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| ==Classification of suicidal ideation==
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| {| class="wikitable"
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| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
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| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
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| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
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| |'''Suicidal events'''
| | _NOTOC _ |
| Completed suicide
| | {{CMG}};{{AE}}{{Vbe}} |
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| |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.
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| | Immunodeficiency secondary to: |
| | *[[Uremia]] |
| | *Protein losing enteropathy |
| | *[[Nephrotic syndrome]] |
| | *Malnutrition |
| | *Cirrhosis |
| | *Hemodialysis |
| | * Intestinal lymphangiectasia |
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| | | | * 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> |
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| | * Environmental hazards: |
| |[[Suicide attempt]]
| | ** Ionizing radiation |
| | **Toxins |
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| |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
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| attempt may or may not result in actual injury
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| |'''Example''':fter a fight with her friends at school, in which they discontinued
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| speaking with her, the patient ingested approximately 16 aspirin
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| and eight other pills of different types on the school
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| grounds. She said that she deserved to die, which was why she
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| swallowed the pills. 2) The patient used a razor blade to lacerate
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| his wrists, his antecubital fossae, and his back bilaterally. He told
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| his therapist that the “the main objective was to stop feeling like
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| that,” and he knew that he could die but didn’t care. According to
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| the patient, he also ingested a bottle of rubbing alcohol because
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| in his health class he heard “that the medulla will get more suppressed
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| that way,” thereby increasing y increasing the chances that he would
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| be “successful” and die
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| |[Preparatory acts
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| towards imminent suicidal behavior
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| |The individual takes steps to injure him- or herself,
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| but is stopped by self or others from starting the
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| self-injurious act before the potential for harm has begun
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| her had gone to school and retrieved a recent “bad” report card.
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| He was fearful of his father’s reaction. Upon his return home, a 5-
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| to 6-hour argument with his parents ensued, and he took a vegetable
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| (broad, sharp) knife and went to his room. He reported putting
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| the knife to his wrist but never puncturing the skin. 2) The patient
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| stated that he “couldn’t stand being depressed anymore”
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| and “wanted to die.” He decided to hang himself. He tied a telephone
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| cord to the door knob and placed the cord loosely around
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| his neck. Then, he stopped himself and did not follow through
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| with the attempt.
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| |[[Hypopituitarism]]
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| |Hypopituitarism is defined as the partial or complete loss of [[anterior pituitary]] function that can result from acquired or [[congenital]] causes.
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| Etiology is as follows:
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| *[[Pituitary]] [[tumors]] | |
| *[[Sellar tumors]] | |
| *[[Head trauma]] | |
| *[[Infection]]
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| *[[Empty sella]]
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| *[[Infiltration]]
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| *Idiopathic
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| *[[Congenital]]
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| [[Signs]] and [[symptoms]] of[[ hypopituitarism]] vary, depending on the deficient
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| [[hormone ]] and severity of the disorder,some of the [[symptoms]] may be as follows:
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| * [[Fatigue]]
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| * [[Weight loss]]
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| * Decreased [[libido]]
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| * Decreased [[appetite]]
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| * Facial [[puffiness]]
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| * [[Anemia]]
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| * [[Infertility]]
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| *[[ Cold insensitivity]].
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| * [[Amenorrha]]
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| *[[Inability to lactate]] in [[breast feeding]] women
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| * Decreased [[facial]] or[[ body hair]] in men
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| * [[Short stature]] in children
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| |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]].
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| A thorough and longitudinal [[history]] and[[ physical examination]], including [[visual field]] testing, are important.
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| Hypopituitarism may involve from one to all endocrine axes regulated by the pituitary
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| In order of frequency: [[growth hormone]] deficiency>[[secondary hypogonadism]]>[[secondary hypothyroidism]]>[[secondary adrenal failure]]).
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| The treatment of permanent hypopituitarism consists of replacement of the peripheral hormones
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| *[[Hydrocortisone]]
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| *[[DHEA]]
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| *[[Thyroxine]]
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| *[[Testosterone]] or [[oestradiol]] | |
| *[[ Growth hormone]] | |
| *[[Surgery]] and/or
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| *[[ Radiotherapy]] to restore normal [[endocrine]] function and quality of life.
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| *Patients with hypopituitarism require lifelong monitoring of serum hormone levels and symptoms of hormone deficiency or excess.
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| *Long-term care and monitoring of patients with hypopituitarism requires a experienced [[endocrinologist]].
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| |[[Hypothyroidism]]
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| |Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to [[autoimmune]] causes described below:
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| *[[Congenital]]
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| *[[Autoimmune]]
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| *[[Drugs]]
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| *[[Post surgery]]
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| *[[Post radiation]]
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| *[[Infiltrative]] e.g., amyloid
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| *[[ Fatigue]]
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| * [[Constipation]]
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| *[[ Dry skin]]
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| *[[ Weight gain]]
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| * [[Cold intolerance]]
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| *[[ Puffy face]]
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| *[[ Hoarseness]]
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| *[[ Muscle weakness]]
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| * Elevated blood [[cholesterol]] level
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| * [[Bradycardia]]
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| *[[ Myopathy]]
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| *[[ Depression]]
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| * Impaired [[memory]]
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| | Diagnosis of [[hypothyroidism]] is based on [[blood]] tests:
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| *T3(triiodothyronine)
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| *T4(Thyroxine) and | |
| *TSH (thyroid stimulating hormone). | |
| *Signs and symptoms are neither [[sensitive]] nor [[specific]] for the diagnosis.
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| *TSH is the most sensitive tool for screening,diagnosis and treatment follow up, when[[ pituitary]] is normal.
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| *The drug of choice for treatment is [[Levothyroxine]].
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| |[[Psychogenic polydipsia]]
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| | Also called as[[ primary polydipsia]] is characterized by[[ polyuria]] and [[polydipsia]]. Causes are:
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| * Defect in the [[hypothalamus]]
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| *Adverse effect of a [[medication]]
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| *Traumatic[[ brain]] injury
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| *[[Psychiatric]] disorders such as [[schizophrenia]]
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| *[[Polyuria]]
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| *[[Polydipsia]]
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| *[[Confusion]]
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| *[[Lethargy]]
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| *[[Psychosis]]
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| *[[Seizures]] and
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| *Sometimes, even [[Death]].
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| |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.
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| *The management strategy in[[ psychiatric]] patients should include:
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| *[[Fluid]] restriction and[[ behavioral]] and [[pharmacologic]] modalities.
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| *The [[water deprivation test]] is the [[gold standard]] test.
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| |}
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