Crisis Intervention

回顧開始服用 sertraline 後的追蹤時程，並判斷何時常規監測必須改為緊急自殺安全介入。

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Time	Data
Week 1	PHQ-9 score 18. Mild nausea and fatigue. The client denies suicidal thoughts, plan, or intent and agrees to the next scheduled contact.PHQ-9 分數 18。輕微噁心及疲倦。個案否認自殺意念、計畫或意圖，並同意下一次預定接觸。
Week 2	PHQ-9 score 16. Nausea is decreasing and sleep is slightly improved. The client denies suicidal thoughts.PHQ-9 分數 16。噁心減輕且睡眠稍微改善。個案否認自殺意念。
Week 3	PHQ-9 score 14. The client says, My family would be better off without me. A loaded firearm is accessible at home.PHQ-9 分數 14。個案表示：「我的家人沒有我會更好。」家中可取得已上膛的槍枝。
Week 4	After urgent crisis evaluation, the client denies current intent. A written safety plan is present, the firearm is stored outside the home, a support person is involved, and follow-up is scheduled for tomorrow.緊急危機評估後，個案否認當下意圖。已備有書面安全計畫，槍枝存放於家外，有支持者參與，且已安排明日追蹤。

Q1. Which response is appropriate at the week 1 contact?第 1 週接觸時，哪項回應是適當的？

Stop all monitoring because suicidal thoughts are denied因否認自殺意念而停止所有監測 Assess symptoms, adverse effects, and suicidality directly and continue planned follow-up直接評估症狀、不良反應及自殺意念，並繼續原定追蹤 Assume the medication is ineffective and double the dose without an order假設藥物無效，在沒有醫囑的情況下將劑量加倍

Q2. What is the nurse's priority at week 3?第 3 週時，護理師的優先處置為何？

Schedule the next routine visit and advise the client to call if thoughts worsen安排下一次常規回診，並告知個案若意念惡化再來電 Ask the client to sign a no-suicide contract and then leave alone請個案簽署不自殺契約，然後讓其獨處 Stay with the client, assess plan and intent, activate urgent evaluation, and restrict firearm access留在個案身邊，評估計畫與意圖，啟動緊急評估，並限制槍枝取得

Q3. Which week 4 information best supports a safer follow-up plan?第 4 週的哪項資訊最能支持較安全的追蹤計畫？

A collaborative written safety plan, restricted firearm access, involved support, and rapid follow-up協作式書面安全計畫、槍枝取得受限、支持者參與及快速追蹤 A verbal promise never to think about suicide again口頭承諾永遠不再有自殺念頭 A lower PHQ-9 score without any assessment of means or supportPHQ-9 分數降低，但未評估工具或支持系統

解析

所有服用抗憂鬱劑的個案都應監測臨床惡化及緊急自殺意念，尤其是在治療初期及劑量調整前後；安全評估並非僅限於 25 歲以下的個案。在第 3 週，關於「沒有我會更好」的陳述加上可取得槍枝，需要立即直接評估並緊急升級處置。護理師不應讓個案獨處，應啟動緊急行為健康路徑，並協作限制致命工具及制定書面安全計畫。承諾或不自殺契約並不足夠。危機評估後，否認當下意圖並不代表追蹤結束；護理師需確認安全計畫、槍枝取得受限、快速追蹤及支持系統參與。

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