Note:
The questions refer to how the patient felt during the
preceeding two weeks. Your evaluation should be based on
observed and reported behavior.
A. Evaluation questions
1. Depressed mood:
Have you felt sad, low, down, depressed, or
hopeless?
2. Loss of
interest: Have you lost interest or pleasure in the
things you usually like to do? Have you been as social as
usual? Have you been less interested in interacting with
others (family, co-workers)?
If
answered yes to one or both of the above symptoms,
continue...
B. Symptom
questions
3. Sleep
disturbance: Have you been sleeping much more than usual
or had difficulty falling asleep or staying
asleep?
4. Appetite
disturbance: Have you lost your appetite or had an
unusual increase in appetite? Any cravings for junk
food?
5. Loss of energy:
Have you been feeling tired or having little
energy?
6. Difficulty
concentrating: Does your thinking seem slower or more
confused than usual? Are you making more
mistakes?
7. Feelings of
worthlessness: Have you felt that you are a failure or
that you let yourself or your family down? What are you
looking forward to? Have you felt guilty about things
that happened in your life?
8. Psychomotor
retardation: Have you been moving or talking more slowly
than usual? Have you felt agitated or on edge? Do you
feel like you have to keep talking or moving all the
time? (Also can be observed)
9. Suicidal
thoughts (bored with life): Have you thought that you or
your family would be better off if you were dead? Have
you thought of killing yourself? Have you tried to
hurt/kill yourself before? When? How many times? What did
you do? Are you thinking of killing yourself? Do you have
a plan? How will you do it? What stops you from acting on
your thoughts?