A 42-year-old woman with established borderline personality disorder and a history of recurrent depressive disorder, currently euthymic, is managed

Question

A 42-year-old woman with established borderline personality disorder and a history of recurrent depressive disorder, currently euthymic, is managed by a specialist personality disorder service. For several years she has experienced daily passive wishes to die and intermittent brief increases in suicidal thoughts after interpersonal stress. At the current review there is no recent escalation, suicidal intent, plan, preparatory behaviour, intoxication or psychosis, and she remains engaged with treatment. According to NICE guidance, which is the most appropriate longitudinal approach to managing her suicidality?

Accepted Answer

Collaboratively formulate long-term and immediate risk, with a crisis plan covering triggers, self-management and access to help; reserve admission for significant risk unmanageable elsewhere.

Answer

Retain a collaborative crisis plan, but arrange brief admission whenever suicidal ideation rises above baseline, irrespective of whether community alternatives can contain the risk.

Answer

Continue community management during every suicidal crisis because admission is generally harmful in borderline personality disorder, even when significant risk cannot be managed by crisis services.

Answer

Use a pre-agreed 7-day sedative prescription as the standard first response to each increase in suicidal ideation, admitting her only if medication fails.

Answer

Use a validated suicide-risk scale at each review and allow the resulting low-, medium- or high-risk category to determine community management or admission.

Chronic Suicidality in BPD — MRCPsych Paper B MCQ