psych2 - april17

[ArchivalUser]

A 36-year-old man comes to the clinic accompanied by his wife for a scheduled appointment. The man has apparently been suffering from a depressed mood since losing his job 5 months prior. A review of depressive symptoms reveals that the patient has significant sleep disturbances, often waking early in the morning and napping in the afternoon; has lost interest in most activities he previously enjoyed; reports feeling sluggish and without energy; and has a markedly diminished appetite. His wife reports that the patient œno longer seems to be himself and is paying little attention to friends and family. The patient often cries for no apparent reason, yet does not wish to discuss what is on his mind. Which of the following is the most appropriate strategy for suicide risk screening in this patient?
(A) Admit patient immediately given high risk; further evaluate in the hospital
(B) Avoid explicitly discussing suicide to minimize risk for initiating suicidal ideation
© Openly ask wife and patient about any thoughts, mention, or plans of suicide
(D) Send wife away and ask explicitly about suicidal ideation, plan, and intent
(E) Stratify suicide risk according to epidemiologic risk factors; admit if high risk

[ArchivalUser]

d

[ArchivalUser]

DDD

[ArchivalUser]

D for sure.

[ArchivalUser]

Ans is D. Depressed patients always need to be asked explicitly about any suicidal thoughts, plans, and intent. The most concerning patients have intent, a plan, and a timeframe. This latter group needs aggressive care, including, if necessary, involuntary admission. Until these factors are known there is no way to decide if one should admit this patient immediately(A)
openly asking the wife and the patient (choice C) about suicide is likely to be less effective than sending the wife away