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An educational approach for clinician-led assessment; branches do not generate a diagnosis or prescribe treatment.
Persistent low mood or loss of interest may coexist with changes in energy, sleep, appetite, concentration and self-worth. Establish an episode and its effect on everyday functioning rather than counting isolated symptoms.
Reconstruct duration, previous episodes, mood elevation, psychotic features, bereavement, substances and medicines. Ask directly about self-harm thoughts and assess their context independently of a questionnaire total.
Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.
Review the bipolar differential before formulating a unipolar episode.
Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.
Agree goals and discuss psychological, social and medication options in relation to severity, previous response and preference. More severe, psychotic or otherwise complex presentations require the appropriate specialist setting. A scale score alone does not select treatment.
Review function, symptoms, engagement, treatment tolerability and emerging activation. Discuss relapse signatures, maintaining factors and a plan for recurrence.
Persistent low mood or loss of interest may coexist with changes in energy, sleep, appetite, concentration and self-worth. Establish an episode and its effect on everyday functioning rather than counting isolated symptoms.
Begin assessment → History, examination and context
Reconstruct duration, previous episodes, mood elevation, psychotic features, bereavement, substances and medicines. Ask directly about self-harm thoughts and assess their context independently of a questionnaire total.
Consider the branch → History suggestive of mood elevation or mixed features?
Use clinical findings and collateral. Uncertainty needs clarification, not a default negative answer.
Yes / concerning features → Priority assessment; No / not established → Formulation and care discussion; Uncertain / not assessed → Obtain the missing information
Review the bipolar differential before formulating a unipolar episode.
After appropriate assessment → Formulation and care discussion
Review the examination, timeline, relevant investigations and consented collateral. Escalate urgent concerns while uncertainty is resolved.
Reassess the branch → History suggestive of mood elevation or mixed features?
Agree goals and discuss psychological, social and medication options in relation to severity, previous response and preference. More severe, psychotic or otherwise complex presentations require the appropriate specialist setting. A scale score alone does not select treatment.
Agree follow-up → Reassess and follow up
Review function, symptoms, engagement, treatment tolerability and emerging activation. Discuss relapse signatures, maintaining factors and a plan for recurrence.
