Ask the patient to describe his or her mood, including usual mood level and fluctuations related to life events. "How did you feel about that?" for example, or, more generally, "How is your overall mood?" The reports from family and friends may be of value.
Has the mood been intense and unchanging, or labile? How long has it lasted?
Is it appropriate to the patient's situation? If depression, have there been episodes of an elevated mood, suggesting a bipolar disorder?
If you suspect depression, assess its severity and any risk of suicide. Ask...
■ Do you feel discouraged or depressed?
■ How low do you feel?
■ What do you see for yourself in the future?
■ Do you ever feel that life isn’t worth living? Or that you want to be dead?
■ Have you ever thought of killing yourself?
■ How did (do) you think you would do it? Do you have a plan?
■ What do you think would happen after you were dead?
It is your responsibility to ask directly about suicidal thoughts. This may be the only way to uncover suicidal ideation and plans that launch immediate intervention and treatment.
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