A 16-year-old boy is brought to the office by his parents for evaluation of depression. For the past 2 weeks, the patient has cried daily since his girlfriend ended their relationship. After school, he has gone directly to his bedroom and has avoided his parents. The patient quit his high school baseball team last week and now only plays violent video games. He sleeps the majority of the day and states that he has no energy and that his appetite has decreased substantially. The patient also falls asleep in class, when he's not skipping school, and his grades have dropped. Last week, he got into a fight with a classmate. The patient's father is an avid hunter and keeps multiple firearms in the basement of their home. Examination shows a cooperative boy with a flat affect. He says that he has no suicidal or homicidal ideation but has multiple superficial lacerations on the wrists and forearms. Which of the following would be the most effective recommendation for decreasing this patient's immediate suicide risk?

Question

A 16-year-old boy is brought to the office by his parents for evaluation of depression.  For the past 2 weeks, the patient has cried daily since his girlfriend ended their relationship.  After school, he has gone directly to his bedroom and has avoided his parents.  The patient quit his high school baseball team last week and now only plays violent video games.  He sleeps the majority of the day and states that he has no energy and that his appetite has decreased substantially.  The patient also falls asleep in class, when he's not skipping school, and his grades have dropped.  Last week, he got into a fight with a classmate.  The patient's father is an avid hunter and keeps multiple firearms in the basement of their home.  Examination shows a cooperative boy with a flat affect.  He says that he has no suicidal or homicidal ideation but has multiple superficial lacerations on the wrists and forearms.  Which of the following would be the most effective recommendation for decreasing this patient's immediate suicide risk?

Quizplus · Accepted Answer

11ec25c8_d713_ab2f_bc81_5dffdf8c7cc3_MD0003_00 Suicide is a leading cause of mortality in adolescents (age 10-17). Over 40% of these deaths involve firearms, and the majority result from access to a gun in the home. Males, as well as individuals with mental health conditions (eg, depression) and risk-taking behavior, are at higher risk for firearm injury. This patient with signs of a mood disorder (eg, sadness, loss of interest, change in sleep and appetite, decreased energy) and impulsivity (eg, cutting, fighting) has access to firearms at home. The single most effective approach to decrease his risk for suicide and prevent firearm injury/death is removing firearms from the home. If this approach is unfeasible, the patient's family should be educated on proper firearm storage. The safest storage strategy is to lock unloaded firearms and ammunition in separate containers. (Choices A and B) Social alienation is common in suicidal patients, and prolonged exposure to violent video games may be associated with increased aggressive behavior. Although restricting video games and/or rejoining a sports team may help the patient's mood, these approaches will not decrease the immediate suicide risk. Therefore, they are not as effective as removing firearms from the home. (Choice C) Reassurance is appropriate in a patient feeling sad after a relationship ends. However, this patient is demonstrating signs of a mood disorder that is interfering with his daily life. His safety should be addressed as he is at risk for suicidal behavior. (Choice D) Although this patient may experience long-term benefit from treatment with a selective serotonin reuptake inhibitor for depression, the therapeutic effects are not immediate. In addition, these drugs include a black-box warning indicating that they may initially increase suicidality in children/adolescents with depression. Educational objective: Suicide is a leading cause of death in adolescents and often involves firearms. Males with mood disorders and impulsivity are at increased risk. Removing firearms from the home, or locking unloaded firearms and ammunition in separate containers, decreases the risk of suicide. References: Firearm storage in homes with children with self-harm risk factors. (http://www.ncbi.nlm.nih.gov/pubmed/29467279) Firearm-related injuries affecting the pediatric population. (http://www.ncbi.nlm.nih.gov/pubmed/23080412) Influence of violent video gaming on determinants of the acquired capability for suicide. (http://www.ncbi.nlm.nih.gov/pubmed/24210745) Firearm legislation and firearm-related fatalities in the United States. (http://www.ncbi.nlm.nih.gov/pubmed/23467753)

A 16-Year-Old Boy Is Brought to the Office by His