Suicide Risk Assessment and Management — MCQs
Which of the following factors is most commonly associated with suicidal tendencies?
A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?
Among which of the following conditions is suicide risk highest?
An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
Magistrate inquest is done in?
What is the primary health concern addressed by the Rashtriya Bal Swasthya Karyakram (RBSK)?
Management of a violent patient in psychiatry includes all except:
Which of the following is false regarding parasuicide?
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?
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?
Suicide Risk Assessment and Management Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following factors is most commonly associated with suicidal tendencies?
- A. Female gender
- B. Severe depression (Correct Answer)
- C. Chronic illness
- D. Younger age group
Explanation: ***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 2: A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?
- A. ECT (Correct Answer)
- B. Selegiline
- C. Haloperidol + Chlorpromazine
- D. Amitriptyline
Explanation: ***ECT (Electroconvulsive Therapy)*** - **ECT** is the most effective and rapid treatment for severe depression, especially when associated with active **suicidal ideation** and intent. - Its quick onset of action (often within days) makes it vital in situations requiring urgent symptom alleviation to ensure patient safety. - **First-line treatment** for geriatric depression with suicidal risk and when rapid response is needed. *Selegiline* - **Selegiline** is a monoamine oxidase inhibitor (MAOI) used for depression and Parkinson's disease, but its antidepressant effects are not immediate. - It would not sufficiently address the patient's acute suicidal intent due to its slower therapeutic onset (several weeks). *Haloperidol + Chlorpromazine* - This combination consists of **antipsychotics**, primarily used for conditions with psychotic features or severe agitation but not as a primary treatment for severe depression with suicidal ideation. - While they might provide some sedation, they do not treat the underlying depressive disorder effectively and rapidly enough to resolve acute suicidal intent. *Amitriptyline* - **Amitriptyline** is a tricyclic antidepressant (TCA) that can be effective for depression but has a delayed onset of action (2-4 weeks). - **Highly contraindicated in suicidal patients** due to its extreme lethality in overdose (cardiotoxic effects). - Its slow therapeutic effect would not be appropriate for an urgent situation involving active suicidal thoughts with intent.
Question 3: Among which of the following conditions is suicide risk highest?
- A. Depression (Correct Answer)
- B. Alcohol dependence
- C. Dementia
- D. Schizophrenia
Explanation: ***Depression*** - **Major depressive disorder** is the psychiatric condition most frequently associated with **suicide**, accounting for a large percentage of completed suicides. - The presence of severe depression, especially with features like **hopelessness**, **agitation**, and **prior suicide attempts**, significantly elevate the risk. *Alcohol dependence* - While **alcohol dependence** is a significant risk factor for suicide, it often co-occurs with mood disorders like depression; alcohol can exacerbate suicidal ideation and impulsivity. - It is an important comorbidity, but **major depression** alone has a higher prevalence in suicide statistics than alcohol dependence as a primary factor. *Dementia* - **Dementia** generally poses a lower risk of completed suicide compared to mood disorders, as cognitive decline can impair the ability to plan and execute such acts. - Early stages of dementia, particularly when insight into cognitive decline is preserved, may carry some risk, but it is not the highest risk condition overall. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide compared to the general population, often due to factors like **command hallucinations**, hopelessness, and adverse effects of medication. - However, **depression** remains the leading psychiatric diagnosis associated with suicide completions.
Question 4: An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
- A. Olanzapine
- B. ECT (Correct Answer)
- C. Mirtazapine
- D. Clozapine
Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is the **treatment of choice** for severe depression with **suicidal ideation** due to its rapid onset of action and high efficacy. - It is particularly indicated when there is an urgent need for symptom remission to prevent self-harm, as verbal therapies and medications take longer to exert their full effects. *Olanzapine* - **Olanzapine** is an **antipsychotic medication** with some antidepressant properties, but it is not the first-line treatment for severe depression with suicidal tendencies. - It is often used as an **adjunctive treatment** in treatment-resistant depression or in psychotic depression with delusions. *Mirtazapine* - **Mirtazapine** is an **antidepressant** that can be very effective in cases of major depressive disorder, especially when insomnia and appetite loss are prominent. - However, its onset of action is not as rapid as ECT, making it less suitable for situations requiring immediate intervention for **severe suicidal risk**. *Clozapine* - **Clozapine** is an **antipsychotic medication** primarily used for **treatment-resistant schizophrenia** and reducing suicidal behavior in schizophrenia. - It is highly effective but has significant side effects, including **agranulocytosis**, and is not a first-line treatment for major depressive disorder with suicidal tendencies.
Question 5: Magistrate inquest is done in?
- A. Death by suicide
- B. Death in suspicious circumstances
- C. Death by accident
- D. Death in psychiatry hospital (Correct Answer)
Explanation: ***Death in psychiatry hospital*** - A **magistrate inquest** is **mandatory** under Section 176 CrPC for deaths occurring in **psychiatric hospitals/institutions**, as these are considered deaths in **state custody** or institutional care. - This ensures **judicial oversight** and independent investigation into the cause and circumstances of death of vulnerable individuals under institutional care. - Among all the options, this is the **most specific and universally mandated** scenario requiring magistrate inquest across all jurisdictions in India. *Death by suicide* - While suicide deaths are unnatural and often require magistrate inquest under Section 176 CrPC, the requirement varies by state and circumstances. - In practice, many suicide deaths may initially be investigated by police with magistrate involvement based on specific circumstances or state protocols. - Not as universally mandated as deaths in custody/institutions. *Death in suspicious circumstances* - Deaths in suspicious circumstances typically require investigation, but the type of inquest (police vs magistrate) depends on the specific nature and severity of suspicion. - While magistrate inquest may be ordered, it is not as automatically mandated as deaths in institutional custody. - The investigating authority determines if magistrate involvement is necessary. *Death by accident* - Accidental deaths may require magistrate inquest depending on the circumstances (e.g., railway accidents, factory accidents). - However, not all accidental deaths automatically mandate magistrate inquest. - Deaths in custody or institutional care have **absolute mandatory** requirement, making psychiatric hospital death the most appropriate answer.
Question 6: What is the primary health concern addressed by the Rashtriya Bal Swasthya Karyakram (RBSK)?
- A. Adult chronic diseases
- B. Elderly health
- C. Non-communicable diseases in the youth
- D. Comprehensive healthcare for children from birth to 18 years (Correct Answer)
Explanation: **Comprehensive healthcare for children from birth to 18 years** - The **Rashtriya Bal Swasthya Karyakram (RBSK)** is a national program explicitly designed to provide comprehensive health screening and early intervention for 0-18 year-olds - Its focus is on detecting and managing the **4 D's**: Defects at birth, Deficiencies, Diseases, and Developmental delays - The program provides regular health check-ups, early detection of health conditions, referral for treatment, and promotes healthy development across this critical age group *Adult chronic diseases* - While public health initiatives address adult chronic diseases, they are not the primary focus of the **RBSK** program, which targets a younger demographic - Programs like the **National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS)** are more aligned with adult chronic disease management *Elderly health* - **RBSK** is specifically focused on the health of children and adolescents, not the elderly population - **National Programme for Healthcare of the Elderly (NPHCE)** is a dedicated initiative for elderly health *Non-communicable diseases in the youth* - While **RBSK** does address some non-communicable diseases (NCDs) through early detection and management, its scope is much broader, encompassing all 4 D's - RBSK aims for **holistic child health** rather than exclusively targeting NCDs in youth, which is a subset of its overall mandate
Question 7: Management of a violent patient in psychiatry includes all except:
- A. CBT (Correct Answer)
- B. Haloperidol
- C. ECT
- D. BZD
Explanation: ***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.
Question 8: Which of the following is false regarding parasuicide?
- A. Also known as attempted suicide.
- B. Mostly seen in psychological disturbances.
- C. A conscious, impulsive, manipulative act to get rid of an intolerable situation.
- D. Hanging is the most common form. (Correct Answer)
Explanation: **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.
Question 9: 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?
- A. Succinylcholine
- B. Dantrolene (Correct Answer)
- C. Edrophonium
- D. Neostigmine
Explanation: **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 10: 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?
- A. Formal thought disorder
- B. Acute alcohol intoxication (Correct Answer)
- C. Chronic severe physical illness
- D. Social isolation
Explanation: **Explanation:** The management of a suicidal patient in the emergency department involves identifying high-risk factors that necessitate immediate psychiatric intervention. **Why Option B is Correct:** **Acute alcohol intoxication** is a transient state that can significantly cloud a clinical assessment. Alcohol acts as a disinhibitor, often leading to impulsive self-harm threats that may resolve once the patient is sober. Standard clinical guidelines (such as those from NICE) suggest that a formal specialist psychiatric assessment should be deferred until the patient is sober, as the "true" underlying mental state and level of intent cannot be accurately determined while intoxicated. However, the patient must be kept in a safe environment until they are fit for assessment. **Why the other options are wrong:** * **A. Formal thought disorder:** This indicates a potential psychotic illness (like Schizophrenia). Psychosis is a major risk factor for "command hallucinations" or delusional thinking, which significantly increases the risk of completed suicide. * **C. Chronic severe physical illness:** Chronic pain or terminal illness (e.g., cancer, end-stage renal disease) are well-established independent risk factors for suicide due to hopelessness and a desire to end suffering. * **D. Social isolation:** Being single, widowed, or living alone (lack of social support) is a core demographic risk factor in suicide risk stratification (e.g., the SAD PERSONS scale). **High-Yield Clinical Pearls for NEET-PG:** * **SAD PERSONS Scale:** A mnemonic for suicide risk (Sex: Male, Age: <19 or >45, Depression, Previous attempt, Ethanol/Drug use, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness). * **Most common method of completed suicide:** Hanging (India and globally). * **Most common method of attempted suicide:** Poisoning/Drug overdose. * **Strongest predictor of suicide:** A previous history of self-harm or suicide attempts.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free