Emergency Psychiatry Practice Questions

Q: Which of the following is false regarding parasuicide?

Hanging is the most common form.. **Explanation:** **Parasuicide** (also known as Deliberate Self-Harm) refers to a non-fatal act in which an individual deliberately causes self-injury or ingests a substance in excess of the prescribed dosage. **Why Option D is the correct answer (False statement):** Hanging is the most common method used in **completed suicides**, not parasuicide. In parasuicide, the intent is often not to die but to communicate distress or manipulate a situation. Therefore, the methods chosen are usually less lethal and allow for intervention. The most common method of parasuicide is **self-poisoning** (e.g., drug overdose or pesticide ingestion) or **superficial wrist cutting**. **Analysis of other options:** * **Option A:** Parasuicide is synonymous with **attempted suicide**, though the term is specifically used for acts where the intent to die is low or ambiguous. * **Option B:** It is frequently seen in individuals with **psychological disturbances**, most notably **Borderline Personality Disorder**, depression, and substance abuse. * **Option C:** It is often a **conscious and impulsive act**. It is frequently described as "manipulative" (or a "cry for help") because the goal is often to escape an intolerable emotional state or to influence the behavior of others. **High-Yield Clinical Pearls for NEET-PG:** * **Gender:** Parasuicide is more common in **females**, whereas completed suicide is more common in **males** (Gender Paradox). * **Age:** Most common in the younger age group (15–30 years). * **Strongest Predictor:** A previous history of parasuicide is the strongest predictor of a future completed suicide. * **SAD PERSONS Scale:** Used to assess the risk of suicide in clinical settings.

Q: A 20-year-old male with a known history of mental illness presented to the emergency room with aggressive behavior and a tendency to physically attack others. Following a psychiatric evaluation, he was prescribed new medications and his previous medication dosage was adjusted. Three days later, he returned to the emergency room with fever (105°F), stiff limbs, altered sensorium, and elevated serum CPK levels. What is the immediate management for this condition?

Dantrolene. **Explanation:** The patient is presenting with the classic tetrad of **Neuroleptic Malignant Syndrome (NMS)**: hyperpyrexia (105°F), muscular "lead-pipe" rigidity, altered mental status, and autonomic instability, following the initiation or dose escalation of antipsychotics. The elevated serum Creatine Phosphokinase (CPK) confirms significant muscle necrosis due to intense rigidity. **1. Why Dantrolene is Correct:** NMS is a life-threatening emergency caused by central dopamine blockade. **Dantrolene** is a direct-acting skeletal muscle relaxant that inhibits the release of calcium from the sarcoplasmic reticulum. It is the drug of choice to treat the severe muscle rigidity and hyperthermia associated with NMS, thereby preventing further rhabdomyolysis and organ failure. **2. Why Incorrect Options are Wrong:** * **Succinylcholine:** A depolarizing neuromuscular blocker used in anesthesia. It is strictly contraindicated here as it can worsen hyperkalemia and potentially trigger Malignant Hyperthermia. * **Edrophonium:** A short-acting acetylcholinesterase inhibitor used in the Tensilon test to diagnose Myasthenia Gravis; it has no role in NMS. * **Neostigmine:** An acetylcholinesterase inhibitor used to treat Myasthenia Gravis or reverse non-depolarizing muscle relaxants; it does not address the pathophysiology of NMS. **Clinical Pearls for NEET-PG:** * **Mnemonic for NMS (FEVER):** **F**ever, **E**ncephalopathy, **V**itals unstable, **E**levated CPK/WBC, **R**igidity. * **First step in management:** Immediately stop the offending antipsychotic agent. * **Specific Pharmacotherapy:** **Dantrolene** (muscle relaxant) or **Bromocriptine/Amantadine** (Dopamine agonists). * **Differential Diagnosis:** Unlike Serotonin Syndrome, NMS is characterized by "lead-pipe" rigidity and bradyreflexia, whereas Serotonin Syndrome features hyperreflexia and myoclonus.

Q: What is the most common cause of parasuicide?

Drug ingestion. **Explanation:** **Parasuicide** (also known as non-suicidal self-injury or deliberate self-harm) refers to an act in which an individual mimics a suicide attempt but without a true fatal intent. The primary goal is often a "cry for help" or an expression of emotional distress rather than death. **Why Drug Ingestion is Correct:** **Drug ingestion (overdose)** is the most common method of parasuicide globally. It is preferred because it is relatively painless, less disfiguring, and allows for a "window of rescue." Common agents include benzodiazepines, analgesics (paracetamol), and antidepressants. In the Indian context, organophosphate poisoning is also frequently seen in rural areas. **Analysis of Incorrect Options:** * **B. Hanging:** This is the **most common method of completed suicide** in India. It is highly lethal and offers little chance of intervention once the act is initiated, making it rare in parasuicide. * **C. Cutting wrist:** While a common method of self-harm (especially in Borderline Personality Disorder), it ranks second to drug ingestion in overall frequency for parasuicide. * **D. Firearms:** This is a highly violent and lethal method. It is rarely used in parasuicide due to its high fatality rate and limited accessibility in the Indian subcontinent. **High-Yield Clinical Pearls for NEET-PG:** * **Most common method of Completed Suicide:** Hanging (India); Firearms (USA). * **Gender Paradox:** Suicide is more common in **males**, but parasuicide (self-harm) is significantly more common in **females**. * **Strongest Predictor:** A previous history of parasuicide/self-harm is the strongest predictor of a future completed suicide. * **Risk Factor:** Depression is the most common psychiatric illness associated with suicide.

Q: Which of the following is NOT a predisposing factor for suicide?

Female sex. ### Explanation In psychiatry, understanding the risk factors for suicide is crucial for both clinical practice and competitive exams like NEET-PG. While suicide is a complex phenomenon, epidemiological data consistently identifies specific demographic and clinical predictors. **Why "Female sex" is the correct answer:** While women are significantly more likely to **attempt** suicide (3 times more often than men), men are more likely to **complete** suicide (3–4 times more often than women). This is often referred to as the "gender paradox" of suicide. Therefore, being female is considered a risk factor for suicidal *gestures/attempts*, but **male sex** is the established predisposing factor for *completed* suicide. **Analysis of Incorrect Options:** * **Depression:** This is the strongest clinical predictor. Approximately 50–70% of individuals who commit suicide have a primary diagnosis of a mood disorder. * **Drug abuse:** Substance use disorders (especially alcoholism) significantly increase impulsivity and lower the threshold for self-harm, making it a major risk factor. * **Living alone:** Social isolation, being single, divorced, or widowed are well-documented sociological risk factors. Integration into a social or family unit acts as a protective factor. **High-Yield Clinical Pearls for NEET-PG:** * **Most common method of suicide:** In India, it is **hanging** (globally, firearms are common where legal). * **Best predictor of future suicide:** A **previous history** of suicide attempts. * **Protective factors:** Marriage, pregnancy, and strong religious/social beliefs. * **SAD PERSONS Scale:** A mnemonic used to assess risk (Sex-Male, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness).

Q: Which of the following is the best predictor of attempting suicide in the future?

Prior suicide attempt. **Explanation:** The single best predictor of a future suicide attempt or completed suicide is a **prior history of suicide attempts**. Statistically, individuals who have attempted suicide once are at a significantly higher risk (up to 40–100 times higher than the general population) of trying again, especially within the first 6 to 12 months following the initial attempt. This is a critical high-yield fact for psychiatric risk assessment. **Analysis of Options:** * **Prior suicide attempt (Correct):** It is the most potent clinical indicator. While many factors contribute to risk, a past history demonstrates both the intent and the "acquired capability" to enact self-harm. * **Alcohol abuse (Incorrect):** Substance abuse is a major **risk factor** and often acts as a disinhibitor, but it is statistically secondary to a previous attempt in terms of predictive power. * **Unemployment & Divorce (Incorrect):** These are **psychosocial stressors** (sociodemographic factors). While they increase vulnerability and are common in suicidal patients, they are non-specific and less predictive than a patient’s own behavioral history. **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Predictor:** Prior suicide attempt. * **Most Common Method (India):** Poisoning (pesticides) and Hanging. * **Gender Paradox:** Females attempt suicide more frequently, but males complete suicide more often (due to the use of more lethal methods). * **Protective Factor:** Strong social support and family ties (especially having young children) are the strongest protective factors. * **Highest Risk Comorbidity:** Depression (most common), followed by Bipolar Disorder and Schizophrenia.

Q: In all of the following conditions, suicidal attempts are more common, EXCEPT?

Panic attack. **Explanation:** The core of this question lies in distinguishing between **suicidal ideation/risk** and the acute presentation of an anxiety disorder. **Why Panic Attack is the correct answer:** While patients experiencing a **Panic Attack** often feel an "impending sense of doom" or a "fear of dying," they do not typically have an active intent to end their lives during the episode. Panic attacks are characterized by intense autonomic hyperactivity (tachycardia, sweating, tremors). While chronic Panic Disorder can increase long-term suicide risk due to comorbidity, an isolated panic attack is not a condition where suicidal *attempts* are a hallmark feature, unlike the other options. **Analysis of Incorrect Options:** * **Severe Depression:** This is the most common psychiatric condition associated with suicide. Feelings of hopelessness, worthlessness, and anhedonia are strong drivers for suicidal attempts. * **Bipolar Disorder:** Patients with Bipolar Disorder (especially during **mixed episodes** or the depressive phase) have a significantly higher rate of suicide attempts compared to the general population. The impulsivity associated with the illness increases the lethality of attempts. * **Old Age:** Elderly individuals (especially males) are a high-risk demographic. Factors like social isolation, chronic physical illness, bereavement, and "silent suicide" (refusing food/meds) contribute to higher rates of completed suicides in this group. **NEET-PG High-Yield Pearls:** * **Strongest Predictor of Suicide:** A previous history of suicide attempts. * **Most Common Method (India):** Poisoning (Pesticides), followed by Hanging. * **Gender Paradox:** Females attempt suicide more frequently, but males complete suicide more often (due to more lethal methods). * **Protective Factor:** Strong social/family support and pregnancy are significant protective factors against suicide.

Question 1

Which of the following is false regarding parasuicide?

Accepted Answer

Hanging is the most common form.

Answer

Also known as attempted suicide.

Answer

Mostly seen in psychological disturbances.

Answer

A conscious, impulsive, manipulative act to get rid of an intolerable situation.

Question 2

A 20-year-old male with a known history of mental illness presented to the emergency room with aggressive behavior and a tendency to physically attack others. Following a psychiatric evaluation, he was prescribed new medications and his previous medication dosage was adjusted. Three days later, he returned to the emergency room with fever (105°F), stiff limbs, altered sensorium, and elevated serum CPK levels. What is the immediate management for this condition?

Accepted Answer

Dantrolene

Answer

Succinylcholine

Answer

Edrophonium

Answer

Neostigmine

Question 3

A patient presents to the emergency department with self-harm and indicates suicidal intent. Which of the following conditions does not warrant an immediate specialist assessment?

Accepted Answer

Acute alcohol intoxication

Answer

Formal thought disorder

Answer

Chronic severe physical illness

Answer

Social isolation

Question 4

Which of the following is a risk factor for suicide?

Accepted Answer

Initial stages of recovery from depression

Answer

Being on Lithium treatment

Answer

Being married

Answer

Being employed

Question 5

What is the most common cause of parasuicide?

Accepted Answer

Drug ingestion

Answer

Hanging

Answer

Cutting wrist

Answer

Firearms

Question 6

Which of the following is NOT a predisposing factor for suicide?

Accepted Answer

Female sex

Answer

Depression

Answer

Drug abuse

Answer

Living alone

Question 7

A patient presents to the emergency department with self-harm and indicates suicidal intent. Which of the following conditions does not warrant an immediate specialist assessment?

Accepted Answer

Acute alcohol intoxication

Answer

Formal thought disorder

Answer

Chronic severe physical illness

Answer

Social isolation

Question 8

Which of the following is the best predictor of attempting suicide in the future?

Accepted Answer

Prior suicide attempt

Answer

Alcohol abuse

Answer

Unemployment

Answer

Divorce

Question 9

In all of the following conditions, suicidal attempts are more common, EXCEPT?

Accepted Answer

Panic attack

Answer

Severe depression

Answer

Bipolar disorder

Answer

Old age

Question 10

Which of the following conditions are associated with suicidal tendencies?

Accepted Answer

Depression, Schizophrenia, Substance abuse

Answer

Depression, Posttraumatic stress disorder, Schizophrenia

Answer

Depression, Substance abuse

Answer

Posttraumatic stress disorder, Substance abuse, Anxiety

Emergency Psychiatry — MCQs

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