Emergency Psychiatry Practice Questions

Q: A 45-year-old recently divorced alcoholic expresses suicidal ideation. What is the next best step?

Hospitalization and safety measures. ***Hospitalization and safety measures*** - In the setting of **suicidal ideation** combined with high-risk factors like **alcohol abuse** and a recent **major life stressor** (divorce), the immediate clinical priority is ensuring patient safety. - **Inpatient psychiatric admission** is the standard of care for acute risk to prevent self-harm, allowing for stabilization and a thorough risk assessment in a controlled environment. *Cognitive Behavioral Therapy and weekly outpatient visits* - While **Cognitive Behavioral Therapy (CBT)** is an effective long-term treatment for mood disorders, it is insufficient for an acute crisis where there is an imminent risk of self-harm. - **Outpatient management** is contraindicated when a patient expresses active suicidal ideation, as it does not provide the 24-hour supervision necessary to protect the patient. *Start antidepressant therapy* - **Antidepressant therapy** typically takes weeks to reach therapeutic efficacy and does not address the immediate, life-threatening danger posed by suicidal ideation. - Initiating medication without first ensuring the patient's **acute physical safety** through hospitalization neglects the primary management goal in psychiatric emergencies. *Monitor for recurrence* - This approach is dangerously passive and inappropriate for a patient presenting with active **suicidal ideation**, which requires immediate intervention. - **Active monitoring** is a component of long-term care, but it fails to address the immediate crisis or the patient's current potential to act on suicidal impulses.

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.

Question 1

A 45-year-old recently divorced alcoholic expresses suicidal ideation. What is the next best
step?

Accepted Answer

Hospitalization and safety measures

Answer

Cognitive Behavioral Therapy and weekly outpatient visits

Answer

Start antidepressant therapy

Answer

Monitor for recurrence

Question 2

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 3

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 4

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 5

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

Emergency Psychiatry — MCQs

Emergency Psychiatry — MCQs

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