|
|
| (121 intermediate revisions by the same user not shown) |
| Line 1: |
Line 1: |
|
| |
|
| ==Classification of suicidal ideation==
| |
|
| |
| {| class="wikitable"
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
| |
|
| |
| |-
| |
|
| |
|
| |'''Suicidal events'''
| | _NOTOC _ |
| Completed suicide
| | {{CMG}};{{AE}}{{Vbe}} |
|
| |
|
| |A self-injurious behavior that resulted in fatality and
| | ==Causes== |
| was associated with at least some intent to die as a
| | [[Hypogammaglobulinemia]] is caused by: |
| result of the act.
| |
|
| |
|
| | Immunodeficiency secondary to: |
| | *[[Uremia]] |
| | *Protein losing enteropathy |
| | *[[Nephrotic syndrome]] |
| | *Malnutrition |
| | *Cirrhosis |
| | *Hemodialysis |
| | * Intestinal lymphangiectasia |
|
| |
|
| | | | * Protein-losing gastroenteropathy |
| example:1) After a long argument with his girlfriend, which resulted in the
| | *[[Nephrotic syndrome]] |
| end of their relationship, the patient collected a rope and rode his
| | *[[Thymoma]] <ref name="pmid29881497">{{cite journal |vauthors=Aouadi S, Ghrairi N, Braham E, Kaabi M, Maâlej S, Elgharbi LD |title=[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome] |language=French |journal=Pan Afr Med J |volume=28 |issue= |pages=253 |date=2017 |pmid=29881497 |pmc=5989270 |doi=10.11604/pamj.2017.28.253.11352 |url=}}</ref> |
| bike to an isolated area where he fatally hanged himself. A suicide
| | * Medications : |
| note was later found. 2) After four documented attempts at suicide,
| | ** Gold |
| the patient stole his uncle’s gun and shot himself and was fatally injured
| | **D-Penicillamine |
| | **Sulfasalazin |
| | **Anticonvulsants |
| | **Glucocorticoids |
| | **Methotrexate |
| | **Calcineurin inhibitors |
| | ** Rituximab<ref name="pmid29755528">{{cite journal |vauthors=Shoukat BA, Ali O, Kumar D, Bilal Gilani M, Zahid A, Aslam Joiya S, Anwar Malik M |title=Hypogammaglobulinemia Observed One Year after Rituximab Treatment for Idiopathic Thrombocytopenic Purpura |journal=Case Rep Med |volume=2018 |issue= |pages=2096186 |date=2018 |pmid=29755528 |pmc=5884289 |doi=10.1155/2018/2096186 |url=}}</ref><ref name="pmid29752554">{{cite journal |vauthors=Farhat L, Dara J, Duberstein S, De A |title=Secondary Hypogammaglobulinemia After Rituximab for Neuromyelitis Optica: A Case Report |journal=Drug Saf Case Rep |volume=5 |issue=1 |pages=22 |date=May 2018 |pmid=29752554 |pmc=5948191 |doi=10.1007/s40800-018-0087-y |url=}}</ref><ref name="pmid29627491">{{cite journal |vauthors=Thorlacius H, Jerkeman A, Marginean FE, Toth E |title=Colorectal malakoplakia in a patient with hypogammaglobulinemia |journal=Gastrointest. Endosc. |volume= |issue= |pages= |date=April 2018 |pmid=29627491 |doi=10.1016/j.gie.2018.04.001 |url=}}</ref> |
|
| |
|
| |-
| | * Environmental hazards: |
| |[[Suicide attempt]]
| | ** Ionizing radiation |
| | **Toxins |
|
| |
|
| |A potentially self-injurious behavior, associated with
| | *Infections |
| at least some intent to die, as a result of the act.
| | ** Viral(Herpes, Measles) |
| Evidence that the individual intended to kill him/
| | **Bacterial(Mycobacterial) |
| herself, at least to some degree, can be explicit or
| | **Parasitic(Malaria, helminthic infections) |
| inferred from the behavior or circumstance. A suicide
| |
| attempt may or may not result in actual injury
| |
| | |
| | |
| | |
| |'''Example''':fter a fight with her friends at school, in which they discontinued
| |
| speaking with her, the patient ingested approximately 16 aspirin
| |
| and eight other pills of different types on the school
| |
| grounds. She said that she deserved to die, which was why she
| |
| swallowed the pills. 2) The patient used a razor blade to lacerate
| |
| his wrists, his antecubital fossae, and his back bilaterally. He told
| |
| his therapist that the “the main objective was to stop feeling like
| |
| that,” and he knew that he could die but didn’t care. According to
| |
| the patient, he also ingested a bottle of rubbing alcohol because
| |
| in his health class he heard “that the medulla will get more suppressed
| |
| that way,” thereby increasing y increasing the chances that he would
| |
| be “successful” and die
| |
| | |
| |-
| |
| |[Preparatory acts
| |
| t
| |
| |[[Adrenal insufficiency]] ranges from mild nonspecific symptoms to life-threatening [[shock]] like condition.
| |
| An important distinction in these patients is the presence of[[ mineralocorticoid deficiency]]. Those with [[secondary]] or [[tertiary adrenal insufficiency]] will typically have preserved[[ mineralocorticoid]] function due to the separate feedback systems.
| |
| Adrenal insufficiency can be
| |
| *[[Primary]]
| |
| *[[Secondary]]
| |
| [[Tertiary]]
| |
| Common causes of primary adrenal insufficiency:
| |
| *[[Autoimmune]]
| |
| *[[Iatrogenic]]
| |
| *[[Drugs]]
| |
| * [[Adrenal hemorrhage]]
| |
| *[[Cancer]]
| |
| *[[Infection]]
| |
| *[[Congenital]]. | |
| *Secondary adrenal insufficiency refers to decreased [[adrenocorticotropic hormone]] (ACTH) stimulation of the [[adrenal cortex]] and therefore does not affect [[aldosterone levels]].
| |
| *Most common causes are: | |
| *[[Traumatic brain injury (TBI) ]] | |
| *[[Panhypopituitarism]]
| |
| *Tertiary adrenal insufficiency refers to decreased [[hypothalamic]] stimulation of the pituitary to secrete [[ACTH]].
| |
| *Exogenous[[ steroid]] administration is the most common cause of tertiary [[adrenal]] insufficiency.
| |
| |
| |
| * [[Fatigue]]
| |
| *[[ Muscle weakness]]
| |
| * [[Loss of appetite]]
| |
| *[[ Weight loss]]
| |
| * [[Abdominal pain]]
| |
| *[[Diarrhea]]
| |
| *[[Vomiting]]
| |
| | |
| Chronic disease is characterized by
| |
| *[[Weight loss]]
| |
| *[[Sparse axillary hair]]
| |
| *[[Hyperpigmentation]]
| |
| *[[Orthostatic hypotension]].
| |
| | |
| Acute [[addisonian]] crisis is characterized by :
| |
| *[[Fever]]
| |
| *[[ Hypotension]].
| |
| |The diagnosis of [[Addisons]] disease is made through rapid [[ACTH]] administration and measurement of [[cortisol]].
| |
| *Lab findings include:
| |
| *[[White blood cell]] count with moderate [[neutropenia]]
| |
| *[[lymphocytosis]]
| |
| *[[ eosinophilia]]
| |
| *Elevated serum[[ potassium]] and [[urea nitrogen]]
| |
| *Low [[sodium]]
| |
| *Low blood[[ glucose]]
| |
| * Morning low plasma [[cortisol]].
| |
| The definitive diagnosis is the [[cosyntropin]] or [[ACTH]] stimulation test. A[[ cortisol]] level is obtained before and after administering [[ACTH]]. A normal person should show a brisk rise in [[cortisol]] level after [[ACTH]] administration.
| |
| | |
| | |
| Management: The management of [[Addison]] [[disease]] involves:
| |
| *[[Gluocorticoid]]
| |
| *[[Mineralocorticoid]]
| |
| *[[Sodium chloride]] replacement.
| |
| Adrenal crisis:
| |
| *In adrenal crisis,measure [[cortisol]] level,then rapidly administer
| |
| *[[ Fluids]]
| |
| *[[ Hydrocortisone]]
| |
|
| |
| |-
| |
| |[[Hypopituitarism]]
| |
| |Hypopituitarism is defined as the partial or complete loss of [[anterior pituitary]] function that can result from acquired or [[congenital]] causes.
| |
| Etiology is as follows:
| |
| *[[Pituitary]] [[tumors]]
| |
| *[[Sellar tumors]]
| |
| *[[Head trauma]]
| |
| *[[Infection]]
| |
| *[[Empty sella]]
| |
| *[[Infiltration]]
| |
| *Idiopathic
| |
| *[[Congenital]]
| |
| |
| |
| [[Signs]] and [[symptoms]] of[[ hypopituitarism]] vary, depending on the deficient
| |
| | |
| [[hormone ]] and severity of the disorder,some of the [[symptoms]] may be as follows:
| |
| * [[Fatigue]]
| |
| * [[Weight loss]]
| |
| * Decreased [[libido]]
| |
| * Decreased [[appetite]]
| |
| * Facial [[puffiness]]
| |
| * [[Anemia]]
| |
| * [[Infertility]]
| |
| *[[ Cold insensitivity]].
| |
| * [[Amenorrha]]
| |
| *[[Inability to lactate]] in [[breast feeding]] women
| |
| * Decreased [[facial]] or[[ body hair]] in men
| |
| * [[Short stature]] in children
| |
| |The diagnosis is based on detailed investigation of symptoms of target endocrine gland function relative to the corresponding pituitary[[ hormone]] deficiency. The clinical manifestations of[[ hypopituitarism]] result from the degree of the specific hormone [[deficiency]].
| |
| A thorough and longitudinal [[history]] and[[ physical examination]], including [[visual field]] testing, are important.
| |
| Hypopituitarism may involve from one to all endocrine axes regulated by the pituitary
| |
| In order of frequency: [[growth hormone]] deficiency>[[secondary hypogonadism]]>[[secondary hypothyroidism]]>[[secondary adrenal failure]]).
| |
| The treatment of permanent hypopituitarism consists of replacement of the peripheral hormones
| |
| *[[Hydrocortisone]]
| |
| *[[DHEA]]
| |
| *[[Thyroxine]]
| |
| *[[Testosterone]] or [[oestradiol]]
| |
| *[[ Growth hormone]]
| |
| *[[Surgery]] and/or
| |
| *[[ Radiotherapy]] to restore normal [[endocrine]] function and quality of life.
| |
| *Patients with hypopituitarism require lifelong monitoring of serum hormone levels and symptoms of hormone deficiency or excess.
| |
| *Long-term care and monitoring of patients with hypopituitarism requires a experienced [[endocrinologist]].
| |
| |-
| |
| |[[Hypothyroidism]]
| |
| |Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to [[autoimmune]] causes described below:
| |
| *[[Congenital]]
| |
| *[[Autoimmune]] | |
| *[[Drugs]] | |
| *[[Post surgery]]
| |
| *[[Post radiation]]
| |
| *[[Infiltrative]] e.g., amyloid
| |
| |
| |
| *[[ Fatigue]]
| |
| * [[Constipation]]
| |
| *[[ Dry skin]]
| |
| *[[ Weight gain]]
| |
| * [[Cold intolerance]]
| |
| *[[ Puffy face]]
| |
| *[[ Hoarseness]]
| |
| *[[ Muscle weakness]]
| |
| * Elevated blood [[cholesterol]] level
| |
| * [[Bradycardia]]
| |
| *[[ Myopathy]]
| |
| *[[ Depression]]
| |
| * Impaired [[memory]]
| |
| | Diagnosis of [[hypothyroidism]] is based on [[blood]] tests:
| |
| *T3(triiodothyronine)
| |
| *T4(Thyroxine) and | |
| *TSH (thyroid stimulating hormone). | |
| *Signs and symptoms are neither [[sensitive]] nor [[specific]] for the diagnosis.
| |
| *TSH is the most sensitive tool for screening,diagnosis and treatment follow up, when[[ pituitary]] is normal.
| |
| *The drug of choice for treatment is [[Levothyroxine]].
| |
| |-
| |
| |[[Psychogenic polydipsia]]
| |
| | Also called as[[ primary polydipsia]] is characterized by[[ polyuria]] and [[polydipsia]]. Causes are:
| |
| * Defect in the [[hypothalamus]]
| |
| *Adverse effect of a [[medication]]
| |
| *Traumatic[[ brain]] injury
| |
| *[[Psychiatric]] disorders such as [[schizophrenia]]
| |
| |
| |
| *[[Polyuria]]
| |
| *[[Polydipsia]]
| |
| *[[Confusion]]
| |
| *[[Lethargy]]
| |
| *[[Psychosis]]
| |
| *[[Seizures]] and
| |
| *Sometimes, even [[Death]].
| |
| |Evaluation of[[ psychiatric]] patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria,[[ hyponatremia]], and the syndrome of inappropriate secretion of antidiuretic hormone.
| |
| *The management strategy in[[ psychiatric]] patients should include:
| |
| | |
| *[[Fluid]] restriction and[[ behavioral]] and [[pharmacologic]] modalities.
| |
| *The [[water deprivation test]] is the [[gold standard]] test.
| |
| |}
| |