Depression

Case Study 142 Depressed Patient with Suicidal
Thoughts
1. What other information should you ask J.B. regarding his

thoughts of suicide?
• Does he have a plan? - when a patient has a plan for killing

themselves, it shows that they have taken so serious consideration in
doing it.
• When does he plan on doing it?
• Have you though of hurting yourself in the past? - patients who have
tried it in the past are most likely to do it again.
2. What characteristics. of J.B. put him at high risk of suicide?
The characteristics that put J.B. at high risk for suicide are as follows:
• Old age/elderly
• Male
• Widower
• Recent Illness
• Lack of support
3. Which psychiatric disorders can result in suicidal ideations

or gestures? Name at least three.
Psychiatric disorders that could result to suicidal ideations or gestures

are:
1. Anxiety
2. Schizophrenia
3. Bipolar Disorder
4. Depression
4. What questions would you ask J.B. to determine whether he

is clinically depressed? Name at least six.
• How long have you been having these feeling of sadness?

• Are you always sleepy?
• Do you have change in your sleeping habits?
• Do you have change in your appetite?
• Have any of your other family members ever been diagnosed as
depressed?
• Do you have the inability to concentrate?
• Do you have the inability to make decisions?
5. Ill people often have trouble sleeping, experience a change

in appetite, reduce their level of activity, and have thoughts of
death. How can you tell the difference between old age with
illness and depression?
Depression causes loss of interest in activities you used to enjoy. There

is a feeling of helplessness and hopelessness, and finding it harder and
harder to get through to the day, and desires to be alone are not
normal. On the other hand, old age can cause fatigue, but it should not
cause a loss of desire, or loss of interest in hobbies and activities unlike
depression.
6. List five of the most common signs of depression in the

older adult.
The common signs of depression amongst older adults are:

• Hopelessness
• Worthlessness
• Anhedonia
• Indecisiveness
• Change in sleeping pattern
CASE STUDY PROGRESS
7. Which of these would be considered soft methods of

suicide? Select all that apply.
a.) Using a gun

b.) Slashing one’s wrist
c.) Hanging
d.) Poisoning with carbon monoxide
e.) Ingesting pills
f.) Inhaling natural gas
8. What immediate interventions would you carry out for J.B.?
Immediate interventions I would carry out for J.B.:

• Suicide precautions
• Contract for safety
• Possible 72 hour observation
• Removal of personal belongings
• One on one supervision
• Maintenance of a safe environment all the way down to utensils
9. Identify two treatments that are available for depression.
1. Pharmacological - antidepressants or anti-anxiety. However, the

most common time for patients to commit suicide are just a couple
week after starting medications, or when they start to feel better.
4. Psychotherapy - Talk therapies are very effective as long as the
patient is compliant.
10. Would J.B. be a candidate for electroconvulsive therapy

(ECT)? Why or why not?
J.B. is definitely not a good candidate for ECT. He has just been through
a major heart surgery which is not recommended for a ECT patient.
Especially that he is of old age, ECT is not a good choice for J.B. Also,
he has never been treated for depression, so he has not failed any
other treatments.
11. What special instructions will you give him regarding the
Lexapro? Select all that apply.
Lexapro boosts one’s serotonin, which plays a role in controlling the

person’s weight. The medication may increase appetite directly, or a
person may begin to eat more as their depression or anxiety lessens.
a.) The full effect of the medication might not be seen for 4-6 weeks.
b.) The medication may cause N/V, dry mouth, sedation, and insomnia.
c.) There are no known food interactions
Taking St. John's wort with an SSRI such as Lexapro might increase the
risk of serotonin syndrome. Drinking alcohol with SSRIs might increase
sedative effects. Both of these interactions are potentially
dangerous.
12. Why do you think that a drug in the SSRI class was chosen
over a tricyclic antidepressant or a monoamine oxidase
inhibitor (MAOI)?
SSRI class was chosen over MAOI because J.B. is a non compliant
diabetic. MAOI’s have strict diet regimens and restrictions. It is unlikely
that J.B would religiously be willing to follow these requirements.
13. What important information needs to be conveyed to J.B’s

daughter about the first few weeks of therapy with the SSRI?
• Do not stop medication all of a sudden

• Do not mix with other medications without prior consultation to
physician
• Maintain follow up appointments with psychiatrist
• Monitor J.B. for toxicity such as head aches and blurred vision
• Monitor J.B, for signs of increased thoughts of suicide, or giving
away his possessions.

Depression

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Case Study 142 Depressed Patient with Suicidal

1. What other information should you ask J.B. regarding his

• Does he have a plan? - when a patient has a plan for killing

2. What characteristics. of J.B. put him at high risk of suicide?

3. Which psychiatric disorders can result in suicidal ideations

Psychiatric disorders that could result to suicidal ideations or gestures

4. What questions would you ask J.B. to determine whether he

• How long have you been having these feeling of sadness?

5. Ill people often have trouble sleeping, experience a change

Depression causes loss of interest in activities you used to enjoy. There

6. List five of the most common signs of depression in the

The common signs of depression amongst older adults are:

CASE STUDY PROGRESS

7. Which of these would be considered soft methods of

a.) Using a gun

8. What immediate interventions would you carry out for J.B.?

Immediate interventions I would carry out for J.B.:

9. Identify two treatments that are available for depression.

1. Pharmacological - antidepressants or anti-anxiety. However, the

10. Would J.B. be a candidate for electroconvulsive therapy

Lexapro boosts one’s serotonin, which plays a role in controlling the

13. What important information needs to be conveyed to J.B’s

• Do not stop medication all of a sudden

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