Deviation in the Standard of Psychiatric Care Resulting in Suicide

Evaluate breaches in the standard of care by evaluating the answers to the questions herein to determine whether or not there was a Deviation in the Standard of Psychiatric Care Resulting in Suicide

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following affective symptoms did the patient present? (Choose all that apply)
    Depressed mood/loss of pleasure in usual activities
    Feeling of worthlessness or guilt/withdrawal from social situations
    Anxiety/irritability
    Suicidal ideation/intent/plan
    None elicited
    Answer unknown
    None of the above
    Why is this important?
    Affective symptoms include those relating to mood, feelings and attitudes.
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  • With which of the following physiological symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
The physiological symptoms of depression include headache, nausea, pain, dyspnea, palpitations, weight change, sleep disturbances, psychomotor disturbances, fatigue, decreased interest and difficulty in performing sexual activities. Depression is common in the elderly, affecting 15 percent; it carries increased risks of morbidity and mortality.

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  • With which of the following cognitive symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Cognition is the mental process of knowing, including aspects such as awareness, perception, reasoning, and judgment.

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  • What was the patient's gender? Why is this important?
    Answer this question
    
Depression is more common in females than males. 

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  • With which of the following risk factors for depression did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    
The risk factors for depression include chronic medical illness, chronic minor daily stress, chronic pain syndrome, female sex, family history of depression, low income/job loss, low self-esteem, low social support, prior depression, single/divorced/widowed, traumatic brain injury, and younger age. 

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  • Was a medical history obtained and documented? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
A physical examination should be performed to rule out physical causes of changes in the patient's mental state, such as substance use and endocrine or neurologic abnormalities. Attention needs to focus on vital sign abnormalities, mental status, signs of substance intoxication or withdrawal; restlessness, agitation, and psychomotor retardation.

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  • With which of the following associated psychiatric disorders did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    
Many clinical conditions and diseases have been noted in persons with major depressive disorder. 

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  • With which of the following associated medical disorders did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
Physical disorders, especially conditions that are chronic, painful, and debilitating are frequently associated with depression. This is particularly true in elderly patients.

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  • Was a screening performed to identify depression? Why is this important?
    Answer this question
    
The U.S. Preventive Services Task Force recommends screening in adolescents and adults in clinical practices that have systems in place to ensure accurate diagnosis, effective treatment, and follow-up. All children and adolescents should be screened for key depressive symptoms including depressive or sad mood, irritability and anhedonia.

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  • Which of the following screening methods were employed?(Choose all that apply) Why is this important?
    Answer this question
    
There is little evidence to recommend one screening method over another, so primary care providers can choose the method that best fits their personal screening preference, the patient population, and the practice setting.

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  • Which of the following signs of depression were elicited from the patient?(Choose all that apply) Why is this important?
    Answer this question
    
The clinician needs to elicit signs of depression which include weight loss or weight gain, slowed speech or movement, evidence of self-neglect, decline in performance in work or school.

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  • Which of the following laboratory tests were performed? (Choose all that apply) Why is this important?
    Answer this question
    
Routine laboratory studies can provide important clues to the diagnosis.

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  • Was the patient diagnosed with depression? Why is this important?
    Answer this question
    
As no screening or case-finding instrument has been demonstrated to be effective on its own, the diagnosis of depression is based on assessment of the patient's clifnical history, signs, and symptoms and the diagnostic criteria from the DSM-IV-TR or the World Health Organization's International Classification of Diseases (ICD-10).

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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    
Routine follow-up evaluations are necessary to offset any complications that may arise Regular check-ups ensure that changes in health are quickly assessed and remedied.

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  • Which of the following had the patient experienced? (Choose all that apply) Why is this important?
    Answer this question
    
Post-partum depression in breast-feeding women occurs in approximately 15% of new mothers. It is important to treat postpartum depression as it can disrupt the mother-child attachment and lead to cognitive, emotional and behavioral problems in the developing child.

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  • Was the patient referred to a psychiatrist? Why is this important?
    Answer this question
    
When symptoms of depression are evident, suicide screening should be a part of any comprehensive psychiatric evaluation.

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  • Did the patient ever attempted suicide in the past? Why is this important?
    Answer this question
    
If a patient had attempted suicide in the past, it is more likely that he/she will make another attempt.

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  • Did the patient verbalize suicidal ideations? Why is this important?
    Answer this question
    
If a patient shares any suicidal thoughts, it is critical to proceed with treatment rather than entertain differential diagnosis. Close surveillance is paramount in patients with suicidal ideation, intention, or plan.

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