AIIMS Delhi NO- 2019
Mental Health Nursing
Medium
A patient has tried to commit suicide with drug overdose. Which of the situation depicts that the patient has high risk of suicide?
Appeared in: AIIMS Delhi NO- 2019
Explanation
- Acute alcohol intake is a significant risk factor for both attempted and completed suicide, as it can trigger the suicidal act.
- Alcohol impairs judgment, lowers inhibitions, and increases impulsivity, reducing a person's restraint against self-harm.
- When combined with a drug overdose, alcohol can have a synergistic (potentiating) effect, which increases the toxicity and lethality of the drugs, raising the likelihood of a fatal outcome.
- Substance use, including alcohol, is associated with increased feelings of despair and aggression, and it deteriorates the cognitive ability to find constructive coping strategies.
Why Other Options Were Wrong
- Option A: While writing a note indicates clear suicidal intent and planning, it does not increase the physiological lethality of the attempt itself. A person can write a note and still use a low-lethality method.
- Option B: Informing a relative can be interpreted as a 'cry for help.' This act suggests ambivalence about dying and may indicate a desire to be found and rescued, which is often considered a protective factor or a sign of lower intent to die.
- Option C: Impulsivity is a general risk factor for self-harm. However, an impulsive attempt may be less thought out and involve less lethal means, potentially reducing the chance of a fatal outcome compared to a well-planned attempt.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Suicide Risk Assessment to guide bedside assessment, documentation, and the next nursing action.
- Nurses must perform a thorough and immediate suicide risk assessment for any patient who has attempted self-harm or expresses suicidal thoughts.
- Screening for acute alcohol and substance use is a critical priority in the assessment, as it directly impacts immediate patient safety, required level of observation, and medical management (e.g., risk of overdose potentiation).
- A patient who has combined alcohol with a drug overdose requires immediate medical attention to manage the toxic effects and close psychiatric observation (e.g., one-to-one monitoring) to prevent further self-harm.
How to Approach the Question
- First, identify the core of the question, which is to find the single factor that indicates the highest risk of a completed suicide among the given options.
- Evaluate each option based on its known impact on the two key components of suicide risk: intent (the desire to die) and lethality (how deadly the method is).
- Analyze 'Wrote a note' and 'Informed a relative' in terms of intent. A note suggests high intent, but informing someone suggests ambivalence or a cry for help.
- Analyze 'Impulsive attempt' in terms of planning and lethality. It may be less planned and therefore less lethal.
- Analyze 'Alcohol intake'. This factor affects both intent (by impairing judgment) and lethality (by potentiating the drug overdose).
- Compare the options. The combination of alcohol and drugs directly increases the physiological danger and likelihood of death, making it the highest risk indicator in this acute situation.
Concept Tested & Keywords
- Concept Tested: Suicide Risk Assessment
- Stem keywords: suicide, drug overdose, high risk
- Lead-in keywords: depicts
- Clinical cues: Patient has tried to commit suicide with drug overdose.
- Negative lead-in flag: false
Question ID
QsWn0x7gTYstpSHY21UpEh
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 5498-5500, 8779-8781, 12440-12442
Practise the full AIIMS Delhi NO- 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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