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[Auto-aggression and lobotomy].
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Two cases of self-cannibalism (autosarcophagy).
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Dermatological manifestations of Tourette syndrome and obsessive-compulsive disorder.
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Cognitive-behavioral treatment of chronically parasuicidal borderline patients.
A randomized clinical trial was conducted to evaluate the effectiveness of a cognitive-behavioral therapy, ie, dialectical behavior therapy, for the treatment of chronically parasuicidal women who met criteria for borderline personality disorder. The treatment lasted 1 year, with assessment every 4 months. The control condition was "treatment as usual" in the community. At most assessment points and during the entire year, the subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. There were no between-group differences on measures of depression, hopelessness, suicide ideation, or reasons for living although scores on all four measures decreased throughout the year.
Emergency treatment of young people following deliberate self-harm.
OBJECTIVE: To examine national patterns in the emergency department assessment and treatment during visits by young people, aged 7 to 24 years, who are seen following an episode of deliberate self-harm. METHOD: An analysis was conducted of a nationally representative sample of hospital emergency department visits from the 1997-2002 National Hospital Ambulatory Medical Care Survey focusing on visits by persons aged 7 to 24 years related to deliberate self-harm. National census data were used to derive population-based rates of emergency department visits for deliberate self-harm overall and stratified by sex, age, race, and ethnicity. Demographic, clinical, and treatment characteristics of the visits are presented including comparisons of visits that resulted in an inpatient admission with those that resulted in discharge to the community. RESULTS: Among young people aged 7 to 24 years, the annual rate of emergency visits with self-harm was 225.3 per 100,000. A mental disorder was diagnosed in 56.0% of these visits including depressive disorders in 15.1% and substance use disorders in 7.3%. Approximately one half of the visits (56.1%) resulted in an inpatient admission. As compared with visits resulting in discharge to the community, emergency department visits that resulted in inpatient admission were significantly more likely to result in the patients receiving a mental disorder diagnosis (63.8% vs 45.7%; P = .03), especially a depressive disorder (22.5% vs 5.8%; P = .005), and receiving psychotropic medications (18.0% vs 4.7%; P = .007), intravenous fluids (39.2% vs 22.3%; P = .02), gastric lavage (24.1% vs 9.8%; P = .02), and a specific antidote for poisoning (12.2% vs 1.3%; P = .02). CONCLUSIONS: Mental disorders are diagnosed in roughly one half of emergency department visits by young people following an episode of deliberate self-harm. Systematic mental health assessments in the emergency department of young people following an episode of deliberate self-harm may improve detection of mental disorders.
Self-inflicted eye injuries.
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Chemical peeling as adjuvant therapy for facial neurotic excoriations.
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National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001.
STUDY OBJECTIVE: We describe the epidemiology of emergency department (ED) visits for attempted suicide and self-inflicted injury. METHODS: Data were obtained from the National Hospital Ambulatory Medical Care Survey, a national probability sample of ED visits. All visits for attempted suicide or self-inflicted injury (E950 to E959) during 1997 to 2001 were included in these analyses. RESULTS: During the 5-year period, there were approximately 412,000 annual ED visits for attempted suicide and self-inflicted injury, or 0.4% of all ED visits. The annual visit rate was 1.5 (1.3 to 1.7) visits per 1,000 US citizens. The mean patient age was 31 years, and visits were most common among patients aged 15 to 19 years, at a rate of 3.3 (95% confidence interval 2.1 to 4.4). ED visit rates were higher among female patients (1.7) than male patients (1.3) and among blacks (1.9) than whites (1.5). Visit rates did not differ by metropolitan status or US region. The most common method of injury was poisoning (68%), followed by cutting or piercing (20%). One third of visiting patients were admitted to the hospital, with 31% of admissions going to the ICU. A psychiatric disorder was coded for 55% of visits, with depressive disorder accounting for 34% and alcohol abuse for 16%. CONCLUSION: ED visits for attempted suicide and self-inflicted injury are relatively common, serious, and most frequent among adolescents and young adults. Self-poisoning is the most common method. The high prevalence of psychiatric and substance abuse disorders in this population suggests these issues should be considered during management and disposition.
The functions of deliberate self-injury: a review of the evidence.
Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. The present article reviews the empirical research on the functions of self-injury. This literature includes self-reports of reasons for self-injuring, descriptions of the phenomenology of self-injury, and laboratory studies examining the effects of self-injury proxies on affect and physiological arousal. Results from 18 studies provide converging evidence for an affect-regulation function. Research indicates that: (a) acute negative affect precedes self-injury, (b) decreased negative affect and relief are present after self-injury, (c) self-injury is most often performed with intent to alleviate negative affect, and (d) negative affect and arousal are reduced by the performance of self-injury proxies in laboratory settings. Studies also provide strong support for a self-punishment function, and modest evidence for anti-dissociation, interpersonal-influence, anti-suicide, sensation-seeking, and interpersonal boundaries functions. The conceptual and empirical relationships among the different functions remain unclear. Future research should address the measurement, co-variation, clinical correlates, and treatment implications of different functions.
Delusions of ocular parasitosis.
PURPOSE: To describe four cases of delusions of parasitosis in which self-inflicted ocular trauma occurred. Delusions of parasitosis is a somatic delusional disorder in which patients have the irrational belief that their bodies are infested by parasites or other infectious organisms. Self-inflicted trauma can result from attempts to eliminate the supposed infestation. METHODS: We reviewed the case histories of four patients (one male, three females, 35 to 45 years of age) who presented with complaints of ocular infestation but had no evidence of infectious ocular disease. The characteristics of these cases were compared with the features of delusions of parasitosis. RESULTS: All patients maintained their beliefs regarding infestation, despite extensive clinical and laboratory investigations that found no evidence of infectious diseases. Self-inflicted eye injury, associated with attempts to eliminate the infestation, occurred in each case. CONCLUSIONS: The cases presented in this report are consistent with a diagnosis of delusions of parasitosis. The eye can be a principal focus of attention in this disorder, which may lead to vision loss caused by self-inflicted injury.
Pain assessment in self-injurious patients with borderline personality disorder using signal detection theory.
Signal detection theory measures of thermal responsivity were examined to determine whether differences in reported pain experienced during self-injurious behavior in female patients with borderline personality disorder (BPD) are explained by neurosensory factors and/or attitudinal factors (response bias). Female patients with BPD who do not experience pain during self-injury (BPD-NP group) were found to discriminate more poorly between noxious thermal stimuli of similar intensity, low P(A), than female patients with BPD who experience pain during self-injury (BPD-P group), female patients with BPD who do not have a history of self-injury (BPD-C group), and age-matched normal women. The BPD-NP group also had a higher response criterion, B (more stoical) than the BPD-C group. These findings suggest that 'analgesia' during self-injury in patients with BPD is related to both neurosensory and attitudinal/psychological abnormalities.
AN UNUSUAL CASE OF AUTOSCOPIC HALLUCINATIONS.
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Dermatitis artefacta of the breast: a series of case reports.
Dermatitis artefacta of the breast is a common disease process with a psychological basis. Psychiatric assessment is a useful adjunct in the management of these patients who at initial presentation seem to have a strictly surgical dermatological problem.