1/9. Ocular Munchausen's syndrome.patients with contrived histories and/or self-induced physical abnormalities (Munchausen's syndrome) are often successful in deceiving physicians. We recently cared for four patients with ocular Munchausen's syndrome. Self-induced ocular manifestations included voluntary nystagmus, subconjunctival hemorrhages, chronic orbital emphysema requiring exenteration, corneal alkali burns, erosions and ulcerations, and abscesses of the periorbital area. Correct diagnoses of ocular Munchausen's syndrome were made only after extensive medical and surgical investigations. Suggestions for evaluation and treatment will also be discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Genital and abdominal self-surgery. A case report.In two separate procedures, a psychiatric patient first performed a bilateral orchiectomy on himself and then later attempted to denervate his adrenal glands. This case suggests that physicians should be alerted to the possibility of self-surgery occurring in patients who have sought elective surgery and have been rejected.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. The role of the psychiatrist in otolaryngology.The patient, staff, and physician benefit when the otolaryngologist and psychiatrist are able to work closely together. Not only is clinical care improved, but time can be spent more efficiently in dealing directly with the patient's problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Factitial synovitis.This unusual case of trauma depicts a 17-year-old female who had a history of chronic synovitis of her left knee for several months. The patient demonstrated persistent knee effusion despite treatment of several physicians. Failure of the left knee to respond to several surgical procedures, as well as the finding of numerous foreign bodies not present previously, evoked a high index of suspicion leading to the diagnosis of factitial synovitis. The paper further defines the entity, describes the personalities involved and the numerous methods used to inflict trauma. Lastly, the treatment regime is given.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. vomiting as a manifestation of borderline personality disorder in primary care.BACKGROUND: patients with borderline personality disorder often are found and treated in psychiatric settings following episodes of self-mutilation, such as wrist-slashing. family physicians care for many patients with borderline personality disorder, but in primary care settings wrist-slashing or other physical mutilation is a less common presenting problem. Frequently these patients complain of such symptoms as nausea and vomiting that do not so obviously suggest psychopathology. methods: Three primary care patients with borderline personality disorder in whom episodic vomiting was the chief complaint are presented. Hypotheses from the literature about the neurobiology of vomiting and self-mutilation are discussed. RESULTS: vomiting is a primary care analogue of self-mutilation in some patients with borderline personality disorder. CONCLUSIONS: family physicians should include careful history taking to corroborate other features of borderline personality disorder in evaluating patients with persistent, episodic vomiting. Obtaining a history of early sexual abuse or chronic interpersonal problems as an adult should not only mitigate the compulsion for extensive, costly, and invasive gastrointestinal system evaluations in such patients, but also suggest more effective treatment strategies.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/9. Recognition of factitial hand injuries.Facitial injuries with various presentations occur with some frequency to the hand because it is a body part that is easily accessible. methods used to produce wounds included insertion of porcupine quills, application of constrictive rubber bands, mascara injections and excoriation of healing wounds. It is important to recognize the factitial origin in order to avoid needless repetitive surgery and permanent hand disability. No specific pattern of psychopathology was found in our cases. The patients' attitude toward their lesions was one of bland unconcern and stoicism. The patients were resistant to psychiatric referral and persisted in seeking medical responsibility for cure. Successful management requires early suspicion and prompt recognition as well as establishment of non-accusatory relationship with the primary physician. Confrontation should be avoided if possible. Even if reinforced with collaborative evidence, such confrontation will have limited effect on the patient's subsequent behavior.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Self-inflicted injuries. Challenging knowledge, skill, and compassion.PROBLEM BEING ADDRESSED: Self-inflicted injuries and other serious self-destructive behaviours are common and difficult to recognize, prevent, and manage. Although they have previously been understood as repeated, failed attempts at suicide, they are better understood as maladaptive coping strategies. OBJECTIVE OF PROGRAM: women who present repeatedly with self-inflicted injuries need help to control this self-destructive behaviour and substitute more positive coping strategies. physicians also need help in working with patients who respond to problems in this way. MAIN COMPONENTS OF PROGRAM: The program is made up of two broad sections. The first section involves understanding the problem and its origins in post-traumatic stress disorders. The second section offers a practical approach to helping patients presenting with injuries inflict upon themselves. CONCLUSIONS: A deeper understanding of the etiology and management of repeated self-inflicted injuries will enable physicians to help patients with this difficult problem while minimizing their own anxiety and frustration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. 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).- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/9. burns in a suicide attempt related to psychiatric side effects of interferon.A 50-year-old woman was admitted to our critical care center after pouring lamp oil on herself and setting herself on fire. Diagnosed with chronic hepatitis, she had received interferon-alpha at another hospital. During interferon therapy she developed anxiety, irritability, sleeplessness, and depression. At our hospital she underwent fluid resuscitation according to the method of Baxter. After treatment with topical cream and ointment, she underwent skin grafting. Interferon was not given. After discharge, wound healing proved satisfactory. She was intelligent and insightful, and her mental condition remained stable with no apparent emotional problems. As she had no significant past medical or psychiatric history and no history of substance abuse, we believe that her depression was a side effect of interferon therapy. A number of reports have described depression and other psychiatric disorders associated with interferon, but none of these accounts have concerned burns sustained in suicide attempts. This case underscores the potential seriousness of adverse reactions to interferon characterized by emotional disturbance and also illustrates that physicians who treat burn patients need to have an understanding of affective disorders and unusual side effects of medication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |