WBR0330

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 62 year old patient presents to the physician's office with major depression. When asked, the patient explains that he has been unemployed for several years, has been abandoned by his family, and has been abusing whiskey. He feels completely hopeless and guilty for everything he has done. The patient also informs the physician that he cannot concentrate anymore on daily activities and is constantly feeling disconnected with no interest. What is the most important question to be asked by the physician during the assessment of this patient?]]
Answer A	AnswerA::"Do you hear any voices in your head that order you what to do?"
Answer A Explanation	AnswerAExp::Asking about psychatric disorders is important, but is not the most important question in this patient.
Answer B	AnswerB::"Have you ever considered committing suicide?"
Answer B Explanation	AnswerBExp::Asking about suicidal ideations and suicidal planning is the most important question in a depressed patient.
Answer C	AnswerC::"Do you have anyone who can help you socially and financially with what you need?"
Answer C Explanation	AnswerCExp::Asking about financial and social support is very important for a depressed patient. Suicidal ideation, however, is much more important.
Answer D	AnswerD::"How many hours of sleep do you get each day?"
Answer D Explanation	AnswerDExp::Too much or too little sleep are both considered symptoms of depression and must be asked in this patient.
Answer E	AnswerE::"Is there any reason you will not be taking the medications that will be prescribed to you?"
Answer E Explanation	AnswerEExp::Confirming adherence to medications should be assessed. However, adherence to medications is not as important as suicidal ideations.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Depression is considered an important risk factor for suicide. Generally, all new patients presenting to the primary care office must be screened for a history of psychiatric disorders, depression, substance abuse, and most importantly, previous suicide attempts. These factors are important risk factors and predictors for future suicide attempts (among other risk factors). It is well-conceded that asking a patient about suicidal ideation will not give them new suicidal ideas. In fact, most studies have shown that patients who have suicidal ideations will be relieved when asked about their intents and will find space for discussion with their physicians about their ideations. Asking about suicidal ideations requires a special approach, especially that some patients with medical and psychiatric disorders might not directly admit their intent to commit suicide. As such, introducing the topic of suicide before asking the question is considered a good technique to ask whether the patient is considering suicide. For instance: "Sometimes when people are feeling down and hopeless they have ideas about hurting themselves or commit suicide" is good approach for suicide. Patients who show risk factors for suicide or show signs of suicide intent, such as saying their are worthless, hopeless, or feel like a burden, or say they'd rather by dead, must always be screened for suicide and about the planning of the suicide (use of gun, hanging, overdose etc.) Educational Objective: Patients with major depression must always be asked about suicidal ideations. Reference: Gliatto MF, Rai AK. Evaluation and treatment of patients with suicidal ideation. Am Fam Physician. 1999;59(6):1500-1506. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::suicide, WBRKeyword::suicidal, WBRKeyword::ideation, WBRKeyword::ideations, WBRKeyword::depression, WBRKeyword::depressive, WBRKeyword::major, WBRKeyword::hopelessness, WBRKeyword::hopeless, WBRKeyword::worthlessness, WBRKeyword::worthless
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