1/62. A syndrome of psychosis following discontinuation of an estrogen-progestogen contraceptive and improvement following replacement: A case report.Mild forms of psychosis associated with low estrogen levels during the perimenopause are relatively frequent. There is scarce data on severe forms of psychosis in these conditions. We report the case of a 51-year-old woman with no previous psychiatric history who amputated her hand in a 'psychotiform' state after discontinuation of her contraceptive medication. Having subsequently jumped out of a window, she suffered a fracture of the dens with central spinal cord injury and symptoms of cruciate paralysis. The patient stabilized under a combined therapy with estrogen-progestogen substitution, antipsychotic medication and add-on oxcarbazepine.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
2/62. Treatment of self-mutilation with olanzapine.BACKGROUND: Self-mutilation or dermatitis artefacta is a facet of a much broader spectrum of factitial disease. Three nonpsychotic patients with self-mutilation are presented in this article who were successfully treated with low dose olanzapine when all other modalities of therapy had failed, including trials with numerous antidepressants and antipsychotics. OBJECTIVE: The patients were simultaneously evaluated and treated by a dermatologist and a psychiatrist who run the psychodermatology or consultation-liaison clinic based at McMaster University. After dermatologic conditions had been excluded as a cause of the clinical findings, olanzapine was prescribed on a trial basis due to its low risk of parkinsonian side-effects and its antihistaminic properties. CONCLUSIONS: The excellent clinical response of the patients can be attributed to the low side-effect profile of the drug but also to the anti-impulsive effect which stems not only from antihistaminic properties but also from its antidopamine and serotonin-blocking action.- - - - - - - - - - ranking = 2keywords = psychotic (Clic here for more details about this article) |
3/62. A unique case of secondary microvascular glansplasty: the last genitoreconstructive frontier?Isolated amputation of the noncarcinogenic penile glans is an extremely rare event. Immediate replantation as a composite graft or by microvascular techniques is the treatment of choice. Secondary reconstruction of the penile glans may be indicated after necrosis as a sequela of infection, surgical resection for malignancy, traumatic loss, and self-mutilation. To date, reported surgical techniques of glanular reconstruction have only been described as part of total phalloplasty. Secondary reconstruction of the penile glans using a sensate radial forearm free flap was performed in a 28-year-old man who presented 3 years after self-amputation in a psychotic state.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
4/62. Autohemicastration in a man without schizophrenia.A 52-year-old unmarried bag craftsman was admitted to East tokyo Metropolitan Hospital because of a large scrotal hematoma. He had accidentally hit his right testis against the edge of a desk early the previous morning. He had resected his right testis with scissors to release from severe pain 30 min after the accident. He had sutured the scrotal incision with two stitches of string by himself. At the emergency operation 36 h after the self-mutilation, we removed a hematoma weighing 283 g and ligated the cut end of the right spermatic cord after adequate debridement. He was diagnosed by a psychiatrist as having slightly low intelligence without psychotic disorder or drug abuse.- - - - - - - - - - ranking = 2.5200018262475keywords = psychotic, schizophrenia (Clic here for more details about this article) |
5/62. Autocastration as a presenting sign of incipient schizophrenia.Previous case reports on autocastration have identified individuals who engaged in genital self-mutilation as being overtly psychotic, as having previously received a diagnosis of schizophrenia, or as having significant dysfunction of ego integrity, manifesting as guilt and low self-esteem. This paper describes a patient who had had no previous psychiatric symptoms or mental health treatment and for whom the act of autocastration was the first sign of incipient schizophrenia.- - - - - - - - - - ranking = 3.2800027393712keywords = psychotic, schizophrenia (Clic here for more details about this article) |
6/62. Mutilation of self and object: the destructive world of the paranoid-schizoid patient and the struggle for containment and integration.Using case material, I have described the three overlapping phases of treatment that occur with some borderline, narcissistic, or psychotic patients. These patients are dealing with paranoid-schizoid experiences of the self and the object. In this part-self, part-object world, many shifting, opposing, and contrary states of feeling and thought occur. acting out is the first phase of analytic treatment. This is an externalization of persecutory anxiety, primitive guilt, and phantasies of annihilation. Projective identification, splitting, and denial are common and tend to make for difficult transference and countertransference problems. During the middle phase of treatment, pathological superego states and manifestations of death instinct color the analysis. The death instinct reacts defensively to the sadistic superego. Technically, the destructive internal conflicts created by these two elements must be clarified and interpreted in the transference. Flexible analytic management and containment are crucial supplements to ongoing interpretation. If these chaotic patients are able to stay in treatment for a period time, the acting out and the superego/death instinct phase gradually give way to phantasies of loss. This is still a paranoid-schinoid perspective of loss, making it persecutory experience. Although depressive anxieties do enter the picture, these still involve pathological anddestructive states of guilt and all-or-nothing threats of abandonment and attack. A case was presented in which the patient managed to continue into the third stage of analytic treatment, long enough to benefit frominternal, structure change. In this final stage, the patient "O" was able to acknowledge, work through, and integrate her prior feelings and phantasies of loss, persecution, and abandonment anxiety into more manageable and reality-based depressive functioning.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
7/62. Self-enucleation and psychosis. Report of two cases and discussion.We report two cases of self-enucleation and the case histories of the two schizophrenic men who carried out this drastic form of self-mutilation. In a review of the literature and consideration of the case material, it is concluded that castration fears, failure to resolve oedipal conflicts, repressed homosexual impulses, severe guilt, and self-punishment are ubiquitous phenomena in such cases. However, we conclude that psychosis, most probably schizophrenia, with a severe disturbance in body image, are necessary variables in the act of self-enucleation.- - - - - - - - - - ranking = 0.38000045656187keywords = schizophrenia (Clic here for more details about this article) |
8/62. Self-inflicted mutilation of the dentition in a schizophrenic patient.A case is presented in which a patient performed mechanical self-mutilation of her dentition during an episode of psychotic illness. The management of this case is described and discussed.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
9/62. Unusual self-inflicted penetrating craniocerebral injury by a nail.Penetrating injuries of the brain caused by a nail are rare. An interesting case of a patient with schizophrenia who attempted suicide by a self-inflicted penetrating intracranial injury using a nail is reported here. The literature related to this unusual case is reviewed.- - - - - - - - - - ranking = 0.38000045656187keywords = schizophrenia (Clic here for more details about this article) |
10/62. An American hijra: a report of a case of genital self-mutilation to become india's "third sex".We report a case of male genital self-mutilation related to the subject's desire to become a "hijra," the "third sex" described in East Indian mythology. The patient is the first American hijra of which we are aware. He emasculated himself, performed a penectomy, and created a perineal urethrostomy. This report adds another potential cause for genital mutilation of which the urologist should be aware, along with accidents, gender dysphoria, psychotic self-injurious behavior, and assault.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
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