Businessman with Fatigue and Chest Pain Masking Suicidal Intent
Work through a somatic presentation that clears the cardiac workup — but demands a deeper screen. Practise recognising masked depression in a high-risk demographic, asking directly about suicidal ideation and means, and acting on what you find before discharge.
Presentation
A 48-year-old male executive presents to the ED with two months of fatigue, chest tightness, and insomnia, referred by his wife after he downplayed his symptoms.
Learning goals
- Screen for suicidal ideation in patients with unexplained somatic complaints after organic causes are excluded
- Identify rationalised altruistic suicidal thinking and firearm access as high-lethality risk factors requiring immediate action
- Practise means restriction counselling and safe involvement of family in safety planning for a patient who minimises psychiatric symptoms
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