Death by self-mutilation after oral cannabis consumption.

Major self-mutilation (amputation, castration, self-inflicted eye injuries) is frequently associated with psychiatric disorders and/or substance abuse. A 35-year-old man presented with behavioral disturbances of sudden onset after oral cannabis consumption and major self-mutilation (attempted amputation of the right arm, self-enucleation of both eyes and impalement) which resulted in death. During the enquiry, four fragments of a substance resembling cannabis resin were seized at the victim's home. Autopsy confirmed that death was related to hemorrhage following the mutilations. Toxicological findings showed cannabinoids in femoral blood (tetrahydrocannabinol (THC) 13.5 ng/mL, 11-hydroxy-tetrahydrocannabinol (11-OH-THC) 4.1 ng/mL, 11-nor-9-carboxy-THC (THC-COOH) 14.7 ng/mL, cannabidiol (CBD) 1.3 ng/mL, cannabinol (CBN) 0.7 ng/mL). Cannabinoid concentrations in hair (1.5 cm brown hair strand/1 segment) were consistent with concentrations measured in chronic users (THC 137 pg/mg, 11-OH-THC 1 pg/mg, CBD 9 pg/mg, CBN 94 pg/mg). Analysis of the fragments seized confirmed that this was cannabis resin with high levels of THC (31-35%). We discuss the implications of oral consumption of cannabis with a very high THC content.

Smoking synthetic marijuana leads to self-mutilation requiring bilateral amputations.

Synthetic cannabinoids have become a worldwide epidemic because they provide a sometimes legal, easily accessible, and presumably safe alternative to marijuana. Recently published reports have linked acute psychosis, myocardial infarctions, convulsions, self-harm, and even terrorist organizations to these designer substances. This case report outlines the first reported case of Black Diamond, a synthetic cannabis, leading to a self-inflicted burn to the bilateral upper extremities requiring a transradial amputation of the right arm and a toe transfer procedure of the left hand after loss of all digits. The patient presented to the emergency department with self-inflicted fourth-degree burns to the bilateral hands and forearms with second-degree burns of the face, for a total body surface area of 14.5%. The patient was found by firefighters with his hands aflame on his kitchen stove. With no previous medical or psychiatric history and collateral information to confirm the patient's mental status prior to use of Black Diamond, the patient's acute psychotic episode was attributed to Black Diamond. After multiple procedures and a lengthy recovery, the patient completed his post-graduate education and entered the professional world. As orthopedic surgeons, we should be involved in educating the public on the harm of these designer drugs, including self-mutilation. The popularity of synthetic drugs in the United States will continue to present a major challenge to all health care providers. Orthopedists are on the front lines of this epidemic because these drugs push patients into risky, traumatic behavior.

Self-mutilation induced by psychotropic substances: a systematic review.

Self-mutilation (SM) not only occurs among patients with schizophrenia, personality disorders or transsexuality but also as a phenomenon induced by psychotropic substances (PS). We intended to find characteristics of patients at risk to perform SM induced by PS (SMIPS), frequent PS within this phenomenon and typical presentations of SMIPS. A systematic review of the literature (including Medline, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Scopus) was conducted. On October 2011 we identified 26 cases (23 publications) of SM related to PS. Majority of patients (85%) was male, mean age was 30 years (median 41 years). Seventy-three percent of patients developed SM subsequent to the use of one PS, 27% presented SM after the use of more than one PS. Alcohol (25%), hallucinogens (25%) and amphetamines (22%) were found most frequently among the reported substances. Major impairment was present in 80%. Our findings suggest male sex, young age, a previous history of abuse of PS and the current use of alcohol, hallucinogens or amphetamines to favour SMIPS.

Suicide-related events among child and adolescent patients during short-term antidepressant therapy.

AIMS: Antidepressants have been of limited use for adolescent subjects with depression because of drug-induced suicide-related events (SRE). Therefore, we investigated actual suicidality and its risk factors during antidepressant therapy among child and adolescent patients in clinical settings. METHODS: The risks of SRE, consisting of suicidal ideation, self-mutilation and suicide attempt, were prospectively monitored among 70 child and adolescent patients (15.4 ± 2.8 years) during the first 3 months of antidepressant therapy. RESULTS: The proportion of SRE decreased from 47.1% to 22.9% after the treatment. Subjects with persistent risks of SRE were significantly characterized by female sex (P < 0.05), psychotic features (P < 0.001), borderline personality disorder (P < 0.01), previous SRE (P < 0.001), and such baseline psychopathology as anhedonia (P < 0.005), irritability (P < 0.005) and hopelessness (P < 0.001). Discriminant analysis showed that baseline severity of SRE, borderline personality disorder and psychotic features were closely associated with SRE during antidepressant therapy. Total scoring using those three pretreatment factors predicted risks of SRE with sufficient sensitivity (81%)/specificity (98%) as well as high positive likelihood ratio (43.9). CONCLUSIONS: These findings suggest that deteriorated risk of SRE in child and adolescent patients receiving antidepressants should not be overestimated while some pretreatment characteristics may be useful to predict the outcome of SRE after antidepressant therapy.

Self-inflicted garlic burns: our experience and literature review.

BACKGROUND: Throughout history, garlic has been used to treat a large variety of illnesses. One of garlic's adverse local effects is contact dermatitis. METHODS: We present three patients treated in the Department of Plastic Surgery for suspected self-inflicted lower extremity burns. RESULTS: The burns had unique features, not consistent with the etiology first claimed by the patients. All were soldiers with low motivation who confessed to using garlic to cause the burns. CONCLUSIONS: Garlic application usually results in local inflammation, but, if applied under a pressure bandage, or if there is poor wound care or a secondary infection, it can cause a severe dermal reaction and a deep chemical burn. We present these cases to increase physician awareness of the characteristics of self-inflicted garlic burns, and review the dermatotoxic effect.

Self-amputation of penis and tongue after use of Angel's Trumpet.

This case report draws attention to the dramatic consequences of the consumption of Angel's Trumpet. Angel's Trumpet contains alkaloids (especially scopolamine, as well as hyoscyamine, atropine and other alkaloids) in a relatively high concentration. When intoxicated with Angel's Trumpet, patients can suffer hallucinations, motoric restlessness, overtalkativeness, convulsive sobbing and sexual excitement, as well as aggressive and autoaggressive behaviour. Somatic symptoms are tachycardia, mydriasis, hypertonia, respiratory disturbances and vomiting, as well as a potentially life-threatening anticholinerg syndrome. In this paper, we report on a young man who amputated his penis and his tongue after having consumed Angel's Trumpet tea, illustrating that consuming this beautiful flower with the name of an angel and the poison of the devil can be very dangerous.

Spinal c-fos expression associated with spontaneous biting in a mouse model of dry skin pruritus.

As a model of dry skin pruritus in mice, one hind paw was treated twice daily with a mixture of acetone/diethylether/water (AEW); controls received water only. A protective collar prevented the animals from accessing the treatment area. At 16 days, the collar was removed and AEW-treated mice exhibited marked biting of the treated paw; the number and cumulative duration of bites was significantly greater than in controls. After 3 additional treatment days (collars intact), animals were perfused for c-fos immunohistochemistry. There was significantly more fos-like immunoreactivity in the ipsilateral lumbar spinal cord of AEW-treated animals, with the majority in superficial laminae. It is proposed that biting of the dry skin reflects pruritus, and that neurons predominantly in superficial laminae of the dorsal horn may signal itch sensation.

Self-biting induced by activation of L-type calcium channels in mice: serotonergic influences.

The L-type calcium channel activator +/-Bay K 8644 has recently been shown to provoke self-injurious biting in young mice. Since the serotonergic systems have been implicated in the expression of self-injurious behavior in both humans and animals, the present studies tested whether drugs influencing serotonin systems could modify the ability of +/-Bay K 8644 to cause this behavior. The ability of +/-Bay K 8644 to provoke self-biting behavior was increased by the serotonin uptake inhibitor fluoxetine or the monoamine oxidase inhibitor clorgyline. On the other hand, the ability of +/-Bay K 8644 to provoke self-biting was decreased by depletion of serotonin with p-chlorophenylalanine or 5,7-dihyroxytryptamine. These results suggest that the ability of +/-Bay K 8644 to provoke self-injurious behaviors may be mediated by serotonergic influences.

Amphetamine usage and genital self-mutilation.

Amphetamine usage has been associated with addiction, psychosis and self-injurious behavior. We report on two patients who severely and repeatedly mutilated their own genitalia while intoxicated on amphetamines and consider possible diagnostic etiologies.

Development of obsessive-compulsive behaviour following cortisone treatment.

In this report, we will describe the first case of obsessive-compulsive behaviour following oral corticosteroid treatment in a 75-year old adult male patient with pulmonary disease, but without previous psychiatric symptoms or organic brain disorder. We will also discuss the clinical and pathophysiological considerations.

Analgesia in phasic and tonic pain tests in a pharmacological model of autotomy.

Self-mutilation or self-injurious behaviour is a well known behavioural disorder in humans. The proposition that this behaviour in animals is a response to chronic pain of peripheral nerve injury has been met with controversy. In the present study a pharmacological model, which produces no sensory or motor loss was used to study how autotomy is related to pain. In a group of rats autotomy was induced by amphetamine in phenoxybenzamine and reserpine treated animals. The pain tests, both phasic and tonic were then performed. The results of this study showed that a total analgesia was produced in both phasic and tonic pain tests, in animals that exhibited autotomy. Injection of naloxone in these animals prevented autotomy. A correlation between autotomy and no pain is suggested in this pharmacological model of autotomy.

Deliberate self-harm and antidepressant drugs. Investigation of a possible link.

BACKGROUND: It is not clear if the frequency of deliberate self-harm (DSH) is the same in patients taking different pharmacological classes of antidepressant drugs. AIMS: To compare the frequency of DSH in patients who had been prescribed a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) prior to the DSH event. METHOD: This was a prospective study in 2776 consecutive DSH cases attending an accident and emergency department. The incidence of DSH in TCA-treated cases and SSRI-treated cases is expressed as number of DSH events per 10 000 prescriptions of each antidepressant. RESULTS: Significantly more DSH events occurred following the prescription of an SSRI than that of a TCA (P<0.001). The occurrence of DSH was highest with fluoxetine and lowest with amitriptyline. CONCLUSIONS: Merely prescribing safer-in-overdose antidepressants is unlikely to reduce the overall morbidity from DSH.

Biochemical effects induced by REM sleep deprivation in naive and in D-amphetamine treated rats.

The neurochemical dysfunction present in patients showing self-mutilating behavior (SMB) is not well understood. In animal models, rapid eye movement (REM) sleep deprivation enhances the SMB induced by the chronic administration of d-amphetamine. To understand the mechanism underlying these effects the levels of dopamine (DA), noradrenaline (NA) and serotonin (5-HT) were measured in REM sleep deprived only, and in REM sleep deprived and d-amphetamine treated rats. DA levels were elevated (31%) after REM sleep deprivation (48 h) in the neostriatum and the cerebral cortex (33%), while the levels of NA and 5-HT remained constant. A 6-day treatment with d-amphetamine (7.5 mg/kg; i.p.) failed to affect, in REM sleep deprived rats, DA, NA and 5-HT levels. It was also found that REM sleep deprivation had no effects on the d-amphetamine induced [3H]DA release from slices of the same regions. Our results suggests that dopaminergic mechanisms are involved in the effects of REM sleep deprivation on SMB.

Self-mutilation and severe self-injurious behavior associated with amphetamine psychosis.

Amphetamine abuse is widespread and is frequently encountered in general hospital settings. We have recently seen amphetamine-induced transient psychosis associated with severe self-injurious behavior and self-mutilation. In the setting of bizarre and/or severe self-injurious behavior, screening for amphetamines is indicated.

Neonatal capsaicin treatment in rats results in scratching behavior with skin damage: potential model of non-painful dysesthesia.

We administered capsaicin or vehicle in 2-day-old rat pups, and for over 6 months examined the rats for damaged skin and for the behaviors of scratching, gnawing and biting their skin. By 35 days of age, all rats in the capsaicin group (n = 10) had damaged skin (i.e., lesions, hair loss and red skin) on the rostral half of their bodies. Skin damage remained prevalent over 6 months, whereas vehicle-treated rats (n = 8) had virtually no skin damage. Gnawing and biting behaviors were rarely observed, however, rats in the capsaicin group frequently scratched themselves. There was a significant positive correlation between the frequency at which rats scratched themselves and the total area of skin damage. Morphine (3.0 mg/kg, i.p.) greatly increased scratching behavior in only the capsaicin-treated rats and naloxone (0.5 mg/kg, i.p.) significantly reduced scratching in these rats. Thus, neonatal capsaicin, in its destruction of the majority of primary afferent C-fibers, is capable of inducing opioid-sensitive scratching behavior.

Effects of guanethidine on sensitization to natural stimuli and self-mutilating behaviour in rats with a peripheral neuropathy.

In the present study we have used a recent rat model for neuropathic pain to investigate the effect of the sympatholytic drug guanethidine on changes in behavioural responses evoked by mechanical, heat and cold stimuli and on self-mutilating behaviour. After a unilateral peripheral mononeuropathy induced by ligatures around the right common sciatic nerve, the left side receiving just a sham wound, lesioned and non-operated control animals were treated with saline or guanethidine (30 mg/kg) for 4 consecutive days commencing 5 days before or 10 days after surgery. Behavioural parameters were followed for 4 weeks after drug treatment. Lesioned rats were found to be sensitized to the otherwise innocuous cold stimulus and showed decreased response thresholds to noxious heat and mechanical stimuli. Some lesioned animals self-mutilated. Treatment with guanethidine diminished heat and cold sensitization considerably, but had less effect on mechanical sensitization and, if administered before surgery, rather increased the severity of self-mutilating behaviour. While these results are in agreement with clinical observations on the prominence of sensitization to evoked stimuli, especially cold, and the effectiveness of guanethidine in sympathetically maintained neuropathic pain, they indicate that the mechanisms involved in sensitization to different stimuli and self mutilating behaviour differ.