Question

A divorced, alcoholic man with major depression presents stating, "What is the point in living?" What is the most appropriate next step in management?

• A. Hospitalize
• B. Cognitive behavioural therapy (CBT)
• C. Antidepressant
• D. Reassure that it is a normal part of life

Hint:

Active suicidal ideation + multiple risk factors = ensure safety first.

Answer 1

The Correct Option is A

Step 1: Identify the clinical priority. This patient has major depression plus several high-risk suicide factors - male sex, divorced (lack of social support), alcohol use, and active passive suicidal ideation ("what is the point in living"). Safety always comes first in psychiatric emergencies.

Step 2: Assess suicide risk. The mnemonic SAD PERSONS (Sex-male, Age, Depression, Previous attempt, Ethanol/alcohol, Rational thinking loss, Social support lacking, Organised plan, No spouse, Sickness) flags multiple risk factors here. A patient verbalising suicidal ideation with depression, alcohol dependence and no social support is at imminent risk.

Step 3: Choose management. The immediate priority for an actively suicidal high-risk patient is to ensure safety, which means inpatient hospitalisation for observation, stabilisation and initiation of treatment.

Step 4: Why the others are wrong. CBT and antidepressants are essential parts of definitive treatment but take days to weeks to act and do not address immediate risk - they are started after the patient is in a safe setting. Calling it a normal part of life is dismissive and dangerous. Hence, hospitalise the patient first.