1/10. Improvement in severe self-mutilation following limbic leucotomy: a series of 5 consecutive cases.BACKGROUND: The efficacy of neurosurgical intervention for self-mutilation behavior associated with severe, intractable psychiatric disorders remains undetermined. We report the effects of limbic leucotomy in 5 consecutive patients with severe self-mutilation behaviors. METHOD: After unsolicited referrals from their psychiatrists and careful consideration by the massachusetts General Hospital Cingulotomy Assessment Committee (MGH-CAC), 5 patients were treated with limbic leucotomy. Their primary DSM-IV psychiatric diagnoses were either obsessive-compulsive disorder or schizoaffective disorder. Comorbid severe, treatment-refractory self-mutilation was an additional target symptom. Outcome was measured by an independent observer using the Clinical Global Improvement. Current Global Psychiatric-Social Status Rating, and DSM-IV Global Assessment of Functioning scales in addition to telephone interviews with patients, families, their psychiatrists, and treatment teams. The mean postoperative follow-up period was 31.5 months. RESULTS: All measures indicated sustained improvement in 4 of 5 patients. In particular, there was a substantial decrease in self-mutilation behaviors. postoperative complications were transient in nature. and postoperative compared with preoperative neuropsychological assessments revealed no clinically significant deficits. CONCLUSION: In carefully selected patients as described in this report, limbic leucotomy may be an appropriate therapeutic consideration for self-mutilation associated with severe, intractable psychiatric disorders.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Situational determinants of inpatient self-harm.Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff observation aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Congenital insensitivity to pain--review and report of a case with dental implications.pain is a protective mechanism for the body. Absence of pain is a symptom in several disorders, both congenital and acquired. The congenital types are present at birth and affect the number and distribution of types of nerve fibers. At present, 5 types of hereditary sensory and autonomic neuropathies have been identified. The various disorders within this group are classified according to the different patterns of sensory and autonomic dysfunction and peripheral neuropathy and the presence of additional clinical features such as learning disability. However, the field is currently moving away from classification based on clinical presentation toward classification based on underlying genetic abnormality. In the absence of pain, patients are at risk of late presentation with illnesses or injuries, and have an increased incidence of traumatic injury. Self-mutilation is an almost invariable feature of these disorders. We report the case of a patient with congenital insensitivity to pain that presented with self-mutilation injuries to his hands and oral tissues caused by biting. The severe nature of these injuries necessitated serial extraction of his primary teeth soon after eruption, which led to a cessation of the problem. The mutilation has not returned following the eruption of the first of his permanent teeth, suggesting that he has learned not to bite himself, even though to do so causes him no discomfort.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. Acne excoriee--a case report of treatment using habit reversal.Acne excoriee is a self-inflicted skin condition in which the sufferer has an urge to pick real or imagined acnieform lesions and which results in a worsening and spreading of the acne. The condition differs from most artefactual dermatoses as the patient usually spontaneously admits the self-inflicted nature of the condition. Although this condition is considered to be a neurotic manifestation of the patient, traditional psychiatric treatments have proved unsuccessful.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. Non-erotic self-choking in five psychiatric inpatients.Recurrent self-choking without suicidal intent has received limited attention in the literature; most reports have focused on the sexual nature of the behavior. The authors describe five psychiatric inpatients who engaged in repeated non-erotic self-choking. Similarities in clinical features of the cases include a history of substance abuse (including abuse of volatile substances), aggressive behaviors, a chronic history of psychotic symptoms leading to repeated long-term hospitalizations, and a sense of relief or pleasure, but no overt sexual stimulation, caused by self-choking. The possible role of limbic system dysfunction in this behavior is considered.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Multiple autoextractions: oral self-mutilation reviewed.Oral self-mutilation occurs in a variety of clinical settings. The etiology of oral self-mutilation can be divided into organic and functional categories. Organic etiologic factors include metabolic and genetic disorders. Functional self-mutilation is performed knowingly, as a response to certain stimuli, and may or may not serve a cognitive purpose. The occurrence of oral self-mutilation with a functional cause represents a diagnostic challenge to practitioners. In this article, a case of autoextraction of multiple posterior teeth in a psychotic 27-year-old white man is presented. Though a wide range of self-mutilation in a person in a psychotic state is well documented, oral self-mutilation, particularly autoextraction, is rare. Although the case reported is extreme in nature, incidence of oral self-mutilation is not uncommon and should be considered in the differential diagnosis of lesions of unknown cause.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Exfoliative cheilitis--a factitious disorder?Exfoliative cheilitis is an uncommon lip lesion usually of great concern to the patient and quite refractory to treatment. The available literature was surveyed, and 3 cases have been described to illustrate various aspects of the condition. The difficulty of treating such lesions has been discussed, and a proposition put forward that the lesions are of a factitious nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Factitious injury of an extremity: a Munchausen variant.Self-induced injury of one or more of the extremities may represent a distinct variety of munchausen syndrome. The nature of the injury may be infectious, dermatologic or orthopedic. The mechanism may be secondary gain or another unconscious motivation that causes a craving for attention. In many cases, the underlying psychopathology is personality disorder.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. dermatitis artefacta.Self-inflicted dermatoses mainly refer to psychiatric disturbances such as psychoses, mental retardation, and personality disorders. Diagnostic clues are found in the nature and the evolution of the lesions as well as in the ambivalent combination of dependency on doctors and hostility toward them revealed in the patient's medical history. Management of dermatitis artefacta patients means dealing with the complex emotional issue of a basic antagonism in the dermatologist-patient relationship. Both the dermatologist and the dermatologic nursing staff should show an understanding and nonaggressive attitude.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Reduction of eye gouging using a response interruption procedure.A profoundly retarded male with severe congenital impairment of vision and hearing was treated for self-inflicted eye gouging. Prior to intervention, continuous mechanical restraint was required to prevent the response, precluding participation in educational and play activities. The response topography, the nature of the client's deficits, and a preliminary behavioral and medical assessment suggested that the response functioned as a source of sensory self-stimulation. Presentation of toys plus differential reinforcement of other behavior (DRO) as alternate sources of stimulation during baseline had no impact on eye gouging. The introduction of a contingent response interruption procedure reduced eye gouging and decreased the amount of time spent in restraints. Treatment effects were replicated in a group setting, and in the natural environment. parents and school personnel were trained to use the treatment, and eye gouging remained infrequent at a 9-month follow-up.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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