[Classical Medical Mistakes - Lack of Appreciation of Psychological Components]. / Klassische ärztliche Fehlleistungen ­ die Verkennung psychologischer Komponenten.

Detailed evidence for psychogenic effects after an accident: evidence from 3 expert reports.

Clinical observation on removal of small foreign bodies touching the optic nerve in the deep orbital region: a case series.

PURPOSE: Five patients presented to our institution with deep intraorbital foreign bodies adjacent to the optic nerve. We removed all foreign bodies by lateral orbitotomy to evaluate the treatment and the benefits of their extraction. METHODS: The clinical outcomes of the five patients were retrospectively analyzed. RESULTS: Radiology in all five patients revealed small foreign bodies touching the optic nerve in the deep orbital region. All patients also suffered from significant secondary psychological disturbances, these including anxiety and altered sleep patterns. They had become preoccupied with a strong desire to remove the intraorbital foreign bodies [IFB]. In this cohort, two had no light perception before surgery, another two had light perception, and one had hand motion perception as well as vitreous hemorrhage that had been plugged with silicone oil in other hospital. All foreign bodies were removed via lateral orbitotomy. Visual acuity improved after the operation in only three cases. However, the psychological well-being of all five patients improved. CONCLUSIONS: Consideration should be given to removal of intraorbital foreign bodies adjacent to the optic nerve, even where a significant degree of vision has already been lost. Furthermore some patients can achieved vision improvement and such surgery can frequently address the significant psychological disturbance that can be associated with such orbital foreign bodies.

Bilateral oedipism.

A 20-year-old woman presented with self-inflicted pencil wounds to her bilateral orbits. CT angiography revealed penetration of pencils through optic canals into temporal lobes. Examination revealed bilateral no light perception, fixed dilated pupils, complete ptosis, and complete ophthalmoplegia. The patient was admitted to the psychiatric ward and her vision and cranial nerve deficits did not improve.

[Voluntary mercury poisoning: biological consequences and psychiatric significance]. / Intoxication volontaire au mercure: conséquences biologiques et signification psychiatrique.

A young patient suffering from schizophrenia had intense headaches and photophobia which were induced by intra-ocular injections of mercury. The clinical diagnosis was established once foreign bodies were visualized on regular X-rays of the patients skull. The mercury intoxication in combination with the secondary irreversible lesions to the eyes necessitated a bilateral enucleation and the use of a chelating treatment with sodium-dimercapto-1-propane sulfate (DMP). Automutilation is a very rare and dramatic complication of schizophrenia. The psychiatric handling and meaning of such dramatic automutilation is discussed in this case report together with a recent review of the toxicologic treatment of mercury intoxication in humans.