Evaluation and management of self-mutilation

Two cases of male genital self-mutilation

Male genital self-mutilation (GSM) is a rare but serious phenomenon. Some of the risk factors for this act are the presence of religious delusions, command hallucinations, low self-esteem, and feelings of guilt associated with sexual offences. Other risk factors include failures in the male role, problems in the early developmental period, such as experiencing difficulties in male identification and persistence of incestuous desires, depression, and having a history of GSM. The eponym Klingsor Syndrome, which involves the presence of religious delusions, is proposed for GSM. Psychiatric case reports of male GSM in the literature are rare and mostly anecdotal.

Genital self mutilation in alcohol withdrawal state complicated with delirium

Genital self mutilation is a rare and a severe form of self-injurious behavior usually described in psychotic disorders, with delusions and hallucinations. It has been ascribed to sexual conflicts, Body image distortions, Internalized aggression, and suicidal intent. This phenomenon has been described in schizophrenia, affective psychosis, alcohol intoxication, and personality disorders. The present case genital self mutilation in a case of alcohol withdrawal state complicated by delirium is reported.

Penile self-mutilation as an unusual sign of a separation-related problem in a crossbreed dog

A two-year-old, male, crossbreed dog was presented for evaluation of licking, biting and severe self-mutilation of its penis, which resulted in ulcers and haemorrhagic preputial discharge. History revealed signs of separation anxiety such as active greeting behaviour, excessive vocalisation and intermittent episodes of licking of the penis when the dog was left alone. The owner reported that he had been hospitalised after a car accident, and he had no chance of seeing the dog. During that time, the behaviour progressed to frequent episodes of licking and biting of the penis. Three weeks of treatment with clomipramine in addition to the presence of the dog's brother, who was brought into the dog's living environment, appeared to produce a considerable degree of improvement. The purpose of this report is to contribute to an increased awareness within veterinary practice of unusual signs of separation anxiety such as penile self-mutilation.

Clinical experience with the management of schizophrenia in the general hospital

On the basis of experience with 74 psychiatric consultations involving patients with schizophrenia admitted to a general hospital medical or surgical ward over a 17-month period (3% of the psychiatric consultations during that period), the authors identified 10 types of problems leading to requests for consultation. The authors used these categories to organize recommendations for management of patients with schizophrenia in the general medical hospital. In addition to conducting conventional consultations, the consultation psychiatrist in such cases often has a role in educating hospital staff about schizophrenia and in serving as a physician for the mentally ill.

Self-inflicted enucleation of both eyes

Categories of self-injurious behaviour are briefly reviewed. Serious and bizarre self injurious behaviour is usually psychotic in origin. The literature concerning self-inflicted enucleation of the eyes is reviewed and two additional patients, both with a diagnosis of schizophrenia, are reported. The lack of pain and the lack of concern shown by the patients and their management are discussed.

Self-mutilation: three cases and a review of the literature

The self-mutilating patient is an unusual psychiatric presentation in the emergency department (ED). Nonetheless, serious underlying psychiatric pathology and drug abuse are important background risk factors. A careful stepwise approach in the ED is essential, although the prognosis, follow-up, and eventual rehabilitation are poor.

Octopus automutilation syndrome

This paper describes an automutilation syndrome (OAS) in three species of captive octopuses, Octopus dolfleini, O. bimaculoides, and O. maya, characterized by external arm and mantle lesions. Three clinical patterns in nine animals had similar and characteristic gross and histopathologic features. Axial nerve or brachial artery lesions were observed in six of the nine cases and vascular lesions were seen in two of eight cases with mantle ulcerations. A relationship between automutilation in the octopus and dysesthesias due to neural or vascular pathology is proposed.