A 52-Year-Old Man Is Brought to the Emergency Department by His

question 127

Multiple Choice

A 52-year-old man is brought to the emergency department by his roommate after threatening to commit suicide.  He is angry about being taken to the hospital and says, "I just want to go home and sleep."  His roommate says, "I can't take it anymore; I thought he was going to jump out of the car on the way to the hospital."  The patient has a history of recurrent major depression, post-traumatic stress disorder, and alcohol abuse.  He describes increasing depression since his divorce 5 years ago.  He feels hopeless, has difficulty getting out of bed, and eats only one meal a day.  The patient ruminates about his failed marriage and blames himself for his heavy drinking and losing contact with his 2 grown children.  He has always owned a gun, which he usually keeps in a locked drawer in a bedside table.  However, in the last week he has taken the gun out and held it before going to sleep "because it feels like a security blanket, it's reassuring."  The patient has suicidal thoughts but does not think he will act on them.  He says, "I just need to know I have a way out."  His medical record indicates that he tried to overdose 3 months ago by taking a handful of sleeping pills and drinking 2 liters of vodka.  Last year, he tried to hang himself in his garage but was discovered by his roommate.  The patient has been followed by a psychiatrist in an outpatient clinic.  He felt better when taking duloxetine but has not taken the medication for the past few months as he can no longer afford it.  He insists that he is not feeling suicidal now and demands to leave. The patient is placed on 1:1 observation, and arrangements are made to hospitalize him.  He is upset and tearful and starts to pace.  He says angrily, "You can't keep me here against my will.  If I wanted to kill myself, I would have done it already.  I just want to go home so I can finally get some rest."  The nursing staff attempts to calm the patient down and offers him water and a sandwich, which he refuses.  The physician approaches the patient to explain the treatment plan.  Which of the following is the most appropriate statement?

• A)I can see that you want to go home, but your risk of hurting yourself is too high.
• B)I can see you are upset, but we can reconsider discharge after speaking with your outpatient psychiatrist.
• C)I understand you are upset, but it is necessary to keep you safe while we treat your depression.
• D)I understand you want to go home, but hospitalization is the only way to ensure that you are safe.
• E)I understand you want to leave, but I would not be doing my duty if I let you go home.

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Definitions:

Experimental Unit

The smallest division of the experimental material such that any two units may receive different treatments during the experiment.

Psychology Class

An academic course focusing on the study of the mind and behavior, covering topics from mental functions to social interactions.

Observational Study

A study in which the investigator does not manipulate variables but rather observes and measures variables without intervention to find relationships.

Double-Blind Experiment

A study in which neither the participants nor the experimenters know who is receiving a particular treatment, used to eliminate bias.