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PubMed2005

National trends in hospitalization of youth with intentional self-inflicted injuries.

OBJECTIVE: The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries. METHOD: Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N=10,831) with a diagnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring inpatient treatment. Overall population-based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, inpatient costs, method of injury, and associated mental disorder diagnoses. RESULTS: The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were increases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%). There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and nonmental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000. CONCLUSIONS: Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders.

Adolescent↗
PubMed1999

Neurologic nonmetabolic presentation of propionic acidemia.

BACKGROUND: Patients with propionic acidemia usually present in the neonatal period with life-threatening ketoacidosis, often complicated by hyperammonemia. It was thought that the neurologic abnormalities seen in this disease were exclusively the consequences of these acute crises. Experience with 2 patients with propionic acidemia indicates that this disease may present first with prominent neurologic disease without the life-threatening episodes of ketoacidosis that usually serve as the alerting signals for a diagnosis of an organic acidemia. OBJECTIVE: To examine the clinical and metabolic aspects of 2 patients with a phenotype that suggested disease of the basal ganglia. DESIGN: Examination of patterns of organic acids of the urine and enzyme assay for propionyl-CoA carboxylase in fibroblasts and lymphocytes. SETTING: Referral population to a biochemical genetics laboratory. PATIENTS: Two patients whose prominent features were hypotonia followed by spastic quadriparesis and choreoathetosis. Both had seizures. One patient was mildly mentally retarded but grew normally physically. The other had profound mental retardation and failure to thrive; he also self-mutilated his lower lip. Self-injurious behavior has not been reported in this disease. MAIN OUTCOME MEASURES: Clinical description, blood ammonia levels, organic acid levels in the urine, and enzyme activity. RESULTS: Excretion of metabolites, including methylcitrate, was typical. Residual activity of propionyl-CoA carboxylase approximated 5% of the control in each patient. CONCLUSIONS: Propionic acidemia can present as a pure neurologic disease without acute episodes of massive ketoacidosis. Hyperammonemia may occur after infancy in some patients, presenting as Reye syndrome.

Adult↗
PubMed2006

The relationship between suicide attempts and low-lethal self-harm behavior among psychiatric inpatients.

In this study, we examined the relationship between suicide attempts and low-lethal self-harm behavior in a sample of psychiatric inpatients. Using a cross-sectional approach, we surveyed 107 participants about their histories of suicide attempts, including overdoses, as well as various low-lethal self-harm behaviors. Compared with those without such histories, individuals with histories of suicide attempts, including overdoses, were significantly more likely to report a greater number of: 1) low-lethal self-harm behaviors; 2) specific symptom clusters of self-harm behavior (i.e., self-mutilation, substance abuse, medically self-defeating behaviors); and 3) specific individual self-harm behaviors (e.g., torturing oneself with self-defeating thoughts, abusing prescription medications). These data suggest that suicide attempts and low-lethal self-harm behavior are likely to co-exist in many psychiatric inpatients.

Adult↗
PubMed1994

Self-inflicted eye injuries: case presentations and a literature review.

OBJECTIVE: The authors' aim was to determine demographic and clinical correlates of self-inflicted eye injury. METHODS: The authors reviewed 41 cases of patients with self-inflicted eye injuries identified through MEDLARS searches of medical literature for the period from 1980 to 1993 and four cases from the first author's clinical practice. RESULTS: Most patients with self-inflicted eye injuries were male, about 31 years old, and had a diagnosis of schizophrenia, drug or alcohol abuse, depressive disorders, or other psychosis. Some patients experienced cognitive distortions, often involving religious and sexual ideation, and intense fear around the time they injured themselves. Thirty-three percent of the patients with self-inflicted eye injuries also showed other types of self-injurious behavior. CONCLUSIONS: Enucleation of the eye may serve as a defense against witnessing or experiencing a forbidden act. Psychodynamic theories addressing self-mutilation do not explain self-induced eye injury particularly well but may assist the therapist in understanding motivation and in restructuring patients' behavior. Management of these patients requires multidisciplinary, multimodal efforts involving medical specialists, patients, family members, and staff.

Adolescent↗
PubMed2005

A psychodynamic approach to screening for the metabolic syndrome.

This article boldly challenges the dynamic psychiatrist to engage directly and vigorously into a matter that many would prefer to regard somewhat passively. That passivity is no longer acceptable. The metabolic syndrome has become a central medical concern because of the epidemic of obesity. It causes cardiovascular disease, diabetes, some cancers, sleep apnea, sexual dysfunction, and infertility. Obesity leads to depression, anxiety, and osteoarthritis. Some atypical antipsychotic medicines contribute to the metabolic syndrome, but the epidemic is widespread independent of atypicals. Practical steps by psychiatrists to monitor metabolic parameters are not as simple as they appear to be. Yet this is an area of clinical practice that cannot be ignored. Psychodynamic therapists need to awaken to the health of patients because the metabolic syndrome is more life-threatening than self-mutilation and many other self-destructive behaviors. The article discusses countertransference and transference issues stirred up when physicians begin to take responsibility for the total health of their patients. Freud oriented us to focus on both sides of the mind body relationship. Recent research on obesity, hypertension, diabetes, sleep, anxiety,depression, exercise and dyslipidemia is reviewed from the viewpoint of how it impinges on the office practice of a dynamic psychiatrist.

Humans↗
PubMed1994

Self-destructiveness in adolescence.

This study is an attempt to formulate the dynamics of the group of adolescents involved in major drug use and other antisocial behavior. As consultant to a drug rehabilitation center for teenagers, the author has had occasion to interview and evaluate a large number of youths whose lives had taken such a turn. Certain aspects of the life style and behavior patterns of these young people show striking similarities. In particular, their behavior evidences the presence of a central self-destructive moiety which can be likened to a negative ego ideal; this acts to shape and to direct their lives. This element in the character structure of these patients is described in clinical and theoretical (developmental) terms, with special address to: a chronic low-grade sense of inner malaise, a tendency to self-blame for whatever goes wrong for family and close friends, feelings of alienation from the larger society around them, behavioral provocativeness in the service of seeking the relief that punishment brings, recurrent gestures of self-mutilation, frequent involvement with cults of devil worship, a record of multiple antisocial acts punctuated by numerous arrests, and repeated suicidal gestures and attempts. The origins of the negative regulatory superego elements which make for this type of psychopathology are explored.

Adolescent↗
PubMed1994

[Open self-injury behavior].

Patients showing self-mutilation behavior are supposed to be a new group of problematic patients in psychiatric institutions. The theme is presented from an anthropological, phenomenological, nosological and etiological point of view. To understand the genesis we apply biological, behavioristic and psychoanalytical concepts. Finally, using this background therapeutic ideas are discussed.

Adolescent↗
PubMed1982

Self-inflicted ocular injuries in children.

Ocular damage resulting from self-mutilation is not uncommon in severely retarded children. Such injuries are caused by repeated headbanging or self-inflicted blows to the face. We treated four children with self-inflicted ocular injuries ranging from corneal lacerations to vitreous hemorrhage and retinal detachment. One child, a 14-year-old boy with tuberous sclerosis, became blind. Persons caring for such children should be alert to changes in the appearance of the pupil, changes in the personality or performance level of the child, and to the development of exotropia. Early treatment and protective equipment (spectacles or helmets) may prevent permanent injury.

Adolescent↗
PubMedDate not supplied

[Self-castration with suicide].

Suicide of a 31 year old man with multiple slashes and stab wounds including complete amputation of penis, scrotum and testicles is reported. Wound patterns in genital self-mutilations are discussed. Despite serious loss of blood the reported survival periods are remarkable; death from bleeding seems to be rare. A review of similar cases shows that self-castrations as well as other self-inflicted genital mutilations are usually associated with psychiatric disorders and transsexuality or hypersexuality.

Adult↗
PubMed1985

Self-injurious behavior in acquired sensory neuropathy.

Self-abusive behavior, noted frequently in congenital sensory neuropathy, was observed in two children with acquired peripheral nerve dysfunction. In one case a laceration over the median nerve was followed by self-induced trauma to the fingers distal to the cut, while the other patient developed self-mutilation in all the extremities following insecticide poisoning and presented with signs of diffuse peripheral neuropathy. Improvement of the self-injurious behavior in each case seemed temporally related to the use of anticonvulsant medications, a treatment that is often suggested for older patients with paresthesias related to peripheral neuropathy. The apparent improvement in these two patients suggests that a trial of these drugs in additional patients with self-abusive behavior associated with peripheral neuropathy would be justified.

Child, Preschool↗
PubMed1978

Youth in crisis: dimensions of self-destructive conduct among adolescent prisoners.

Self-mutilation and attempted suidcide among adolescent prisoners are explored in relation to concrete coping tests posed in prison and to self-esteem problems posed by failure of external (family) and internal (peer) support systems. Crisis sequences are traced using verbatim excerpts from interviews with self-destructive prisoners and conceptualized in terms of enduring adolescent needs and concerns. Some general observations regarding strategies of intervention with crisisprone prisoners are included.

Adjustment Disorders↗
PubMed1982

The influence of housing condition on autotomy following dorsal rhizotomy in rats.

Forty-four rats were subjected to unilateral intradural section of dorsal roots T13-L6. Of these, 10 were housed alone and 34 were housed with female rats. Each of the 10 animals housed alone-self-mutilated to an extreme degree, with 7 cannibalizing the denervated limb. Only of the animals housed with a female showed any sign of self-biting, and this was a minor, isolated incident. These results are discussed with particular reference to dorsal rhizotomy in rats serving as a model of chronic pain.

Animals↗
PubMed1996

Characteristics of women with alcohol and other drug problems: findings of an Australian national survey.

Two hundred and sixty-seven women were interviewed in a national survey examining the characteristics, treatment needs and treatment experiences of Australian women who had received treatment for their alcohol and other drug problems. More than half the women were mothers, of whom almost one-third had surrendered custody of their children. Polydrug use was the norm among these women, who in general had substantial experience with the legal system. A sizeable proportion of women had experienced physical and psychological health problems such as hepatitis, eating disorders, self-mutilation, suicide attempts and low self-esteem. The majority of the sample had a life-time history of physical or sexual violence. The implications of these findings are discussed and recommendations are provided for attracting and retaining women in appropriate services.

Adolescent↗
PubMed2001

Autocastration as a presenting sign of incipient schizophrenia.

Previous case reports on autocastration have identified individuals who engaged in genital self-mutilation as being overtly psychotic, as having previously received a diagnosis of schizophrenia, or as having significant dysfunction of ego integrity, manifesting as guilt and low self-esteem. This paper describes a patient who had had no previous psychiatric symptoms or mental health treatment and for whom the act of autocastration was the first sign of incipient schizophrenia.

Adult↗
PubMed2000

Neurotransmitter changes in the pathophysiology of Lesch-Nyhan syndrome.

The neurological symptoms of Lesch-Nyhan syndrome (LNS) are assumed to result from the neurotransmitter changes in this disorder. Among them, the dopaminergic system is believed to play a role in the self-injurious behavior through receptor supersensitivity. However, the precise mechanism underlying the dopamine supersensitivity remains unclear. An increased serotonergic action in the striatum may be crucial for the appearance of self-injurious behavior, and pharmacological evidence suggests the efficacy of serotonin agonists/antagonists for the treatment of the self-mutilation in LNS.

Animals↗
PubMedDate not supplied

Case presentation of a substance-abusing borderline patient. Illustrating use of the immediate transactional experience.

This paper presents a severely disturbed self-mutilating person with a chronic substance abuse history. It demonstrates how use of the immediate transactional experience is an analytic model, facilitated treatment. The authentic use of the therapist's self is endorsed as mutative in facilitating personality change in the patient. Fellow professionals are encouraged to respond to this paper in the service of fruitful analytic dialogue, in the service of promoting more effective treatment of this difficult population in equally difficult times.

Adult↗
PubMed1983

Clinical vampirism. A presentation of 3 cases and a re-evaluation of Haigh, the 'acid-bath murderer'.

Clinical vampirism is named after the mythical vampire, and is a recognizable, although rare, clinical entity characterized by periodic compulsive blood-drinking, affinity with the dead and uncertain identity. It is hypothetically the expression of an inherited archaic myth, the act of taking blood being a ritual that gives temporary relief. From ancient times vampirists have given substance to belief in the existence of supernatural vampires. Four vampirists, including Haigh, the 'acid-bath murderer', are described. From childhood they cut themselves, drank their own, exogenous human or animal blood to relieve a craving, dreamed of blood-shed, associated with the dead, and had a changing identity. They were intelligent, with no family mental or social pathology. Some self-cutters are auto-vampirists; females are not likely to assault others for blood, but males are potentially dangerous. Vampirism may be a cause of unpredictable repeated assault and murder, and should be looked for in violent criminals who are self-mutilators. No specific treatment is known.

Adult↗