WBR0330

Author	[[PageAuthor::Serge Korjian M.D. (Reviewed by Alison Leibowitz) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 52-year-old man presents to the physician's office for fatigue and feelings of guilt and hopelessness. Upon questioning, the patient explains that he has been unemployed for several years, and has been drinking whiskey in excess for the past 2 months. He cannot concentrate on daily activities, has had little appetite, and has been having difficulty falling asleep. Which of the following questions is most important to ask 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 symptoms of specific psychiatric disorders is essential, as it can lead to further diagnosis, but is not the most important question in this patient.
Answer B	AnswerB::"Have you ever considered committing suicide?"
Answer B Explanation	AnswerBExp::Inquiring about suicidal ideations and suicidal plans are the most important questions to ask 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::Inquiring about financial and social support is important, but asking about suicidal ideations is more essential.
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, but due to the plethora of signs presented in this patient, it is more important to inquire about suicidal ideations. .
Answer E	AnswerE::"Is there any reason you would not take the medications that will be prescribed to you?"
Answer E Explanation	AnswerEExp::Confirming adherence to administered medications should be assessed, but is not as important as inquiring about suicidal ideations.
Right Answer	RightAnswer::B
Explanation	[[Explanation::The patient in this scenario likely has major depressive disorder, which is considered a risk factor for suicide. Generally, patients who present to the primary care office with feelings of hopelessness and guilt must be screened for a history of psychiatric disorders, depression, substance abuse, and most importantly, previous suicide attempts. These are often predictors for future suicide attempts (among other psychiatric risk factors). Asking a patient about suicidal thoughts likely will not augment their suicidal mentality, but rather will provide relief by offering space for discussion about their ideations. Inquiring about suicidal ideations requires a special approach, given that some patients with medical and psychiatric disorders might not directly admit their intent to commit suicide. For example, it can be beneficial to introduce the topic, prior to directly asking whether the patient is considering suicide. Patients who demonstrate risk factors for suicide or show signs of suicidal intent, such as saying they are are worthless, hopeless, feel like a burden, or would rather by dead, should be screened for suicidal tendencies and further questioned about their planned method of suicide. Educational Objective: Patients with symptoms of major depression should be asked about suicidal ideations. References: Gliatto MF, Rai AK. Evaluation and treatment of patients with suicidal ideation. Am Fam Physician. 1999;59(6):1500-1506.]]
Approved	Approved::Yes
Keyword	WBRKeyword::suicide, WBRKeyword::suicidal ideation, WBRKeyword::depression, WBRKeyword::depressive, WBRKeyword::major, WBRKeyword::hopelessness, WBRKeyword::hopeless, WBRKeyword::worthlessness, WBRKeyword::worthless, WBRKeyword::psychiatry, WBRKeyword::mental health
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