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PubMed2001

Suicide by self-immolation in Berlin from 1990 to 2000.

We investigated retrospectively the forensic autopsy cases of suicide by self-immolation in Berlin from 1990 to 2000. There were 46 cases (35 men and 11 women), corresponding to 0.76% of all known suicides committed in Berlin during this period. The most common reasons for self-immolation were separation from a partner or financial problems. Two individuals had political reasons. There was a history of mental disturbances in 65% of these suicide cases. The location of the self-immolation was outdoors in 65%, the rest were indoors, except for three victims, who committed suicide in their cars. In nearly all cases, the individuals had doused themselves with an inflammable fluid, usually petrol. One-third of the victims died from burn shock, about 20% from a combination of severe burns and inhalation trauma. The median body surface area burnt was 78% for all cases. The blood had a mean 21% carboxyhemoglobin concentration and 0.07 microg/ml of cyanide. Suicide by self-immolation was committed under the influence of drugs in nine cases and of alcohol in 11 cases.

Adult↗
PubMed1997

Lethal suicidal intoxication with propafenone, after a history of self-inflicted injuries.

Report of a suicidal mono-intoxication with the class IC antiarrythmic drug propafenone. A 20-year-old female physician's assistant secretly ingested the substance (presumably 20 tablets per 300 mg) about 4-6 h before her death, and in the interim remained under the supervision of her physician. An ECG taken about 1/2-2 h after ingestion showed widening of the QRS complex and signs of an acute load of the right ventricle; the clinical symptoms were nausea, vomiting and hypotonia. After about 4 h without serious symptoms acute loss of consciousness and cardiac failure occurred, resuscitation efforts remained unsuccessful. At autopsy propafenone was found in blood (12 micrograms ml-1), liver (60 micrograms g-1) and cardiac muscle (11 micrograms g-1).

Adult↗
PubMed1998

Intentional and unintentional injury in the State of Nevada: 1989-1992.

INTRODUCTION: Data from a large population-based trauma registry were used to assess risk factors and outcomes associated with injuries that were either caused unintentionally, were self-inflicted, or resulted from an assault. DESIGN: A retrospective analysis was conducted of all cases of serious trauma (N = 19,505) occurring in the State of Nevada during the 4-year period from January 1, 1989, through December 31, 1992. The outcome measures of interest were Injury Severity Score, hospitalization, and mortality. RESULTS: Of all patients with unintentional injuries, 9.9% died compared with 44.8% of those whose injuries were intentionally caused. Nearly half (49.0%) of all deaths occurred in persons who were intentionally injured. Of the intentional injuries, 70% were from assaults. Self-inflicted injuries accounted for 5.2% of all injuries but 28.2% of the deaths in the registry. Firearms were most often used in both assaults (38.8%) and self-inflicted injuries (87.4%). Logistic regressions showed that, compared with unintentional injuries, assaults were more likely to occur in urban counties, among males, African Americans, and young adults. Also, compared with unintentional injuries, self-inflicted injuries were more likely to occur in urban counties, among Caucasian, and the 65+ age group. CONCLUSION: Although the overwhelming number of injuries in the registry were unintentionally caused, deaths from intentionally caused injuries accounted for almost half of all deaths. The data from Nevada's registry provided the ability to identify who is at risk for trauma-related injury and death. Prevention programs should be designed to target these populations. As prevention programs are implemented, trauma registries such as Nevada's will provide a sound source of data for assessing long-term trends in injury patterns.

Adolescent↗
PubMed2001

Congenital insensitivity to pain with anhidrosis.

Congenital insensitivity to pain with anhidrosis is an autosomal-recessive disorder resulting from defective neural crest differentiation with loss of the first-order afferent system, which is responsible for pain and temperature sensation. There is also a neuronal loss in the sympathetic ganglia. Lack of sweating, hyperthermia, and infections of bones are main features of the disorder; however, contradictory results have been published regarding eccrine sweat gland innervation. A 5-year-old male patient with typical clinical manifestations of congenital insensitivity to pain with anhidrosis is presented. Immunohistochemistry with antibodies against S100 protein and neuron-specific enolase failed to reveal nerve fibers in the vicinity of the eccrine sweat glands. The roles of the nerve growth factor and tyrosine kinase receptor gene mutations in the pathogenesis of the disease are also discussed.

Biopsy↗
PubMed1997

Managing deliberate self-harm: the A & E perspective.

This paper reports on a retrospective survey of the Accident and Emergency (A & E) treatment of patients who have deliberately harmed themselves. Reasons for self-harm are identified, and current management in A & E is discussed. Suggestions are made for providing these patients with high-quality holistic care instead of treating only their physical injuries.

Emergency Service, Hospital↗
PubMed1998

Female survivors of abuse attending A & E with self-injury.

Accident and Emergency departments are concerned with trauma whatever the source or client age. This mixed trauma culture can be a distressing place, not least for women whose self-injury is 'self-inflicted' rather than accidental in nature. The women, who might be survivors of childhood sexual abuse, are sometimes viewed as service abusers, on occasions subjected to misinterpretation, labelled as 'time-wasters' and consequently stigmatized. The misunderstanding based on misinterpretation of language and theory is explored briefly, as is some appropriate literature on self-injury and abuse. The definitions of self-injury and some of the myths associated with self-injuring women are developed. The relationship of self-injury with suicide is briefly explored, as are issues related to distress and self-injury. The demand on nurses and the case for the development of an appropriate non-medical theory is explored. Areas of positive practice, some of which were visited while the author was on a Nightingale Scholarship, are noted as is the need for nurses to learn from voluntary and survivor groups who work with and for self-injuring women. Client needs and staff awareness is examined in brief. Literature from the survivor perspective is utilized and the conclusion is drawn largely from the recommendations made by this literature.

Adult↗
PubMed1997

Sarcoid-like foreign body reaction in body piercing: a report of two cases.

We report two cases of body piercing as a religious practice that subsequently led to the development of granulomatous nodules at previously punctured sites of the skin and oral mucosa. These lesions were diagnosed as sarcoid-like foreign body reaction after other possible causes including sarcoidosis, tuberculosis, tuberculoid leprosy, fungal infections, viral infections, and Crohn's disease were excluded.

Adult↗
PubMed2002

Sexual molestation of males: associations with psychological disturbance.

BACKGROUND: There are no epidemiological data in Europe on associations between sexual molestation in males and psychological disturbance. AIMS: To investigate whether sexual molestation in males is a significant predictor of psychological disturbance. METHOD: We recruited men attending general practice and genitourinary medicine services. Participants took part in a computerised interview about sexual molestation as children or adults. We ranked reported sexual experiences into three categories of decreasing severity. Each category was treated as an independent predictor in a multivariate analysis predicting different types of psychological disturbance. RESULTS: Men who reported child sexual abuse were more likely to report any type of psychological disturbance. Men who reported sexual molestation in adulthood were 1.7 (1.0-2.8) times more likely to have experienced a psychological disorder, but self-harm was the single most likely problem to occur (odds ratio=2.6, range=1.3-5.2). Men reporting 'consenting' sexual experiences when aged under 16 years also were more likely to report acts of self-harm (odds ratio=1.7, range=0-2.8). CONCLUSIONS: Sexual abuse as a child or adult is associated with later psychological problems. All forms of sexual molestation were predictive of deliberate self-harming behaviour in men.

Adolescent↗
PubMed1989

Factitious illness and the ENT surgeon.

Factitious illness' is a recently classified group of diseases characterized by repeated purposeful simulation of physical or mental illness in order to obtain medical or psychiatric treatment. 'Münchausen Syndrome' is a classical example of this group. The case reported is a 26-year-old Caucasian male who presented with recurrent facial swelling between December 1978 and November 1987. His true condition eluded diagnosis for so long because he presented repeatedly with overt clinical signs which appeared severe enough to justify the symptoms claimed.

Adult↗
PubMed1984

Suicidal intent and repeated self-harm.

The value of identifying self-harm patients who repeat with rising suicidal intent is discussed. A study is described measuring changes in intent with repetition by means of an intent scale. Patients repeating once in 5 years scored significantly higher in intent for their second episodes, while multiple repeaters tended to score lower for second episodes. Patients under the age of 35 were most at risk for repetition with increasing intent within 2 years. No correlation emerged between the rise in intent and the time interval between episodes over a 7-year period. The 5-year suicide rate was higher among rising intent repeaters than other cases. These findings are discussed.

Follow-Up Studies↗
PubMed1976

General practice aspects of self-poisoning and self-injury.

A sample of individuals who had carried out acts of self-poisoning or self-injury were interviewed and information was also obtained from their general practitioners. More of both the men and the women had visited their general practitioners in the year before the acts than would have been predicted from national statistics, although this was not found to the same extent for persons aged 16-24. Thirty-six per cent of the sample had contacted their general practitioners during the week before the act and over 60% in the month beforehand. Sixty-three per cent had visited them for a variety of psychiatric and social reasons during the preceding year and had nearly all been prescribed psychotropic drugs, usually tranquillizers or sedatives. These were commonly the drugs taken in acts of self-poisoning. Methods of prevention are discussed.

Adolescent↗
PubMed1989

Self-injurious behaviour and the Gilles de la Tourette syndrome: a clinical study and review of the literature.

Thirty (33%) of 90 patients with the Gilles de la Tourette syndrome exhibited self-injurious behaviour. Fourteen were head bangers, of whom two had cavum septum pellucidum. Clinical correlates of self-injury were the severity of Gilles de la Tourette syndrome symptoms and psychopathology, with special reference to obsessionality and hostility. We discuss an additional patient who died from a subdural haematoma as a result of head banging, and three who had permanent vision impairment from self inflicted eye injuries.

Adolescent↗
PubMed1977

People who deliberately poison or injure themselves: their problems and their contacts with helping agencies.

A representative sample of 130 people was interviewed shortly following self-poisoning or self-injury. The interview method is described. Events in the week prior to the attempt, and the incidence of various kinds of chronic problems are reported. Events involving key relationships were much more common than other kinds. The most important event was a quarrel, particularly in the 48 hours prior to the attempts and more common with female than with male attempters. The possible relevance of quarrels to understanding overdose behaviour is discussed. Nearly a third were receiving non-psychiatric treatment at the time of the 'attempt'. Approximately one quarter were currently receiving psychiatric treatment and a half had received it at some time. A substantial proportion had been admitted to either psychiatric or non-psychiatric hospitals within the past year. The proportions indicating the need for various kinds of help are reported. Most people said they needed 'someone to talk to'. More than half had been in contact with some form of helping agency during the week prior to the attempt. The possible significance of these findings is discussed. An attempt was made to look for 'syndromes' or groupings of problems. The resulting analysis, whilst of interest, did not lead to a satisfactory method for classifying individuals. It was concluded that a more satisfactory typology of 'attempters' is likely if types of relationship problems are investigated in more detail.

Adolescent↗