"Incursion Sign" Does Not Exist in Depression Literature
I cannot find any evidence of a clinical sign, symptom, or diagnostic criterion called "incursion sign" in the context of depression in any of the provided guidelines, FDA drug labels, or research literature.
What You May Be Looking For
Based on the context of your question about severe depression or depressive episodes, you may be referring to one of the following:
Key Diagnostic Features of Major Depressive Disorder
Major depressive disorder requires at least 5 symptoms during a 2-week period, including either depressed mood or anhedonia (loss of interest/pleasure), plus additional symptoms such as:
- Significant weight changes or appetite disturbance 1
- Insomnia or hypersomnia 1
- Psychomotor agitation or retardation 1
- Fatigue or loss of energy 1
- Feelings of worthlessness or inappropriate guilt 1
- Diminished ability to think, concentrate, or indecisiveness 1
- Recurrent thoughts of death or suicidal ideation 1
Observable Physical Signs in Depression
Depression presents with objective physical signs that clinicians should actively assess:
- Retardation of movements with diminished gestures and expressions 2
- Psychomotor agitation manifested by severe restlessness 2
- Muscle tension, wringing of hands, weeping and moaning 2
- Autonomic signs including tachycardia, dry mouth, sweaty palms, cold clammy skin, pallor, pupillary dilatation, and tremor 2
- Tired appearance, self-concerned demeanor, and loss of interest in surroundings 2
Critical Warning Signs Requiring Immediate Action
Any patient endorsing thoughts of self-harm or suicidal ideation requires immediate psychiatric evaluation:
- The PHQ-9 specifically assesses "thoughts that you would be better off dead or hurting yourself in some way" 1
- Suicidal thoughts, risk of self-harm, severe depression or agitation, or presence of psychosis or confusion (delirium) require immediate referral to a psychiatrist, psychologist, or equivalently trained professional 1
- Suicidal thoughts are among the strongest predictors of severe depression diagnosis 3
Screening and Assessment Approach
Use validated screening tools to identify depression severity:
- Start with the PHQ-9 for initial screening, with scores ≥10 suggesting moderate depression and ≥15 suggesting severe depression 1
- If moderate to severe symptomatology is detected, conduct further diagnostic assessment to identify the nature and extent of depressive symptoms 1
- Assessment should identify signs and symptoms of depression, severity of cancer symptoms (e.g., fatigue), possible stressors, risk factors, and times of vulnerability 1
Common Pitfall
Do not confuse subjective symptom reporting with objective clinical signs. Depression includes both subjective symptoms (depressed mood, anhedonia) and objective physical signs (psychomotor changes, autonomic symptoms) that should be actively observed and documented 2.
If "incursion sign" is terminology used in your specific clinical setting or represents a translation issue, please clarify the term so I can provide more targeted guidance.