# 16歲青少年新近被診斷重度憂鬱症,口服fluoxetine 20 mg每日已1週。母親回報青少年「精力較佳」但異常安靜,將心愛物品送人,最近還傳了道別訊息給朋友。護理師最優先的行動為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375256&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

16歲青少年新近被診斷重度憂鬱症,口服fluoxetine 20 mg每日已1週。母親回報青少年「精力較佳」但異常安靜,將心愛物品送人,最近還傳了道別訊息給朋友。護理師最優先的行動為何?

## 選項

1. 立即指導母親停用fluoxetine，因為這些徵象顯示藥物正在惡化憂鬱症並引發自殺意念。
2. 建議家屬等待4週後的下一次預定門診，因為這些反應通常無需干預即可自行緩解。
3. 立即進行直接的自殺風險評估 — 詢問自殺意念、計畫、手段、既往嘗試,並與家屬共同擬定安全計畫。 **✔ 正確答案**
4. 解釋fluoxetine使用初期常會出現精力增加和情緒較平靜，這表示憂鬱症開始好轉，因此無需干預。

**正確答案: 3**

## 解析

SSRI對25歲以下患者,尤其於治療開始1〜2個月或調整劑量後,有自殺意念與行為增加的FDA黑框警告。精力與動機常先於情緒恢復,使原本失能的患者具有付諸行動的能量。情境中的警訊(贈物、道別訊息、社交退縮)需立即進行直接自殺風險評估,使用如C-SSRS工具,擬定安全計畫、限制手段(槍枝、藥物)並明確追蹤。安撫、延後就診或自行停藥皆不安全。

## 深入解析

直接詢問自殺不會植入念頭 — 沉默才會。青少年新近開始SSRI的標準是前4週每週、之後每兩週追蹤,並對家屬進行警訊衛教。

## 臨床情境

情境 16歲新診斷MDD,fluoxetine 20 mg口服每日已1週。母親來電:青少年「較有精力」但退縮,整理舊照、把吉他送朋友,昨晚發訊「媽媽我愛妳」。無自殺企圖紀錄,但家中可取得槍枝。目前與父母在家,同意至診所。

## 重要概念

- **SSRI黑框警告** — FDA黑框警告(2004/2007):兒童、青少年及25歲以下年輕成人在SSRI治療早期及調整劑量後自殺意念/行為風險上升,需明確知情同意與治療初期每週監測。
- **C-SSRS** — 哥倫比亞自殺嚴重度量表 — 簡短且通過驗證的工具,評估自殺意念強度、行為與頻率,將風險分為低/中/高並指導照護層級。
- **手段限制** — 降低致命手段(鎖好或移除槍枝、限制藥物儲量、收好利器)的可及性,是預防自殺證據最強的措施之一,也是任何安全計畫的核心。

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