Suicidal Guy (do not rely on Step 1 knowledge!)

[DocSikorski]

65y.o. guy, was developing a plan to kill himself for weeks, bought a gun... now he was saved by his friend from killing himself and hospitalized for 4 weeks.
He showed improvement with inpatient therapy and now he is discharged with an advice to visit a therapist regularly and prescribed ssri.

When will the guy kill himself?

a. right after discharge
b. 2 weeks after starting ssri (he started takin right after discharge)
c. 1 week after discharge
d. 1 month after discharge (he will take ssri all the time)
e. after he gets the gun back
f. when the new plan is ready
g. when Justin Bieber releases the new single (he still on ssri)

[Anders]

Although i liked G but i have to choose B

[step_enhancer]

Answer E

the g option is very funny

[XpaezX]

D

SSRI's start to work after 3 to 6 weeks since the start of the treatment, patients killthemselves when they start to feel better and have the energy to do so..

I find extremely rare he will get the gun back.. seing he tried to kill himself (unless im not familiar with the US law)

All of us would kill ourselves with option G thats for sure

[bashir]

D. depressed patients commit suicide once they get better and regain the energy. antidepressents take 3 weeks to work so after 1 month of SSRI he will get better and likely will have the energy to finish the deal.

[DocSikorski]

Why would you kill yourself if you are fine?!

if depressed pt has adequate treatment - it means he is no longer depressed!

I was stuck with this q, cuz I remember from step 1 that SSRI take 2 weeks to kick in, but step 2 teaches us that they gain maximal effect 3-6 weeks after the treatment has begun.

So the answer is B. 2 weeks after discharge...

[step_enhancer]

Explanation

[DocSikorski]

Originally Posted by step_enhancer

Explanation

Ask UsmleRx...

I assume when he is discharged - he is still positive from just having the treatment, but slowly will get back to his "kill-myself" routine before SSRI will kick in...

[step_enhancer]

Originally Posted by DocSikorski

Ask UsmleRx...

I assume when he is discharged - he is still positive from just having the treatment, but slowly will get back to his "kill-myself" routine before SSRI will kick in...

usmleRx does not provide explanation ??

[Hitman]

ans is A ......... as ssri takes 2 to 3 weeks to have an effect .

[DocSikorski]

answer b.
SSRI take 6-8 wk to reach maximal effect. Anxiolytic effects take place in a few days. The energizing effects implicated in high risk of suicidality start at 2 wk after beginning treatment. Pt's have more energy to carry out their plans between the start of treatment and its maximal effect (ssri have delayed onset of action).

[DocSikorski]

Originally Posted by Hitman

ans is A ......... as ssri takes 2 to 3 weeks to have an effect .

thats the step 1 knowledge that got you

[XpaezX]

Originally Posted by Hitman

ans is A ......... as ssri takes 2 to 3 weeks to have an effect .

When a depressed patient feels like he is right in the deepest hole they dont have the energy to kill themselves, is after the antidepressant starts to work that they feel more motivated to do so, why? because they believe this goodness cannot be forever and are afraid they will fall back to their shitty situation, thats why as soon as they have energy secondary to the antidepressant kicking in thats when they are going to try again and often succeed (men that is, women try more but fail harder LOL)

[Hitman]

Originally Posted by DocSikorski

thats the step 1 knowledge that got you

i dont know about this ....... but would doubt this is right , dont trust Rx much ........ but would have gone with A as uw has a similar qs i guess to point out that ssri takes 2 to 3 wks for effect this is usually the base for such qs and such Qs banks make you go the wrong way . I rather not be over smart and select B becoz this is how i get most of the qs wrong ...... i think i am Dr House and try and make simple Qs complicated ......... .

would still stick to A ......( lets keep it Simple ) .......

[DocSikorski]

Originally Posted by XpaezX

When a depressed patient feels like he is right in the deepest hole they dont have the energy to kill themselves, is after the antidepressant starts to work that they feel more motivated to do so, why? because they believe this goodness cannot be forever and are afraid they will fall back to their shitty situation, thats why as soon as they have energy secondary to the antidepressant kicking in thats when they are going to try again and often succeed (men that is, women try more but fail harder LOL)

I think women fail more often cuz they cut their wrists and call their boyfriends with the words "look what you've done to me"

[DocSikorski]

Originally Posted by Hitman

i dont know about this ....... but would doubt this is right , dont trust Rx much ........ but would have gone with A as uw has a similar qs i guess to point out that ssri takes 2 to 3 wks for effect this is usually the base for such qs and such Qs banks make you go the wrong way . I rather not be over smart and select B becoz this is how i get most of the qs wrong ...... i think i am Dr House and try and make simple Qs complicated ......... .

would still stick to A ......( lets keep it Simple ) .......

It's totally controversial, I hope boards still are a "fair game" and we will not see shiet like that...
It was just interesting for me to come across this question

[Hitman]

Originally Posted by DocSikorski

It's totally controversial, I hope boards still are a "fair game" and we will not see shiet like that...
It was just interesting for me to come across this question

yes true . but would recommend A in exam instead of B ....... lesser chances of getting it wrong becoz they base the qs on a simple fact and we complicate it with the help of such Q banks .........

[DocSikorski]

Originally Posted by Hitman

yes true . but would recommend A in exam instead of B ....... lesser chances of getting it wrong becoz they base the qs on a simple fact and we complicate it with the help of such Q banks .........

the thing is, q says that he had improvement during the treatment, why would he kill himself right after that...
well I dunno..

[XpaezX]

Originally Posted by DocSikorski

the thing is, q says that he had improvement during the treatment, why would he kill himself right after that...
well I dunno..

They kill themselves because they have the energy to do it... the reason i exposed is the reason given in uworld step 1, they cannot believe everything is getting better and hence decide to end their lives.. SSRI's have the black box warning stating that same fact, somehow in the beginning of treatment the incidence of suicide is greater because of what Hitman and myself stated.. i wouldnt pick A because the dude hasnt even started to take SSRI's whereas in B or even D are more likely for the reasons i already stated

[Hitman]

Originally Posted by XpaezX

They kill themselves because they have the energy to do it... the reason i exposed is the reason given in uworld step 1, they cannot believe everything is getting better and hence decide to end their lives.. SSRI's have the black box warning stating that same fact, somehow in the beginning of treatment the incidence of suicide is greater because of what Hitman and myself stated.. i wouldnt pick A because the dude hasnt even started to take SSRI's whereas in B or even D are more likely for the reasons i already stated

yes but he starts taking SSRI right after discharge , but you mean to say the rate of suicide is greater in two weeks after SSRI rather than day 1 ??? infact hes the most depressed on leaving the hospital so no big deal difference between 2 wks , 1 week and right after discharge becoz SSRI not yet working ???

[XpaezX]

Originally Posted by Hitman

yes but he starts taking SSRI right after discharge , but you mean to say the rate of suicide is greater in two weeks after SSRI rather than day 1 ??? infact hes the most depressed on leaving the hospital so no big deal difference between 2 wks , 1 week and right after discharge becoz SSRI not yet working ???

The point is not how depressed he is, but how he improves after treatment..

I didnt make this up, it is labeled in all SSRI's, people thought they caued a paradoxical increase in suicide rates by themselves, when in fact the fact that the patient is improving, eating more, getting more energy, and starting to again be a little bit functional is the double edge weapon..

Daugherty also states this several times.. the most dangerous time for a suicidal/depressed patient is WHEN THEY ARE FEELING OK!

[Hitman]

Originally Posted by XpaezX

The point is not how depressed he is, but how he improves after treatment..

I didnt make this up, it is labeled in all SSRI's, people thought they caued a paradoxical increase in suicide rates by themselves, when in fact the fact that the patient is improving, eating more, getting more energy, and starting to again be a little bit functional is the double edge weapon..

Daugherty also states this several times.. the most dangerous time for a suicidal/depressed patient is WHEN THEY ARE FEELING OK!

oh ! didnt know about this . thanks ........

but i found this on wiki .

• An additional meta-analysis by the FDA in 2006 found an age-related effect of SSRI's. Among adults younger than 25 years, results indicated that there was a higher risk for suicidal behavior. For adults between 25 and 64, the effect appears neutral on suicidal behavior but possibly protective for suicidal behavior for adults between the ages of 25 and 64. For adults older than 64, SSRI's seem to reduce the risk of both suicidal behavior.[35]

Suicide warnings

The FDA findings resulted in a black box warning on SSRI and other antidepressant medications regarding the increased risk of suicidal behavior in patients younger than 24.[47] Similar precautionary notice revisions were implemented by the Japanese Ministry of Health.[48] In 2004 the Medicines and Healthcare products Regulatory Agency in the United Kingdom issued a warning about increases in 'insomnia, agitation, weight loss, headache, tremor, loss of appetite, self harm and suicidal thoughts' when the medications are used with children and adolescents.[49]
The introduction of a warning regarding the association between SSRIs and suicide by the FDA in 2004 led to a dramatic decrease in prescriptions of these medications to young people. Originally, there were concerns that the decrease in prescriptions caused by the warnings could increase the number of teenage suicides in the US.[50] However, the most recent data from the US National Center for Health Statistics put these concerns to rest. The suicide rates for persons younger than 25 has actually decreased between 2004 and 2007.[51][52]


i guess you are right but its more for pts under 25 and 25 to 64



above 64 .risk is negligible .....