A nurse working on an inpatient psychiatric unit observes a client who was admitted for major depressive disorder suddenly appear calm and report 'feeling at peace' after expressing hopelessness for several days. Which interpretation is most clinically concerning?
- A.The client is responding well to antidepressant therapy
- B.The client may have made a decision to attempt suicide and feels relief
- C.The client's mood cycling is consistent with bipolar disorder
- D.The client is demonstrating healthy coping and resilience
Show answer & rationale
Correct answer
B. The client may have made a decision to attempt suicide and feels relief
Rationale
B is correct: A sudden calm or apparent improvement in a severely depressed patient who recently expressed hopelessness is a classic warning sign of suicide risk. The relief may come from having made a decision to act. This requires immediate safety assessment and notification of the treatment team. A is incorrect: Antidepressants take 2-4 weeks to achieve therapeutic effect; a rapid overnight mood change is unlikely to be medication response. C is incorrect: While possible, the sudden calm after hopelessness is a more urgent concern for immediate safety than a diagnostic consideration. D is incorrect: A sudden shift from expressed hopelessness to calm should never be assumed to be positive coping without a thorough safety evaluation.
Key concepts