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Clinical Review Quiz

Suicidality in the General Hospitalized Patient

Dylan P. Wint, MD, and Mayada Akil, MD

Dr. Wint is a clinical fellow and Dr. Akil is a senior advisor to the Director; both are at the
National Institute of Mental Health, National Institutes of Health, Bethesda, MD.

The questions below are based on the article
“Suicidality in the General Hospitalized Patient”.

Choose the single best answer for each question.

1. A 30-year-old woman has been in the hospital for 4 days. Prompted by her nurse’s concerns about the patient’s frequent crying spells, you ask her whether she is depressed. She says that she is and admits that she has suicidal thoughts. What information must you obtain before you leave the room?
  1. How many times she has attempted suicide in the past
  2. Whether she has borderline personality disorder
  3. Whether she uses alcohol or drugs
  4. Whether she intends to act on her suicidal thoughts
  5. When she started thinking about suicide
Click here to compare your answer.

2. Which combination of age and gender poses the highest risk for a suicide attempt?

  1. Female, younger than 30 years
  2. Male, younger than 30 years
  3. Female, age is irrelevant
  4. Male, older than 60 years
  5. Female, between 40 and 60 years
Click here to compare your answer.

3. What is the most common psychiatric problem in patients with suicidal ideation?

  1. Anxiety
  2. Neurosis
  3. Depression
  4. Personality disorder
  5. Substance abuse
Click here to compare your answer.

4. What is the most appropriate first step in treating a patient who expresses serious suicidal intent?

  1. Administer parenteral clomipramine or haloperidol
  2. Obtain emergency psychiatric consultation
  3. Assign a one-on-one observer
  4. Inform the patient’s family of the situation
  5. Carefully document the change in condition
Click here to compare your answer.

5. What is the most reliable way to gauge a patient’s suicidal intent?
  1. Ask the patient about her/his energy level
  2. Directly ask the patient if s/he intends to harm herself/himself
  3. Request a psychiatric consultation
  4. Obtain a history of prior suicide attempts
  5. Carefully observe the patient’s affect, somatization, and tendency to exaggerate
Click here to compare your answer.

6. Which of the following is most likely to increase a patient’s risk for suicide?

  1. Cancer
  2. Chronic pain
  3. Depression
  4. HIV
  5. Myocardial infarction
Click here to compare your answer.

7. Which symptom is required for a DSM-IV diagnosis of a major depressive episode?

  1. Decreased energy
  2. Increased or decreased sleep
  3. Thoughts of suicide or death
  4. Decreased interest
  5. Depressed mood or anhedonia
Click here to compare your answer.

8. Which of these is a myth about suicidality?

  1. Patients with a history of self-injury have an elevated risk of death by suicide
  2. People who frequently mention their suicidal ideas do not act on them
  3. Asking about self-harm does not inspire patients to think about suicide
  4. In patients with borderline personality disorder, the number of prior attempts predicts the risk of death by suicide
  5. Suicidal ideation is not a standard response to life-threatening or debilitating ill
Click here to compare your answer.


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