Which of the following clinical features is associated with the HIGHEST imminent suicide risk and warrants immediate hospitalization?

Explanation

## Imminent Suicide Risk Assessment **Key Point:** The presence of **active suicidal ideation + specific plan + access to lethal means** constitutes the highest imminent risk and is a psychiatric emergency requiring immediate hospitalization. ### The Suicide Risk Spectrum | Risk Level | Features | Action | |---|---|---| | **Imminent (Highest)** | Active ideation + detailed plan + access to means | Immediate hospitalization, 1:1 observation | | **High** | Active ideation + plan (but no access) OR intent to act soon | Hospitalization, close monitoring | | **Moderate** | Active ideation + vague plan OR passive ideation with risk factors | Intensive outpatient care, safety planning | | **Low** | Passive ideation only, no plan, protective factors present | Outpatient management, psychotherapy | **High-Yield:** The **SAD PERSONS** mnemonic helps assess suicide risk, but the presence of a specific plan with means access is the single strongest predictor of imminent danger. ### Components of Imminent Risk Assessment 1. **Ideation:** Active (intent to die) vs. passive (wish to be dead but no intent) 2. **Plan specificity:** Vague vs. detailed method, timing, location 3. **Access to means:** Presence of lethal agent (pesticide, rope, firearm, medication) 4. **Intent:** Stated likelihood of acting on ideation 5. **Recent attempt:** Previous attempts, especially recent ones **Clinical Pearl:** A patient who says "I want to die and I have already bought rat poison and plan to take it tonight" requires emergency psychiatric hospitalization. Passive ideation alone ("I wish I were dead") without plan or means is lower risk. ### Why Other Options Are Lower Risk - **Passive ideation without plan:** Indicates distress but not imminent danger - **Remote history of attempt (>5 years):** Indicates past vulnerability but not current imminent risk - **Depression with anhedonia but no ideation:** High risk for future suicide but not imminent [cite:Harrison 21e Ch 397]