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: Suicidal tendencies are least common in which of the following demographic groups or conditions?

Married individuals. **Explanation:** The risk of suicide is heavily influenced by socio-demographic factors and psychiatric comorbidities. According to **Durkheim’s theory of social integration**, individuals with strong social ties and support systems have a significantly lower risk of suicide. **Why Married Individuals is the Correct Answer:** Marriage acts as a major **protective factor** against suicide. It provides social integration, emotional support, 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:** * **Individuals who are alone:** Social isolation is a high-risk factor. Living alone, being single, or experiencing recent bereavement increases the risk due to a lack of "social buffers." * **Individuals with depression:** Psychiatric illness is the strongest predictor of suicide. Approximately 15% of patients with severe Depressive Disorder eventually die by suicide. It is a state of high vulnerability. * **Males:** While females make more suicide *attempts*, **males are more likely to complete suicide** (the Gender Paradox). This is because men typically use more lethal methods (e.g., firearms, hanging). **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Predictor:** A previous history of suicide attempts is the single best predictor of a future completed suicide. * **Age:** Risk generally increases with age; the elderly (especially males >65) are at very high risk. * **Employment:** Unemployment and financial instability are significant risk factors. * **Protective Factors:** Marriage, pregnancy (in women), and strong religious beliefs/affiliations.

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.

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

Suicidal tendencies are least common in which of the following demographic groups or conditions?

Accepted Answer

Married individuals

Answer

Individuals who are alone

Answer

Individuals with depression

Answer

Males

Question 5

What is the most common cause of parasuicide?

Accepted Answer

Drug ingestion

Answer

Hanging

Answer

Cutting wrist

Answer

Firearms

Emergency Psychiatry — MCQs

Emergency Psychiatry — MCQs

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