Episode notes
The PMHNP is evaluating a new patient who has been referred by his employer for evaluation. His supervisor is concerned about his mental health and his safety. The NP evaluates the patient and does not find criteria consistent with major depressive disorder, but identifies which of the following as particularly concerning for risk of suicide? A. Anhedonia B. Hopelessness C. Depressed mood D. Weight loss --- YouTube: https://www.youtube.com/watch?v=sNlBelJr92M&...
Transcript
Read the transcript · about 750 words
Voiceover: Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Expert Fitzgerald faculty clinicians share their knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So, if you're ready, let's jump right in.
Sally Miller: The PMHNP is evaluating a new patient who has been referred by his employer for evaluation. His supervisor is concerned about his mental health and his safety. The NP evaluates the patient and does not find criteria consistent with major depressive disorder, but identifies which of the following as particularly concerning for risk of suicide?
A. Anhedonia
B. Hopelessness
C. Depressed mood
D. Weight loss.
The question is which of the following as particularly concerning for risk of suicide? And in this case, in any case to answer that question, B is the correct answer.
Whether or not the patient meets criteria for a major depressive episode, the presence of hopelessness is particularly alarming as compared to all other findings listed. While not every patient will meet criteria for a depressive episode, many with a constellation of features including hopelessness, previous attempts, unemployment or poor economic conditions, adverse childhood experiences, and a number of other risk factors still presents an appreciable risk for suicidality. And so, it really is an important distinction. Remember, not all people that feel depressed have a major depressive episode. And not everyone who has a major depressive episode feels depressed.
In your clinical rotations, how many times did you encounter a patient who clearly has a diagnosis of major depressive episode, but tells you, "Nah, I don't really feel depressed. I just don't feel like doing anything. I have no motivation. I have no energy. I have no interest.” So the first thing here is it's important to recognize the difference between feeling depressed and a depressive episode.
The next thing is that hopelessness as a symptom, whether the patient does meet criteria for major depressive episode or does not, hopelessness in its own right is a really significant risk factor for suicidality whether or not they have a depressive disorder or a depressive episode. The patient who genuinely feels hopeless about the future, the patient who genuinely feels as if there is no hope. There is nothing to look forward to. There is no reason to go on does have an increased risk for suicidality. And there are several other things that we look for when we're doing a suicide risk assessment. Again, with or without depressive disorder, with or without even a depressive mood, someone who has a history of previous attempts. Patients that have immediate relationship risk factors like social isolation or current relationship problems or the victim of bullying. The recent loss of a significant other, not necessarily just an intimate partner, but anyone significant in their life, whether it was a, you know, a parent or a sibling or a child or a friend or whatever, whether it's an immediate loss or the anniversary of a loss. These are all things that are that in themselves constitute a risk for suicidality. Which is why a suicide risk assessment should be a separate distinct thing from a depression risk assessment.
Adverse childhood experiences. I know you're familiar with the adverse childhood experiences study. And if you're not, you definitely want to tune up on that for your board's review as well. It almost always shows up in a question or two. Adverse childhood experiences or ACE like is a phenomenon where it evaluates the incidence of adverse childhood experiences as the risk for a number of things later in the lifespan including suicidality. So again, the answer to this question is if you evaluate a patient and you find that they have anhedonia, depressed mood, weight loss, these are all symptoms of a major depressive episode and they may actually have it. But those things in their own right don't constitute a significant risk for suicidality. However, hopelessness, whether in the context of a depressive episode or separately, separate from a depressive episode, hopelessness specifically is very concerning for suicide risk.
Voiceover: Thank you for listening to NP Certification Q&A presented by Fitzgerald Health Education Associates. Please rate, review, and subscribe to this podcast. And for more NP resources, visit fhea.com.
Transcript supplied by the publisher with the episode.
Podcast
PMHNP Certification Q & A
Fitzgerald Health Education Associates · Learning · English
This podcast is for NP students studying to pass their PMHNP certification exam. Expert Fitzgerald faculty clinicians share their knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer.
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