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|[[Hypopituitarism]]
|[[Suicidal ideation]]
|Hypopituitarism is defined as the partial or complete loss of [[anterior pituitary]] function that can result from acquired or [[congenital]] causes.
|Passive thoughts about wanting to be dead or active
Etiology is as follows:
thoughts about killing oneself, not accompanied
*[[Pituitary]] [[tumors]]
by preparatory behavior.a
*[[Sellar tumors]]
*[[Head trauma]]
*[[Infection]]
*[[Empty sella]]
*[[Infiltration]]
*Idiopathic
*[[Congenital]]
|
|
[[Signs]] and [[symptoms]] of[[ hypopituitarism]] vary, depending on the deficient
* Active: The patient reported to the doctor that he was thinking
about hanging himself in the closet. He was taken to the hospital
and admitted.
* Passive: The patient reported ideas about wanting
to be dead but denied acting on these feelings.


[[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]].
==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
|-
 
|''' Non-Suicidal events'''
Self-injurious
behavior, no
suicidal intent
 
|Self-injurious behavior associated with no intent to
die. The behavior is intended purely for other reasons,
either to relieve distress (often referred to as
“self-mutilation,” e.g., superficial cuts or scratches,
hitting/banging, or burns) or to effect change in
others or the environment
 
 
|  
The patient was feeling ignored. She went into the family kitchen
where her mother and sister were talking. She took a knife out of
the drawer and made a cut on her arm. She denied that she
wanted to die at all (“not even a little”), but she just wanted them
to pay attention to her. 2) The patient reported feeling agitated
and anxious after a fight with her parents. She went into her
room, locked the door, and made several superficial cuts on the
inside of her arms. She stated that she felt relieved after cutting
herself and that she did not want to die. She reported that she
had done this before at times of distress and that it usually helped
her feel better. 3) The patient was in class, where a test was about
to begin, and stabbed himself with a pencil in order to be taken
to the nurse’s office. 4) A 14-year-old girl wrote her name on her
arm with a penknife and said that she often does so in order to reduce
her anxiety. 5) The patient was noted to have multiple superficial
burns on his arms. Upon questioning, he denied trying to
|-
|-
|[[Hypothyroidism]]
|[[Suicide attempt]]
|Hypofunctioning of the thyroid gland due to multifactorial etiology ranging from congenital to [[autoimmune]] causes described below:
 
*[[Congenital]]
|A potentially self-injurious behavior, associated with
*[[Autoimmune]]
at least some intent to die, as a result of the act.
*[[Drugs]]
Evidence that the individual intended to kill him/
*[[Post surgery]]
herself, at least to some degree, can be explicit or
*[[Post radiation]]
inferred from the behavior or circumstance. A suicide
*[[Infiltrative]] e.g., amyloid
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
towards imminent suicidal behavior
|The individual takes steps to injure him- or herself,
but is stopped by self or others from starting the
self-injurious act before the potential for harm has begun
 
 
|
|
*[[ Fatigue]]
her had gone to school and retrieved a recent “bad” report card.
* [[Constipation]]
He was fearful of his father’s reaction. Upon his return home, a 5-
*[[ Dry skin]]
to 6-hour argument with his parents ensued, and he took a vegetable
*[[ Weight gain]]
(broad, sharp) knife and went to his room. He reported putting
* [[Cold intolerance]]
the knife to his wrist but never puncturing the skin. 2) The patient
*[[ Puffy face]]
stated that he “couldn’t stand being depressed anymore”
*[[ Hoarseness]]
and “wanted to die.” He decided to hang himself. He tied a telephone
*[[ Muscle weakness]]
cord to the door knob and placed the cord loosely around
* Elevated blood [[cholesterol]] level
his neck. Then, he stopped himself and did not follow through
* [[Bradycardia]]
with the attempt.
*[[ 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]]  
|[[Suicidal ideation]]
| Also called as[[ primary polydipsia]] is characterized by[[ polyuria]] and [[polydipsia]]. Causes are:
|Passive thoughts about wanting to be dead or active
* Defect in the [[hypothalamus]]
thoughts about killing oneself, not accompanied
*Adverse effect of a [[medication]]
by preparatory behavior.a  
*Traumatic[[ brain]] injury
*[[Psychiatric]] disorders such as [[schizophrenia]]
|
|
*[[Polyuria]]
* Active: The patient reported to the doctor that he was thinking
*[[Polydipsia]]
about hanging himself in the closet. He was taken to the hospital
*[[Confusion]]
and admitted.
*[[Lethargy]]
* Passive: The patient reported ideas about wanting
*[[Psychosis]]
to be dead but denied acting on these feelings.
*[[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.
|}
|}

Revision as of 17:30, 23 August 2017

Classification of suicidal ideation

Classification Definition Examples
Suicidal events

Completed suicide

A self-injurious behavior that resulted in fatality and

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 end of their relationship, the patient collected a rope and rode his bike to an isolated area where he fatally hanged himself. A suicide note was later found. 2) After four documented attempts at suicide, the patient stole his uncle’s gun and shot himself and was fatally injured

Suicide attempt A potentially self-injurious behavior, associated with

at least some intent to die, as a result of the act. Evidence that the individual intended to kill him/ herself, at least to some degree, can be explicit or 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

towards imminent suicidal behavior

The individual takes steps to injure him- or herself,

but is stopped by self or others from starting the self-injurious act before the potential for harm has begun


her had gone to school and retrieved a recent “bad” report card. He was fearful of his father’s reaction. Upon his return home, a 5- to 6-hour argument with his parents ensued, and he took a vegetable (broad, sharp) knife and went to his room. He reported putting the knife to his wrist but never puncturing the skin. 2) The patient stated that he “couldn’t stand being depressed anymore” and “wanted to die.” He decided to hang himself. He tied a telephone cord to the door knob and placed the cord loosely around his neck. Then, he stopped himself and did not follow through with the attempt.

Suicidal ideation Passive thoughts about wanting to be dead or active

thoughts about killing oneself, not accompanied by preparatory behavior.a

  • Active: The patient reported to the doctor that he was thinking

about hanging himself in the closet. He was taken to the hospital and admitted.

  • Passive: The patient reported ideas about wanting

to be dead but denied acting on these feelings.













Classification of suicidal ideation

Classification Definition Examples
Non-Suicidal events

Self-injurious behavior, no suicidal intent

Self-injurious behavior associated with no intent to

die. The behavior is intended purely for other reasons, either to relieve distress (often referred to as “self-mutilation,” e.g., superficial cuts or scratches, hitting/banging, or burns) or to effect change in others or the environment


The patient was feeling ignored. She went into the family kitchen where her mother and sister were talking. She took a knife out of the drawer and made a cut on her arm. She denied that she wanted to die at all (“not even a little”), but she just wanted them to pay attention to her. 2) The patient reported feeling agitated and anxious after a fight with her parents. She went into her room, locked the door, and made several superficial cuts on the inside of her arms. She stated that she felt relieved after cutting herself and that she did not want to die. She reported that she had done this before at times of distress and that it usually helped her feel better. 3) The patient was in class, where a test was about to begin, and stabbed himself with a pencil in order to be taken to the nurse’s office. 4) A 14-year-old girl wrote her name on her arm with a penknife and said that she often does so in order to reduce her anxiety. 5) The patient was noted to have multiple superficial burns on his arms. Upon questioning, he denied trying to

Suicide attempt A potentially self-injurious behavior, associated with

at least some intent to die, as a result of the act. Evidence that the individual intended to kill him/ herself, at least to some degree, can be explicit or 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

towards imminent suicidal behavior

The individual takes steps to injure him- or herself,

but is stopped by self or others from starting the self-injurious act before the potential for harm has begun


her had gone to school and retrieved a recent “bad” report card. He was fearful of his father’s reaction. Upon his return home, a 5- to 6-hour argument with his parents ensued, and he took a vegetable (broad, sharp) knife and went to his room. He reported putting the knife to his wrist but never puncturing the skin. 2) The patient stated that he “couldn’t stand being depressed anymore” and “wanted to die.” He decided to hang himself. He tied a telephone cord to the door knob and placed the cord loosely around his neck. Then, he stopped himself and did not follow through with the attempt.

Suicidal ideation Passive thoughts about wanting to be dead or active

thoughts about killing oneself, not accompanied by preparatory behavior.a

  • Active: The patient reported to the doctor that he was thinking

about hanging himself in the closet. He was taken to the hospital and admitted.

  • Passive: The patient reported ideas about wanting

to be dead but denied acting on these feelings.