Table 1 Improved response format for the Clinical Global Impression severity scale in depression.

Normal, not at all ill

The patient has no symptoms to suggest depression

Borderline mentally ill

The patient complains of periodic tiredness, unhappiness or loss of optimism, but this does not affect his/her relationships or job.

Working life and family life are a little less pleasant for the patient. He/she describes moments of sadness and internal tension.

Mildly ill

The patient is tired, has difficulty taking initiatives or making an effort. Labile mood. At times, deterioration of professional performance.

The patient is tense and irritable. He/she has difficulty concentrating on daily tasks, although he/she mostly gets them done.

Moderately ill

The patient is sad and talks about waves of anxiety. His/her nights are restless. His/her professional life is taking the toll despite efforts to face up to it.

The patient has to fight against moments of despair. He/she is exhausted. His/her relationships are affected.

Markedly ill

The patient is listless, says he/she cries easily. He/she is eating irregularly, the face is thin. He/she complains of an impoverished emotional life, he/she can see no future.

The patient is no longer able to struggle against his/her sad mood. He/she describes a permanent state of internal tension. Everything is difficult to bear.

Severely ill

The patient is without reaction, permanently overwhelmed with his/her sad and painful mood. He/she is not eating.

The patient's face and utterance are devoid of affects. He/she has no plans, and says he/she is waiting to die.

Among the most extremely ill patients

The patient is cachectic, utterances are incoherent and centred on morbid themes. Distress is extreme.

The patient is prostrate, eyes averted. The face expresses painful tension. The interview is virtually impossible because of a refusal to communicate. The few utterances are delirious.