Cases reported "Self Mutilation"

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1/7. Self-castration.

    BACKGROUND: Deliberate genital self-mutilation is rare. Successful self-castration has been reported in a small number of individuals. METHOD: This study reports one such case of self-castration in a transsexual who was dissatisfied with waiting times for sex reassignment surgery (SRS). RESULT AND CONCLUSION: The apparent triggering factor in this case appears to be depression related to the lengthy waiting times for SRS. As neither psychotherapy nor hormonal manipulation is successful, consideration should be given to improving the resources for patients with genuine gender dysmorphism.
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ranking = 1
keywords = psychotherapy
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2/7. Case study: delicate skin cutting: management beyond the skin and implications of superficial habitual self-mutilation.

    A 16-year-old girl accompanied by her mother was noted to have several thin, well healed brown lines on the distal third of her left flexural forearm (Figure). She admits to having recently made these marks by skin cutting. She feels depressed and at times feels life "is not worth living." She denies alcohol or substance abuse or true suicidal ideation, plan, or intent. Her mother describes her as previously well adjusted and a good student who has become erratic and moody in the past 6 months, with worsening school performance. Her father had a history of depression and alcoholism and died 3 years ago. She is undergoing psychotherapy and pharmacotherapy with sertraline with good results. She has not cut her skin in 3 months. Her mood and behavior have improved.
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ranking = 1
keywords = psychotherapy
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3/7. Ocular munchausen syndrome resulting in bilateral blindness.

    PURPOSE: munchausen syndrome is a factitious disorder in which patients knowingly harm themselves for subconscious psychological reasons in order to be hospitalized. Recognition of this psychopathology is important, to prevent potentially severe eye damage. Ocular munchausen syndrome is uncommon. The authors describe an elderly woman with recurrent, probably self-induced, ocular trauma leading to bilateral blindness. The authors are unaware of any previously reported cases of munchausen syndrome resulting in bilateral blindness and occurring in old age. CASE REPORT: A 73-year-old woman was first seen in 1991 with a closed-globe injury to the right eye, apparently following a household fall. physical examination showed no sign of extraocular trauma. Right visual acuity was 20/30 after 2 months. She was readmitted in May 2003 with left globe rupture, allegedly following a domestic fall. No extraocular trauma was found. She developed ocular phthisis 6 months postoperatively. The patient was admitted again in February 2004 with right globe rupture, following another alleged domestic fall. physical examination showed no sign of extraocular trauma. Right visual acuity was 20/400 2 months postoperatively. Psychiatric evaluation revealed munchausen syndrome. psychotherapy was prescribed, but refused by her family. CONCLUSIONS: Diagnosis of munchausen syndrome is difficult to make in the ophthalmic department. Munchausen patients have little or no ability to control their self-destructive behavior. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist with experience in factitious disorders. Even with psychotherapy, which is often refused, the prognosis remains poor.
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ranking = 1
keywords = psychotherapy
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4/7. psychotherapy and neurotic excoriations.

    During the period from 1979 to 1985, 22 patients with the primary forms of neurotic excoriations (NE) accepted referral to the author. Twenty of them completed a psychotherapy program which was eclectic in form and allowed for individual weighting of its single elements. At the follow-up, on average after 5 years, valid evidence was found of a positive effect of goal-directed psychotherapy in NE patients.
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ranking = 2
keywords = psychotherapy
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5/7. Self-inflicted hand injuries: diagnostic challenge and treatment.

    Self-inflicted injuries are probably more common than is generally appreciated. Three patients with self-inflicted hand injuries are described. A delay in making the correct diagnosis resulted in severe hand disability in 2 of the patients. early diagnosis of this entity, combined with prompt psychotherapy, prevented disability in the third. The pertinent literature is reviewed and the importance of early diagnosis and psychotherapy is stressed.
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ranking = 2
keywords = psychotherapy
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6/7. Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment.

    A case report of a patient with a recurrent factitial vesicocutaneous and a tensor fasciae latae musculocutaneous flap were employed in reconstruction. Difficulty in diagnosis and treatment of this patient with factitial disease is emphasized. Excessive hospitalization and cost reflect these difficulties. A life-threatening disease was modified by planned reconstruction coordinated with antidepressant medication and psychotherapy. Treatment centered on avoiding insight and maintaining denial ASA defense mechanism. The transference of self-mutilation in the suprapubic region to the donor thigh was most important in this patient's survival.
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ranking = 1
keywords = psychotherapy
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7/7. Self-mutilation accompanying religious delusions: a case report and review.

    A case is described of a man who castrated himself while depressed over deviated sexual urges, with eventual favorable response to psychiatric hospitalization and psychotherapy. The literature on self-mutilation is then reviewed, comparing 26 cases of enucleation of eyes, cutting off a hand, mutilating genitals (by males) and cutting out the tongue. Recommendations for treatment and study are attention to previous history or evidence of self-injury, preoccupation with Biblical passages regarding self-injury, preceding drug abuse and early loss of the father in males. Rapid tranquilization and intensive psychotherapy are advised following hospitalization.
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ranking = 2
keywords = psychotherapy
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