[Recurrent voluntary ingestion of metallic objects in prison by a female patient]. / Ingestion volontaire d'objets métalliques à répétition chez une patiente en milieu carcéral.

INTRODUCTION: Recurrent and intentional ingestion of metallic objects is a rare but important phenomenon. It has attracted great interest among mental health professionals over the last decades. However, this issue is rarely reported in the literature. A deep exploration of its clinical and specific psychopathological aspects remains limited. CASE REPORT: We report the case of a 32-year-old female patient, who was sentenced to 20 years in prison for homicide against her cousin, the daughter of an uncle who had raped her when she was 14. This affair was hushed by the patient's family and the patient was submitted to several acts of abuse by her family. Following her incarceration, she repeatedly ingested metallic objects requiring repeated admissions in a department of surgery for endoscopic extractions or surgical interventions. She impulsively ingested more than 30 times various metallic objects such as wire, razor blades, spoons, etc., under the pressure of impulsiveness and massive anxiety. Voluntary metal ingestions, associated with iterative self-mutilation behaviors, took place within the framework of a borderline personality disorder, the incarceration and the conditions of imprisonment playing a role in initiating and retaining the behavior. CONCLUSION: Through this case report, we examine the specific psychiatric aspects of intentional ingestion of metallic objects in order to better understand this behavior.

[Treatment of patients with suicidal and autoagressive neck, thorax and abdomen injuries].

The issue is devoted to the analysis of case reports of 305 patients with suicidal and autoagressive neck, thorax and abdomen injuries. The objective prevalence of penetrating injuries of the abdomen among men with depressive disorders was registered. The most complicated, both for surgeon and psychiatrist, were cases of combined neck, thorax and abdomen injuries in elderly patients.

Queimadura autoinfligida em mulheres: a violência de gênero inscrita no corpo / Self-inflicted burn on women: gender violence in scribed on the body

O objeto deste estudo consiste na violência autoinfligida em mulheres por queimadura. As lesões por queimadura são consideradas causas externas (acidentes e violências) e tem contribuído para o aumento geral dos índices de morbimortalidade acarretando perda de anos de vida produtiva. São resultantes de múltiplos fatores como condições socioeconômicas, violências e desigualdade de gênero. Esta pesquisa teve como objetivos: analisar o perfil sociodemográfico das mulheres que vivenciaram queimadura autoinfligida; descrever as circunstâncias e o contexto social relacionados à queimadura autoinfligida em mulheres; analisar os fatores motivadores da queimadura autoinfligida em mulheres; e, discutir a queimadura autoinfligida em mulheres na perspectiva de gênero. Trata-se de uma pesquisa de abordagem qualitativa e exploratória. Os cenários da pesquisa foram dois Centros de Tratamento de Queimados (Municipal e Federal) localizados no Estado do Rio de Janeiro. Os sujeitos do estudo foram 10 mulheres com história de queimadura autoinfligida e que não tivessem história de tentativa de suicídio anterior e diagnóstico de sofrimento psíquico, uma vez que estas situações poderiam comprometer a análise das vivências de violência. A coleta de dados foi realizada através de entrevista semi-estruturada, com roteiro previamente elaborado, no período de novembro de 2009 a março de 2010. Os dados foram analisados através da técnica de Análise de Conteúdo de Bardin, tendo emergido duas categorias: a) A vida da depoente antes da queimadura: percepção da sua condição pessoal; relações familiares envolvendo mãe, pai, avós, irmãos e filhos; relações sociais e relação com o companheiro; b) Queimadura autoinfligida em mulheres: uma questão de violência de gênero: fatores motivadores da queimadura autoinfligida na perspectiva da mulher e queimadura autoinfligida como desfecho da vivência de violência conjugal...

The object of this study is self-inflicted violence in women by burning. Burn injuries are considered external causes (accidents and violence) and have contributed to the overall increase in mortality rates resulting in loss of productive life. They are the result of multiple factors such as socioeconomic status, violence and gender inequality. This study sought to analyze the demographic profile of women who experienced self-inflicted burns; describe the circumstances and social context related to self-inflicted burning in women, analyze the factors which motivated self-inflicted burn in women, and discuss self-inflicted burns in women from a gender perspective. This is both a qualitative and an exploratory study. The research scenarios were two Burns Treatment Centers (Municipal and Federal) located in the State of Rio de Janeiro. The study subjects were 10 women with a history of self-inflicted burns who didn´t have a history of previous suicide attempts and diagnosis of psychological distress, since these situations could compromise the analysis of the experiences of violence. Data collection was conducted by means of a semi-structured interview with a predefined script, from November 2009 to March 2010. Data was analyzed with Bardin´s Content Analysis technique, and two categories have emerged: a) The life of the deponent before the burn: perceptions of her personal condition, family relations involving mother, father, grandparents, siblings and children; social relations and relationship with her partner, b) Self-inflicted burn in women: a matter of gender violence: motivating factors to self-inflicted burns from a woman's perspective and self-inflicted burns as an outcome of the experience domestic violence...

[Bilateral oedipism: a case report]. / Oedipisme bilatéral non concomitant: à propos d'un cas.

INTRODUCTION: Oedipism (or self-enucleation) is a rare form of self-mutilation and most often described in acutely psychotic patients, less frequently among drug addicts or the mentally deficient. CASE REPORT: We report a case of a 46-year-old man, who, 3 years after having enucleated his left eye during an acute bout of delirium symptomatic of schizophrenia, mutilated his right eye in the same way. We detail the emergency medical and surgical management indicated in these circumstances. CONCLUSIONS: In most cases described, self-mutilation involves one eye and rarely both. This case of bilateral oedipism is therefore exceptional. In these circumstances, it is necessary to prevent any intracerebral complications induced by the traction exerted on the optic nerve, such as subarachnoid hemorrhage, whose signs can be masked by the patient's psychic state, and to take the neuropsychiatric precautions necessary.

Tyrosinaemia type II with diffuse plantar keratoderma and self-mutilation.

Tyrosinaemia type II (oculocutaneous tyrosinaemia or Richner-Hanhart syndrome) is a rare and potentially treatable genetic disorder. Corneal opacities or ulcers, circumscribed palmoplantar keratoderma and subnormal intelligence form the classical triad of this syndrome. A case with additional features of self-harm and diffuse plantar keratoderma is discussed. Emphasis is laid on the importance of early diagnosis and intervention in the form of dietary regulation to prevent the neurological signs and treat the oculocutaneous symptoms.

Self-mutilation in young children following brachial plexus birth injury.

Brachial plexus injury in adults commonly produces persistent pain. Pediatric textbooks and case series suggest that perinatal brachial plexus injury is very rarely associated with pain, though this is difficult to determine in preverbal infants. Some of these young children self-mutilate the affected extremity, which may or may not reflect pain. This study was designed to characterize the clinical presentation and course of self-mutilation following perinatal brachial plexus injury. In this retrospective chart review, 280 patients were identified as having a perinatal brachial plexus injury from 1990-2002. Self-mutilation behavior was defined as excessive mouthing of or biting of any part of the affected limb, and/or loss of any parts of the affected limb secondary to biting and infection. Case reports were generated which described the severity of the primary injury, the types of surgical interventions, the duration and temporal relationship of behavior with surgical interventions and the nature of the self-mutilation behavior. Eleven patients demonstrated self-mutilating behavior, yielding a cumulative incidence of 3.9%. The median age of onset of this behavior was 17 (IQR=11-21) months, the median onset of the behavior was 8 (IQR) months after surgery and the median duration of this behavior was 6 (IQR=4-7) months. The incidence of self-mutilation among children who had undergone surgery was 6.8% (9 of 133 children) compared to the 1.4% (2 of 147 children) for non-surgical patients (P<0.05). Seven of 24 children (29.1%) who underwent brachial plexus dissection demonstrated self-mutilation, which was significantly different from the incidence of self-mutilation in children who did not have surgery (P < 0.001). Self-mutilation behavior in our population occurred more frequently in children following brachial plexus microsurgery. The reasons for this association are unclear, but may be related to either the surgery or the severity of the initial injury or both.

Clinical and theoretical issues in self-injurious behavior

This article presents an overview of pathological self-injurious behavior (SIB). Historical and cultural aspects, epidemiology, classifications and clinical aspects and pathogenesis are described. The importance of comprehensive assessment of symptomatology and functions of SIB for treatment planning are discussed

[Therapy refractory unilateral chronic blepharokeratoconjunctivitis as the chief manifestation of auto-aggression syndrome. Clinico-histopathologic findings]. / Therapieresistente einseitige chronische Blepharokeratokonjunktivitis als Leitbefund für Autoaggressionssyndrome. Klinisch-histopathologische Befunde.

UNLABELLED: Autoaggressive syndromes as causes of diseases underlying chronic blepharitis and keratoconjunctivitis that are refractory to treatment are often difficult to recognize. PATIENTS: Three female patients (age 21, 25, 41 years) and one male patient (age 42 years) had suffered from a right-(4x) or left-(1x) handed treatment-refractory blepharokeratoconjunctivitis for 1, 2, 11 and 30 months prior to admission. In each case more than 5 ophthalmologists and 2-6 eye hospitals had been consulted, and extraocular surgery had been performed 1-4 times. RESULTS: Patients presented with a visual acuity of 0.3 p (1x), 0.1 (1x), FC (1x), HM (1x). In three patients contact eczema of the facial skin and lids and a corneal pannus were observed; in two patients we saw purulent pseudomembranous and in two patients chronic cicatrizing keratoconjunctivitis. Conjunctival smears grew P. aeruginosa, and S. aureus; impression cytology showed infiltration with neutrophils and epithelial keratinization; histopathology indicated chronic inflammatory, partly purulent subepithelial and stromal conjunctival infiltrate with hyper- and parakeratosis fibrous strands and epithelial cell loss; the lower lids showed parakeratosis, focal necrosis, intercellular edema and a lymphohistiocytic round-cell infiltrate. Furthermore, multiple allergies to antibiotics and preservatives (4x), lacerations of the arms and legs (2x) and an irritative-toxic dermatitis (1x) were substantiated. In the patients who agreed to a psychiatric consultation, somatized-agitated longing for care combined with a dependent and infantile personality (1x) and reactive depression (2x) were verified. CONCLUSIONS: In patients suffering from treatment-refractory unilateral chronic blepharokeratoconjunctivitis correlated with the hand, one must take into consideration the fact that other factors may be involved: possible exacerbation prior to examinations; multiple inpatient diagnostic and surgical procedures in different locations; histopathological mixed inflammatory patterns; and psychiatric syndromes.

Factitious disease of periocular and facial skin.

PURPOSE: To describe the clinical appearance of factitious (or self-inflicted) lesions on periocular skin and face. METHODS: All patients with factitious cutaneous disease who were examined at Mayo Clinic, Rochester, Minnesota, between 1985 and 1997 were identified. For patients with lesions on the face and periocular skin, the demographic features, clinical descriptive characteristics of their lesions, associated psychopathology, and treatments were ascertained. RESULTS: Of 38 patients with factitious dermatitis, 18 (47%) had facial lesions. Of these 18 patients, 15 (83%) were female. The mean age (+/- SD) of the patients with facial lesions was 35.2 +/- 15.7 years (range, 9 to 66 years). Eight patients (44%) had neurotic excoriations, nine (50%) had dermatitis artefacta, and one (6%) had trichotillomania. The working diagnoses of five patients cared for initially in the Department of Ophthalmology were corneal epithelial and facial desquamation associated with severe pain of unknown cause, medial cicatricial ectropion of probable vasculitic cause, basal cell carcinoma of the nasojugal fold, recurrent preseptal cellulitis resistant to medical treatment, and madarosis of the upper eyelids of unknown cause. CONCLUSION: Cutaneous factitious disease may masquerade as numerous clinical entities and should be included in the differential diagnosis of lesions of the periocular skin.

Self-inflicted mutilation of the dentition in a schizophrenic patient.

A case is presented in which a patient performed mechanical self-mutilation of her dentition during an episode of psychotic illness. The management of this case is described and discussed.

Integration of medical and psychiatric management in self-mutilation.

The traditional management of factitious patients with self-inflicted injuries consists of medical/surgical treatment of the physical lesions, followed by psychiatric referral. The former is assigned to the dermatologist, the surgeon, or the primary care physician. More often than not, the subsequent psychiatric referral for treatment of the psychiatric disorder underlying and actually causing the self-mutilation fails because of self-mutilators' notorious resistance to psychiatric help. The integration of a psychiatric strategy into the medical management is more effective than a sequential division of medical/surgical and psychiatric treatment. This integrated treatment strategy is based on three key issues: education of the medical team in understanding the self-mutilation as a morbid form of help-seeking behavior, the judicious use of confrontation as a therapeutic tool, and the combination of psychotropic drug treatment with psychotherapeutic techniques.

Recurrent voluntary anterior dislocation of the hip: case report and review of the literature.

Recurrent dislocation of the hip is uncommon in children, and anterior dislocation, as in the case reported, is extremely rare. Terminology is often confusing, with "recurrent," "voluntary," and "habitual" dislocations described. The causative pathology of the dislocation must be determined before appropriate treatment can be selected; computed tomography can be helpful in making this decision.

Liaison consultation psychiatry with patients who have replantation surgery to the upper limb.

Thirty-eight patients who had replantation surgery to the upper limb were studied and findings, case vignettes and specific liaison-consultation issues are presented. The assessment of the patient for pre-existing psychopathology, such as drug and alcohol abuse and personality abnormalities, is emphasised; the possibility of the amputation having been a deliberate, self-inflicted act is noted; and the roles of pre-accident stress and emotional conflict are discussed. Data concerning adverse post-operative emotional reactions are presented and body-image changes, including the disruption to body integrity and the reintegration of the bodily part, are described. The psychological aspects of replantation surgery are compared to other forms of surgery, in particular amputation and renal transplantation.

Uma intervençäo comportamental num caso complexo de automutilaçöes compulsivas / A behavioral intervention in a complex case of compulsive self mutilations

É apresentado um caso bastante complexo com rituais compulsivos de automutilaçäo. Näo foi possível conduzir uma avaliaçäo completa mas, ainda assim, a possibilidade de uma intervençäo rápida e eficaz tinha que ser encontrada devido a existência de rituais altamente perigosos. Este artigo pretende mostrar que isto é possível com a metodologia comportamental, ainda em casos onde näo é possível se obter um entendimento completo

Self-mutilation.

Self-mutilation presents great diagnostic and therapeutic difficulties and the financial expenditure involved in its treatment is considerable. The ten patients comprising the present investigation were on average hospitalized for 314 days and were operated on 15 times. Only two can be considered to have recovered. Greater knowledge of these patients and closer cooperation between the surgeon, psychiatrist, general practitioner and social authorities should make their treatment more effective.

Replantations surgery following self-inflicted amputation.

Four cases of self-inflicted amputation of the upper limb which were surgically replanted are described. Three of the four patients are psychiatrically well, employed and pleased with the surgical result. The fourth patient committed suicide. The literature of self-mutilation and replantation surgery is reviewed and psychological factors and the role of the psychiatrist in replantation surgery are discussed.

Male genital self-mutilation.

Men who intentionally mutilate or remove their own genitals are likely to be psychotic at the time of the act, to have a number of goals and aims relating to conflicts about the male role, and to be vulnerable to sociocultural and psychological forces in a causal network as yet unknown. However, from a review of the cases of 53 male self-mutilators, it appears that a significant number involve individuals not psychotic at the time of the act but rather having character disorders and rageful feelings toward themselves or women, and transsexual males who premeditate their own gender conversion surgery. The psychiatric consultant's role in the management of such an individual in the general hospital setting includes not only care of a patient with a psychotic or impulse disorder but also involves support of the house staff, who are distressed by the fear, guilt, hopelessness, anger, and revulsion that the patient's act of genital self-mutilation causes.