WBR1136

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Psychiatry
Sub Category	SubCategory::Psychiatry
Prompt	[[Prompt::A 41-year-old woman was brought to an emergency room by police. She has swallowed 5 pills of alprazolam of 0.5mg, in front of her best friend. Her friend called psychiatrist and psychiatrist asked the local police department to escort the patient to the hospital emergency room. On examination, her left forearm has many healed cut marks. She told an emergency room physician that, she broke up with her boyfriend 2 hours back. She always had a rocky relationship and was never able to sustain a long term relationship. On further questioning, she revealed, that she takes Fluoxamine 40mg OD, Alprazolam 1mg at bed time, Lithium 900mg extended release, Oxycodone 2.5 mg two times a day, and Ibuprofen XR PRN. She always had extreme emotional outbursts like panic, rage, and threatening behavior to the stressors. Also an empty feeling and sense of abandonment. Her vitals were stable. What should be the next best step in the management?]]
Answer A	AnswerA::Reassure and send her back to home
Answer A Explanation	AnswerAExp::Reassurance is necessary but patient needs to be admitted in the hospital.
Answer B	AnswerB::Consult ethics committee
Answer B Explanation	AnswerBExp::Consult of ethics committee is not required if the patient is harm to himself or others.
Answer C	AnswerC::Admit the patient involuntarily
Answer C Explanation	[[AnswerCExp::Involuntarily admission is required if the patient is harm to himself or others. One may not have accurate history of ingestion in an suicidal attempt. Complete lab and toxicology screen is required. The patient has to be medically and psychiatrically stabilized before hospital discharge and he is allowed to back to community.]]
Answer D	AnswerD::Refer her to another doctor
Answer D Explanation	AnswerDExp::Refer of another doctor is not required if the patient is harm to himself or others.
Answer E	AnswerE::Do a psychiatric consult
Answer E Explanation	AnswerEExp::Consult of psychiatrist is not required if the patient is harm to himself or others.
Right Answer	RightAnswer::C
Explanation	[[Explanation::An suicidal attempt is always taken seriously and admission to hospital is done, even if it's against patient's wishes. Educational Objective: References: http://www.ncbi.nlm.nih.gov/pubmed/22369082 www.ncbi.nlm.nih.gov/pubmed/11434483]]
Approved	Approved::No
Keyword	WBRKeyword::Suicide, WBRKeyword::Borderline Personality Disorder
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::