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| _NOTOC_
| | _NOTOC _ |
| {{CMG}};{{AE}}{{Vbe}} | | {{CMG}};{{AE}}{{Vbe}} |
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| | ==Causes== |
| | [[Hypogammaglobulinemia]] is caused by: |
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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 |
| | *[[Nephrotic syndrome]] |
| | *[[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> |
| | * Medications : |
| | ** Gold |
| | **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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| ==Classification of suicidal ideation==
| | * Environmental hazards: |
|
| | ** Ionizing radiation |
| {| class="wikitable"
| | **Toxins |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Classification
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Definition
| |
| ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Examples
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|
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| |-
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|
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|
| |'''Suicidal events'''
| | *Infections |
| Completed suicide
| | ** Viral(Herpes, Measles) |
| | | **Bacterial(Mycobacterial) |
| |A self-injurious behavior that resulted in fatality and
| | **Parasitic(Malaria, helminthic infections) |
| was associated with at least some intent to die as a
| |
| result of the act.
| |
| | |
| | |
| |
| |
| example:1) After a long argument with his girlfriend, which resulted in the
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| end of their relationship, the patient collected a rope and rode his
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| bike to an isolated area where he fatally hanged himself. A suicide
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| note was later found. 2) After four documented attempts at suicide,
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| the patient stole his uncle’s gun and shot himself and was fatally injured
| |
| | |
| |-
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| |[[Suicide attempt]]
| |
| | |
| |A potentially self-injurious behavior, associated with
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| at least some intent to die, as a result of the act.
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| Evidence that the individual intended to kill him/
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| herself, at least to some degree, can be explicit or
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| 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
| |
| | |
| |-
| |
| |[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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| | |
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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 | |
| 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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|
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| |-
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| |[[Suicidal ideation]]
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| |Passive thoughts about wanting to be dead or active
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| thoughts about killing oneself, not accompanied
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| by preparatory behavior.a
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| |
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| * Active: The patient reported to the doctor that he was thinking | |
| about hanging himself in the closet. He was taken to the hospital
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| and admitted.
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| * Passive: The patient reported ideas about wanting | |
| to be dead but denied acting on these feelings.
| |
| | |
| | |
|
| |
| |}
| |
| | |
| ==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
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|
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| |-
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| | |
| |''' Non-Suicidal events'''
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| Self-injurious
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| behavior, no
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| suicidal intent
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| | |
| |Self-injurious behavior associated with no intent to
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| die. The behavior is intended purely for other reasons,
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| either to relieve distress (often referred to as
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| “self-mutilation,” e.g., superficial cuts or scratches,
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| hitting/banging, or burns) or to effect change in
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| others or the environment
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| The patient was feeling ignored. She went into the family kitchen
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| where her mother and sister were talking. She took a knife out of
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| the drawer and made a cut on her arm. She denied that she
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| wanted to die at all (“not even a little”), but she just wanted them
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| to pay attention to her. 2) The patient reported feeling agitated
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| and anxious after a fight with her parents. She went into her
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| room, locked the door, and made several superficial cuts on the
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| inside of her arms. She stated that she felt relieved after cutting
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| herself and that she did not want to die. She reported that she
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| had done this before at times of distress and that it usually helped
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| her feel better. 3) The patient was in class, where a test was about
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| to begin, and stabbed himself with a pencil in order to be taken
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| to the nurse’s office. 4) A 14-year-old girl wrote her name on her
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| arm with a penknife and said that she often does so in order to reduce
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| her anxiety. 5) The patient was noted to have multiple superficial
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| burns on his arms. Upon questioning, he denied trying to kill himself
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| |-
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| |Other, no
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| deliberate
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| self-harm
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| | |
| |No evidence of any suicidality or deliberate self-injurious
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| behavior associated with the event. The
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| event is characterized as an accidental injury, psychiatric
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| or behavioral symptoms only, or medical
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| symptoms or procedure only
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| | |
| |1) The patient had a cut on the neck from shaving. 2) The patient
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| was hospitalized for worsening of OCD or depressive symptoms
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| with no suicidal thoughts or actions or 3) aggressive behavior.
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| 4) Hospitalization was because of an infection, rhinoplasty, or
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| pregnancy
| |
| |}
| |
| | |
| ==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
| |
|
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| |-
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| | |
| |''' Indeterminate or
| |
| potentially
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| suicidal events'''
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| Self-injurious
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| behavior,
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| suicidal intent
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| unknown
| |
| |Self-injurious behavior where associated intent to
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| die is unknown and cannot be inferred. The injury
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| or potential for injury is clear, but why the individual
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| engaged in that behavior is unclear.
| |
| | |
| | |
| | 1) The patient cut her wrists after an argument with her boyfriend.
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| 2) The patient was angry at her husband. She took 10 to 15 diazepam
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| tablets and flushed the rest down the toilet. Her husband
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| called the police for help, and she was taken to the hospital. She
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| was groggy and stayed overnight in the hospital. 3) A 9-year-old
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| patient had spoken about suicide frequently. After learning that
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| his baseball coach was retiring, he began scratching his arm with
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| a pencil.
| |
| | |
| |-
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| |Not enough
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| information
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| | |
| |Insufficient information to determine whether the
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| event involved deliberate suicidal behavior or ideation.
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| There is reason to suspect the possibility of
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| suicidality but not enough to be confident that the
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| event was not something other, such as an accident
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| or psychiatric symptom. An injury sustained
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| on a place on the body consistent with deliberate
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| self-harm or suicidal behavior (e.g., wrists), without
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| any information as to how the injury was received,
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| would warrant placement in this category
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| | |
| |1) A child who “stabbed himself in [the] neck with a pencil.” The
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| event may have been deliberate as opposed to accidental, as suggested
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| by “stabbed,” but not enough information was provided to
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| determine whether the event was deliberate. 2) A cut on the neck.
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|
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| |}
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| ==References==
| |
| | |
| Posner K, Melvin GA, Stanley B, Oquendo MA, Gould M: Factors
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| in the assessment of suicidality in youth. CNS Spectr 2007; 12:
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| 156–162
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