Major Self-mutilation in the First Episode of Psychosis

Schizophrenia Bulletin (Impact Factor: 8.45). 06/2008; 35(5):1012-21. DOI: 10.1093/schbul/sbn040
Source: PubMed


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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    ABSTRACT: Suicide is a serious public health problem, with more than 800,000 deaths taking place worldwide each year. Mental disorders are associated with increased risk of suicide. In schizophrenia and other psychotic disorders, the lifetime risk of suicide death is estimated to be 5.6%. The risk is particularly high during the first year of the initial contact with mental health services, being almost twice as high as in the later course of the illness. The most consistently reported risk factor for suicide among people with psychotic disorders is a history of attempted suicide and depression. Suicide risk in psychosis in Denmark decreased over time, most likely because of improved quality of inpatient and outpatient services. There is a high proportion of young people with first-episode psychosis who attempted suicide before their first contact with mental health services. This finding suggests that the mortality rates associated with psychotic disorders may be underreported because of suicide deaths taking place before first treatment contact. However, currently, no data exist to confirm or refute this hypothesis. Attempted suicide can be an early warning sign of later psychotic disorder. Data from different studies indicate that the risk of suicide attempt during the first year of treatment is as high as 10%. The most important risk factors for attempted suicide after the first contact are young age, female sex, suicidal plans, and a history of suicide attempt. Early intervention services are helpful in first-episode psychosis, and staff members should, in collaboration with the patients, monitor the risk of suicide and develop and revise crisis plans.
    Full-text · Article · May 2015 · The Journal of nervous and mental disease
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    • "Large et al. [55] suggest that one of the primary causes for major self-mutilation is the individual's first psychotic break. In cases with schizophrenia, the degree of injury extent can be rather bizarre and potentially very harmful. "
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    ABSTRACT: The treatment of external genitalia trauma is diverse according to the nature of trauma and injured anatomic site. The classification of trauma is important to establish a strategy of treatment; however, to date there has been less effort to make a classification for trauma of external genitalia. The classification of external trauma in male could be established by the nature of injury mechanism or anatomic site: accidental versus self-mutilation injury and penis versus penis plus scrotum or perineum. Accidental injury covers large portion of external genitalia trauma because of high prevalence and severity of this disease. The aim of this study is to summarize the mechanism and treatment of the traumatic injury of penis. This study is the first review describing the issue.
    Full-text · Article · Aug 2014 · BioMed Research International
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    • "Harth et al. noticed that dermatitis artefacta may coexist with psychiatric disorders [7]. It can be interpreted as a re-activation of a childhood injury or trauma such as sexual/physical abuse or neglect and represent a non-verbal “cry for help” [2, 8]. Like in our case, the harmful behavior may be associated with psychotic disorders. "
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    ABSTRACT: Dermatitis artefacta is a disease that occurs as a result of a self-inflicted injury of the skin. The skin lesions are most often located on the areas within easy reach of the patient's dominant hand sparing the middle part of the back. Dermatitis artefacta may coexist with psychiatric disorders and imitate many dermatologic diseases. As most of the patients with self-inflicted dermatoses usually initially deny any psychiatric problems, what delays psychiatric intervention, they are typically first seen by dermatologists. We are reporting a case of a 35-year-old man with a 3-year-long history of schizophrenia who has been treated at a dermatologist's office sequentially with acne, bacterial lesions, suspected tuberculosis. However, the treatment was ineffective. He was diagnosed with dermatitis artefacta after 7 years of disease duration. During this time he was treated with many medicines e.g. isotretinoin, which is contraindicated in psychosis as it worsens the course of disease. After establishing the correct diagnosis and antipsychotic treatment, a significant improvement was obtained in both skin condition and mental state. These are the reasons why we would like to recommend close cooperation between dermatologists and psychiatrists.
    Full-text · Article · Aug 2014 · Postepy Dermatologii I Alergologii
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