High suicide risk — MCCQE Part 1 MCQ

Correct answer: E — Ensure immediate safety, arrange emergency psychiatric assessment and breach confidentiality as necessary

Ensure immediate safety, arrange emergency psychiatric assessment and breach confidentiality as necessary is the single best answer because the age, timing, examination findings and investigations in the vignette fit High suicide risk better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to CANMAT depression guidelines and provincial mental health legislation, with attention to acuity, safety-netting and local provincial pathways.

Reference: CANMAT depression guidelines and provincial mental health legislation