GP CCE Cases · mental-health
Adult depression with suicidal ideation — CCE clinical encounter
CCE-style clinical encounter: a 38-year-old teacher with moderate depression, passive-to-active suicidal ideation and an unaddressed bipolarity question. The candidate must assess risk, safety-plan, clear the differential before prescribing, and set continuation expectations.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 38-year-old secondary teacher attends after a colleague suggested she 'see someone'. For eight weeks she has felt flat, wakes at 3 am, has stopped netball and is eating 'whatever is around'. PHQ-9 completed on arrival scores 17. When you ask about item 9 she pauses and says she has thought about 'not being here' but would not do anything — though last week she googled how many paracetamol would be dangerous. She drinks four coffees and about six standard drinks weekly. Her cousin was once told she had 'manic depression'.
Objectives
- Complete a structured depression assessment integrating the PHQ-9 score with clinical severity. [1]
- Assess suicide risk directly and respond proportionately to plan-plus-access ideation. [6] [8]
- Clear bipolarity before any prescription using MDQ-based history. [4]
- Negotiate first-line treatment for moderately severe depression with evidence framing. [11]
- Set duration-of-therapy and review expectations that survive the first follow-up. [21] [24]
References7ShowHide
- [1]Kroenke K, Spitzer RL, Williams JB The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001.PMID 11556941
- [4]Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry, 2000.PMID 11058490
- [6]Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry, 2011.PMID 22193671
- [8]Brown GK, Batdorf WH, Dedert EA, Kumpula MJ, Day KT, et al. National implementation of advanced training in the safety planning intervention in the Department of Veterans Affairs health care system. Psychol Serv, 2025.PMID 38900568
- [11]Cipriani A, Furukawa TA, Salanti G, Chaimani A, Atkinson LZ, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet, 2018.PMID 29477251
- [21]Geddes JR, Carney SM, Davies C, Furukawa TA, Kupfer DJ, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet, 2003.PMID 12606176
- [24]Warner CH, Bobo W, Warner C, Reid S, Rachal J Antidepressant discontinuation syndrome. Am Fam Physician, 2006.PMID 16913164