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Farkašová Iannaccone S, Ginelliová A, Farkaš D, Sopková D. Suicide by sharp force associated with major self-mutilation and self-cannibalism. Forensic Sci Med Pathol 2024; 20:1538-1542. [PMID: 37450169 PMCID: PMC11790802 DOI: 10.1007/s12024-023-00674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Self-stabbing and self-cutting represents an uncommon method of suicide. We present a case of a 30-year-old man who was found dead in the forest. The body was naked and showed multiple cut and stab wounds on different parts of the body (face, neck, chest, abdomen, and extremities). A single-edged kitchen knife was found approximately 20 m from the body. Parts of both ears, the fifth toe of the right foot, and the scrotum were cut off. At the autopsy, two of the severed body parts-the toe and the part of the left ear-were found in the stomach. The cause of death was asphyxiation due to blood aspiration resulting from a cut throat injury. A police investigation uncovered a history of substance abuse and two previous suicidal attempts using a knife. Upon complex analysis of all the evidence, the manner of death was ruled a suicide, which was preceded by actions of major self-mutilation and self-cannibalism, both considered rare behavioral patterns.
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Affiliation(s)
- Silvia Farkašová Iannaccone
- Department of Forensic Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia
| | - Alžbeta Ginelliová
- Medico-Legal and Pathological-Anatomical Department of Health Care Surveillance Authority, Ipeľská 1, Košice, 043 74, Slovakia
| | - Daniel Farkaš
- Medico-Legal and Pathological-Anatomical Department of Health Care Surveillance Authority, Ipeľská 1, Košice, 043 74, Slovakia
| | - Dorota Sopková
- Department of Forensic Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, 040 11, Košice, Slovakia.
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Abdella MK, Gebreselassie KH, Kurabachew HA. Self-inflicted penile and testicular amputation: A very rare case report and treatment dilemma in the absence of microsurgical service. Int J Surg Case Rep 2024; 122:110043. [PMID: 39043098 PMCID: PMC11318470 DOI: 10.1016/j.ijscr.2024.110043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Genital self-mutilation is a rare urologic surgical emergency that is usually encountered in patients with underlying psychiatric illness. Because of shortage of published data and variance in management schemes worldwide, these conditions can present a significant management dilemma. CASE PRESENTATION In this case report we present this rare phenomenon, where a known schizophrenic patient presented after he amputated both of his testes and penis under the influence of command hallucination. After 15 h of the incident, macroscopic replantation of the severed genitalia was done and psychiatric evaluation and management initiated simultaneously. But the replantation failed after 9th post operative day. DISCUSSION Initial management of patients presenting with genital amputation should be resuscitation. The severed organ has to be washed with sterile saline and placed in "double bag". There are multiple factors for the success of replantation, the major ones are cooling of the amputated organ and precise microsurgical replantation. CONCLUSION Early intervention and microscopic replantation are crucial for the successful outcome.
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Affiliation(s)
- Mejudin Kedir Abdella
- Department of Surgery, Urology unit, Worabe Comprehensive Specialized Hospital, Ethiopia.
| | | | - Henok Ababu Kurabachew
- Department of Psychiatry, College of Health and Medical Science Dilla University Dilla, Ethiopia
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Cucu AI, Costea CF, Silișteanu SC, Blaj LA, Istrate AC, Patrascu RE, Hartie VL, Patrascanu E, Turliuc MD, Turliuc S, Sava A, Boişteanu O. Repetitive Self-Inflicted Craniocerebral Injury in a Patient with Antisocial Personality Disorder. Diagnostics (Basel) 2024; 14:1549. [PMID: 39061686 PMCID: PMC11276516 DOI: 10.3390/diagnostics14141549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Self-inflicted penetrating injuries in patients with mental disorders are a rare phenomenon. The authors report the case of a prisoner who recurrently presented to the emergency department over a period of four years for self-insertion of six metal foreign bodies into the skull. Computed tomography each time revealed the presence of a metal foreign body (screw, nail, metal rod, and wire) passing through the frontal bone into the frontal lobe. In each situation, the foreign body was safely extracted with a favorable outcome. Despite the use of the latest imaging modalities, metal artifacts can limit the assessment of vascular involvement, and special attention must be given to preoperative planning. Surgical extraction of the foreign body can be safely performed when appropriate preoperative planning is carried out to consider all possible complications.
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Affiliation(s)
- Andrei Ionut Cucu
- Faculty of Medicine and Biological Sciences, University Stefan cel Mare of Suceava, 720229 Suceava, Romania;
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
| | - Claudia Florida Costea
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Ophthalmology, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania
| | - Sînziana Călina Silișteanu
- Faculty of Medicine and Biological Sciences, University Stefan cel Mare of Suceava, 720229 Suceava, Romania;
| | - Laurentiu Andrei Blaj
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Neurosurgery, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania
| | - Ana Cristina Istrate
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
| | - Raluca Elena Patrascu
- National Institute for Infectious Diseases Prof. Dr. Matei Bals, 021105 Bucharest, Romania;
- Infectious Diseases Department, Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
| | - Vlad Liviu Hartie
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania; (E.P.); (O.B.)
| | - Emilia Patrascanu
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania; (E.P.); (O.B.)
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Mihaela Dana Turliuc
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Neurosurgery, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania
| | - Serban Turliuc
- Department of Psychiatry, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iaşi, Romania;
| | - Anca Sava
- Emergency Clinical Hospital Prof. Dr. Nicolae Oblu, 700309 Iasi, Romania; (L.A.B.); (A.C.I.); (V.L.H.); (M.D.T.); (A.S.)
- Department of Morpho-Functional Sciences I, Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iași, Romania
| | - Otilia Boişteanu
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Grigore T. Popa Iasi, 700115 Iasi, Romania; (E.P.); (O.B.)
- Sf. Spiridon County Clinical Emergency Hospital Iași, 700111 Iași, Romania
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Oyaci Y, Yildirim YE, Aytac HM, Pehlivan S, Aydin PC. The relationship of the methylation status and polymorphism of glucocorticoid receptor gene ( NR3C1) with attempted suicide or non-suicidal self-injury patients in schizophrenia. J Investig Med 2024; 72:449-456. [PMID: 38494341 DOI: 10.1177/10815589241242715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
We aim to investigate the methylation of NR3C1 gene promotor and NR3C1 BclI polymorphism in schizophrenia (SCZ) patients with attempted suicide or non-suicidal self-injury (NSSI). A sample of 112 patients with SCZ was included in the study. Structured Clinical Interview for Diagnostic and Statistical Manual-Fourth Edition Axis I Disorders was used to confirm the diagnosis according to The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision criteria. The patients were evaluated by data forms that had sociodemographic, suicidal behavior, and NSSI information. Methylation-specific polymerase chain reaction (PCR) was used to identify the methylation of the NR3C1 gene. The analysis of the BclI polymorphism of the NR3C1 gene was evaluated by using the PCR restriction fragment length polymorphism. Our results revealed that although the NR3C1 gene methylation was not statistically significantly different, there was a significant difference in NR3C1 genotype distribution among the SCZ groups with and without attempted suicide. SCZ patients carrying the CC genotype had a lower risk of attempted suicide (Odds Ratio [OR]: 0.421; 95% Confidence Interval [CI]: 0.183-0.970; p = 0.040), while having the GG genotype in SCZ patients was associated with a higher risk of attempted suicide (OR: 3.785; 95% Cl: 1.107-12.945; p = 0.042). Additionally, due to NSSI in SCZ patients, there were no significant differences in NR3C1 gene methylation and NR3C1 genotype distribution among the groups. We propose that the NR3C1 BclI polymorphism may be associated with attempted suicide in Turkish patients diagnosed with SCZ.
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Affiliation(s)
- Yasemin Oyaci
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Turkey
| | - Yusuf Ezel Yildirim
- University of Health Sciences Department of Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Hasan Mervan Aytac
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
- Department of Psychiatry, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sacide Pehlivan
- Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Turkey
| | - Pinar Cetinay Aydin
- University of Health Sciences Department of Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Fekih-Romdhane F, Houissa L, Cheour M, Hallit S, Loch AA. Body image as a mediator in the relationship between psychotic experiences and later disordered eating: A 12-month longitudinal study in high school adolescents. Int J Soc Psychiatry 2024; 70:518-530. [PMID: 38160417 DOI: 10.1177/00207640231218686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND The relationship between psychosis and disordered eating remains a challenging area of research to which little interest was paid. Using longitudinal data, we aimed to explore the hypothesis that the pathways from psychotic experiences (PEs) to disordered eating (DE) and body-mass index (BMI) are mediated by body-image disturbances. METHODS A prospective longitudinal study was performed. High-school students (N = 510, 61.2% females, mean age of 16.05 ± 1.01 years) were asked to complete three scheduled assessments (Baseline, 6 months, and 12 months). RESULTS Two body image components, that is, Overweight Preoccupation and Body Area Satisfaction, mediated the prospective association between baseline PEs and DE 12 months later. Direct effects were significant. After accounting for indirect effects through more severe body image concerns at 6 months, higher baseline PEs were significantly associated with greater DE at 12 months. Baseline PEs and 6-month body image explained a significant proportion of variance in 12-month DE. However, we did not find evidence of a direct prospective association between PEs and BMI. CONCLUSION This study is the first to assess the mediating role of body image between PEs and DE. Findings offer promising new avenues for early intervention to help mitigate the effects of PEs on DE in adolescents.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry 'Ibn Omrane', Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Lilia Houissa
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry 'Ibn Omrane', Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Majda Cheour
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry 'Ibn Omrane', Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Sao Paulo, Brazil
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Vardharajan A, Mohan M, Pushpanathan D, Venkatramani H, Sabapathy SR. Replantation of an Amputated Hand at Wrist Level Due to Self-Mutilation: Considerations in Management. Indian J Plast Surg 2023; 56:273-275. [PMID: 37435346 PMCID: PMC10332901 DOI: 10.1055/s-0043-1768916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illnesses. Limb amputations are grievous injuries that radically decrease the quality of life. Controversy exists as to the advisability of replantation of the self-amputated limb. We report a case of self-amputation of the hand in a 54-year-old gentleman in a fit of psychosis. He underwent replantation of the hand and was given timely psychiatric help. Interdisciplinary management helped in improving the mood of the patient and he cooperated well with the rehabilitation schedule. Recent literature encourages surgeons to replant the limb and treat the mental illness with close observation for warning signs. We conclude that replantation along with early initiation of psychiatry treatment can help the patient overcome psychosis, realize the implications of his actions, and provide the motivation to perform physiotherapy to achieve the optimum outcome possible in the replanted hand.
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Affiliation(s)
- Ashwini Vardharajan
- Department of Plastic, Hand, and Microsurgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, India
| | - Monusha Mohan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Dakshana Pushpanathan
- Department of Psychiatry, KMCH Institute of health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Hari Venkatramani
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S. Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Mahfoud D, Fekih-Romdhane F, Abou Zeid J, Rustom L, Mouez C, Haddad G, Hallit S. Functionality appreciation is inversely associated with positive psychotic symptoms in overweight/obese patients with schizophrenia. BMC Psychiatry 2023; 23:306. [PMID: 37127566 PMCID: PMC10152629 DOI: 10.1186/s12888-023-04795-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND While the relationship between negative aspects of body image and positive schizophrenia symptoms was extensively investigated and is relatively well-established, there is a dearth of literature on the relationship between positive symptoms and positive aspects of body image, such as body appreciation and functionality appreciation, in patients with schizophrenia. This study aimed to (1) compare weight stigma, body and functionality appreciation between obese/overweight and normal-weight patients with schizophrenia, and (2) explore the associations between these variables and positive psychotic symptoms in the obese/overweight group. METHOD A cross-sectional study was conducted in the Psychiatric Hospital of the Cross, Lebanon during September 2022 recruiting selected in-patients diagnosed with schizophrenia. Patients were classified as overweight/obese if they had a BMI > 25 (N = 76 (37.25%), aged 55.57 ± 11.30 years, 42.6% females). The Weight self‑stigma questionnaire, the Functionality Appreciation Scale, and the Body Appreciation Scale, and the Positive and Negative Syndrome Scale (PANSS) were used. RESULTS No significant difference was found between overweight/obese and normal-weight patients for all variables, except for weight stigma; a significantly higher weight stigma score was significantly found in overweight/obese compared to normal-weight patient. In the bivariate analysis, higher functionality appreciation was significantly associated with higher positive PANSS scores. The results of the linear regression, taking the positive PANSS score as the dependent variable, showed that higher functionality appreciation (Beta = - 0.52) and higher social support (Beta = - 0.16) were significantly associated with lower positive PANSS scores, whereas having a secondary education level compared to illiteracy (Beta = 7.00) was significantly associated with higher positive PANSS scores. CONCLUSION Although based on cross-sectional data, these findings preliminarily suggest that higher functionality appreciation can help reduce the severity of positive psychotic symptoms in overweight/obese schizophrenia patients, and that interventions aimed at improving functionality appreciation could be regarded beneficial therapeutic targets in the treatment of psychosis.
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Affiliation(s)
- Daniella Mahfoud
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Jawad Abou Zeid
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Lea Rustom
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Charbel Mouez
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Georges Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
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Toribio-Vázquez C, Yebes Á, Quesada-Olarte J, Rodriguez A, Alonso-Bartolomé M, Ayllon H, Martinez-Piñeiro L. Genital Mutilation in Males. Curr Urol Rep 2023; 24:121-126. [PMID: 36401111 DOI: 10.1007/s11934-022-01129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE OF THE REVIEW Genital mutilation in males can range from minor injuries (cuts from a blade) to severe urological emergencies (testicular or penile amputation). Due to the rarity of these events, there is a lack of extensive reports, as most of the available literature is regarding single cases. Genital mutilation has been associated with psychotic and non-psychotic causes, psychiatric conditions, drug consumption, sexual practices, or even cultural or religious beliefs. It is crucial to perform a psychiatric evaluation of these patients to obtain the best therapeutic approach. This manuscript serves as a review of the currently available knowledge regarding male genital mutilation. RECENT FINDINGS A great variety of reasons have been associated with genital mutilation. Previous authors have distinguished between those that present with a clear mental health precursor from cases with no psychotic background. Nevertheless, sometimes, it is difficult to make this distinction. Recently, reconstructive techniques for amputation cases have moved towards a microsurgical approach in order to improve outcomes. A holistic therapeutic approach must be performed to increase the chances of effective treatment. Close collaboration between urologists, psychiatrists, and emergency doctors is essential to ensure the best care for patients performing genital mutilation. Future publications must evaluate differences in treatment options and the impact that these have on the long-term well-being of patients undergoing genital self-mutilation.
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Affiliation(s)
- Carlos Toribio-Vázquez
- Urology department, Hospital Universitario La Paz, Paseo de La Castellana 261, Madrid, 28046, Spain.
| | - Álvaro Yebes
- Urology department, Hospital Universitario La Paz, Paseo de La Castellana 261, Madrid, 28046, Spain
| | - José Quesada-Olarte
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Chicago, IL, 60612, USA
| | - Andrea Rodriguez
- Urology department, Hospital Universitario La Paz, Paseo de La Castellana 261, Madrid, 28046, Spain
| | - María Alonso-Bartolomé
- Urology department, Hospital Universitario La Paz, Paseo de La Castellana 261, Madrid, 28046, Spain
| | - Héctor Ayllon
- Urology department, Hospital Universitario La Paz, Paseo de La Castellana 261, Madrid, 28046, Spain
| | - Luis Martinez-Piñeiro
- Urology department, Hospital Universitario La Paz, Paseo de La Castellana 261, Madrid, 28046, Spain.,Instituto de Investigación Hospital Universitario La Paz (IDiPaz), Calle de Pedro Rico, 6, Madrid, 28029, Spain
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Muacevic A, Adler JR. A Rare and Complex Case of Non-suicidal Self-Mutilation in a Patient With Schizophrenia. Cureus 2023; 15:e33269. [PMID: 36741672 PMCID: PMC9891735 DOI: 10.7759/cureus.33269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
The literature describing acts of non-suicidal self-mutilation (NSSM) in the adult population is limited. Of the cases that document NSSM, a disproportionate number of these individuals have a history of psychiatric illnesses. Although the motivation to perform NSSM varies across patients, the literature suggests that past self-injurious behaviors, extreme religious delusions, and command hallucinations are the most significant risk factors. The primary forms of NSSM include ocular, genital, and limb mutilation. Limb mutilation is the least common of the three and typically occurs proximal to the wrist or hand. Here, we present a rare case involving a 42-year-old man with schizophrenia who was hospitalized due to osteomyelitis of his autoamputated digits. This case is unique in involving multiple digits of the hand and using a rare amputation method. We aim to compare this case with the existing body of work on NSSM and identify factors that may predispose patients to act on these extreme impulses. We also highlight a novel interventional program that reduces psychiatric and medical comorbidities.
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Khutoryanskaya JV, Grechanyy SV. [Non-suicidal self-injurious behavior in conduct disorders and schizotypal disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:69-76. [PMID: 37942975 DOI: 10.17116/jnevro202312309269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To compare the methods and motives of non-suicidal self-injurious behavior (NSIB) in conduct disorders and schizotypal disorder. MATERIAL AND METHODS The main group consisted of 91 patients (77.8%), aged 13-24 years, with behavioral disorders and NSIB, who completed questionnaires using the self-harm statements questionnaire. The younger subgroup consisted of 54 patients under the age of 18 with a diagnosis of «Behavior Disorders» (ICD-10 F91), the older subgroup included 37 patients aged 18 years or more with a diagnosis of Emotionally Unstable Personality Disorder (F60.3). The comparison group consisted of 100 patients, aged 13-41 years with a diagnosis of schizotypal disorder (F21) and NSIB. We used clinical-psychopathological, standardized and statistical methods. RESULTS Significant differences were revealed in the sexual preference for NSIB (p=0.0001), a number of leading types of NSIB, and the absence of differences in the motives of self-injurious behavior in patients of the compared groups. In the comparison group, cuts and cauterization prevailed as the leading type of NSIB, in patients with behavioral disorders prevailed obstacles to wound healing, which is hypothetically associated with the influence of obsessive psychopathological mechanisms, since pathological excoriation has the same nature as obsessive-compulsive disorder and is included with it in the same DSM-5 category. The impulsive subtype of NSIB observed in this situation usually arises due to an increasing sense of tension and is associated with the motive of intrapersonal self-regulation. CONCLUSION The study showed that the difference between the compared nosological groups according to the methods and motives of self-harming actions is determined not so much by intergroup differences as by sex and age patterns within each of the compared groups. This allows us to talk about the proximity of the mechanisms of self-harm in various mental disorders, and the phenomenon of NSIB itself should be considered rather as a nosologically nonspecific psychopathological phenomenon.
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Affiliation(s)
- J V Khutoryanskaya
- Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - S V Grechanyy
- Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia
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Sangha S, Shah K, Gajaram G, Prasad V. Oedipism and Self-Amputation in a Schizoaffective, Depressed Type Patient: To Heal or Feel Pain? Cureus 2021; 13:e17515. [PMID: 34595081 PMCID: PMC8474022 DOI: 10.7759/cureus.17515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
Major self-mutilation, defined as self-inflicted physical harm without suicidal intent, can be a catastrophic complication of schizoaffective disorder. Oedipism and self-amputation are two sequelae seen in schizoaffective patients. Oedipism is a type of self-mutilation where an individual inflicts an ocular injury to oneself, often leading to blindness. Self-amputation, another complication seen in those with schizoaffective disorder, is defined as the act of deliberately removing healthy limbs. This case report discusses a 39-year-old Ukrainian-American male with a history of schizoaffective disorder who displayed both oedipism and self-amputation behavior of varying extremities. The patient’s plan of care was established once an extensive history was obtained and medical records were consolidated. This report contributes to the literature on rare cases of oedipism and self-amputation in patients diagnosed with schizoaffective disorder, depressed type.
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Affiliation(s)
| | - Khushbu Shah
- Psychiatry, Richmond University Medical Center, Staten Island, USA
| | | | - Vivek Prasad
- Psychiatry, Allina Hospitals, Owatonna, USA.,Psychiatry, Mayo Clinic Health System - Locums, Rochester, USA
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Lupu S, Bratu OG, Tit DM, Bungau S, Maghiar O, Maghiar TA, Scarneciu CC, Scarneciu I. Genital self-mutilation: A challenging pathology (Review). Exp Ther Med 2021; 22:1130. [PMID: 34504580 DOI: 10.3892/etm.2021.10564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022] Open
Abstract
Genital self-mutilation is a pathology that leads to numerous and important discussions, rarely presented in the medical literature. There have been many attempts to explain the reasons behind these medical phenomena, but single cases have been generally reported, making it extremely difficult to draw valid conclusions. It is acknowledged that there are psychotic and non-psychotic causes, from psychiatric problems and sexual identity disorders to cultural or religious reasons, alcohol or recreational drug consumption, unconventional types of sexual satisfaction or self-satisfaction. Recent theories consider self-mutilation as a phenomenon of reducing distress or tension, as an expression of feelings of anger or sorrow. It is believed that 55-85% of those who have resorted to self-mutilation have at least once in their life tried to commit suicide. There is evidence that early discovery and intervention as well as proper treatment in regards to psychosis can significantly reduce the number of self-mutilation episodes, with a protective role of these individuals. Cases of genital self-mutilation may be considered real medical emergencies, sometimes extremely challenging and accompanied by severe complications. Injury of the genital area is usually accompanied by numerous early or long-term complications due to the marked vascular area and to the microbial flora present in this part of the body. The degree of mutilation is an unforeseen aspect that the medical staff may have to encounter during the intervention, sometimes testing their imagination and surgical skills when dealing with such a case. Understanding the causes of these self-aggressive behaviors, which may be life-threatening, is critical and multidisciplinary mobilization is needed after treatment of the acute phases. The outcome of these patients depends on integrated collaborative work. These cases represent a serious reason for frustration for the physicians involved in solving them, and knowledge of these issues is valuable to urologists, psychiatrists and other health professionals.
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Affiliation(s)
- Sorin Lupu
- Clinic of Urology, Brasov Emergency Clinical County Hospital, Brasov 500326, Romania
| | - Ovidiu Gabriel Bratu
- Clinical Department 3, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 3700 Oradea, Romania
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 3700 Oradea, Romania
| | - Octavian Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 3700 Oradea, Romania
| | - Teodor Andrei Maghiar
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 3700 Oradea, Romania
| | - Camelia C Scarneciu
- Department of Fundamental, Prophylactic and Clinical Disciplines, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
| | - Ioan Scarneciu
- Department of Medical and Surgical Specialities, Faculty of Medicine, 'Transilvania' University of Brasov, 500019 Brasov, Romania
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Commentary: Diagnostic and Treatment Issues in Psychosis. J Psychiatr Pract 2021; 27:338-339. [PMID: 34398586 DOI: 10.1097/pra.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 3 cases presented in this issue highlight challenges in evaluating and treating patients with psychotic symptoms. The first case involved the rare but debilitating condition of periodic catatonia, the second case involved the use of intranasal oxytocin to augment an antipsychotic for a patient with worsening psychotic symptoms (and a prior diagnosis of schizophrenia) in the postpartum period, and the third case involved auto-enucleation (often referred to as "Oedipism"), a violent form of self-mutilation, in a patient presenting with first-episode schizophrenia. These case reports reinforce the need to consider a wide differential diagnosis before initiating treatment. Understanding the broad spectrum with which psychotic symptoms can present, or rare presentations of more common conditions, can help clarify the diagnosis and guide treatment, and hopefully help prevent or reduce future self-harm or violence, psychotic episodes, and hospitalizations.
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The Vision of Blindness-Sight Versus Insight: A Case Report and Literature Review of Self-enucleation (Oedipism). J Psychiatr Pract 2021; 27:333-337. [PMID: 34398585 DOI: 10.1097/pra.0000000000000558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Self-enucleation or "Oedipism" is a rare ophthalmic and psychiatric emergency. Given the severity of its consequences, it requires proper medical management and that clinicians understand and be aware of the psychiatric presentation. Important clinical considerations include identification of various etiologies leading to self-enucleation, awareness of possible complications, and provision of appropriate care. We present a case of bilateral self-enucleation by a young male patient in the context of his first episode of psychosis and review the literature on this clinical entity. Ocular damage interferes significantly with activities of daily living and is associated with decreased quality of life so that identifying risk factors is of major importance to prevent this dangerous behavior.
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Tsanakalis F, Almadhyan A, Flondell-Sité D. A rare case of complete male genital self-amputation posing challenges in the psychiatric diagnosis and management. Heliyon 2021; 7:e07349. [PMID: 34195445 PMCID: PMC8239729 DOI: 10.1016/j.heliyon.2021.e07349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 10/27/2022] Open
Abstract
Genital self-mutilation (GSM) is a rare phenomenon encountered mostly within the context of severe mental illness. The following case report highlights a rare case of self-inflicted total penile self-amputation in a patient with a psychiatric history of polydrug abuse and attention deficit disorder (ADD). The patient engaged in penile self-amputation under the influence of command hallucinations and religious delusions. He was operated on with microsurgical penile replantation but the penis had to be amputated after two weeks because of postoperative complications. The patient was admitted for compulsory psychiatric treatment. During the prolonged hospitalization course, he was arrested for stabbing two other patients and was transferred to a forensic psychiatric unit. The case fits the description for Klingsor Syndrome and involved multiple interacting risk factors that complicated the initial presentation and the ensuing management of the condition in the hospital setting.
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Affiliation(s)
- Fotios Tsanakalis
- Department of Liaison Psychiatry and Psychiatric Emergency Cases, Skåne University Hospital, Malmö, Sweden
| | - Abdullah Almadhyan
- Department of Liaison Psychiatry and Psychiatric Emergency Cases, Skåne University Hospital, Malmö, Sweden
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Chechko N, Stormanns E, Podoll K, Stickel S, Neuner I. Self-enucleation of the right eye by a 38-year-old woman diagnosed with schizoaffective disorder: a case report. BMC Psychiatry 2020; 20:563. [PMID: 33238922 PMCID: PMC7690205 DOI: 10.1186/s12888-020-02974-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autoenucleation is a rare form of self-mutilation typically associated with psychiatric disorders such as schizophrenia, substance-induced psychosis and bipolar disorder. The act is usually unilateral, although bilateral attempts are also well documented in the literature. CASE PRESENTATION It is a case study involving a female patient (NN) diagnosed with schizoaffective disorder who self-enucleated her right eye following sexual intercourse with a fellow patient, and was forcefully prevented by staff from enucleating the second eye. We report recurrent episodes of her illness culminating in this severe act of self-mutilation. The motivational reasons behind this form of self-harm along with differential diagnosis and potential treatment options are discussed in the context of the available literature. CONCLUSION Autoenucleation is commonly associated with religious and sexual delusions, and patients are thought to be at a greater risk of further self-harm. Timely antipsychotic treatment is likely to reduce the risk of such extreme forms of self-harm, although they can occur despite robust therapeutic intervention and treatment attempts. While self-inflicted eye injuries are rare, their prevention in what is typically a difficult patient group is fraught with challenges.
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Affiliation(s)
- Natalia Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Pauwelsstrasse 23, 52074, Aachen, Germany. .,Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany. .,Institute of Neuroscience and Medicine (INM-7), Forschungszentrum Juelich, Juelich, Germany.
| | - Eva Stormanns
- grid.412301.50000 0000 8653 1507Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Pauwelsstrasse 23, 52074 Aachen, Germany
| | - Klaus Podoll
- grid.412301.50000 0000 8653 1507Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Pauwelsstrasse 23, 52074 Aachen, Germany
| | - Susanne Stickel
- grid.412301.50000 0000 8653 1507Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Pauwelsstrasse 23, 52074 Aachen, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Irene Neuner
- grid.412301.50000 0000 8653 1507Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, Uniklinik RWTH Aachen, Pauwelsstrasse 23, 52074 Aachen, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-4), Forschungszentrum Juelich, Juelich, Germany
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Okafor L, Choudry A, Mudhar HS, Sandramouli S. Oedipism: An unusual case of auto-enucleation including mechanism of avulsion. Eur J Ophthalmol 2020; 32:1120672120972028. [PMID: 33183093 DOI: 10.1177/1120672120972028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Self-inflicted enucleation, also known as auto-enucleation (AE) or Oedipism, is an uncommon and severe form of ocular injury which presents as an ophthalmic and psychiatric emergency. Usually known to occur with untreated psychosis, this case is a rare report which demonstrates AE as a result of a subsequently diagnosed drug induced psychosis. We report the clinical presentation, management and for the first time a detailed speculative account about the mechanism of AE, based on our clinicopathologic findings. CASE REPORT A 53-year old Afro-Caribbean patient was arrested following an altercation and was incarcerated awaiting arraignment. The patient had no previous psychiatric history but tested positive for cannabis, opiates and cocaine as well as admitting to illicit drug use in the community. Whilst in custody, the patient self-enucleated his right eye. The patient declined consent to eye examination and was subsequently admitted under section 2 of the Mental Health Act. After full work-up including Goldmann visual fields and magnetic resonance imaging, he underwent right orbital exploration under anesthetic where AE was confirmed whilst the left eye showed evidence of attempted enucleation. The residual tenons and conjunctiva was subsequently repaired without placement of an orbital implant in the right orbit. The globe was sent for histology which revealed clues to the potential mechanism of auto-enucleation. CONCLUSION This case is unique as it offers an alternative presentation to those most commonly reported in the current literature, highlights the sparsity of literature detailing the mechanism of AE and stimulates discussion around various potential systemic etiological differential diagnoses, management strategies and complications of AE.
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Affiliation(s)
- Linda Okafor
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Abid Choudry
- Department of Psychiatry, Black Country Healthcare Foundation Trust, Penn Hospital, Wolverhampton, UK
| | - Hardeep S Mudhar
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, Royal Hallamshire Hospital Sheffield, Sheffield, UK
| | - Soupramanien Sandramouli
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Güney E, Alnıak İ, Erkıran M. Predicting factors for non-suicidal self-injury in patients with schizophrenia spectrum disorders and the role of substance use. Asian J Psychiatr 2020; 52:102068. [PMID: 32371364 DOI: 10.1016/j.ajp.2020.102068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/19/2022]
Abstract
Non-suicidal self-injury (NSSI) has been shown as a characteristic feature in many clinical populations in recent years and schizophrenia is one of the most common psychiatric disorders which is associated with NSSI. In this study, we aimed to investigate predictors of NSSI in patients with schizophrenia spectrum disorders (SSD) and the role of lifetime substance use disorder (SUD). A sample of 165 patients with a diagnosis of SSD who were in remission participated in the study. Lifetime NSSI was assessed using the Inventory of Statements About Self-injury (ISAS). Lifetime SUD were evaluated. Logistic regression analysis was conducted to predict NSSI. SUD was found to be related to NSSI in patients with SSD, and it was associated with an approximately fourfold increase in the risk of NSSI. The rates of lifetime SUD in our sample and in the NSSI (+) group were 38.2 % and 55.6 %, respectively. The most commonly abused substances among patients with NSSI were cannabis and synthetic cannabinoids. The prevalence of NSSI was 43.6 % in our sample. 'Self-cutting' was the most common type and 'affect regulation' was the most common function of NSSI. One of the most significant risk factors for NSSI was a previous history of suicide attempts. SUD appears to be a significant predictor of NSSI in patients with SSD. Further investigation of treatable risk factors such as SUD which are related to NSSI is needed. It is also essential to screen SSD patients for NSSI due to the probable relation to high risk of suicide.
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Affiliation(s)
- Erengül Güney
- Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, Bakırköy, İstanbul, 34280, Turkey.
| | - İzgi Alnıak
- Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, Bakırköy, İstanbul, 34280, Turkey
| | - Murat Erkıran
- Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, Bakırköy, İstanbul, 34280, Turkey
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Olding J, Zisman S, Olding C, Fan K. Penetrating trauma during a global pandemic: Changing patterns in interpersonal violence, self-harm and domestic violence in the Covid-19 outbreak. Surgeon 2020; 19:e9-e13. [PMID: 32826157 PMCID: PMC7392113 DOI: 10.1016/j.surge.2020.07.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/01/2020] [Accepted: 07/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The restrictions imposed on social activity in response to the Covid-19 pandemic have had a profound impact globally. In the UK, the NHS was placed on a war-footing, with elective surgery, face-to-face outpatient clinics, and community care facilities all scaled back as a temporary measure to redistribute scarce resources. There has been concern during this period over increasing levels of violence in the domestic setting, as well as self-harm. METHODS Data was collected on all patients presenting with traumatic penetrating injuries during the 'lockdown' period of 23rd March to 29th April 2020. Demographics and injury details were compared with the same period in the two preceding years. RESULTS Overall trauma fell by 35% compared with the previous year. Over one in four penetrating injuries seen were a result of self-harm, which was significantly higher than in previous years (11% in 2019, 2% in 2018). There were two cases of injuries due to domestic violence, while a total of 4 cases of injury arose in separate violent domestic incidents. Self-harm commonly involved penetrating injury to the neck. DISCUSSION Our centre has seen an increase in the proportion of penetrating injuries as a result of both self-harm and violence in the domestic setting. The number of penetrating neck injury cases, which can represent suicidal intent or a major presentation of psychiatric illness, is of particular concern. We must further investigate the effect of social restrictions on violent injury, and how home confinement may influence a changing demographic picture of victims.
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Affiliation(s)
- James Olding
- Department of Oral & Maxillofacial Surgery, King's College Hospital, London, SE5 9RS, United Kingdom
| | - Sophia Zisman
- South London and Maudsley NHS Foundation Trust (SLaM), London, SE5, United Kingdom
| | - Carole Olding
- Emergency Department, King's College Hospital, London, SE5 9RS, United Kingdom
| | - Kathleen Fan
- Department of Oral & Maxillofacial Surgery, King's College Hospital, London, SE5 9RS, United Kingdom; Faculty of Dentistry, Oral Craniofacial Sciences, King's College London, United Kingdom.
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20
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Lebelo LT, Grobler GP. Case study: A patient with severe delusions who self-mutilates. S Afr J Psychiatr 2020; 26:1403. [PMID: 32670631 PMCID: PMC7343943 DOI: 10.4102/sajpsychiatry.v26i0.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 03/05/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Lesiba T Lebelo
- Department of Psychiatry, School of Medicine, University of Pretoria, Pretoria, South Africa
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21
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Ban KY, Osborn DPJ, Hameed Y, Pandey S, Perez J, Jones PB, Kirkbride JB. Personality disorder in an Early Intervention Psychosis cohort: Findings from the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PLoS One 2020; 15:e0234047. [PMID: 32502161 PMCID: PMC7274401 DOI: 10.1371/journal.pone.0234047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
AIM Personality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services. METHODS Participants were aged 16-35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed. RESULTS Of 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0-5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6-5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2-2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1-1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1-0.7). There was no association between PD and neighbourhood-level deprivation or population-density. CONCLUSIONS Recording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.
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Affiliation(s)
- Ka-Young Ban
- Division of Psychiatry, UCL, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Yasir Hameed
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Santvana Pandey
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
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Two Cases of Nonsuicidal Self-Injury Comprising Partial Autoamputation of the Apex of the Tongue. Case Rep Dent 2020; 2020:8691270. [PMID: 32148976 PMCID: PMC7057006 DOI: 10.1155/2020/8691270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/04/2020] [Accepted: 01/31/2020] [Indexed: 11/17/2022] Open
Abstract
The prevalence of nonsuicidal self-injury (NSSI) in adults is lower than that in adolescents and it is more prevalent in patients with psychiatric disorders. Sleep disturbances such as nightmares are associated with NSSI after accounting for depression; thus, persons with major NSSI sometimes present at medical institutions during the night seeking emergency treatment. Gingival tissues comprise the most frequent target of self-injury of the oral cavity using oral hygiene tools. Most NSSI in the oral cavity is minor because such tools are blunt. Major NSSI such as autoamputation of the tongue is rare. We describe two patients who partially autoamputated the apex of their own tongues using edged tools. Case 1 was a 55-year-old female with depression who had defaulted from psychiatric intervention. She had cut off her tongue using a Japanese kitchen knife and presented with the dry, necrotic amputated portion and blood oozing from the remainder of her tongue. We debrided and sutured the remainder of the tongue without reattaching the amputated portion. Her postoperative course was uneventful, and she was free of adverse events such as functional disability and wound infection. Case 2 was a 69-year-old female with schizophrenia who had defaulted from psychiatric intervention and had cut off her tongue using scissors. The amputated portion of the tongue was lost and the remainder, which was oozing blood, was debrided and sutured. She defaulted on a follow-up appointment. Neither of these patients had suicidal intent. The prevalence of NSSI across all age groups has recently increased, and the risk that self-injury will become normalized has become a concern. Thus, dentists as well as oral and maxillofacial surgeons should be aware of the possibility that patients will present with major NSSI requiring emergency treatment.
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Vakhshori V, Bouz GJ, Mayfield CK, Alluri RK, Stevanovic M, Ghiassi A. Trends in Pediatric Traumatic Upper Extremity Amputations. Hand (N Y) 2019; 14:782-790. [PMID: 29845883 PMCID: PMC6900692 DOI: 10.1177/1558944718777865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Traumatic upper extremity amputation in a child can be a life-altering injury, yet little is known about the epidemiology or health care costs of these injuries. In this study, using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), we assess these trends to learn about the risk factors and health care costs of these injuries. Methods: Using the HCUP KID from 1997 to 2012, patients aged 20 years old or younger with upper extremity traumatic amputations were identified. National estimates of incidence, demographics, costs, hospital factors, patient factors, and mechanisms of injury were assessed. Results: Between 1997 and 2012, 6130 cases of traumatic upper extremity amputation occurred in children. This resulted in a $166 million cost to the health care system. Males are 3.4 times more likely to be affected by amputation than females. The most common age group to suffer amputation is in older children, aged 15 to 19 years old. The frequency of amputation has declined 41% from 1997 to 2012. The overwhelming majority of amputations (92.54%) involved digits. Conclusions: Pediatric traumatic amputations of the upper extremity are a significant contribution to health care spending. Interventions and educational campaigns can be targeted based on national trends to prevent these costly injuries.
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Affiliation(s)
- Venus Vakhshori
- University of Southern California, Los
Angeles, USA,Venus Vakhshori, Department of Orthopaedic
Surgery, Keck Medical Center at the University of Southern California, 1520 San
Pablo Street, Suite 2000, Los Angeles, CA 90033, USA.
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Limb Self-Amputation Without Replantation: A Case Report and Management Considerations. PSYCHOSOMATICS 2019; 60:316-320. [DOI: 10.1016/j.psym.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022]
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Gadelkareem RA, Shahat AA, Abdelhafez MF, Reda A, Khalil M. Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. II. Urological Self-Inflicted Harms: 1. Unintentional Patient's Side-Inflictor Urological Injuries. Curr Urol 2019; 12:74-80. [PMID: 31114464 PMCID: PMC6504803 DOI: 10.1159/000489423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/10/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Unintentional self-inflicted injuries mainly refer to those injuries which are inflicted by the patient himself with benign intentions. In urology, they may vary and result in significant morbidities. PATIENTS AND METHODS A retrospective search of our patients' data records for the reported cases of patient's side-inflictor urological injuries during the period July 2006 - June 2016 was made. Each case was studied for age, gender, primary diagnosis, injury inflictor, involved organ, motivating factor, mechanism, diagnosis, management, and final outcome. RESULTS Of more than 55,000 urological procedures, 26 patients (0.047%) were involved in unintentional patient's side-inflictor urological injuries. The age range was 8-76 years and included 23 males and 3 females. Fifteen patients (57.7%) had urological disorders before the injury. They could be differentiated into direct organ involvement injuries (53.8%) and catheter involvement injuries (46.2%). External male urogenital organs were involved in 69.3% of cases which were diagnosed on physical examination. The inflictor of the injury was the patient himself, a relative, and another patient in 73.1, 19.2, and 7.7% of cases, respectively. Motivating factors were relief of painful conditions (34.6%), psychiatric disorders (38.5%), and sexual purposes (27%). Final outcomes were short-term harm, long-term harm, and permanent disability in 50, 11.5, and 38.5% of cases, respectively. CONCLUSION Unintentional patient's side-inflictor urological injuries are very rare events and mainly involve the external male urogenital organs under different motivating stressors. They could be differen-tiated into direct organ and catheter manipulation injuries with variable final outcomes from mild short-term harms to permanent disabilities.
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Affiliation(s)
- Rabea A. Gadelkareem
- Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
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Delusion, excitement, violence, and suicide history are risk factors for aggressive behavior in general inpatients with serious mental illnesses: A multicenter study in China. Psychiatry Res 2019; 272:130-134. [PMID: 30580136 DOI: 10.1016/j.psychres.2018.12.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 01/13/2023]
Abstract
Little is known about the risk factors for aggression in general clinical settings in China. The aim of this study is to explore potential risk factors for inpatients with serious mental illness. The study was conducted from 15 March to 14 April 2013 and involved 16 general psychiatric institutions in China. A standardized data collection form was used to collect demographic and clinical characteristics data, including information on current hallucinations, delusions, depression, excitement, aboulia, apathy, and adherence to treatment. Information on lifetime history of violence and suicidality was also collected. The Modified Overt Aggression Scale (MOAS) was also administered to indicate recent (past week) aggression. A total of 511 inpatients were enrolled. On the basis of a score of five or greater on the MOAS, 245 inpatients were assigned to aggressive group and 266 were assigned to non-aggressive group. A lifetime history of violent behaviour (OR = 3.1, 95% CI = 1.95-5.11), suicide (OR = 3.0, 95% CI = 1.49-6.10), as well as current delusions (OR = 1.92, 95% CI = 1.24-2.97), and excitement (OR = 2.63, 95% CI = 1.57-4.39) were associated with aggression. The study suggested violent history, suicide history, current delusions, and excitement are the risk factors for aggression among general psychiatric inpatients with serious mental illnesses.
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Psychodermatology: An Association of Primary Psychiatric Disorders With Skin. ACTA ACUST UNITED AC 2019; 48:50-57. [DOI: 10.1016/j.rcp.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/26/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
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Etlouba Y, Laher A, Motara F, Moolla M, Ariefdien N. First Presentation with Psychotic Symptoms to the Emergency Department. J Emerg Med 2018; 55:78-86. [DOI: 10.1016/j.jemermed.2018.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 10/16/2022]
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Huang X, Fox KR, Ribeiro JD, Franklin JC. Psychosis as a risk factor for suicidal thoughts and behaviors: a meta-analysis of longitudinal studies. Psychol Med 2018; 48:765-776. [PMID: 28805179 DOI: 10.1017/s0033291717002136] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Research has long noted higher prevalence rates of suicidal thoughts and behaviors among individuals with psychotic symptoms. Major theories have proposed several explanations to account for this association. Given the differences in the literature regarding the operationalization of psychosis and sample characteristics, a quantitative review is needed to determine to what extent and how psychosis confers risk for suicidality. METHODS We searched PsycInfo, PubMed, and GoogleScholar for studies published before 1 January 2016. To be included in the analysis, studies must have used at least one psychosis-related factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2541 studies. Fifty studies were retained for analysis, yielding 128 statistical tests. RESULTS Suicide death was the most commonly studied outcome (43.0%), followed by attempt (39.1%) and ideation (18.0%). The median follow-up length was 7.5 years. Overall, psychosis significantly conferred risk across three outcomes, with weighted mean ORs of 1.70 (1.39-2.08) for ideation, 1.36 (1.25-1.48) for attempt, and 1.40 (1.14-1.72) for death. Detailed analyses indicated that positive symptoms consistently conferred risk across outcomes; negative symptoms were not significantly associated with ideation, and were protective against death. Some small moderator effects were detected for sample characteristics. CONCLUSIONS Psychosis is a significant risk factor for suicide ideation, attempt, and death. The finding that positive symptoms increased suicide risk and negative symptoms seemed to decrease risk sheds light on the potential mechanisms for the association between psychosis and suicidality. We note several limitations of the literature and offer suggestions for future directions.
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Affiliation(s)
- X Huang
- Department of Psychology,Florida State University,Tallahassee, FL,USA
| | - K R Fox
- Department of Psychology,Harvard University,Cambridge, MA,USA
| | - J D Ribeiro
- Department of Psychology,Florida State University,Tallahassee, FL,USA
| | - J C Franklin
- Department of Psychology,Florida State University,Tallahassee, FL,USA
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Coussa RG, Mikhail M, Flanders M, Arthurs BP. Ocular self-mutilation: a case series. Can J Ophthalmol 2017; 53:e65-e67. [PMID: 29631845 DOI: 10.1016/j.jcjo.2017.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/13/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Mikel Mikhail
- Department of Ophthalmology, McGill University, Montreal, Que
| | | | - Bryan P Arthurs
- Department of Ophthalmology, McGill University, Montreal, Que
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Napa W, Tungpunkom P, Pothimas N. Effectiveness of family interventions on psychological distress and expressed emotion in family members of individuals diagnosed with first-episode psychosis: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1057-1079. [PMID: 28398985 DOI: 10.11124/jbisrir-2017-003361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND A critical period for persons with first-episode psychosis is the first two years after diagnosis, when they are at high risk of suicide attempts, violent behaviors and substance abuse. This period also has a great impact on the psychological distress of family members, particularly caregivers who either provide care or live with ill family members. In addition, the families also report feelings of being overwhelmed when accessing service facilities at this critical point. These consequences impact on the affective tone/atmosphere in the family, also referred to as so-called expressed emotion. In addition, expressed emotion research has indicated that the family atmosphere contributes to recurrent psychosis and lengthy hospital stays for patients in the initial phase. Therefore, family interventions aimed at reducing psychological distress and improving expressed emotion in families during this critical time are very important. Modern research has yielded international evidence addressing these outcomes, but little is known about which interventions are the most effective. Therefore, this review aimed to evaluate the effectiveness of these interventions. OBJECTIVES The objective of this review was to examine the effectiveness of family interventions on psychological distress and expressed emotion in family members of persons with first-episode psychosis (FEP). INCLUSION CRITERIA TYPES OF PARTICIPANTS Family members of persons with FEP and who had received treatment after being diagnosed within two years. TYPES OF INTERVENTION(S) Studies that examined interventions among family members of persons with FEP. Family interventions referred to any education, psychoeducation, communication, coping and problem-solving skills training and cognitive behavioral therapy that was provided to family members of persons with FEP. OUTCOMES Psychological distress and expressed emotions of those family members. TYPES OF STUDIES Randomized controlled trials, quasi-experimental studies, cohort studies and case-control studies. SEARCH STRATEGY The preliminary search was conducted in MEDLINE and CINAHL with keywords containing the title, abstract and subject description analysis as the first identification of related studies. An extensive search was conducted in other databases including ProQuest Dissertations and Theses, ScienceDirect, Scopus, PsychINFO, ThaiLIS and Thai National research databases. In addition, searches of reference lists and other manual searches were undertaken. METHODOLOGICAL QUALITY Studies were critically appraised by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Data were extracted using the standardized data extraction tools from the Joanna Briggs Institute. The mean score and standard deviation (SD) were extracted for targets outcomes relating to psychological distress and expressed emotion. DATA SYNTHESIS Quantitative data could not be pooled due to the heterogeneity of the included studies. Data were synthesized based on the individual results from the three included studies and have been presented in a narrative format accompanied with tabulated data. RESULTS Data synthesis of the three individual studies indicated that there were no statistically significant interventions that address psychological distress and expressed emotion in family members who live with and care for persons with FEP. There is insufficient evidence available to evaluate the effect sizes for pooled outcomes. CONCLUSION Based on the results of this review, there is insufficient evidence to validate the effectiveness of family interventions on psychological distress and expressed emotion in family members who live with and care for persons with FEP. In addition, based on the individual primary studies, the implications for practice should be carefully considered.
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Affiliation(s)
- Wilai Napa
- 1Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi, Mahidol University, Bangkok, Salaya, Thailand 2Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand 3Faculty of Nursing, Chiang Mai University, Thailand Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence, Chiang Mai, Thailand 4Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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Seeman MV. Identity and schizophrenia: Who do I want to be? World J Psychiatry 2017; 7:1-7. [PMID: 28401044 PMCID: PMC5371169 DOI: 10.5498/wjp.v7.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/07/2016] [Accepted: 01/02/2017] [Indexed: 02/05/2023] Open
Abstract
Many individuals with schizophrenia have occasional difficulty defining both to themselves and to others who they truly are. Perhaps for this reason they make attempts to change core aspects of themselves. These attempts may be delusional, but are too often unjustly dismissed as delusional before the potential value of the change is considered. Instead of facilitation, obstacles are placed in the way of hoped-for body modifications or changes of name or of religious faith. This paper discusses the various changes of identity sometimes undertaken by individuals with schizophrenia who may or may not be deluded. Ethical and clinical ramifications are discussed. The recommendation is made that, when clinicians respond to requests for help with identity change, safety needs to be the main consideration.
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Mannarino VS, Pereira DCS, Gurgel WS, Costa CBF, Valença AM, Fontenelle LF, Mendlowicz MV. Self-Embedding Behavior in Adults: A Report of Two Cases and a Systematic Review. J Forensic Sci 2016; 62:953-961. [PMID: 27982450 DOI: 10.1111/1556-4029.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/07/2016] [Accepted: 09/17/2016] [Indexed: 11/27/2022]
Abstract
Self-embedding behavior (SEB) is the repeated insertion of sharp objects, such as needles or pins, into the soft tissues of abdomen, limbs, and other body parts. In this study, two cases of SEB were reported and the scientific worldwide literature reviewed. Thirty-two cases of SEB were identified through systematic searches in the main bibliographic databases. Mean age was 35 years (SD = 8.97). Just over two-thirds of the patients were female. Although the number of embedded objects could be as high as 200, major clinical and surgical complications were uncommon and mortality was null. Patients with SEB presented three major diagnoses: psychotic (25%), personality (21.9%), and factitious (28.1%) disorders. The practice of SEB largely went undetected as the patients themselves did not bring it to the attention of family members or physicians and usually denied they have engaged in SEB. A high level of suspicion is required to avoid a missed diagnosis.
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Affiliation(s)
- Victor S Mannarino
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Débora C S Pereira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil
| | - Wagner S Gurgel
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Carolina B F Costa
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Centro Psiquiátrico do Rio de Janeiro (CPRJ), Praça Coronel Assunção, SN, Rio de Janeiro, RJ, Brazil
| | - Alexandre M Valença
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil.,D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Rio de Janeiro, RJ, Brazil.,School of Psychological Sciences & Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, 3800, Australia
| | - Mauro V Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB - UFRJ), Avenida Venceslau Brás, 71 fundos, Rio de Janeiro, RJ, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói, RJ, Brazil
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Sakson-Obada O, Chudzikiewicz P, Pankowski D, Jarema M. Body Image and Body Experience Disturbances in Schizophrenia: an Attempt to Introduce the Concept of Body Self as a Conceptual Framework. CURRENT PSYCHOLOGY 2016; 37:390-400. [PMID: 29563762 PMCID: PMC5845076 DOI: 10.1007/s12144-016-9526-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disturbances in body experience are described as key schizophrenia symptoms and early disease predictors. In case studies, different disorders relating to body experience are presented, but only a few empirical studies have aimed to distinguish the characteristics of body experience in schizophrenia, and these have been selected arbitrarily and without reference to cohesive theoretical model. To integrate this fragmentary approach, we propose a body self (BS) model, composed of: functions; representations (e.g., body image); and sense of body identity. The aim of the study was to determine whether the BS differentiates schizophrenic patients from healthy controls, and to investigate the relations between aspects of BS and a history of illness and clinical characteristics. The Body Self Questionnaire and the Positive and Negative Syndrome Scale were administered to 63 schizophrenic patients and 63 healthy subjects. The difference was found in the functions of the body-self (perceiving, interpreting, and regulating body experience), in the sense of body identity, and in one of three aspects of body image explored (e.g., acceptance of biological sex). Disturbances in BS were related to positive symptoms and to the number of hospitalizations for other diseases. Together, the results demonstrate that schizophrenia is more body experience than body image disorder, since the negative emotional attitude towards the body and acceptance of fitness were not distinctive for schizophrenia. The link between the disturbances in BS and the number of nonpsychiatric hospitalizations suggests that misinterpretation of body experiences in schizophrenia can promote a search for medical attention.
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Affiliation(s)
- Olga Sakson-Obada
- Institute of Psychology, Adam Mickiewicz University, 89 Szamarzewskiego Street, 60-568 Poznan, PL Poland
| | - Paulina Chudzikiewicz
- III Psychiatric Clinic, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, PL Poland
| | - Daniel Pankowski
- Faculty of Psychology, University of Warsaw, Stawki 5/7 Street, 00-183 Warsaw, PL Poland
| | - Marek Jarema
- III Psychiatric Clinic, Institute of Psychiatry and Neurology, Sobieskiego 9 Street, 02-957 Warsaw, PL Poland
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Carter G, Page A, Large M, Hetrick S, Milner AJ, Bendit N, Walton C, Draper B, Hazell P, Fortune S, Burns J, Patton G, Lawrence M, Dadd L, Dudley M, Robinson J, Christensen H. Royal Australian and New Zealand College of Psychiatrists clinical practice guideline for the management of deliberate self-harm. Aust N Z J Psychiatry 2016; 50:939-1000. [PMID: 27650687 DOI: 10.1177/0004867416661039] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To provide guidance for the organisation and delivery of clinical services and the clinical management of patients who deliberately self-harm, based on scientific evidence supplemented by expert clinical consensus and expressed as recommendations. METHOD Articles and information were sourced from search engines including PubMed, EMBASE, MEDLINE and PsycINFO for several systematic reviews, which were supplemented by literature known to the deliberate self-harm working group, and from published systematic reviews and guidelines for deliberate self-harm. Information was reviewed by members of the deliberate self-harm working group, and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to successive consultation and external review involving expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest and expertise in deliberate self-harm. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for deliberate self-harm provide up-to-date guidance and advice regarding the management of deliberate self-harm patients, which is informed by evidence and clinical experience. The clinical practice guidelines for deliberate self-harm is intended for clinical use and service development by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSION The clinical practice guidelines for deliberate self-harm address self-harm within specific population sub-groups and provide up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
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Affiliation(s)
- Gregory Carter
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Translational Neuroscience and Mental Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia Department of Consultation Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah, NSW, Australia
| | - Andrew Page
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Health Research, Western Sydney University, Richmond, NSW, Australia
| | - Matthew Large
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - Sarah Hetrick
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Allison Joy Milner
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nick Bendit
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW, Australia
| | - Carla Walton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Centre for Psychotherapy, Hunter New England Mental Health Service and Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Brian Draper
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Philip Hazell
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Fortune
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia The University of Auckland, Auckland, New Zealand University of Leeds, Leeds, UK Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Jane Burns
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Young and Well Cooperative Research Centre, The University of Melbourne, Melbourne, VIC, Australia Brain & Mind Research Institute, The University of Sydney, Sydney, NSW, Australia Orygen Youth Health Research Centre, Melbourne, VIC, Australia
| | - George Patton
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia National Health and Medical Research Council, Canberra, ACT, Australia Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, VIC, Australia Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Mark Lawrence
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Tauranga Hospital, Bay of Plenty, New Zealand
| | - Lawrence Dadd
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Mental Health & Substance Use Service, Hunter New England, NSW Health, Waratah, NSW, Australia Awabakal Aboriginal Medical Service, Hamilton, NSW, Australia Pital Tarkin, Aboriginal Medical Student Mentoring Program, The Wollotuka Institute, The University of Newcastle, Callaghan, NSW, Australia Specialist Outreach NT, Darwin, Northern Territory, Australia
| | | | - Jo Robinson
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen Christensen
- Clinical Practice Guideline for Deliberate Self-harm Working Group, RANZCP, Melbourne, Victoria, Australia Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
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Khandelwal A, Chauhan K, De Sousa A, Sonavane S, Pawar A. Genital Self-mutilation in a Case of First Episode Psychosis. Indian J Psychol Med 2016; 38:361-3. [PMID: 27570352 PMCID: PMC4980908 DOI: 10.4103/0253-7176.185951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Genital self-mutilation (GSM) is a much rare finding and more commonly associated with psychosis when it comes to comparison with self-mutilation as a whole. There have been anecdotal case reports of GSM in psychotic disorders with most of them being in long standing psychoses. We describe herein a case of GSM during the first episode of psychosis where multiple phenomenological variables were seen responsible for the act.
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Affiliation(s)
- Anuj Khandelwal
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Khushboo Chauhan
- Department of Psychiatry, B. J. Medical College, Pune, Maharashtra, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Sushma Sonavane
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Alka Pawar
- Department of Psychiatry, B. J. Medical College, Pune, Maharashtra, India
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Virasoro R, Tonkin JB, McCammon KA, Jordan GH. Penile Amputation: Cosmetic and Functional Results. Sex Med Rev 2015; 3:214-222. [PMID: 27784611 DOI: 10.1002/smrj.50] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Penile amputation is a rare type of external genital trauma. It may arise from accidental trauma, assault or self-inflicted mutilation. As with all trauma, initial management focuses on assessment and resuscitation of the patient. When available, hypothermic preservation of the detached penis should be undertaken. AIM This review serves to compile the current available information on etiology and management of penile amputation injuries, with focus on functional and cosmetic results. MAIN OUTCOME MEASURES Main outcome measures were penile cosmetics, viability, and sensation; urethral patency and graft survival, functionality. METHODS A literature search using Medline, PubMed (U.S. National Library of Medicine and the National Institutes of Health), and abstracts from scientific meetings was performed from 1980-2013. RESULTS Due to the rarity of penile amputation injuries, no randomized trials exist. Likewise, available published series on management of this condition are comprised of a small number of patients. CONCLUSIONS Penile amputation is rare but challenging. Current microreplantation procedures have a uniformly good result with a minimum number of post-operative complications. When microreplantation cannot be performed, older corporal reattachment techniques may be offered. When phallic reconstruction is required, a microsurgical free forearm flap phalloplasty may be performed to restore the patient with an acceptable cosmetic and functional phallus. Virasoro R, Tonkin JB, McCammon KA, and Jordan GH. Penile amputation: Cosmetic and functional results. Sex Med Rev 2015;3:214-222.
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Affiliation(s)
- Ramón Virasoro
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Jeremy B Tonkin
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kurt A McCammon
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Gerald H Jordan
- Department of Urology, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health at Urology of Virginia, Eastern Virginia Medical School, Norfolk, VA, USA
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Rahmanian H, Petrou NA, Sarfraz MA. Self-Amputation in Two Non-Psychotic Patients. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e231. [PMID: 26576171 PMCID: PMC4644618 DOI: 10.17795/ijpbs-231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 08/09/2014] [Accepted: 10/28/2014] [Indexed: 01/16/2023]
Abstract
Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.
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Affiliation(s)
- Hamid Rahmanian
- Locum Consultant Psychiatrist , Camden & islington NHS Trust, London, UK
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Selby EA, Kranzler A, Fehling KB, Panza E. Nonsuicidal self-injury disorder: The path to diagnostic validity and final obstacles. Clin Psychol Rev 2015; 38:79-91. [DOI: 10.1016/j.cpr.2015.03.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 03/25/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
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Abstract
Suicide is a serious public health problem, with more than 800,000 deaths taking place worldwide each year. Mental disorders are associated with increased risk of suicide. In schizophrenia and other psychotic disorders, the lifetime risk of suicide death is estimated to be 5.6%. The risk is particularly high during the first year of the initial contact with mental health services, being almost twice as high as in the later course of the illness. The most consistently reported risk factor for suicide among people with psychotic disorders is a history of attempted suicide and depression. Suicide risk in psychosis in Denmark decreased over time, most likely because of improved quality of inpatient and outpatient services. There is a high proportion of young people with first-episode psychosis who attempted suicide before their first contact with mental health services. This finding suggests that the mortality rates associated with psychotic disorders may be underreported because of suicide deaths taking place before first treatment contact. However, currently, no data exist to confirm or refute this hypothesis. Attempted suicide can be an early warning sign of later psychotic disorder. Data from different studies indicate that the risk of suicide attempt during the first year of treatment is as high as 10%. The most important risk factors for attempted suicide after the first contact are young age, female sex, suicidal plans, and a history of suicide attempt. Early intervention services are helpful in first-episode psychosis, and staff members should, in collaboration with the patients, monitor the risk of suicide and develop and revise crisis plans.
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Self-inflicted needle injuries to the eye: a curing pain. Case Rep Psychiatry 2015; 2015:960579. [PMID: 25810940 PMCID: PMC4355111 DOI: 10.1155/2015/960579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 11/28/2022] Open
Abstract
There are few reports of severe self-injury to eyes in patients with schizophrenia. We report on a 41-year-old woman, primarily visiting for symptoms of endophthalmitis resulting from self-inflicted needles. Further evaluations established the diagnosis of schizophrenia because of arguing and commenting on auditory hallucinations and negative symptoms including social isolation, decreased self-care, blunt affect, and a monotone voice. The patient had been suffering from auditory hallucinations for several years and found relief in bodily pain caused by needles. The patient received 6 mg of risperidone. Hallucinations were resolved and self-injury behaviour was not repeated.
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Nordentoft M. Specialised assertive intervention in early psychosis. Lancet Psychiatry 2015; 2:2-3. [PMID: 26359592 DOI: 10.1016/s2215-0366(14)00056-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Merete Nordentoft
- University of Copenhagen, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark.
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Soren S, Surjit, Chaudhury S, Bakhla AK. Multiple self-inserted pins and nails in pericardium in a patient of schizophrenia: Case report and review. Ind Psychiatry J 2015; 24:82-7. [PMID: 26257490 PMCID: PMC4525439 DOI: 10.4103/0972-6748.160959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This report is the case of multiple self-inserted pins and nails in chest and pericardial cavity in a young male suffering from schizophrenia. This act of self-mutilation was done to get relief from burning sensation in chest and palpitations. Review of the relevant literature revealed that self-inflicted intra-cardiac needle injuries occur mainly in young and middle-aged adults suffering from psychiatric disorders, commonly depression, schizophrenia, and substance use disorders. In one-fourth of the patients, it is due to deliberate self-harm. About 70% use a single needle but 30% may use multiple needles. Second attempts are rare. Majority of the patients (85%) are managed by surgery and recover from the injury. The condition has a low mortality rate of 5%.
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Affiliation(s)
- S Soren
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand, India
| | - Surjit
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand, India
| | - S Chaudhury
- Pravara Institute of Medical Sciences (Deemed University), Rural Medical College, Loni, Maharashtra, India
| | - A K Bakhla
- Department of Psychiatry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Dermatitis artefacta as a symptom of schizophrenia? Postepy Dermatol Alergol 2014; 31:277-9. [PMID: 25254016 PMCID: PMC4171666 DOI: 10.5114/pdia.2014.40921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/13/2013] [Accepted: 06/23/2013] [Indexed: 12/02/2022] Open
Abstract
Dermatitis artefacta is a disease that occurs as a result of a self-inflicted injury of the skin. The skin lesions are most often located on the areas within easy reach of the patient's dominant hand sparing the middle part of the back. Dermatitis artefacta may coexist with psychiatric disorders and imitate many dermatologic diseases. As most of the patients with self-inflicted dermatoses usually initially deny any psychiatric problems, what delays psychiatric intervention, they are typically first seen by dermatologists. We are reporting a case of a 35-year-old man with a 3-year-long history of schizophrenia who has been treated at a dermatologist's office sequentially with acne, bacterial lesions, suspected tuberculosis. However, the treatment was ineffective. He was diagnosed with dermatitis artefacta after 7 years of disease duration. During this time he was treated with many medicines e.g. isotretinoin, which is contraindicated in psychosis as it worsens the course of disease. After establishing the correct diagnosis and antipsychotic treatment, a significant improvement was obtained in both skin condition and mental state. These are the reasons why we would like to recommend close cooperation between dermatologists and psychiatrists.
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Kim JH, Park JY, Song YS. Traumatic penile injury: from circumcision injury to penile amputation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:375285. [PMID: 25250318 PMCID: PMC4164514 DOI: 10.1155/2014/375285] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/16/2014] [Accepted: 08/16/2014] [Indexed: 02/07/2023]
Abstract
The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunyang University Hospital, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
| | - Jae Young Park
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Yun Seob Song
- Department of Urology, Soonchunyang University Hospital, College of Medicine, Soonchunhyang University, Seoul, Republic of Korea
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Kharbach Y, Amiroune D, Ahsaini M, Bout A, Riyach O, Stuurman-Wieringa RE, Mellas S, Tazi MF, Khallouk A, El Fassi MJ, Rammouz I, Farih MH. Penile self-mutilation preceded by bizarre delusions: two case reports. J Med Case Rep 2014; 8:246. [PMID: 25000934 PMCID: PMC4105862 DOI: 10.1186/1752-1947-8-246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/24/2014] [Indexed: 11/23/2022] Open
Abstract
Introduction Genital self-mutilation is listed as a symptom of borderline personality disorder. The type of injury varies from simple skin laceration to total amputation of the penis and testicles. These injuries are urological and surgical emergencies. Case presentation We report two cases of penile self-mutilation precipitated by erotic and religious bizarre delusions. Our first patient is a 24-year-old Moroccan man who visited our emergency room with a metallic ring at the root of his penis which had caused marked edema of his entire penis. Our second patient is a 26-year-old Moroccan man evaluated in our emergency unit. A clinical examination revealed a wound at the dorsal side of his penis with complete transection of the dorsal vein and imperfect hemostasis. The two patients were treated in our emergency unit after which a favorable clinical course was observed. Conclusion Cases of genital self-mutilation are urological and psychiatric emergencies, therefore it is important that surgical and psychiatric teams collaborate closely while managing cases of genital self-mutilation.
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Affiliation(s)
- Youssef Kharbach
- Department of Urology, Hassan II University Hospital, Fez, Morocco.
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Abstract
INTRODUCTION Cases of folie à deux resulting in homicide challenge traditional definitions of delusions. Secondaries who abandon their beliefs soon after separation from a primary raise doubts about the status of their delusional beliefs at the time of the offence. In this paper, we apply the "two-factor" model of delusions to a series of cases of folie à deux resulting in homicide. METHOD A retrospective analysis of five cases. RESULTS The primary affected person appeared to be the source of the delusional content in each of the cases. Impairment of belief evaluation was evident to some degree in all patients. There appeared to be a range of underlying causes of impaired belief evaluation. The transitory nature of the reported beliefs in some secondary cases suggested that they were due to motivational rather than neuropathological mechanisms. Social isolation contributed to the inability to critically appraise beliefs in most cases. CONCLUSION The two-factor model is a useful method to contrast the emergence of a shared delusional belief in primary and secondary patients with folie à deux. Folie à deux demonstrates the need to consider the exogenous source of delusional content in many patients.
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Affiliation(s)
- Olav Nielssen
- a Clinical Research Unit for Anxiety and Depression , St. Vincent's Hospital , Sydney , Australia
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How successful are first episode programs? A review of the evidence for specialized assertive early intervention. Curr Opin Psychiatry 2014; 27:167-72. [PMID: 24662959 DOI: 10.1097/yco.0000000000000052] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It has been hypothesized that the first 5 years after first episode of psychosis are a critical period with opportunities for ameliorating the course of illness. On the basis of this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions. RECENT FINDINGS The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials, such as the Lambeth Early Onset trial, the Croydon Outreach and Assertive Support Team trial and the Norwegian site of Optimal Treatment trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred to standard treatment. However, the positive effects on service use and ability to live independently seem to be durable. SUMMARY Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high-quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing 2 years of intervention with extended treatment periods.
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Abstract
OBJECTIVES Facial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in terms of its comorbidities, and to outline the different types of facial mutilation, as well as the basic approach to the patients with facial self-mutilation. METHODS We undertook a review of all published cases of facial self-mutilation (1960-2011). RESULTS We identified 200 published cases in 123 relevant papers. Four major groups of comorbidities emerged: psychiatric, neurological and hereditary disorders, and a group of patients without identified comorbidities. There were three general patterns of facial self-mutilation: (1) major and definitive mutilation, with the ocular globe as primary target--seen in patients with psychotic disorders; (2) stereotypical mutilation involving the oral cavity and of variable degree of severity, most often seen in patients with hereditary neuropathy or encephalopathy; (3) mild chronic self-mutilation, seen in patients with non-psychotic psychiatric disorders, acquired neurological disorders, and patients without comorbidities. About 20% of patients that mutilated their face also mutilated extra-facial structures. Patients with psychiatric conditions, especially those with psychotic disorders, had significantly higher (p<0.05) rates of permanent facial self-mutilation than others. Most treatment plans were very individually based, but some principles, such as prevention of irreversible loss of function and structure, or development of infection are applicable to all patients with facial self-mutilation. CONCLUSIONS Facial self-mutilation is a potentially severe manifestation of diverse conditions. Several aspects of facial self-mutilation remain to be fully characterised from a clinical perspective.
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Repetitive transcranial magnetic stimulation (rTMS) in schizophrenia with treatment-refractory auditory hallucinations and major self-mutilation. J Neural Transm (Vienna) 2014; 122 Suppl 1:S19-23. [DOI: 10.1007/s00702-013-1151-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 12/20/2013] [Indexed: 11/26/2022]
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