SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide
Expansion
Core symptoms: persistent low mood and anhedonia (loss of interest or pleasure), present most days for at least two weeks.
Additional symptoms (SIGECAPS)
- S - Sleep disturbance, classically early morning waking
- I - Interest loss
- G - Guilt and worthlessness
- E - Energy loss and fatigue
- C - Concentration impairment
- A - Appetite and weight change
- P - Psychomotor retardation or agitation
- S - Suicidal ideation
Biological (somatic) symptoms are the ones suggesting more severe illness: early morning waking, diurnal variation with mood worst in the morning, weight loss and loss of libido.
Always ask directly about suicide. Asking does not increase risk, and omitting it is the commonest and most serious failure. Ask about ideation, plans, preparatory acts, previous attempts, means available and protective factors.
Screening tools: the two-question PHQ-2 for case finding, then PHQ-9 for severity and monitoring.
Exclude organic causes: hypothyroidism, anaemia, B12 deficiency, medication (steroids, beta blockers, isotretinoin), alcohol and drug use, and consider bipolar disorder by asking about periods of elevated mood.