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PubMed1989

Resolving incest experiences through inpatient group therapy.

1. Yalom's "curative factors" provide a helpful "here and now" model for inpatient group therapy with incest survivors. 2. Psychiatric nurses are in an excellent position to identify female patients who have been sexually abused and to establish and conduct therapy groups for these women. 3. Preparation of women for the group by the therapist is an essential prerequisite for successful integration into the group. 4. During hospitalization, some of the women may experience brief psychotic episodes, suicidal ideation, self-mutilation, and increased depression, which may preclude group attendance for brief periods. However, these experiences will provide ongoing opportunities for exploration of group feelings of anger, helplessness, despair, and alienation.

Confidentiality↗
PubMed1991

Classification system for factitious syndromes in the hand with implications for treatment.

We evaluated 29 patients with factitious disorders in the hand who received Worker's Compensation benefits. Three types of factitious hand disorders based on physical presentation were self-mutilation and wound manipulation, edema, and finger and hand deformities. Two distinct psychological diagnoses present were factitious disorder with physical symptoms and conversion disorder. The Minnesota Multiphasic Personality Inventory revealed two personality profiles: emotionally dependent and angry and hostile. Behavioral treatment was implemented. The emotionally dependent group responded well, with 80% returning to work. The angry and hostile group had a much poorer response, with 21% returning to work. None of the self-multilating patients returned to work. We recommend a combined evaluation by a physician, a psychologist, and a hand therapist to achieve a definitive diagnosis for these disorders. The identification of psychological profiles assists in ascertaining which patients will be responsive to behavioral treatment.

Accidents, Occupational↗
PubMed1999

HIV and HCV infection among drug users in Japan.

AIMS: To assess seroprevalence of human immunodeficiency virus (HIV), hepatitis C virus, injecting drug use, unsafe sexual behaviours, self-mutilation and tattoos in patients attending a drug and alcohol treatment centre in Japan. DESIGN: Cross-sectional survey. SETTING: The work was carried out at the National Sanitarium of Shimousa, Chiba, Japan, a 32-bed inpatient centre specializing in drug and alcohol treatment. MEASUREMENTS: Laboratory analyses for HIV antibody, hepatitis C antibody, hepatitis B antigen and antibody; questionnaires for history of sexual activities, needle and syringe use; physical examination with assessment of self-amputated finger joints, tattoos, scars from lacerations and cigarette burns. FINDINGS: No patients tested positive for anti-HIV. The seroprevalence of anti-HCV positives was 53.8% of methamphetamine-dependent patients, 18.4% of solvent-dependent patients and 5.6% of alcohol-dependent patients. Past needle sharing was reported by 82.1% of methamphetamine-dependent patients, 18.4% of solvent-dependent patients and 5.6% of alcohol-dependent patients. A history of syringe sharing was reported by 87.2% of methamphetamine-dependent patients. More than two-thirds of all patients reported contact with commercial sex workers. Casual sexual contacts were more common among solvent and methamphetamine-dependent patients than those dependent on alcohol. Tattoos and cigarette burns were more common among methamphetamine and solvent-dependent patients than among alcohol-dependent patients. Among the methamphetamine-dependent patients, 20.5% reported self-amputated finger joints compared with none in the other patient groups. CONCLUSIONS: HCV prevalence is a significant problem among methamphetamine users in Japan, probably because of a high rate of needle and/or syringe sharing. Although HIV infection is currently negligible, the very high rate of needle and syringe sharing could give rise to a significant increase in the HIV rate among drug users in the future.

Adult↗
PubMed1996

[Symptom complex, prevalence of trauma and body image of psychiatric patients with self-injury behavior].

Within the group of in-patients the patients exhibiting self-injurious behavior (SIB) have a significantly more disturbed body image--as assessed by the Holtzman Inkblot Technique (HIT)--than the patients who do not have this symptomatology. The more disturbed the body image, the higher the frequency of SIB. The method of self-injury most frequently reported is cutting the skin of the extremities, followed by burning the skin with cigarettes or open flames. This behavior serves the purpose of alleviating diffuse internal tension, of directing aggression inward, i.e. toward the self, and of terminating depersonalization states. During the act of self-mutilation, the perception of pain is lessened appreciably or inactivated. 48 percent of the female patients in this group suffered sexual abuse during childhood.

Adolescent↗
PubMed1989

Clozapine antagonism of D-1 and D-2 dopamine receptor-mediated behaviors.

When tested in rats supersensitive to dopamine agonists, the atypical neuroleptic clozapine displayed pharmacological properties expected of both a D-1 and D-2 receptor antagonist. The locomotor response induced by the D-1 receptor agonist SKF-38393 in neonatal-6-hydroxydopamine (6-OHDA)-lesioned rats was reversed in a dose-related fashion, although a complete blockade of this behavior was not observed indicative for only a partial antagonism of D-1 receptor function. Clozapine also blocked the self mutilation resulting from L-dihydroxyphenylalanine (L-DOPA) administration to neonatal-6-OHDA-lesioned rats, an effect previously linked to D-1 receptor activation. At higher doses, clozapine blocked the locomotor activity elicited by the D-2 agonist LY-171555 in adult-6-OHDA-lesioned rats. Therefore, the action of clozapine on D-1 as well as D-2 receptor-mediated behaviors contributes to its pharmacological effects. The ability of clozapine to stop self-mutilatory behavior in neonatal-6-OHDA-lesioned rats suggests that this drug might be an effective treatment for self-injurious behavior associated with the Lesch-Nyhan syndrome and mental retardation.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1997

The discrimination between overt and non-overt self-inflicted lesions.

Injuries following autoaggressive behaviour are found in patients examined in forensic medicine as well as in psychiatric clinics. Self-mutilation often is combined with a borderline personality disorder in psychiatric patients. Our investigation compares injuries and wounds in psychiatric patients and those in persons examined in the Institute for Forensic Medicine after referral by the police. Our intention was to show evident differences and/or conformities in both of these groups. Additionally we describe a 'third group' of patients which has not yet been mentioned. These women showed, at the same time, characteristics of patients with overt self-injuries and of those with non-overt self-injuries. In this 'third group' we can often find a mixture of reality and fantasy/imagination.

Adolescent↗
PubMed1992

Sexual abuse and the problem of embodiment.

In this paper, trauma, sexual abuse, and some of the potential resulting long-term effects, are explored in terms of the problem of embodiment and the formation of personal identity and psychological integrity. That is, what effect does severe sexual abuse have on an individual's, particularly a child's, sense of living in his or her body and, by extension, living in the world? First, trauma and dissociation are analyzed and linked to the development and maintenance of a "posttraumatic" sense of personal identity. Then, several disorders associated with sexual abuse--dissociation, multiple personality disorder, eating disorders, somatization disorder, self-mutilation, suicide, and suicide attempts--are examined in terms of their phenomenological coherence and relation to the problem of embodiment. This conceptual framework may be of use to clinicians and researchers assessing and treating the survivors of sexual abuse.

Body Image↗
PubMedDate not supplied

A case report: recognizing factitious injuries secondary to multiple eating disorders.

This report describes the uncommon problem of a female patient diagnosed with an eating disorder, bulimia nervosa, who reported self-mutilating dental factitious behavior. The case presents a serious diagnostic and management problem. Notwithstanding the clinical appearance of the dentition, a thorough medical-dental history was essential for this uncommon diagnosis.

Adolescent↗
PubMed1998

The dental problems and management of a patient suffering from congenital insensitivity to pain.

Congenital insensitivity to pain is a rare condition usually manifested in childhood by a history of unrecognized trauma, indifference to painful stimuli or self-mutilation. This paper describes the management of a 13-month-old male who had severely lacerated his tongue by habitually chewing it, using soft polyvinyl mouthguards retained with a minimal amount of denture fixative.

Dental Care for Children↗
PubMed2003

Long-term glue sniffing: report of six cases.

OBJECTIVE: Glue is cheap and readily available, and is frequently misused, especially by adolescents. Long-term effects of regular use, in terms of the psychiatric symptoms and cognitive function, have rarely been reported, however. METHOD: We retrospectively reviewed the psychiatric symptoms and the results of cognitive tests for six long-term glue sniffers admitted to a psychiatric ward. RESULTS: Our results suggest that long-term abuse of these adhesive products is often associated with violent behavior and/or self-mutilation. Functional deterioration, characterized by impairment of intelligence, was noted for most of the patients, with some developing psychosis. CONCLUSIONS: Chronic glue sniffing may cause functional deterioration, and even psychosis. The associated violent behaviors in long-term glue sniffers also warrant caution.

Adolescent↗
PubMed2004

Case report: the Lesch-Nyhan syndrome.

BACKGROUND: The Lesch-Nyhan syndrome (LNS) is a rare x-linked excessive disorder of purine metabolism, caused by the congenital absence of hypoxanthine guanine phosphoribosyl transferase (HGPRT). CASE REPORT: In January 2000 a 2 year old boy was referred to a paediatric dental office in Landshut, Germany, because of severe and repeated lip chewing and aggressive tongue biting. A medical history revealed a normal pregnancy with no complications but a diagnosis of muscular hypotonia was made at four months of age. At 18 months a diagnosis of LNS was established through biochemical analysis and molecular examinations. The child displayed self-destructive behaviour, typical in children with LNS. Shortly thereafter the patient was supplied with arm cuffs for self-protection which were not tolerated and the self-mutilation continued. Eventually the extraction of all primary teeth was deemed necessary to prevent additional medical problems for this child. FOLLOW-UP: One year after the dental extractions the patient presented with no bite injuries but was now using his fingers to injure himself.

Bites, Human↗
PubMed1986

Food deprivation reveals strain differences in opiate intake of Sprague-Dawley and Wistar rats.

Two groups of naive, male, albino rats derived from different genetic strains (Sprague-Dawley and Wistar) were given a 5 micrograms/ml etonitazene solution as their only available liquid. Liquid intake and body weights were recorded every 24 hr. Etonitazene intake was compared to baseline water intake, and drug intake was then compared when the rats were food deprived (25 sessions) and food satiated (24 sessions). Both groups drank similar amounts of water and etonitazene during the initial food satiation phase, although drug intake was slightly below water intake. When they were food deprived, the Wistar group's mean etonitazene intake almost doubled, while the Sprague-Dawley group's drug intake decreased by nearly 50%. The etonitazene intake in the Sprague-Dawley group never exceeded that of the vehicle, water; thus, it appeared that the drug was not functioning as a reinforcer. Food deprivation increased etonitazene intake above water levels in the Wistar group, indicating that the drug was serving as a reinforcer. Both groups showed similar drug effects during food deprivation, such as erratic drinking patterns, self-mutilation and other forms of stereotypy. Thus, both strains were sensitive to etonitazene's effects; they appeared to differ only with respect to the reinforcing effects. These results suggest that genetically-based differences in the reinforcing effects of drugs may be revealed by food deprivation.

Animals↗
PubMed1982

Visual screening: an alternative method for reducing stereotypic behaviors.

Visual screening, a mildly aversive response suppression procedure, was evaluated across two studies for its effectiveness in reducing topographically similar and dissimilar stereotypic behaviors of four developmentally disabled children. In the first study, a multiple baseline design across subjects and behaviors was used to assess the effectiveness of the procedure as a treatment for reducing the visual and auditory self-stimulatory responses of two 9-yr-old mentally retarded and behaviorally disturbed children. A multiple baseline design across subjects was used in the second study to evaluate the effectiveness of visual screening as a treatment for reducing stereotypic fabric pulling and self-mutilative ear bending, respectively, of two 13-yr-old mentally retarded, autisticlike adolescents. Long-term follow-up data for both studies were reported. The results suggested that visual screening was an easily administered, effective, and exceptionally durable treatment procedure for controlling a variety of stereotypic behaviors commonly associated with the developmentally disabled.

Adolescent↗
PubMed2000

Controversies and challenges of ritual abuse.

Children who have survived ritual abuse have endured physical, psychological, and sexual trauma; brain-washing; and mind-altering drugs. Their trust in adults has been eroded. Their coping strategies include anxiety, denial, self-hypnosis, dissociation, and self-mutilation. Although reports of ritual abuse initially seem hard to believe, nurses have a responsibility to detect clues to abuse, diagnose the child's responses, and recognize controversial issues regarding ritual abuse. To evaluate ritual abuse, nurses should avoid interview strategies that influence the child's recall (e.g., coaching, suggestions) and recognize that some reports are discounted as false memories because they emerge from fantasy, distortions, innocent deceptions, false beliefs, lies, or adult coaching. Nurses play an important role in case finding and treatment. They can evaluate clues to ritual abuse to reduce sources of error in assessment, build a child's trust, monitor their own attitudes toward ritual abuse, and intervene to increase self-esteem, empathy, boundary establishment, and coping. Nurses have an important opportunity to detect and begin healing the wounds caused by a child's abuse.

Ceremonial Behavior↗
PubMed2003

Suicidal ideation and behavior in children's homes.

The aim of this cross-sectional study is to report the self-destructive and suicidal behavior of 98 children and adolescents in child welfare institutions. The children were evaluated using the Child Behavior Checklist (CBCL), the Children's Global Assessment Scale (CGAS) and questionnaires about suicidal and violent behavior, filled in by the child's key worker. Thirty-two per cent of the sample had presented suicidal thoughts, threats or suicide attempts during the previous 6 months. Suicidality was associated with low general functioning level (CGAS<61), self-mutilating behavior and violence. Furthermore, suicidal children had significantly higher CBCL total, externalizing, internalizing, anxious-depressive and aggressive scores. Children with suicide attempts (8% of the sample) had a significantly higher number of different types of traumatic experiences before the placement and higher somatization syndrome scores compared to children with suicidal ideation or non-suicidal children.

Adolescent↗
PubMed2005

[Surgical management of cutaneous pathomimia. A report case].

UNLABELLED: Cutaneous pathomimia is a behaviour disorder witch interest the skin. In some cases, self-mutilation can be serious and require a surgical treatment. CASE REPORT: A 60 year old woman consults for extensive scar interesting the face and the scalp and realising the aspect of burn face in cicatricle level. The treatment consisted on excision and skin graft. The patient was addressed to Psychodermatology consultation. Authors show the place of plastic surgery in management of cutaneous pathomimia.

Cicatrix↗
PubMed1996

[Complete and partial deficiency of HPRT].

The Lesch-Nyhan syndrome results from a complete or virtually complete deficiency of the purine salvage enzyme, hypoxanthine guanine phosphoribosyl transferase (HPRT). The disease is characterized by hyperuricemia, choreoathetosis, spasticity, compulsive self-mutilation, and mental retardation. Patients with a partial deficiency of HPRT are spared most of the neurological disorder of Lesch-Nyhan syndrome. The specific relationship between HPRT deficiency and the neurological dysfunction in the Lesch-Nyhan syndrome is not known, at present. The genetic lesion which result in HPRT deficiency are heterogeneous. About 90 different mutations were found in over 110 families. The DNA-based mutation detection technique can be used for the diagnosis of affected males and for the determination of carrier status of asymptomatic females. This technique is also applicable for the prenatal diagnosis for Lesch-Nyhan syndrome. Transgenic mice, deficient in HPRT activity, have been obtained but they do not show any neurological dysfunction. After administration of 9-ethyladenine, however, they showed the self-injury behavior.

Adenine↗
PubMed1994

Use of naltrexone for treatment of psychogenically induced dermatoses in five zoo animals.

Naltrexone was used successfully in controlling self-mutilation behavior in 3 zoo animals from 2 families (Felidae and Sciuridae). It had no effect on 2 other zoo animals from 2 families (Canidae and Ursidae). Long-term administration of glucocorticoids was not satisfactory in controlling the behaviors, and concerns were raised about potential long-term adverse effects, especially with regard to fertility. Detrimental effects were not noticed in any of the zoo animals treated with naltrexone. Two males successfully sired healthy offspring.

Animals↗