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Difficulty: HardMental Health Concepts

A client with a history of severe major depressive disorder presents to an outpatient psychiatric clinic for a follow-up appointment. The client has been taking a prescribed selective serotonin reuptake inhibitor (SSRI) for four weeks. The nurse notes the client appears uncharacteristically calm, smiles softly, and hands the nurse a sealed envelope, stating, 'I will not be needing to come back here. I have finally found the permanent solution to my struggles.' Which of the following is the priority response by the nurse?

  1. You mentioned finding a permanent solution. Are you planning to commit suicide?Answer
  2. B
    It sounds like you are feeling much better today. What is the solution you have found?
  3. C
    Why do you feel that you no longer need to continue your treatment with us?
  4. D
    I will keep this envelope safe for you, but we need to discuss the importance of continuing your medication.

Answer

The nurse must directly ask the client about suicidal ideation or intent to self-harm.
The client's presentation—a sudden shift to a calm affect, handing over an envelope, and making statements about a 'permanent solution' after four weeks of SSRI therapy—strongly indicates a high risk for imminent suicide. Antidepressants can increase energy levels before fully alleviating depressive cognitive symptoms, providing the client with the motivation and energy to carry out a lethal plan. The priority action is to ensure safety by directly and clearly asking the client about suicidal ideation.

Step-by-Step Solution

1
Analyze the client's clinical presentation and timeline.
The client has been on an SSRI for four weeks, exhibits a sudden shift to a calm affect, is giving away a sealed envelope, and speaks of a 'permanent solution'.
Recognizing the timeline of antidepressant therapy is critical, as it often provides the energy to carry out a suicide plan before the severe depressed mood fully lifts.
2
Determine the priority nursing action based on the assessment.
The immediate priority is to assess for the presence of a suicide plan and intent.
Client safety is the highest priority (Maslow's hierarchy/safety and security). When covert or overt signs of suicide are present, the nurse must ask direct, unequivocal questions about self-harm.

Key Concept

Assessing Suicide Risk and Sudden Mood Improvement
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Topics

Mental Health Concepts

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