From the Guidelines
The most appropriate statement is option C: "You weren't expecting a conversation with your roommate would turn into a trip to the hospital; what do you think caused your roommate to feel scared?" This approach is supported by the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines, which emphasize the importance of a collaborative approach between patient and clinician in assessing and managing patients at risk for suicide 1. The guidelines recommend a semi-structured interview regarding recent suicide ideation and history of suicide attempts, as well as an unstructured conversation about recent stressors and current problems, using supportive listening techniques. Option C aligns with these recommendations by encouraging the patient to reflect on her recent behaviors that might have alarmed others, while also acknowledging her frustration and validating her feelings about the unexpected hospital visit. This patient-centered and non-threatening approach is essential in emergency psychiatric evaluations, where establishing rapport and trust with a reluctant patient is crucial 1. By asking what might have scared the roommate, the clinician indirectly addresses the reported suicidal ideation while allowing the patient to share her perspective, which is essential for an accurate assessment of her mental state and suicide risk. Additionally, the American Academy of Child and Adolescent Psychiatry's practice parameter for the assessment and treatment of children and adolescents with suicidal behavior emphasizes the importance of looking for signs of mania or hypomania, as well as obtaining information from a third party, which option C facilitates 1. Overall, option C is the most appropriate statement as it prioritizes the patient's safety and well-being while also establishing a therapeutic dialogue. Some key points to consider when evaluating this patient include:
- Assessing her mental state and level of suicidality
- Obtaining information from a third party, such as her roommate or parents
- Looking for signs of mania or hypomania, such as decreased need for sleep, excessive participation in multiple activities, or agitated behavior
- Collaborating with the patient to identify clear signs of crisis and develop a crisis response plan
- Providing supportive listening techniques and validating her feelings and concerns.
From the Research
Assessment of the Situation
The patient is a 22-year-old woman presenting with depressive symptoms, including suicidal thoughts, and has been experiencing these symptoms for the past month. Her roommate expressed concern about her safety, which led to her parents bringing her to the emergency department.
Key Considerations
- The patient's suicidal thoughts and recent withdrawal from activities (not attending classes) indicate a significant level of distress and potential risk to herself.
- The patient's initial reaction to being at the hospital (yelling at her parents and stating she feels fine) may be a defense mechanism or denial of her situation.
Appropriate Response
Given the patient's presentation and the concerns raised by her roommate and parents, the most appropriate initial response would be to acknowledge her upset while also emphasizing the need for an evaluation to ensure her safety. This approach should prioritize empathy and understanding of her feelings while also being clear about the necessity of assessing her mental health state.
Options Analysis
- Option A: "I understand that you're upset and don't want to be here, but in order for you to leave, we need to talk about how you've been feeling recently." This option is empathetic and sets a clear condition for her potential discharge, making it a reasonable choice.
- Option B: This option mentions the need for a full evaluation and offers medication if she cannot remain calm, which might be perceived as confrontational or dismissive of her current emotional state.
- Option C: While empathetic, this option does not directly address the immediate concerns about her safety.
- Option D: This option may reinforce her perception that her parents' concerns are the primary issue rather than addressing her own well-being.
- Option E: Directly asking about suicidal thoughts can be appropriate, but it should be done with sensitivity and as part of a broader assessment of her mental state.
Most Appropriate Statement
The most appropriate statement would be one that balances empathy with the need for a thorough evaluation to ensure the patient's safety. Among the provided options, A seems to be the most balanced approach, as it acknowledges her feelings while also clearly stating the necessity of discussing her recent emotional state.
There are no research papers provided that directly assist in answering this question about the most appropriate statement in response to the patient's situation 2, 3, 4, 5, 6.