upset over minor problems. He does not get overtly hostile or threatening. No history of assaults.
No problems with suicidal ideation or attempts.
100 ___95 ___90 ___85 ___80 ___75 X 70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is a high school graduate with fairly good ADL skills. It is felt that he could work at a job, if he were motivated to work
(i.e., he has the work skills but not the motivation).
5. Substance Abuse
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5

Smokes cigarettes. Drinks socially about once a month.
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Only occasionally ill; however, he is mildly obese. He does not exercise, and his diet is poor.

100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
No more than mild difficulties living in a halfway house and being supported with Social Security Disability Income. No
legal problems.
GAF Equivalent: #1 40 + #2 70 + #3 80 + #4 75 = 265 / 4 = 65

Name: Janet Smith (Lakeview Nursing Home) #: 12345 Age: 64

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is often preoccupied and has some difficulties with depression. No hallucinations or delusions.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. has moderate difficulty with her social skills.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has a past history of assaultive behavior. Currently she is having no more than mild problems with anger and irritability.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 X 25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Due to cognitive decline and unsteady gait, pt. is unable to independently care for herself. She has great difficulty doing
basic housework. She needs supervision to dress. She is unable to use public transportation.
5. Substance Abuse
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonabuser___ Alcohol Abuser X Drug Abuser___ Both___

Pt. has renal failure that requires weekly dialysis. She has hypertension. About 3 years ago, she suffered a CVA. Currently her
gait is unstable, and she is at high risk for falling.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 X 25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is in a very supportive and reasonably safe environment. Pt. has a guardian for person and estate. The institution meets
her basic needs. She has no significant legal problems.

100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
GAF Equivalent: #1 60 + #2 60 + #3 70 + #4 30 = 220 / 4 = 55


Name: Jacqueline Young (Roberts Memorial Outpatient) #: 12346 Age: 6
100 ___95 X 90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Primarily (check one): Not Impaired X Antisocially Impaired___ Other Impairment___ Both___
Pt. appears psychologically very healthy except for being shy. Her shyness is well within the normal limits. She copes well
with day-to-day problems. She is very cooperative with her medical treatments, unless they are painful (e.g., she is certainly
not pleased with getting shots or IVs).
2. Social Skills
100 ___95 X 90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Despite her shyness, she gets along well with other kids and adults. When motivated, she can be very socially effective. She
has many friends and no difficulty developing new friendships. Generally, she is very pleasant and engaging. She has good
communication skills.
3. Violence
100 ___95 X 90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonviolent X Violent to Self___ Violent to Others___ Violent to Self and Others___
For her age, she has no problems with impulse control. Occasionally angry and upset over minor problems. She has a very
normal level of conflicts with others. She gets into occasional short, nonvicious fights when her 4-year-old brother torments
or picks on her. No self-abusive behaviors.
100 ___95 X 90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
She has above-average intelligence. She had some minor problems with reading; however, with special attention, this
quickly resolved. She is able to do small chores around the house with no difficulty. She is able to ride her bicycle and drive
her “Barbie” car with no difficulty.
5. Substance Abuse
100 X 95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5

She sees smoking as “nasty,” otherwise, she has no significant exposure to, knowledge of, or craving for substance abuse. No
one smokes at her home or abuses drugs or alcohol.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
She has cystic fibrosis. At this point in her illness, she has only mild symptoms. She has never required hospitalization;
however, she requires treatments several times a day, including chest therapy.

100 X 95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
She lives in a very safe neighborhood in a stable home situation with her parents. She has good financial security. Her
treatments are mostly covered by insurance. No legal or custody problems.
GAF Equivalent: #1 95 + #2 95 + #3 95 + #4 95 = 300 / 4 = 95
Notes
II. Long-Form Scoring Sheet

The long-form scoring sheet simply provides the rater with more space to enter the problem
descriptions. Two completed long-form scoring sheets for the K Axis follow.
Name: Ronald Graham (Lakeview State Hospital) #: 12347 Age: 37

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 X 25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Primarily (check one): Not Impaired___ Antisocially Impaired X Other Impairment___ Both___
Pt. has a long history of antisocial behaviors and arrests, including breaking and entering, credit card theft, and
embezzlement from work. It is felt that pt. was feigning mental illness before being found “not guilty by reason of insanity”
for attempted murder. After being found not guilty by reason of insanity, despite his refusal to continue taking
antipsychotic medication, pt.’s “psychotic” symptoms rapidly diminished. Pt. is felt to be very self-centered and almost
totally insensitive to the feelings and needs of others. This is supported by psychological testing, which substantiates the
clinical impression that pt. is impaired by severe antisocial and narcissistic traits. Pt. is meticulously well dressed. He has
good eye contact. He reports being pleased that he is in various treatment activities and that he is looking forward to being
released by the courts because he feels that all of his mental problems have been resolved. During the interview, pt. was
friendly but arrogant and condescending.
2. Social Skills
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. appears to have very good but superficial social skills. Pt. is able to be very polite, engaging, and friendly. Pt. is not at all
awkward in his interactions with others. Pt. has a good understanding of the feelings and needs of others and uses this to
his advantage, often at the expense of others. He is able to maintain many fairly close relationships as long as those
relationships meet his needs.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Five years ago, pt. attempted to murder someone with whom he had been in jail. He savagely stabbed that person four
times. Years later that person continued to be confined to a wheelchair as a result of his injuries. Pt. states that he is now
glad that he did not kill the person; however, otherwise he shows very little remorse for his victim. Pt. claims that the
person he stabbed was someone who broke pt.’s arm when they were in prison together because pt. would not provide him
with sexual favors. They were both out of jail at the time of the attempted murder. During pt.’s hospitalization, he has had
episodic problems with being intimidating and threatening. Pt. has not been assaultive. He is often very angry and
frustrated over delays in his discharge from the hospital. Pt. admits to a background of violence; however, he currently does
not see himself as violent. Pt. continues to be fascinated with violent video games and weapons, especially knives. Pt. denies
having any thoughts or impulses to hurt himself or others. Pt. has no history of suicidal or self-abusive behavior except for
cutting his wrist once to get transferred out of the general inmate area into the much safer mental health unit.
Continued on next page

KENNEDY AXIS V: SCORING SHEET © 1986–2003, Continued from previous page

Name: Ronald Graham (Lakeview State Hospital) #: 12347 Age: 37
100 ___95 X 90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. appears to be very bright, and, as expected, his IQ is in the high-normal range. He is a high school graduate. He had no
difficulty with college courses he took in prison. His initial imprisonment was because of two convictions for embezzling
money, one while managing an auto parts store. He hopes to eventually complete a college degree in business. Since his
hospitalization following being found not guilty by reason of insanity, he progressed well on computers in his job at the
Rehab Business Center. In his community vocational placement, he has worked for a couple of years in an office supply
store where he is felt to be quite successful.
5. Substance Abuse
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5

Pt. reports having problems with alcohol from age 15 until his arrest for attempted murder at age 32. He reports that just
before his arrest, he was drinking 2 fifths of scotch each week. He was reported to have been drinking at the time of the
attempted murder. He has had no overdoses, blackouts, delirium tremens, or withdrawal seizures. He denies any past use of
illicit drugs, except for occasional use of cocaine or marijuana. Pt. has never been arrested for DWI or drug-related crimes.
Pt. smokes one pack per day. Pt. denies any current impulses to use drugs or alcohol; however, he is monitored closely with
urine toxicology screens and Breathalyzer tests to ensure that he does not abuse substances while in the community.
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has fairly good health. He has no significant medical problems except for a mild, chronic cough from smoking. Pt.’s
broken arm healed years ago with no residual problems.

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 X 15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Ongoing court evaluations and dispositions are being made around whether the patient can be safely released back into the
community. About 5 years ago he made a serious attempt to kill someone by stabbing that person four times. The victim is
currently still confined to a wheelchair as a result of his injuries. The pt.’s next court appearance will be in about 3 months.
Pt. feels that he is long overdue for discharge.
GAF Equivalent: #1 30 + #2 90 + #3 50 + #4 95 = 265 / 4 = 65

Name: Natalie Moore (Roberts Memorial Hospital) #: 12348 Age: 14

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 X 35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has a history of being sexually abused by her father and a neighborhood boy. She has occasional flashbacks of the sexual
abuse. She is usually dressed in a morbid manner with black makeup, black dress, black jewelry, pierced eyebrows, and studded
leather wrist and neck bands. She is stubborn, rebellious, oppositional, and very negativistic. She has some sexual identity
problems and is obsessed with Marilyn Manson. She complains of mild sadness; however, she has no vegetative signs of
depression. At times, she is withdrawn and paranoid and isolates herself. She is not delusional or hallucinating, except for the
flashbacks.
2. Social Skills
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. appears to have fairly good social skills; however, she is very much into “antiestablishment” issues. Pt. is able to be polite and
engaging. She has some close friends; however, when around strangers, she is generally withdrawn and isolative. Her friends are
mostly very antiestablishment, like herself. She has good verbal skills.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 X 5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonviolent___ Violent to Self X Violent to Others___ Violent to Self and Others___
Pt. has made a number of suicide attempts and is generally preoccupied with death. She carries around a black orchid as a symbol
of death and collects sharp objects to cut herself with. She states that she is a freak and that she hates herself. At times she
knowingly places herself in situations in which she is at risk of sexual abuse. She states that suicide attempts can happen very
spontaneously. For example, her last attempt, 1 week ago, occurred because she became very angry when she learned that her
mother was listening in on her phone conversations. She picked up a vase and threw it through a window of her mother’s fourth-
floor apartment. Her mother and a cousin had to restrain her to prevent her from jumping out of the window. During the
attempt, pt. sustained a deep, 3-inch cut on her right leg. She states that periodically she also cuts her leg or stomach without
telling anyone. She states that the cuts are usually superficial. Once she tried to stab herself in the stomach; however, the knife
wouldn’t go through. She states that currently she is having impulses to throw herself down the hospital stairs; however, she
states that she doesn’t believe that she would act on the impulses.


Name: Natalie Moore (Roberts Memorial Hospital) #: 12348 Age: 14
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is bright and does well in school when motivated. She has no difficulty functioning at her grade level; however, because of
failing motivation, truancy, and conflicts with teachers and other students, she is doing very poorly in school. She has no
difficulty with her ADLs.
5. Substance Abuse
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonabuser___ Alcohol Abuser___ Drug Abuser___ Both X

Pt. reports frequently using marijuana and alcohol over the last 2 years. She would not report the exact frequency of drug and
alcohol use; however, she reports last using marijuana about 1 week ago. Pt. smokes cigarettes on a daily basis.
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has good health. Her good health is probably because of her young age because she neglects her health and does not do
anything to maintain her good health.

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. lives in a dysfunctional family. When her father lived at home, he sexually abused her. Pt.’s parents are now divorced and she
has not had any contact with her father for 2 years. Her mother works as a nurse and often has to work long hours to pay the
bills. It has been very difficult for her mother to support the family without the father’s help. Pt. is often home alone. Pt.’s home
is located in a relatively safe neighborhood; however, pt. hangs out with older kids who often use and deal drugs and get into
trouble with the law. At times, she knowingly places herself at risk of sexual abuse by adolescent boys that she hangs around with
in her neighborhood. She has never been arrested and is in no trouble with the law.
GAF Equivalent: #1 40 + #2 80 + #3 10 + #4 90 = 220 / 4 = 55

III. Computerized, Variable-Length Scoring Sheet

This variable-length scoring sheet can be created on the computer by simply entering the short-form
scoring sheet into any sophisticated word processor, such as Microsoft Word or Corel WordPerfect.
Then simply enter the necessary information directly onto the computerized form as you would enter
any text information into a word processor.
Once you have completed entering the necessary information, you can use the word processor to
delete any unused space from the scoring sheet, enter any necessary page breaks, make any other
necessary changes to “clean up” the document, and print the computerized, variable-length scoring
sheet.
The following are samples of completed computerized, variable-length scoring sheets.

Name: Patricia Brown (Lakeview Residence) #: 12349 Age: 35
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 X 25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has multiple delusions and religious preoccupations. Pt. is actively responding to hallucinations, including yelling at the
voices. Pt.’s insight and judgment are impaired.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. is pleasant but moderately awkward in her attempts to be friendly and engaging. Because of her pleasant personality, she is
well liked by staff. Pt. states that she has many friends. Pt. states that she keeps in touch with her friends mostly by telephone;
however, it is felt that she is greatly exaggerating her circle of friends. It is likely that her only real friend is her sister. Despite a
fairly engaging personality, it is felt that her yelling at the voices frightens off potential friends. Pt.’s communications are
somewhat vague.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has mild problems with anger and irritability; however, when she drinks excessive amounts of caffeine, she becomes very
hostile. Currently, this is not a problem for pt. because staff prevents her from drinking excessive amounts of caffeine.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. appears to have normal intelligence. Before the onset of her illness, she completed 1 year of college. Pt. has fairly good
independent living skills and is able to live independently in the community for short periods. At times, she is able to work for a
few weeks. Pt. has some difficulty using public transportation.
5. Substance Abuse
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonabuser___ Alcohol Abuser___ Drug Abuser X Both___

Pt. smokes cigarettes and is very dependent on caffeine. She reports frequently drinking 40 or more cups of coffee per day. When
she is able to get the coffee she wants, she becomes very hostile and anxious from the caffeine. To prevent this, she is monitored
closely to prevent her from drinking excessive caffeine. If given the opportunity, she would quickly revert back to drinking large
quantities of coffee.
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has fairly good medical health. She has no acute or chronic medical problems.
100 ___95 ___90 X 85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has no significant financial problems or legal problems. She appears safe in her community residence. Financial aid from her
sister helps to prevent pt. from having any significant financial problems.
GAF Equivalent: #1 30 + #2 60 + #3 70 + #4 50 = 210 / 4 = 55


Name: Robert Davis (Lakeview State Hospital) #: 12350 Age: 58
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. has a history of delusional thinking, mostly paranoia. The content of pt.’s speech is somewhat bizarre, and he is moderately
guarded. There is no evidence of hallucinations.
2. Social Skills
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. appears to have fairly good social skills. He is able to be very charming, pleasant, and engaging, especially when in the
company of the guys at a bar. He has a good sense of humor. His deafness and alcoholism, not his lack of social skills, make him
vulnerable to victimization.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
When intoxicated, pt. has been hostile, threatening, and assaultive. His assaults are mild and do not result in any significant
injury. Because of his long-term hospitalization, he has had very little access to alcohol; however, it is felt that if given the
opportunity, he would drink and become threatening and assaultive.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is a high school graduate who became physically disabled in the military by an injury to his ears. Despite his very impaired
hearing, pt. is able to compensate fairly well. He is able to use public transportation with only minimal difficulty. He appears to
be fairly good at budgeting his money. He is able to dress and attend to his personal hygiene without any significant assistance.
5. Substance Abuse
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 X 20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5

Pt. has a long history of severe alcohol abuse, including drinking to near lethal levels. If given the opportunity, it is felt that he
would drink to a potentially lethal level and likely pass out in the streets. During his last escape, he nearly died when he passed
out near a bar on Main Street. He also becomes hostile and aggressive when drinking. He has poor insight into his problem with
alcohol and is not motivated to quit. He does not have independent privileges because of his high risk of escaping and drinking
to a potentially lethal level while on escape. Pt. is a chronic smoker and has medical complications from both smoking and
drinking.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 X 35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is almost totally deaf. He is able to communicate fairly well using residual speech and crude sign language. He has mild
cirrhosis of his liver and moderate COPD.
100 ___95 ___90 ___85 ___80 X 75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
No more than mild difficulties living in the hospital. He is supported by money from his military disability income. No current
legal problems.
GAF Equivalent: #1 50 + #2 80 + #3 50 + #4 50 = 230 / 4 = 60


Name: Joseph Jones (Lakeview State Hospital) #: 12351 Age: 49
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 X 35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is paranoid and suspicious of others. May act on suspicions that others are stealing from him. There is no evidence of
hallucinations. Pt. is generally withdrawn and difficult to engage in conversation. His affect is blunted. Depressed at times.
Periodically refuses to eat or drink with resultant dehydration and hypotension. Periodically noncompliant with meds.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 X 40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. is a loner and does not mix well with others. No friends. Able to interact superficially, although very awkwardly, with others.
Able to be passively friendly. Never able to form close, intimate social relationships. Not grossly inappropriate in social
interactions. No inappropriate touching.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 X 20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has a long history of assaultive outbursts. In the past, pt. threatened to kill his sister. Pt. has threatened with a knife and a
hammer. Pt. has thrown furniture during assaultive episodes. Pt. is labile, sullen, irritable, and easily agitated. Assaults are
unpredictable and are usually in response to minor problems, such as thoughts that others are stealing his things. At times, pt.
requires seclusion and prn meds for threatening behavior. Pt. will recompensate within hours to a few days after an assault. Pt. is
felt to be at very high risk of seriously injuring others. No active suicidal ideation, but at times he states that he wants to die.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. is a high school graduate, but he required special classes. Full-scale IQ = 78. Could maintain low-level employment, such as a
stocking shelves in a supermarket, if not for his temper and impulsive behaviors. Fairly good fine-motor skills. Pt. has coping
skills to function in the community. Works 10 hours per week in supportive environment.
5. Substance Abuse
100 X 95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5

No history of use of drugs, including cigarettes or alcohol.
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. had a massive congenital hydrocephalus and a CVA at age 15. Currently, pt. has left-sided weakness with a mild to moderate
gait disturbance, temporal hemianopsia, and mildly dysarthric speech. Pt. has epilepsy, which is well controlled with medication.
Chronic problems with seborrheic dermatitis. Periodic treatment needed for self-induced dehydration.
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Pt. has things stolen from him in his hospital environment; otherwise, he is not having any problems in this area.
GAF Equivalent: #1 40 + #2 45 + #3 25 + #4 50 = 160 / 4 = 40

Name: Barbara Williams (Lakeview State Hospital) #: 12352 Age: 34

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 X 5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. will do almost anything to ensure that she does not gain weight. It is felt that if given the opportunity, she would starve
herself to a medically dangerous and potentially fatal state. At her current 79 pounds, she is close to a life-threatening situation.
She makes inconsistent and contradictory statements about her ability to tolerate various foods. She makes false claims that
various medical authorities have told her that she could not tolerate various foods. She also reports that they stated that because
of her food intolerances, consuming food, even high-calorie foods, would not lead to any weight gain. She was extremely
resistant to being placed on close observation to prevent her from self-induced vomiting. She claims that her vomiting is because
of food intolerances rather than being self-induced. However, she was extremely resistant to working with the dietitian on
resolving any food intolerances that she may have. She would quickly vomit almost any place available, including the toilet, bath
drain, or shower drain. She would vomit into her sheets and hide the sheets. She sneaks in medication that she takes to disguise
the medical symptoms of her vomiting. She was extremely resistive to efforts to tube-feed her; however, tying her down and tube-
feeding her is often the only way to ensure adequate nutritional intake and to reverse a potentially life-threatening situation.
Pt. often writes frivolous complaints about staff members and attempts to get her human rights representatives to block
needed treatment. Pt. is at times consumed with strategies to fight treatment. This ties up a lot of staff time and makes it very
difficult to provide needed treatment.
2. Social Skills
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 70 65 65 60 55 50 45 40 30 25 20 15 5
Pt. is somewhat awkward in her interactions with others. Despite this, she is able to maintain several long-term relationships,
including her marriage of 8 years. She has some difficulty sharing with others and some difficulty understanding the feelings of
others.
3. Violence
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonviolent___ Violent to Self X Violent to Others___ Violent to Self and Others___
Periodically, pt. has self-destructive and suicidal ideation. Pt.’s expressions of suicidal thoughts are seen as attempts to manipulate
staff rather than actually wanting to hurt herself. Mostly, she cuts herself very superficially or burns herself with a cigarette.
However, due to her high level of anger, she is felt to possibly be a real danger to attempt to seriously hurt herself in order to
manipulate staff. On rare occasions, pt. attacks staff; however, because of her frail status, the assaults are usually minor. She
reports while on day pass a couple of months ago that she laid on the railroad tracks and waited for a train to come. She reported
that after laying on the tracks for ½ hour, she gave up and returned to the hospital. When on constant observation status, she
would often be very resistive to allowing staff to adequately monitor her, including hiding under the covers or refusing to come
out from under the bed. While hiding, she would at times cut herself superficially.
100 ___95 X 90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Pt. graduated from college with a teaching degree; however, she has never taught school. She received training in medical
administration and ran a physician’s office for several years. She has very good ADL skills, which are consistent with a successful
college graduate. Her IQ is well above average. Currently, she is working part-time as a medical secretary while on day passes.
Before her hospitalization, she had no difficulty maintaining her home with her husband and driving her car.


Name: Barbara Williams (Lakeview State Hospital) #: 12352 Age: 34
5. Substance Abuse
100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 X 55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Primarily (check one): Nonabuser___ Alcohol Abuser___ Drug Abuser X Both___

There is evidence of moderate abuse of over-the-counter medications, such as diet pills and laxatives. As a teenager, she abused
marijuana and alcohol; however, this has not been a problem for many years. She smokes about one pack a day.
100 ___95 ___90 ___85 ___80 ___75 ___70 X 65 ___60 ___55 ___50 ___45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 90 85 80 75 75 70 70 65 60 55 55 50 40 35 25 15 5
Despite years of abusing her body through starvation, electrolyte imbalance, and the like, she is in fairly good health. Periodically
she does have some problems with gastritis; however, there is no significant evidence that she has the food intolerances that she
claims. Any food intolerances that she claims to have are felt to be psychological problems and malingering rather than actual
physical problems. It is felt that she greatly exaggerates and feigns symptoms to avoid eating.

100 ___95 ___90 ___85 ___80 ___75 ___70 ___65 ___60 ___55 ___50 X 45 ___40 ___35 ___30 ___25 ___20 ___15 ___10 ___5 ___
100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5
Ongoing consultations with pt.’s medical guardian and court are being made for various permissions to provide pt. with needed
psychiatric treatment. She and her husband, a schoolteacher, have ongoing financial difficulties as a result of her years of soaring
medical expenses. This situation appears to be causing them to lose their home.
GAF Equivalent: #1 10 + #2 70 + #3 50 + #4 95 = 225 / 4 = 55

Notes

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CHAPTER 7

COMPLETED KENNEDY AXIS V SCORING SHEETS

I. Standard-Form Scoring Sheet ......................................................................................................... 7–5

COMPLETED KENNEDY AXIS V SCORING SHEETS

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Susan Anderson (Front Street Residence) #: 12341 Age: 34

Primarily (check one): Nonabuser X Alcohol Abuser___ Drug Abuser___ Both___

7. Ancillary Impairment (optional)

GAF Equivalent: #1 30 + #2 60 + #3 60 + #4 50 = 200 / 4 = 50

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Keith Brown (Lakeview State Hospital) #: 12342 Age: 55

Primarily (check one): Nonabuser X Alcohol Abuser___ Drug Abuser___ Both___

7. Ancillary Impairment (optional)

GAF Equivalent: #1 30 + #2 45 + #3 40 + #4 25 = 140 / 4 = 35

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Helen Johnson (Friendly House Residence) #: 12343 Age: 62

Primarily (check one): Nonabuser X Alcohol Abuser___ Drug Abuser___ Both___

7. Ancillary Impairment (optional)

GAF Equivalent: #1 40 + #2 50 + #3 70 + #4 40 = 200 / 4 = 50

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Albert Morgan (Lakeview Residence) #: 12344 Age: 24

Primarily (check one): Nonabuser X Alcohol Abuser___ Drug Abuser___ Both___

7. Ancillary Impairment (optional)

GAF Equivalent: #1 40 + #2 70 + #3 80 + #4 75 = 265 / 4 = 65

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Janet Smith (Lakeview Nursing Home) #: 12345 Age: 64

Primarily (check one): Nonabuser___ Alcohol Abuser X Drug Abuser___ Both___

7. Ancillary Impairment (optional)

GAF Equivalent: #1 60 + #2 60 + #3 70 + #4 30 = 220 / 4 = 55

Kennedy Axis V: Scoring Sheet © 1986–2003

Primarily (check one): Nonabuser X Alcohol Abuser___ Drug Abuser___ Both___

7. Ancillary Impairment (optional)

II. Long-Form Scoring Sheet

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Ronald Graham (Lakeview State Hospital) #: 12347 Age: 37

Continued on next page

KENNEDY AXIS V: SCORING SHEET © 1986–2003, Continued from previous page

Primarily (check one): Nonabuser___ Alcohol Abuser X Drug Abuser___ Both___

7. Ancillary Impairment (optional)

GAF Equivalent: #1 30 + #2 90 + #3 50 + #4 95 = 265 / 4 = 65

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Natalie Moore (Roberts Memorial Hospital) #: 12348 Age: 14

Continued on next page

KENNEDY AXIS V: SCORING SHEET © 1986–2003, Continued from previous page

Primarily (check one): Nonabuser___ Alcohol Abuser___ Drug Abuser___ Both X

7. Ancillary Impairment (optional)

GAF Equivalent: #1 40 + #2 80 + #3 10 + #4 90 = 220 / 4 = 55

III. Computerized, Variable-Length Scoring Sheet

Kennedy Axis V: Scoring Sheet © 1986–2003

Primarily (check one): Nonabuser___ Alcohol Abuser___ Drug Abuser X Both___

GAF Equivalent: #1 30 + #2 60 + #3 70 + #4 50 = 210 / 4 = 55

Kennedy Axis V: Scoring Sheet © 1986–2003

Primarily (check one): Nonabuser___ Alcohol Abuser X Drug Abuser___ Both___

GAF Equivalent: #1 50 + #2 80 + #3 50 + #4 50 = 230 / 4 = 60

Kennedy Axis V: Scoring Sheet © 1986–2003

Primarily (check one): Nonabuser X Alcohol Abuser___ Drug Abuser___ Both___

GAF Equivalent: #1 40 + #2 45 + #3 25 + #4 50 = 160 / 4 = 40

Kennedy Axis V: Scoring Sheet © 1986–2003

Name: Barbara Williams (Lakeview State Hospital) #: 12352 Age: 34

Primarily (check one): Nonabuser X Alcohol Abuser_ Drug Abuser_ Both___

Primarily (check one): Nonabuser X Alcohol Abuser_ Drug Abuser_ Both___

Primarily (check one): Nonabuser X Alcohol Abuser_ Drug Abuser_ Both___

Primarily (check one): Nonabuser X Alcohol Abuser_ Drug Abuser_ Both___

Primarily (check one): Nonabuser_ Alcohol Abuser X Drug Abuser_ Both___

Primarily (check one): Nonabuser X Alcohol Abuser_ Drug Abuser_ Both___

Primarily (check one): Nonabuser_ Alcohol Abuser X Drug Abuser_ Both___

Primarily (check one): Nonabuser_ Alcohol Abuser_ Drug Abuser___ Both X

Primarily (check one): Nonabuser_ Alcohol Abuser_ Drug Abuser X Both___

Primarily (check one): Nonabuser_ Alcohol Abuser X Drug Abuser_ Both___

Primarily (check one): Nonabuser X Alcohol Abuser_ Drug Abuser_ Both___

Primarily (check one): Nonabuser_ Alcohol Abuser_ Drug Abuser X Both___