Major self-mutilation in the first episode of psychosis

Schizophrenia Bulletin (Impact Factor: 8.61). 06/2008; 35(5):1012-21. DOI: 10.1093/schbul/sbn040
Source: PubMed

ABSTRACT Major self-mutilation (MSM) is a rare but catastrophic complication of severe mental illness. Most people who inflict MSM have a psychotic disorder, usually a schizophrenia spectrum psychosis. It is not known when in the course of psychotic illness, MSM is most likely to occur. In this study, the proportion of patients in first episode of psychosis (FEP) was assessed using the results of a systematic review of published case reports. Histories of patients who had removed an eye or a testicle, severed their penis, or amputated a portion of a limb and were diagnosed with a schizophrenia spectrum psychosis were included. A psychotic illness was documented in 143 of 189 cases (75.6%) of MSM, of whom 119 of 143 (83.2%) were diagnosed with a schizophrenia spectrum psychosis. The treatment status of a schizophrenia spectrum psychosis could be ascertained in 101 of the case reports, of which 54 were in the FEP (53.5%, 95% confidence interval = 43.7%-63.2%). Patients who inflict MSM in FEP exhibited similar symptoms to those who inflict MSM later in their illness. Acute psychosis, in particular first-episode schizophrenia, appears to be the major cause of MSM. Although MSM is extremely uncommon, earlier treatment of psychotic illness may reduce the incidence of MSM.

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Available from: Matthew Large, Jan 14, 2015
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    • "Many studies have indicated that the risk of suicide is highest within the first year of the initial hospital contact. Although this is true for all mental illnesses, suicide risk appears to be especially elevated among individuals who had been diagnosed with a bipolar disorder and with disorders in the schizophrenia spectrum (Large et al., 2009; Nordentoft et al., 2004; Nordentoft et al., 2011; Nordentoft et al., 2013b). In the analyses of the Danish register data, the excess mortality from suicide in the first year of the initial hospital contact was 1.6 times greater compared with the later phases of the illness (Nordentoft et al., 2004). "
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