Disabling Effects

They may have:

• Low mood that is characteristically worse in the evening than in the morning.
• Lack of energy, interest and irritability.
• Associated anxiety, phobias and obsessional symptoms may also be present and they may experience difficulty going to sleep or periods of wakening during the night.

Mobility

People would normally have no difficulty finding their way around outdoors because they do not usually experience any confusion, inattention, memory loss or impaired judgement. There would be no physical restriction of walking ability.

Care

People would normally be expected to care for themselves by maintaining personal hygiene and preparing meals etc. They would have little or no functional limitation on a day-to-day basis arising from any symptoms nor would they need supervision or watching over to prevent abnormal or untoward behaviour.

Disabling Effects

People with a moderate restriction will display 2 out of 3 of the following:

• Depressed mood
• Loss of enjoyment
• Fatiguability

at least 4 of the following: 

• Reduced concentration and attention
• Reduced self esteem and self confidence
• Ideas of guilt and unworthiness
• Bleak and pessimistic views of the future
• Ideas of self harm or suicide
• Disturbed sleep
• Reduced appetite

However, people with a moderate restriction would not normally exhibit:

• Significant self neglect
• Psychotic symptoms such as hallucinations and delusions
• Significant slowing of movements or agitation

Mobility

Agoraphobia, physical inertia and apathy may require someone to encourage the moderately depressed person to get out and about. Those people with associated agoraphobia or severe anxiety may have difficulty finding their way around unfamiliar places and may require support.

Care

The following care requirements would normally be necessary:

• Encouragement to go out and engage in social activities.
• Encouragement to take medication, but this is likely to be limited to once or twice a day.

Disabling Effects

They may have:

• Severely depressed mood
• Prominent biological symptoms such as loss of appetite weight and sleep disturbance
• Severe agitation or significant slowing of movements.

There may also be:

• Significant impairment of concentration and memory possibly resulting in confusion, psychotic symptoms such as delusions of guilt, worthlessness or poverty, persecutory hallucinations and significant social withdrawal.
• Insight is likely to be limited.

Mobility

If there is significant impairment of concentration, insight, judgement or memory or psychosis or psychomotor retardation present, there may be a need for guidance or supervision.

Apart from the rare occurrence of depressive stupor, (motionless and mute) there would be no physical restriction of walking ability. People with depressive stupor will be hospitalized and usually respond to treatment within a period of weeks.

Care

If there is significant impairment of concentration and motivation and/or presence of psychosis or psychomotor retardation the customer may require:

• Help to plan and prepare a main meal.
• They would normally also need prompting to go to bed, use the toilet, deal with incontinence, maintain hygiene and appearance, wash and dry, use the bath and shower, dress, move around indoors, use the stairs, get in and out of a chair, eat and drink and use medication or medical treatment.
• Help with communication may be required and there may be an increased risk of suicide. (For further information please see section on self-harm).