IGIMS Staff Nurse - 2018
Mental Health Nursing
Easy
There is increased danger of suicide when a patient is?
Appeared in: IGIMS Staff Nurse - 2018
Explanation
- The highest risk for suicide occurs when a patient is beginning to improve from severe depression.
- This is known as a paradoxical risk, where the patient's energy and motivation return before their mood and feelings of hopelessness improve.
- As antidepressants start working, they can cause an "activation syndrome" with agitation and increased energy, providing the patient with the capacity to act on pre-existing suicidal thoughts.
- This creates a dangerous window where the will to die is still present, but the physical inability to act is gone.
Why Other Options Were Wrong
- Option B: While patients who are extremely depressed have high rates of suicidal ideation, they often suffer from severe psychomotor retardation, meaning they lack the physical energy and cognitive organization to carry out a suicide plan.
- Option C: Lethargy is a state of low energy, fatigue, and apathy. A lethargic patient is less likely to have the physical or mental energy to plan and execute a suicide attempt.
- Option D: Gender is a demographic risk factor, not an acute clinical state indicating immediate danger. While females have a higher rate of suicide attempts, males have a higher rate of completed suicides.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Suicide risk assessment in patients with depression to guide bedside assessment, documentation, and the next nursing action.
- Nurses must maintain heightened vigilance during the initial weeks of antidepressant therapy, as this is the highest-risk period.
- A sudden improvement in energy or a patient appearing suddenly calm or at peace can be a major warning sign that they have made the decision to commit suicide and have the energy to act.
- Nursing interventions include placing the patient on close observation (e.g., 1-to-1 or 15-minute checks), removing potential means of self-harm from the environment, and directly asking the patient about suicidal thoughts, plans, and intent.
How to Approach the Question
- First, identify the core of the question, which is about identifying the period of greatest suicide risk in a patient's clinical course.
- Analyze each option in terms of a patient's mental and physical state.
- Recall the key psychiatric nursing principle of 'paradoxical suicide risk' during recovery from depression.
- Contrast the options representing acute clinical states (improving, extremely depressed, lethargic) with the demographic factor (female).
- Recognize that the ability to act (energy) combined with the desire to die (hopelessness) creates the most dangerous situation. This occurs during the initial improvement phase.
- Select the option that describes this high-risk window where energy has returned but mood has not yet lifted.
Concept Tested & Keywords
- Concept Tested: Suicide risk assessment in patients with depression
- Stem keywords: increased danger, suicide, patient
- Lead-in keywords: increased danger
- Negative lead-in flag: false
Question ID
QBE6r7tMTgeVHzKlhj8Qxy
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. 5511-5513, 3861-3863, 5497-5499
Practise the full IGIMS Staff Nurse - 2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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