A client who has attempted suicide has an underlying diagnosis of depression. Based on the biochemical function that is most associated with suicidal behavior, the nurse anticipates which medication classification will be ordered for the client?

Choice A reason: Neuroleptic malignant syndrome is associated with antipsychotics, not SSRIs like paroxetine, causing muscle rigidity and hyperthermia via dopamine blockade. The client’s symptoms, including hyperreflexia and diarrhea, align with serotonin excess, not dopamine-related issues, making this condition unlikely.

Choice B reason: Agranulocytosis, a severe reduction in white blood cells, is unrelated to paroxetine’s mechanism. SSRIs increase serotonin, not affecting hematopoiesis. The client’s symptoms like hyperpyrexia and hyperreflexia indicate serotonin toxicity, not an immunological or bone marrow disorder.

Choice C reason: Acute dystonic reactions involve muscle spasms from antipsychotics’ dopamine antagonism, not SSRIs. Paroxetine’s serotonin increase causes hyperreflexia and hyperpyrexia, consistent with serotonin syndrome, not extrapyramidal symptoms, making this diagnosis inappropriate for the described clinical presentation.

Choice D reason: Serotonin syndrome results from excessive serotonin due to paroxetine, an SSRI, overstimulating 5-HT receptors, causing hyperreflexia, hyperpyrexia, and autonomic instability. These symptoms reflect serotonin-driven neural excitation, particularly in the brainstem and spinal cord, matching the client’s clinical presentation accurately.

Choice A reason: Acute stress disorder involves trauma-related symptoms like dissociation or hyperarousal following a traumatic event, driven by amygdala hyperactivity and cortisol dysregulation. The nurse’s symptoms stem from emotional overload, not personal trauma, making this diagnosis inappropriate, as it does not involve direct exposure to a traumatic stressor.

Choice B reason: Derealization disorder involves persistent feelings of unreality or detachment, linked to altered temporoparietal neural activity. The nurse’s symptoms of worry and intrusive thoughts about the patient’s family reflect emotional exhaustion, not perceptual distortions, making derealization unrelated to the described empathetic overload.

Choice C reason: Compassion fatigue results from chronic exposure to patients’ suffering, leading to emotional exhaustion and intrusive thoughts. It involves burnout-related changes in cortisol and serotonin signaling, impairing emotional regulation in the prefrontal cortex. The nurse’s excessive worry about the patient’s family aligns with this stress-induced condition.

Choice D reason: Dissociative disorder involves disruptions in identity or memory, often linked to trauma and altered hippocampal-amygdala connectivity. The nurse’s symptoms are emotional, not dissociative, stemming from empathetic overload rather than trauma-induced neural changes, making this diagnosis irrelevant to the described scenario.