Emergency Psychiatry Practice Questions

Q: Which of the following is LEAST associated with suicidal tendencies?

Being married. **Explanation:** The risk of suicide is influenced by various sociodemographic and clinical factors. In psychiatry, these are often categorized into **risk factors** and **protective factors**. **Why "Being Married" is the correct answer:** Marriage is considered one of the strongest **protective factors** against suicide. It provides social support, emotional stability, and a sense of responsibility toward family members (especially if children are involved). Statistically, married individuals have the lowest rates of suicide compared to those who are single, divorced, widowed, or separated. **Analysis of Incorrect Options:** * **Being alone (Option A):** Social isolation and living alone are significant risk factors. Lack of a support system increases the likelihood of acting on suicidal ideation. * **Depression (Option B):** Psychiatric illness is the strongest predictor of suicide. Approximately 90% of people who commit suicide have a diagnosable mental disorder, with Major Depressive Disorder being the most common. * **Being male (Option C):** While women make more suicide *attempts* (3:1 ratio), men are more likely to *complete* suicide (4:1 ratio). This is primarily because men tend to use more lethal methods (e.g., firearms, hanging). **NEET-PG High-Yield Pearls:** * **Strongest Risk Factor:** A previous history of suicide attempts. * **Gender Paradox:** Females attempt more; Males complete more. * **Age:** Risk increases with age; the elderly (especially men >65) are at high risk. * **SAD PERSONS Scale:** A mnemonic used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness). * **Employment:** Unemployment and financial instability increase risk.

Q: Which of the following is a risk factor for suicide?

Unmarried status. **Explanation:** Suicide risk assessment is a high-yield topic in NEET-PG, often evaluated using the **SAD PERSONS scale**. Identifying demographic and clinical risk factors is crucial for triaging psychiatric emergencies. **Why "Unmarried status" is correct:** Social isolation is a significant predictor of suicidal behavior. Being unmarried (including those who are single, divorced, separated, or widowed) lacks the "protective effect" of social support and family integration. Studies consistently show that individuals living alone or lacking a stable domestic partner have higher rates of completed suicide compared to those who are married. **Analysis of Incorrect Options:** * **Female sex:** While women are more likely to *attempt* suicide (higher parasuicide rates), **men** are significantly more likely to *complete* suicide (often using more lethal methods). * **Age 30 years:** Suicide risk follows a bimodal distribution, peaking in **adolescents/young adults** and the **elderly (age >65)**. Age 30 falls into a relatively lower-risk middle period compared to these extremes. * **Married status:** Marriage is considered a **protective factor** against suicide, as it typically provides emotional support and a sense of responsibility toward dependents (especially children). **Clinical Pearls for NEET-PG:** * **Strongest Predictor:** The single best predictor of a future suicide attempt is a **previous history of suicide attempts**. * **Gender Paradox:** Females attempt more; Males complete more. * **Psychiatric Comorbidity:** Over 90% of suicide victims have a diagnosable mental disorder, most commonly **Depression** or **Substance Use Disorder**. * **High-Risk Occupations:** Doctors (especially anesthesiologists and psychiatrists) and farmers have higher reported risks.

Q: Management of a violent patient in psychiatry includes all except:

CBT. ***CBT*** - **Cognitive Behavioral Therapy (CBT)** is a long-term psychological intervention aimed at changing maladaptive thought patterns and behaviors. It is **not suitable for immediate management** of an acutely violent patient. - While CBT can be beneficial for aggression management in a stable patient, it requires patient cooperation, cognitive engagement, and time, which are not available during a **violent psychiatric emergency**. *Haloperidol* - **Haloperidol** is a potent typical antipsychotic frequently used in acute settings for rapid tranquilization of violent or severely agitated patients. - It is effective in reducing **psychosis-related agitation** and can be administered **intramuscularly** for quick onset of action. - Often used in combination with benzodiazepines for optimal control of acute violence. *ECT* - **Electroconvulsive Therapy (ECT)** may be considered in **severe, treatment-resistant cases** of violence associated with conditions like uncontrolled mania, catatonic excitement, or psychotic depression when pharmacological interventions have failed. - While not used for immediate acute management due to logistical requirements (consent, anesthesia, specialized setup), it can be an effective option for severe psychiatric conditions with persistent violence. - It works by inducing a brief controlled seizure, which can rapidly alleviate severe symptoms. *BZD* - **Benzodiazepines (BZDs)** like lorazepam or diazepam are **first-line agents** in the acute management of violent or agitated patients due to their rapid anxiolytic, sedative, and muscle relaxant properties. - They are particularly useful for **calming acute agitation** and are often combined with antipsychotics for rapid tranquilization. - Can be administered intramuscularly or intravenously for quick action in psychiatric emergencies.

Q: A 22-year-old woman presents with a 2-week history of low mood, anhedonia, and suicidal ideation. She has a history of major depressive disorder. What is the most appropriate initial treatment?

Admit to the hospital. ***Admit to the hospital*** - The presence of **suicidal ideation** in a patient with a history of major depressive disorder is a critical indicator for **immediate hospitalization** to ensure safety and prevent self-harm. - Inpatient care allows for close monitoring, a structured environment, and urgent initiation of treatment in a crisis situation. *Start an SSRI* - While **SSRIs (Selective Serotonin Reuptake Inhibitors)** are a first-line treatment for major depressive disorder, starting them initially without addressing the immediate danger of **suicidal ideation** is inappropriate due to the delayed onset of action and potential initial worsening of symptoms. - The patient's safety must be secured before outpatient pharmacological management is initiated, as SSRIs can take several weeks to show full therapeutic effects. *Start a benzodiazepine* - **Benzodiazepines** can reduce anxiety and agitation, but they do not treat the underlying depressive disorder or the risk of **suicidal ideation**. - Their use for depression and suicidality is limited due to the potential for dependence, abuse, and masking of underlying symptoms, and they are not a primary treatment for severe depression with suicidal ideation. *Start cognitive-behavioral therapy* - **Cognitive-behavioral therapy (CBT)** is an effective psychotherapy for major depressive disorder, but it is not an appropriate initial intervention when **suicidal ideation** is present due to the urgent need for safety and stabilization. - CBT requires active participation and consistent engagement over time, which may not be feasible or safe for a patient in acute crisis with high suicidal risk.

Q: Which of the following factors is most commonly associated with suicidal tendencies?

Severe depression. ***Severe depression*** - **Major depressive disorder** is the strongest and most common risk factor for suicidal ideation and attempts, significantly increasing suicidal tendencies [1]. - The profound **hopelessness**, **worthlessness**, and altered cognitive processing associated with severe depression contribute largely to suicidal thoughts [2]. - Depression is present in approximately **90%** of individuals who die by suicide. *Female gender* - While **females** have higher rates of **suicide attempts** and self-harm, **males** have a higher rate of completed suicides using more lethal methods. - Female gender alone is not the most common risk factor for suicidal tendencies compared to the profound impact of severe mental illness like depression [1]. *Chronic illness* - **Chronic medical conditions** can increase the risk of depression and subsequent suicidal ideation due to pain, functional limitations, and loss of independence [3]. - However, chronic illness is generally considered an **indirect risk factor**, often mediating its effect through the development of mental health disorders like depression [3]. *Younger age group* - Suicide is a leading cause of death in **adolescents and young adults**, highlighting significant concern in this demographic [1]. - While younger age is a risk factor, especially with concurrent mental health issues or stressors, it is not as universally predictive of suicidal tendencies as severe depression across all age groups [1].

Question 1

Which of the following is LEAST associated with suicidal tendencies?

Accepted Answer

Being married

Answer

Being alone

Answer

Depression

Answer

Being male

Question 2

Which of the following is a risk factor for suicide?

Accepted Answer

Unmarried status

Answer

Female sex

Answer

Age 30 years

Answer

Married status

Question 3

Management of a violent patient in psychiatry includes all except:

Accepted Answer

CBT

Answer

Haloperidol

Answer

ECT

Answer

BZD

Question 4

A 22-year-old woman presents with a 2-week history of low mood, anhedonia, and suicidal ideation. She has a history of major depressive disorder. What is the most appropriate initial treatment?

Accepted Answer

Admit to the hospital

Answer

Start an SSRI

Answer

Start a benzodiazepine

Answer

Start cognitive-behavioral therapy

Question 5

A 35-year-old female with major depressive disorder, who started on an SSRI three weeks ago, now reports increased anxiety, restlessness, insomnia, and thoughts of suicide. Analyze and choose the next step.

Accepted Answer

Urgent psychiatric evaluation and safety assessment.

Answer

Add short-term anxiolytic and urgent psychiatric referral.

Answer

Continue SSRI and add augmentation therapy with close monitoring.

Answer

Gradually taper SSRI and monitor closely.

Question 6

Which of the following factors is most commonly associated with suicidal tendencies?

Accepted Answer

Severe depression

Answer

Female gender

Answer

Chronic illness

Answer

Younger age group

Question 7

Which of the following patients has the highest suicide risk?

Accepted Answer

A 60 year old male who recently lost his wife and lives alone

Answer

A 42 year old female, who lives with family

Answer

A 42 year old female, who is single and lives alone

Answer

A 22 year old male, who is single

Emergency Psychiatry — MCQs

Emergency Psychiatry — MCQs

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