Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Severity, functional impairment and psychotic features
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Severe depression with loss of safety
Immediate suicidal intent, psychotic commands, refusal of food or fluids, profound self-neglect, catatonia or inability to care safely for a child or vulnerable adult requires urgent specialist and physical assessment.
Action: Stabilise medical consequences, reduce access to means, provide proportionate observation and obtain same-day mental-health review. Assess capacity for each decision, initiate safeguarding when needed and consider voluntary admission or the correct legal framework if essential care is refused.
Synopsis
Judge depressive severity by symptom burden, duration, function, context, safety and psychotic or catatonic features, using measures as aids rather than thresholds and escalating severe impairment to specialist care without delay.
NICE describes less severe and more severe depression using symptom severity and functional impairment rather than a questionnaire cutoff alone.
Assess breadth, intensity, duration, persistence and trajectory of symptoms alongside self-care, relationships, work, caregiving, money and treatment use.
Ask what support or effort makes apparent functioning possible; attendance or good grooming can conceal major impairment and carer burden.
Key red flags
Psychotic guilt, nihilism, poverty or deserved-punishment beliefs may drive refusal of food, shelter, medicine or life-saving care and require direct inquiry.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.