Suicide risk assessment and management US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Suicide risk assessment and management. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Suicide risk assessment and management US Medical PG Question 1: A 19-year-old female college student is brought into the emergency department by her boyfriend. The boyfriend reports that the patient got caught stealing from the company she works for and subsequently got fired. The boyfriend received a text that evening saying “I’ll miss you.” When he arrived at her dorm room, the patient was slumped in the shower covered in blood. The patient agreed to be driven to the emergency room. When asked about what happened, the patient replies “I just want out of this life.” The patient has bipolar disorder, and takes lithium as prescribed. She has a psychiatrist she sees every week, which the boyfriend confirms. She has never had a prior suicide attempt nor has she ever been hospitalized for a psychiatric disorder. The patient’s vitals are stable. Upon physical examination, a 4 centimeter vertical incision is noted on the patient’s left forearm. During the patient’s laceration repair, she asks if she will be admitted. She states, “these ups and downs are common for me, but I feel better now.” She verbalizes that she understands that she overreacted. She asks to go home, and her boyfriend insists that he will stay with her. They both confirm that neither of them have guns or know any peers with access to guns. Which of the following is the most appropriate management for the patient?
- A. Have the patient sign a suicide contract before discharge
- B. Set up a next-day appointment with the patient’s psychiatrist
- C. Involuntarily admit the patient (Correct Answer)
- D. Call the patient’s parents
- E. Discontinue lithium and start valproate
Suicide risk assessment and management Explanation: ***Involuntarily admit the patient***
- The patient's statement "I just want out of this life" combined with the **suicide attempt** (cutting her forearm after a text expressing suicidal ideation) indicates a high risk of self-harm. Despite her current verbalizations of feeling better, the **impulsivity** and severity of the attempt warrant involuntary admission for safety.
- The sudden shift in mood and desire to go home after a serious suicide attempt, stating "these ups and downs are common for me, but I feel better now," suggests potential **lability** and a continued risk that cannot be safely managed with outpatient follow-up alone.
*Have the patient sign a suicide contract before discharge*
- **Suicide contracts** have not been consistently shown to be effective in preventing suicide and can create a false sense of security.
- Given the **actual suicide attempt** and the patient's underlying psychiatric condition, a contract is insufficient to ensure her safety.
*Set up a next-day appointment with the patient’s psychiatrist*
- While follow-up with her psychiatrist is crucial, relying solely on a **next-day appointment** is inadequate given the acute and severe nature of the suicide attempt.
- There is a significant risk of another attempt before the appointment, and the patient needs the **structured environment and constant observation** of an inpatient setting.
*Call the patient’s parents*
- While involving the patient's support system is generally helpful, this action does not directly address the immediate **safety risk** posed by the recent suicide attempt.
- Parental involvement should be considered, but it is not the primary or most appropriate immediate management for a patient at **high risk of self-harm**.
*Discontinue lithium and start valproate*
- Modifying psychotropic medication is a decision made by a psychiatrist after a thorough evaluation, often over time, and is not the immediate or most appropriate "management" in the **emergency setting** for an acute suicide attempt.
- The priority is **safety and stabilization**, not an immediate medication change, especially given that she is already on a mood stabilizer.
Suicide risk assessment and management US Medical PG Question 2: A 17-year-old white female with a history of depression is brought to your office by her parents because they are concerned that she is acting differently. She is quiet and denies any changes in her personality or drug use. After the parents step out so that you can speak alone, she begins crying. She states that school has been very difficult and has been very depressed for the past 2 months. She feels a lot of pressure from her parents and coaches and says she cannot handle it anymore. She says that she has been cutting her wrists for the past week and is planning to commit suicide. She instantly regrets telling you and begs you not to tell her parents. What is the most appropriate course of action?
- A. Prescribe an anti-depressant medication and allow her to return home
- B. Refer her to a psychiatrist
- C. Explain to her that she will have to be hospitalized as she is an acute threat to herself (Correct Answer)
- D. Tell her parents about the situation and allow them to handle it as a family
- E. Prescribe an anti-psychotic medication
Suicide risk assessment and management Explanation: ***Explain to her that she will have to be hospitalized as she is an acute threat to herself***
- This patient is actively suicidal and engaging in **self-harm (cutting)**, which represents an immediate and serious risk to her life, necessitating **involuntary hospitalization** for her safety.
- In cases of acute suicidality, the ethical principle of **beneficence** (acting in the patient's best interest) and **non-maleficence** (avoiding harm) overrides confidentiality to ensure the patient's immediate safety.
*Prescribe an anti-depressant medication and allow her to return home*
- While an antidepressant may be part of long-term management, simply prescribing medication and sending her home is **inappropriate and dangerous** given her active suicidal ideation and self-harm.
- Antidepressants can have a delayed onset of action (2-4 weeks) and, in some adolescents, may initially increase the risk of **suicidal thoughts**, making close monitoring essential.
*Refer her to a psychiatrist*
- A referral to a psychiatrist is crucial for comprehensive evaluation and long-term treatment, but it does **not address the immediate danger** presented by her active suicidal plans and self-harm.
- An urgent psychiatric consultation or hospitalization is needed first, with a referral following stabilization.
*Tell her parents about the situation and allow them to handle it as a family*
- While parents must be informed, simply delegating the responsibility to them is **insufficient and potentially negligent** given the patient's acute suicidal risk.
- **Medical professionals** have a duty to ensure the safety of a suicidal minor, which often requires a higher level of intervention than parental supervision alone.
*Prescribe an anti-psychotic medication*
- There is **no indication of psychosis** in this patient's presentation; her symptoms are consistent with severe depression and acute suicidality.
- Prescribing an antipsychotic would be **inappropriate** and could cause unnecessary side effects without addressing the underlying depressive disorder or acute suicidal crisis.
Suicide risk assessment and management US Medical PG Question 3: An 82-year-old woman comes to the physician because of difficulty sleeping and increasing fatigue. Over the past 3 months she has been waking up early and having trouble falling asleep at night. During this period, she has had a decreased appetite and a 3.2-kg (7-lb) weight loss. Since the death of her husband one year ago, she has been living with her son and his wife. She is worried and feels guilty because she does not want to impose on them. She has stopped going to meetings at the senior center because she does not enjoy them anymore and also because she feels uncomfortable asking her son to give her a ride, especially since her son has had a great deal of stress lately. She is 155 cm (5 ft 1 in) tall and weighs 51 kg (110 lb); BMI is 21 kg/m2. Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tired and has a flattened affect. Cognition is intact. Which of the following is the most appropriate initial step in management?
- A. Begin mirtazapine therapy
- B. Begin cognitive-behavioral therapy
- C. Notify adult protective services
- D. Assess for suicidal ideation (Correct Answer)
- E. Recommend relocation to a nursing home
Suicide risk assessment and management Explanation: ***Assess for suicidal ideation***
- The patient exhibits several **risk factors for depression**, including **insomnia**, **early morning awakening**, **anorexia**, **weight loss**, and significant **anhedonia** (lack of enjoyment in activities).
- Given her age, recent loss of her husband, social withdrawal, feelings of guilt, and significant emotional distress, it is crucial to first assess for **suicidal ideation** before initiating other treatments.
- **Elderly patients with depression have elevated suicide risk**, especially with recent bereavement and social isolation. Safety assessment is the **mandatory first step** in managing any patient with major depressive symptoms.
*Begin mirtazapine therapy*
- While **mirtazapine** is an effective antidepressant that could address several of her symptoms (insomnia, poor appetite, depression), it should only be considered after a **thorough safety assessment**, particularly for suicide risk.
- Starting medication without assessing for immediate danger may overlook critical safety concerns.
*Begin cognitive-behavioral therapy*
- **Cognitive-behavioral therapy (CBT)** is an effective treatment for depression and could be beneficial for this patient.
- However, similar to medication, it is a subsequent treatment step. The immediate priority is to rule out **suicidal intent** given the severity of her depressive symptoms.
*Notify adult protective services*
- There is no direct evidence of **abuse or neglect** in the provided information that would warrant involving adult protective services.
- Her feelings of guilt and worry about burdening her family, while contributing to her depression, do not indicate that her son or daughter-in-law are harming her.
*Recommend relocation to a nursing home*
- While the patient is elderly and potentially depressed, there is no medical or social necessity presented that indicates she requires or would benefit from a **nursing home** at this stage.
- This step would be premature and does not address the immediate mental health concerns or potential safety issues.
Suicide risk assessment and management US Medical PG Question 4: A 24-year-old woman visits her psychiatrist a week after she delivered a baby. She is holding her baby and crying as she waits for her appointment. She tells her physician that a day or so after her delivery, she has been finding it difficult to contain her feelings. She is often sad and unable to contain her tears. She is embarrassed and often starts crying without any reason in front of people. She is also anxious that she will not be a good mother and will make mistakes. She hasn’t slept much since the delivery and is often stressed about her baby getting hurt. She makes excessive attempts to keep the baby safe and avoid any mishaps. She does not report any loss of interest in her activities and denies any suicidal tendencies. Which of the following is best course of management for this patient?
- A. Get admitted immediately
- B. Come back for a follow-up in 2 weeks (Correct Answer)
- C. Start on a small dose of fluoxetine daily
- D. Give her child to child protective services
- E. Schedule an appointment for electroconvulsive therapy
Suicide risk assessment and management Explanation: ***Come back for a follow-up in 2 weeks***
- This patient presents with symptoms highly suggestive of **postpartum blues**, which typically resolve spontaneously within two weeks after delivery.
- Reassurance, emotional support, and monitoring her symptoms with a follow-up appointment are the most appropriate initial steps.
*Get admitted immediately*
- Immediate admission is generally reserved for more severe conditions like **postpartum psychosis**, characterized by delusions, hallucinations, or severe disorganization, which are not described here.
- Her symptoms, though distressing, do not indicate a level of impairment or danger requiring urgent inpatient care.
*Start on a small dose of fluoxetine daily*
- **Antidepressant medication** like fluoxetine is typically considered for **postpartum depression** if symptoms persist beyond two weeks or are severe from the outset.
- Given the transient nature of postpartum blues, medication is not the first-line treatment.
*Give her child to child protective services*
- This action is extreme and entirely unwarranted, as there is no indication of **child abuse, neglect, or harm** from the mother.
- Her increased anxiety about the baby's safety indicates concern, not a risk to the child's well-being.
*Schedule an appointment for electroconvulsive therapy*
- **Electroconvulsive therapy (ECT)** is a highly effective, but usually last-resort, treatment reserved for severe, treatment-refractory depression or psychosis, especially when rapid response is critical.
- Her symptoms do not currently warrant such an intensive intervention.
Suicide risk assessment and management US Medical PG Question 5: A 16-year-old boy comes to the physician for the evaluation of fatigue over the past month. He reports that his energy levels are low and that he spends most of his time in his room. He also states that he is not in the mood for meeting friends. He used to enjoy playing soccer and going to the shooting range with his father, but recently stopped showing interest in these activities. He has been having difficulties at school due to concentration problems. His appetite is low. He has problems falling asleep. He states that he has thought about ending his life, but he has no specific plan. He lives with his parents, who frequently fight due to financial problems. He does not smoke. He drinks 2–3 cans of beer on the weekends. He does not use illicit drugs. He takes no medications. His vital signs are within normal limits. On mental status examination, he is oriented to person, place, and time. Physical examination shows no abnormalities. In addition to the administration of an appropriate medication, which of the following is the most appropriate next step in management?
- A. Hospitalization
- B. Recommend alcohol cessation
- C. Recommend family therapy
- D. Instruct parents to remove guns from the house (Correct Answer)
- E. Contact child protective services
Suicide risk assessment and management Explanation: ***Instruct parents to remove guns from the house***
- The patient has **suicidal ideation** and access to a firearm, which is a significant risk factor for suicide attempts. Removing access to lethal means is a crucial and immediate safety measure.
- While other interventions are important, securing the environment by removing firearms directly addresses an immediate and modifiable **suicide risk factor**, especially in an adolescent with depression.
*Hospitalization*
- Although the patient expresses suicidal thoughts, he states he has **no specific plan**, which suggests he may not require immediate inpatient psychiatric hospitalization.
- Hospitalization is typically reserved for individuals with a **specific suicide plan**, intent, and significant risk that cannot be managed in an outpatient setting.
*Recommend alcohol cessation*
- While **alcohol use** is a concern and can exacerbate depression or suicidal ideation, addressing this is not the most immediate next step in managing acute suicide risk.
- Alcohol cessation is a valuable long-term goal but does not directly mitigate the immediate danger posed by access to lethal means.
*Recommend family therapy*
- **Family therapy** could be beneficial in addressing family conflicts and improving communication, which might contribute to the patient's stress.
- However, addressing family dynamics is a long-term intervention and does not take precedence over immediately securing the patient's safety concerning lethal means.
*Contact child protective services*
- There is no information in the vignette to suggest **child abuse or neglect** by the parents.
- Financial problems and parental fighting, while disruptive, do not automatically constitute grounds for involving child protective services.
Suicide risk assessment and management US Medical PG Question 6: In 2006, three researchers from North Carolina wanted to examine the benefits of treating the risk of suicidality in children and adolescents by looking at randomized, multicenter, controlled trials of sertraline usage compared to placebo. Their analysis found clinically significant benefits of the drug and a positive benefit-to-risk ratio for sertraline in adolescents with major depressive disorder. They also found that 64 depressed children and adolescents need to receive the drug for 1 extra patient to experience suicidality as an adverse outcome. In other words, if 64 treated individuals received sertraline, some would experience suicidality due to their illness, some would not experience suicidality, and 1 individual would become suicidal due to the unique contribution of sertraline. Which of the following statements is true for this measure (defined as the inverse of the attributable risk), which aims to describe adverse outcomes this way?
- A. Higher measures indicate greater risk.
- B. Input values must be probabilities of the events of interest. (Correct Answer)
- C. Multiple risks can be contained and described within one result.
- D. The final metric represents proportions in percentage terms.
- E. The measure can include multiple events at one time.
Suicide risk assessment and management Explanation: ***Input values must be probabilities of the events of interest.***
- The measure described (- the inverse of the **attributable risk** - or more accurately, the **Number Needed to Harm** or **NNH**) is derived from **absolute risk reduction**, which requires the risk of an event in the exposed group and the risk of the event in the unexposed/control group to be expressed as **probabilities or proportions**.
- These probabilities are essential for calculating the difference in event rates, which is then inverted to get the NNH.
*Higher measures indicate greater risk.*
- A **higher NNH** (e.g., 64 in this case) indicates that a larger number of patients need to be treated for one additional adverse event to occur, implying a **lower risk** associated with the treatment.
- Conversely, a **lower NNH** (e.g., 10) would mean fewer patients need to be treated for one additional adverse event, indicating a **higher risk**.
*Multiple risks can be contained and described within one result.*
- The NNH (or Number Needed to Treat) is typically calculated for a **single specific outcome** (either beneficial or harmful).
- While an overall benefit-to-risk analysis might involve considering multiple outcomes, the NNH itself quantifies the impact for **one defined event**.
*The final metric represents proportions in percentage terms.*
- The final metric (NNH) is expressed as a **whole number** (e.g., 64), representing the number of patients.
- It does **not represent a proportion or a percentage**; rather, it indicates how many individuals need to be exposed to experience one additional event.
*The measure can include multiple events at one time.*
- The NNH is event-specific; it calculates the number of patients for **one particular adverse event**.
- To analyze multiple events, one would need to calculate **separate NNH values** for each individual event.
Suicide risk assessment and management US Medical PG Question 7: A 29-year-old man with post-traumatic stress disorder is admitted to the hospital following an intentional opioid overdose. He is a soldier who returned from a deployment in Afghanistan 3 months ago. He is divorced and lives alone. His mother died by suicide when he was 8 years of age. He states that he intended to end his life as painlessly as possible and has also contemplated using his service firearm to end his life. He asks the physician if assisted suicide is legal in his state. He does not smoke or drink alcohol but uses medical marijuana daily. Mental status examination shows a depressed mood and constricted affect. Which of the following is the strongest risk factor for suicide in this patient?
- A. Male sex
- B. Lack of social support
- C. Attempted drug overdose (Correct Answer)
- D. Use of medical marijuana
- E. Family history of completed suicide
Suicide risk assessment and management Explanation: ***Attempted drug overdose***
- A **prior suicide attempt** is the single strongest predictor of future suicide completions. This patient's recent intentional overdose significantly elevates his risk.
- The fact that the attempt involved a **lethal method** (opioid overdose) indicates high suicidal intent and lethality, further increasing the risk.
*Male sex*
- While men have a **higher rate of completed suicide** than women, male sex alone is not the strongest individual risk factor compared to a prior attempt.
- This is a demographic risk factor that contributes to overall risk but does not carry the same weight as a direct behavioral indicator of suicidality.
*Lack of social support*
- **Social isolation** and lack of support are significant risk factors for suicide. The patient's divorce and living alone contribute to his vulnerability.
- However, while important, research consistently shows that a **previous suicide attempt** is a more potent predictor of future suicide than social isolation.
*Use of medical marijuana*
- While **substance use disorders** (including marijuana use, especially if used to self-medicate) can increase suicide risk by impairing judgment and increasing impulsivity, it is not the strongest factor here.
- There is no direct evidence presented that this patient's medical marijuana use directly triggered his current suicidal intent, unlike his documented overdose attempt.
*Family history of completed suicide*
- A **family history of suicide** (specifically, his mother's suicide) is a recognized risk factor, indicating genetic predisposition, environmental factors, or a learned coping mechanism.
- However, a personal history of a **serious suicide attempt** carries significantly more weight in predicting future suicide completions than a family history alone.
Suicide risk assessment and management US Medical PG Question 8: A 60-year-old Caucasian man is brought to the emergency department by his roommate after he reportedly ingested a bottle of Tylenol. He reports being suddenly sad and very lonely and impulsively overdosed on some pills that he had laying around. He then immediately induced vomiting and regurgitated most of the pills back up and rushed to his roommate for help. The patient has a past medical history significant for hypertension and diabetes. He takes chlorthalidone, methadone, and glimepiride regularly. He lives in a room alone with no family and mostly keeps to himself. The patient’s vital signs are normal. Physical examination is unremarkable. The patient says that he still enjoys his life and regrets trying to overdose on the pills. He says that he will probably be fine for the next few days but has another bottle of pills he can take if he starts to feel sad again. Which of the following is the best predictor of this patient attempting to commit suicide again in the future?
- A. His race
- B. He has a previous attempt (Correct Answer)
- C. He has a plan
- D. His lack of social support
- E. His age
Suicide risk assessment and management Explanation: ***He has a previous attempt***
- A **history of prior suicide attempts** is the strongest predictor of future suicidal behavior. Each attempt increases the risk of subsequent attempts and eventual death by suicide.
- The patient's immediate remorse and reaching out for help, while positive, do not negate the significant risk associated with the actual attempt.
*His race*
- While certain racial and ethnic groups may have varying suicide rates, **race alone is not the most significant independent predictor** in an individual case when compared to direct behavioral risk factors.
- Socioeconomic factors and cultural influences often play a more prominent role than race itself.
*He has a plan*
- The patient had a plan and attempted to act on it, but the question asks for the **best predictor of *future* attempts**, not the immediate risk.
- While having a plan indicates immediate risk, a **previous attempt** is a stronger longitudinal predictor of *repeated* behavior.
*His lack of social support*
- **Social isolation and lack of social support** are significant risk factors for suicide and can contribute to feelings of hopelessness.
- However, the direct behavioral evidence of a **past attempt** is a more potent and immediate predictor of recurrence than a demographic or social factor.
*His age*
- **Older age can be a risk factor** for suicide, especially for white males, due to factors like chronic illness, loss of loved ones, and social isolation.
- Nevertheless, a **previous suicide attempt** is a more powerful and direct indicator of future risk regardless of age.
Suicide risk assessment and management US Medical PG Question 9: A 27-year-old woman is brought to the physician by her parents because they are concerned about her mood. They say that she has “not been herself” since the death of her friend, who was killed 3 weeks ago when the fighter jet he piloted was shot down overseas. She says that since the incident, she feels sad and alone. She reports having repeated nightmares about her friend's death. Her appetite has decreased, but she is still eating regularly and is otherwise able to take care of herself. She does not leave her home for any social activities and avoids visits from friends. She went back to work after taking 1 week off after the incident. Her vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she appears sad, has a full range of affect, and is cooperative. In addition to taking measures to evaluate this patient's anxiety, which of the following is the most appropriate statement by the physician at this time?
- A. I can see that you have gone through a lot recently, but I think that your reaction is especially severe and has persisted for longer than normal. Would you be open to therapy or medication to help you manage better?
- B. I am worried that you may be having an abnormally severe reaction to what is an understandably stressful event. I recommend attending behavioral therapy sessions to help you deal with this challenge.
- C. Your grief over the loss of your friend appears to have a negative effect on your social and functional capabilities. I recommend starting antidepressants to help you deal with this challenge.
- D. I'm so sorry, but the loss of loved ones is a part of life. Let's try to find better ways for you to deal with this event.
- E. I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts? (Correct Answer)
Suicide risk assessment and management Explanation: ***I understand that the sudden loss of your friend has affected you deeply. Sometimes in situations like yours, people have thoughts that life is not worth living; have you had such thoughts?***
- This statement empathetically acknowledges the patient's grief while **directly assessing for suicidal ideation**, which is crucial in any evaluation of a patient experiencing significant emotional distress, especially after a recent loss.
- The patient's presentation, including sadness, social withdrawal, decreased appetite, and nightmares, is consistent with **grief**, but the physician must rule out more severe conditions like **major depressive disorder (MDD)**, for which suicidal thoughts are a key diagnostic criterion and safety concern.
*I can see that you have gone through a lot recently, but I think that your reaction is especially severe and has persisted for longer than normal. Would you be open to therapy or medication to help you manage better?*
- This statement is somewhat judgmental ("especially severe and has persisted for longer than normal") for a patient only three weeks out from a traumatic loss, which could invalidate her feelings.
- While therapy or medication might be considered, it's generally too early to classify her normal grief response as an abnormal or prolonged reaction without first screening for immediate safety concerns like suicidal ideation.
*I am worried that you may be having an abnormally severe reaction to what is an understandably stressful event. I recommend attending behavioral therapy sessions to help you deal with this challenge.*
- Similar to the previous option, labeling her reaction as "abnormally severe" at this early stage (3 weeks post-loss) can be perceived as invalidating and may make the patient less open to further discussion or treatment.
- Recommending therapy without first assessing for suicidal ideation or a more comprehensive diagnostic evaluation is premature and misses a critical screening step.
*Your grief over the loss of your friend appears to have a negative effect on your social and functional capabilities. I recommend starting antidepressants to help you deal with this challenge.*
- While her social and functional capabilities are affected, grief is a normal human response, and recommending antidepressants after only 3 weeks post-loss, without a full psychiatric evaluation or ruling out suicidal ideation, is often premature.
- **Antidepressants** are typically considered for **MDD** or **prolonged grief disorder**, usually after a longer period (e.g., 6 months for adults) or if symptoms are markedly severe and debilitating, especially with an immediate safety concern.
*I'm so sorry, but the loss of loved ones is a part of life. Let's try to find better ways for you to deal with this event.*
- This statement, particularly "the loss of loved ones is a part of life," can come across as dismissive and insensitive to the patient's individual pain and trauma.
- It minimizes her experience and does not create an empathetic environment necessary for a patient to open up about potentially sensitive topics, such as suicidal thoughts.
Suicide risk assessment and management US Medical PG Question 10: A 26-year-old man is brought to the emergency room by his roommate after he was found attempting to commit suicide. His roommate says that he stopped him before he was about to jump off the balcony. He has been receiving treatment for depression for about a year. 6 months ago, he had come to the hospital reporting decreased interest in his daily activities and inability to concentrate on his work. He had stopped going out or accepting invitations for any social events. He spent several nights tossing and turning in bed. He also expressed guilt for being unable to live up to his parents’ expectations. His psychiatrist started him on fluoxetine. He says that none of the medications have helped even though the dose of his medication was increased on several occasions, and he was also switched to other medications over the course of the past year. He has mentioned having suicidal thoughts due to his inability to cope with daily activities, but this is the first time he has ever attempted it. Which of the following would this patient be a suitable candidate for?
- A. Electroconvulsive therapy (Correct Answer)
- B. Exposure therapy
- C. Cognitive behavioral therapy
- D. Olanzapine
- E. Amitriptyline
Suicide risk assessment and management Explanation: ***Electroconvulsive therapy***
- The patient exhibits **severe, treatment-resistant depression with active suicidal ideation and a recent attempt**, making ECT an appropriate and often life-saving intervention.
- ECT is highly effective for severe depression, especially when other treatments have failed and there is an **imminent risk of suicide**.
*Exposure therapy*
- This therapy is primarily used for **anxiety disorders, phobias, and PTSD**, where it helps individuals confront fears.
- It is not indicated for treating severe, persistent depressive episodes or acute suicidal ideation.
*Cognitive behavioral therapy*
- While CBT is effective for depression, this patient's **severe and refractory nature of his depression**, coupled with an active suicide attempt, indicates a need for a more rapid and intensive intervention than CBT alone can provide.
- CBT by itself would generally not be sufficient for a patient with **acute suicidal risk** who has failed multiple pharmacological treatments.
*Olanzapine*
- Olanzapine is an **antipsychotic medication** that can be used as an adjunct in treatment-resistant depression, but it is not typically the first-line augmentation strategy after multiple antidepressant failures and is not as rapidly effective for acute suicidality as ECT.
- Using an atypical antipsychotic like olanzapine alone would not address the immediate, life-threatening risk as effectively as ECT in this severe situation.
*Amitriptyline*
- Amitriptyline is a **tricyclic antidepressant (TCA)**, which is an older class of antidepressants.
- Given the patient has failed multiple prior antidepressant trials and presents with severe, suicidal depression, starting another antidepressant, especially a TCA with its **higher side effect profile and slower onset of action**, would not be appropriate for immediate risk management.
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