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[Encephalopathy with self mutilations in a twin. Normal HGPRT activity. Hyperuricosuria without major hyperuricemia. Apropos of the limits of the Lesch-Nyham syndrome].
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[Self mutilation of the lower lip, associated with athetosis and oligophrenia without purine metabolism disorder ("pseudo Lesch-Nyhan syndrome")].
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Self mutilation: inward pain turned inside out.
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Lithium for the control of aggressive and self-mutilating behaviour.
Lithium has been used for many years in the treatment and prophylaxis of affective disorders. Since 1969, evidence has been accumulating in relation to its effectiveness in the control of aggressive behaviour. This review summarizes the published evidence.
[A case of self-mutilation of testis].
A 22-year old man was admitted to the emergency room of our hospital with bleeding from scrotal wound. He had resected his own scrotum and both testes by himself with a small knife, since he thought that his testes had developed necrosis. He had thrown his scrotal skin and both testes away in a lavatory. We closed the wide wound surface and the surrounding skin after ligation of the spermatic cord. The post-operative course was uneventful. The patient was referred to the psychiatric department of our hospital and received supportive psychotherapy under diagnosis of schizophrenia. This is the 23rd case to be reported as self-injury of the external genitalia and the 7th case limited to testis in the Japanese literature.
[Artifactual disorders--between deception and self-mutilation. Experiences in consultation psychiatry at a university clinic].
During a 18-year-period 93 patients (f = 76, m = 17) with a factitious disorder were identified in the psychiatric consultation service of a university hospital (incidence: 0.62%). 50% of women were working in medical professions whereas only 6% of men. Chronic courses of illness were prevailing, but at least one quarter of female patients showed an intermittent type. There was a classical Munchhausen syndrome in 11% of patients. Depressive and anxiety disorders (10%, 4%) were to be respected as psychiatric comorbidity. Ca 25% of the patients suffered from a somatic illness in addition to the factitious disorder, and one third of the women had symptoms of psychosomatic, especially of eating disorders. Previous somatoform disorders, deliberate self harm and attempts of suicide were to be noted in the psychiatric history of many patients. There were frequent traumatizing events (foster home, disturbing family disharmony, physical and sexual abuse, early losses, serious illnesses) in the early biography. Various psychosocial stressors could be identified in the actual eliciting situation. The results are discussed in respect of epidemiology, development and clinical phenomenology of factitious disorders, psychodynamics and psychopathology of deception and self harm, and therapeutic options in the psychiatric consultation service.
Genital self-mutilation in males: psychodynamic anatomy of a psychosis.
This paper describes a man who mutilated his genitals while psychotic. His personal case history is analyzed and compared to the findings earlier described in similar patients. The present article attempts to make a psychotic process understandable both in light of the individual patient's history and in light of shared common unconscious themes.
[Cornea-crystalline lens needle-prick wounds from self-mutilation].
Automutilation is a voluntary autoprovoked lesion, which determines infirmities of different degrees. The paper presents the case of a 25-year-old patient, who, being in detention, pricked his both eyes using a needle. This action provoked endophthalmitis and bilateral traumatic cataract. The particularity of the case consists of the bilaterality of the autoagression, with serious evolution at the both eyes.
[Self-mutilation and autophagia].
The case history of a 51 year-old man with paranoid-hallucinatory schizophrenia is presented. Very intensive autoaggressive actions (cutting off the ears, partial amputation of the penis, eating of the amputated pieces, sawing off the left lower leg) led to very unusual autopsy findings (i.e. the glans of the penis was found in the colon). The cause of death was prolonged exsanguination.
[Microsurgical penis replantation following self mutilation].
Although amputation of the penis is a rare problem, a complete reconstruction of all penile structures should be attempted in one stage. This way the best chance for full rehabilitation of the patient can be achieved. A microsurgical reimplantation with microsurgical sutures of arteries, veins, nerves and urethra after total amputation of the penis is reported. Eight months after surgery normal appearance and function, including a good urine flow and absence of urethral stricture, capability of erection and nearly normal sensitivity, was found.
Self-mutilation in mice associated with otitis media.
Mutilation of the external ear and adjacent tissues was an enzootic problem in outbred Mcr:(ICR) breeder mice in a commercial colony. Necropsy examination of affected and randomly selected, nonaffected adult breeder mice revealed a probable association of the cutaneous lesions with suppurative otitis media. Several microorganisms, including Mycoplasma pulmonis and Pasteurella pneumotropica, were isolated from the tympanic bullae.
[Laxative induced diarrhea- -a form of self-mutilation].
In the differential diagnosis of gastrointestinal disturbances the possibility of laxative abuse is considered either too late or not at all. The sequel is a protracted course of illness with a series of expensive and fruitless investigations. On the basis of three recently observed cases of laxative-induced diarrhea the problems of diagnosis and management are discussed. Methods of securing early diagnosis are mentioned. The overall prognosis must be considered unfavorable. The importance is stressed of long-term follow-up of these patients at community level, to ensure timely intervention should complications arise and to prevent further unnecessary investigations.
[Amputation of fingers or a hand. Accident or self-mutilation].
Among the high number of cases of hand injuries investigated each year by accident insurance companies, cases continually occur which give rise to the suspicion of attempted insurance fraud by means of purposely inflicted injuries. Such cases are often difficult to prove. Based on 3 case reports (amputation by means of a chain saw, a blow with an axe and a cutting machine), reconstruction at the place of the crime is shown to be extremely advantageous. The reconstruction of the crime is one of the most important evidential elements. It is recommended for all cases where there is any doubt.
Self-mutilation. Plastic spherules in penile skin in yakuza, Japan's racketeers.
Despite the reduction in crime in Japan there is a problem with organized racketeer groups, or yakuza in Japanese. The members of the yakuza can be recognized by their speech and behavior and by their physical characteristics such as tattooing and digital amputations. Penile balls are unusual sexual devices that have been found on some yakuza. Nine cases of unusual way of identifying yakuza are reported. A survey of a detension house showed that 28 prisoners out of 130, or 21.5%, had penile balls. Penile balls and the yakuza are discussed in relation to forensic psychiatry.
Case study: delicate skin cutting: management beyond the skin and implications of superficial habitual self-mutilation.
A 16-year-old girl accompanied by her mother was noted to have several thin, well healed brown lines on the distal third of her left flexural forearm (Figure). She admits to having recently made these marks by skin cutting. She feels depressed and at times feels life "is not worth living." She denies alcohol or substance abuse or true suicidal ideation, plan, or intent. Her mother describes her as previously well adjusted and a good student who has become erratic and moody in the past 6 months, with worsening school performance. Her father had a history of depression and alcoholism and died 3 years ago. She is undergoing psychotherapy and pharmacotherapy with sertraline with good results. She has not cut her skin in 3 months. Her mood and behavior have improved.
[Self-mutilation in men--injury pattern and motivation].
6 cases of self-inflicted injuries in male individuals are reported. The age of the affected men was between 15 and 46 years whereas the younger age predominated. Alleged incidents were robberies in 3 cases, rape in one case, violation in custody in one case and an assault originating in personal motives in one case. In 4 cases, the typical injury pattern of self-infliction was present showing parallel course and superficiality of the wounds in areas accessable by the persons's own hands. In 2 cases, atypical injuries (i.e. deep cuts and massive signs of strangulation respectively) were found. However, in most cases, the underlying motive was to gain affection. An autoerotic accident was tried to be disguised in one case. Profit was the leading motive in another case.
[Accident or planned self mutilation? Probability of accidental injuries during chopping].
The results of 200 chopping experiments with a big axe and a smaller cleaver on two different chopping-block levels were presented. Objects were beech-billets with relatively big cross-section areas. In 66 per cent of all experiments the holding hand was put partially or completely upon the surface of the billet, in a principally endangering position. The lateral deviations from the intended impact place were in 62 per cent not more than +/- 1.5 cm; 7.5 per cent hit closer to the holding hand, in the utmost case 3.7 cm, the angle with the aspired sagittal impact plane in most cases not transgressing 5 degrees in the direction of the holding hand and never more than 15 degrees. It can be deduced, that unwilled forefinger injuries from axe stroke are not to be expected on the base phalanx very probably; those in a right angle to the finger axis are not possible, however. For the thumb these rules do not hold in like manner.