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Suicide risk — ABIM Board MCQ

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ModeratePsychiatry relevant to Internal MedicineSuicide riskABIM Board

A 49-year-old with major depression states that he intends to shoot himself tonight and has a loaded firearm at home. He cannot identify a reason to remain safe. What is the immediate management?

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Correct answer: D — Maintain safety and arrange emergency psychiatric evaluation

The best answer is “Maintain safety and arrange emergency psychiatric evaluation”. Specific intent, imminent timing, available lethal means and inability to maintain safety indicate acute high suicide risk. He needs immediate supervised safety, comprehensive evaluation, lethal-means intervention and an appropriate secure level of care, potentially hospitalization. Screening scores and laboratory tests do not replace risk management, and unsupervised discharge is unsafe.

Reference: 2024 VA/DoD Suicide Risk Clinical Practice Guideline: https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/MH/srb/index.asp