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Medical management of self-enucleation.

Self-enucleation or oedipism is a specific manifestation of psychiatric illness distinct from the milder forms of self-inflicted ocular injury. In this article, we discuss the previously unreported medical complication of subarachnoid hemorrhage accompanying self-enucleation. The diagnosis was suspected from the patient's history and was confirmed by computed tomographic scan of the head. This complication may be easily missed in the overtly psychotic patient. Specific steps in the medical management of self-enucleation are discussed, and medical complications of self-enucleation are reviewed.

Adult↗

Abuse, feelings, and health behaviors in a student population.

Behavioral sequelae of child abuse are frequently cited, but there are few studies that examine the strength of association between behavioral effect and abuse for children in a nonclinical setting. Seven hundred twelve junior high school students (mean age, 13.5 years) were surveyed for self-report of personal experience with abuse, certain health behaviors, and self-esteem. Physical and/or sexual abuse was reported by 18.3% of students. Both types of abuse were associated with the following behaviors: running away; considering hurting oneself; suicide attempts; and the use of drugs, pot (marijuana), cigarettes, and laxatives. No clinically significant relationships were found between abuse and report of anger, sadness, or self-esteem. These data suggested that some feelings and behaviors were common among all adolescents sampled, while others were more common among abused adolescents. Recognition of strong associations should help direct clinical management. The results of this study confirm findings from some previous reports and indicate the need for further studies of children who are not in a clinical setting.

Adolescent↗

A case of stigmata.

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Black or African American↗

Countersymbiotic suicide.

In the course of studying the outcome of treatment for severely disturbed schizophrenics on a special ward, the authors encountered three instances of suicide with many features in common. All three cases involved young Hispanic male patients who demonstrated pathologically symbiotic relationships with their mothers. None had a history of overt suicide attempts prior to their actual death by jumping. These incidents occurred while the patients were en route to, or at, the maternal home on an unauthorized leave from the hospital. We present the case histories and offer a dynamic interpretation. In each case, it is likely that the underlying desire was to kill the mother. This either was not permissible or, alternatively, the patients' ego boundaries were not sufficiently clear to permit differentiation of self and mother. The patients saw any attempt, short of suicide, to loosen the symbiotic bond as being futile, hence, our terminology of the event as "countersymbiotic suicide."

Adolescent↗

Multiple personalities. A report of 14 cases with implications for Schizophrenia and hysteria.

Evidence exists to support the concept of pathology or diseases of hypnosis. Multiple personalities is such a syndrome, as are many or perhaps all cases of hysteria (Briquet's syndrome). The crux of multiple personalities is the subject's unrecognized abuse of self-hypnosis, by which she creates personalities, beginning at age 4 to 6 years. The process of self-hypnosis allows the delegation of an experience or a function to an alter ago, henceforth relegated to unconsciousness by the amnesia of hypnosis. Most of these patients qualify for the diagnosis of hysteria (Briquet's syndrome), and many are diagnosed incorrectly as being schizophrenic because of their hallucinations, paranoid ideas, and "delusions." Hysteria may owe many of its characteristics to the self-hypnotic induction of conversion and other symptoms.

Adaptation, Psychological↗

Endorphin activity in childhood psychosis. Spinal fluid levels in 24 cases.

Twenty 2- to 13-year-old infantile autistic children (16 boys and four girls) and four 4- to 13-year-old children (two boys and two girls) with other kinds of childhood psychoses were compared with eight 6-month-old to 6-year-old normal children with regard to cerebrospinal fluid contents of endorphin fractions I and II. The psychosis groups showed higher mean cerebrospinal fluid endorphin fraction II levels, and 11 (55%) of the 20 autistic patients showed values higher than the highest in the group of normal children. There was a trend toward a correlation between high fraction II levels and self-destructiveness and decreased pain sensibility in the psychotic children. The results are regarded as preliminary but as warranting further research in this potentially fruitful field.

Adolescent↗