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LeBlanc MA, Hudec MA, Weise L. A case report of an atypical severe case of skin picking disorder managed by a multidisciplinary team. BMC Psychiatry 2024; 24:238. [PMID: 38549048 PMCID: PMC10979611 DOI: 10.1186/s12888-024-05712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/25/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND While skin picking disorder remains relatively common, it often does not present to psychiatry until significant morbidity or comorbidities are reached. It is described as recurrent picking of skin leading to skin lesions, with repeated attempts to decrease or stop skin picking. It is also often associated with significant distress or functional impairment. There has been limited research in this specific disorder and treatment efficacy has often been poor in severe cases. For various reasons, only a small amount of patients with this disorder present to care, and often to a multidisciplinary team prior to psychiatry. CASE PRESENTATION This is a case presentation of a 44 year old male with a complex past psychiatric history, ultimately untreated for an underlying skin picking disorder. He presented for urgent medical care following a self-inflicted wound through the central frontal bone and dura over the course of 2 years. He was treated with current psychiatric evidence based medicine, including an SSRI, antipsychotic augmentation and NAC, along with habit reversal techniques during the admission. He was concurrently managed with the neurosurgery team, initially with a poor prognosis due to the severity of his presentation. He required debriding of the devitalized bone within the adjacent brain to cover the dural defect, IV antibiotics for 6 weeks, and an initial skin graft on his initial admission. CONCLUSIONS This case in particular highlighted the importance of urgent treatment via a multidisciplinary approach to avoid mortality. It highlights the importance of increasing awareness about the disorder and that treatment with SSRI's, along with antipsychotic and NAC adjuncts remains the mainstay of acute treatment.
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Affiliation(s)
- Marissa A LeBlanc
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 6509-5909 Veteran's Memorial Lane, Halifax, NS, B3H 2E2, Canada.
- Nova Scotia Health, Halifax, NS, Canada.
| | - Mary-Ann Hudec
- Department of Psychiatry, Dalhousie University, Abbie J. Lane Building, 6509-5909 Veteran's Memorial Lane, Halifax, NS, B3H 2E2, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | - Lutz Weise
- Nova Scotia Health, Halifax, NS, Canada
- Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada
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2
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Galeotti A, Aristei F, Putrino A, Vallese S, Figà-Talamanca L, Vallogini G, Garret-Bernardin AM, Festa P, Magliarditi F, Caputo M. Oral self-inflicted accidental trauma in patients with neurological disorders: a case report of dental management in infants with cerebellar hypoplasia. J Clin Pediatr Dent 2024; 48:196-203. [PMID: 38548650 DOI: 10.22514/jocpd.2024.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/10/2023] [Indexed: 04/02/2024] Open
Abstract
Self-inflicted oral injuries, accidental or otherwise, can cause major consequences. Measures need to be taken to protect individuals from chronic self-injurious behaviour; however, there are no official guidelines on the subject. The purpose of this article is to show the case of a 1-year-old patient with neurological disorders who, following the eruption of deciduous teeth, had self-inflicted a traumatic ulcer on his tongue and lower lip. Following a multidisciplinary approach involving several operating units of our hospital to make a diagnosis, an oral device was designed to completely cover the dental elements to prevent recurrence of the trauma and to prevent further worsening of the injuries already caused. The purpose of this work is to demonstrate that although the surgical approach, such as extraction of the dental elements, may be the quickest solution in situations similar to the one presented, the high biological cost and irreversibility of the result lead to seeking alternatives and more conservative solutions such as the one described.
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Affiliation(s)
| | | | - Alessandra Putrino
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Silvia Vallese
- Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | | | | | | | - Paola Festa
- Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | | | - Martina Caputo
- Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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3
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Moore TR, Lee S, Freeman R, Mahmoundi M, Dimian A, Riegelman A, Simacek JJ. A Meta-Analysis of Treatment for Self-Injurious Behavior in Children and Adolescents With Intellectual and Developmental Disabilities. Behav Modif 2024; 48:216-256. [PMID: 38197303 DOI: 10.1177/01454455231218742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Self-injurious behavior (SIB) among children and youth with developmental disabilities has not diminished in prevalence despite the availability of effective interventions, and the impact on quality of life for people and their families is devastating. The current meta-analysis reviews SIB intervention research between 2011 and 2021 using single-case experimental designs with children and youth up to 21 years old and provides a quantitative synthesis of data from high-quality studies including moderator analyses to determine effects of participant and study characteristics on intervention outcomes. Encouraging findings include a high level of effectiveness across studies in the decrease of SIB (Tau-U = -0.90) and increase of positive behavior (Tau-U = 0.73), as well as an increase in studies (relative to prior reviews) reporting intervention fidelity, generalization, maintenance, and social validity. However, our findings shed limited light on potential moderating variables in the development of interventions for children and youth who exhibit SIB. Of the potential moderators of intervention effects, only implementer (researcher/therapist vs. parent/caregiver) and setting (clinic vs. home) were significantly associated with improved outcomes. We discuss the need for more robust involvement of natural communities of implementers in SIB intervention research to better equip them to effectively and sustainably meet the needs of people they care for. We also discuss the importance of creating systems enabling broad access for children with SIB to effective interventions in service of reducing burden for people, families, and society over time.
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Affiliation(s)
- Timothy R Moore
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Seunghee Lee
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Rachel Freeman
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Maryam Mahmoundi
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Adele Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
| | - Amy Riegelman
- Social Sciences Libraries, University of Minnesota, Minneapolis, USA
| | - Jessica J Simacek
- Institute on Community Integration, University of Minnesota, Minneapolis, USA
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4
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Pasa Morgan MA, Muzzolon M, Abagge KT, Carvalho VO. The Challenge of a Strange Rash: Dermatitis Artefacta. J Pediatr 2024; 266:113881. [PMID: 38135029 DOI: 10.1016/j.jpeds.2023.113881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Mariana A Pasa Morgan
- Pediatric Dermatology Division, Department of Pediatrics, Federal University of Paraná, UFPR, Curitiba, Brazil; Postgraduate Program in Child and Adolescent Health, Complexo Hospital de Clínicas of the Federal University of Paraná, UFPR, Curitiba, Brazil
| | - Mariana Muzzolon
- Postgraduate Program in Child and Adolescent Health, Complexo Hospital de Clínicas of the Federal University of Paraná, UFPR, Curitiba, Brazil
| | - Kerstin T Abagge
- Pediatric Dermatology Division, Department of Pediatrics, Federal University of Paraná, UFPR, Curitiba, Brazil
| | - Vânia O Carvalho
- Pediatric Dermatology Division, Department of Pediatrics, Federal University of Paraná, UFPR, Curitiba, Brazil
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5
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Riva A, Bizzi F, Borgatti R, Mensi M, Charpentier Mora S, Di Guardo S, Nacinovich R. Family functioning of adolescents with restrictive eating disorders with or without nonsuicidal self-injury. Clin Psychol Psychother 2024; 31:e2955. [PMID: 38356195 DOI: 10.1002/cpp.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
Family influence is a crucial factor in the onset and maintenance of eating disorders. Nonsuicidal self-injury (NSSI) and restrictive eating disorders (REDs) co-occur in a significant percentage of subjects but family functioning of these families remains underexplored. This study examines the family functioning perceptions of 80 families with adolescents experiencing RED, comparing those with and without NSSI, alongside a control group, utilising the FACES-IV assessment. The study also aims to compare the triadic (adolescent-mother-father) perception of family functioning in the three groups. The results reveal distinct family dynamics in adolescents with both RED and NSSI, marked by problematic functioning perceptions from all family members and low parental agreement. A further understanding of the family functioning of adolescents with RED with NSSI can help clinicians in defining the treatment setting.
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Affiliation(s)
- Anna Riva
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina Mensi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
| | | | - Simona Di Guardo
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Renata Nacinovich
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Díaz-Marsa M, Gálvez-Merlín A, Guillen AI, de la Torre-Luque A, López-Villatoro JM, Beato-Fernández L, Polo-Montes F, León-Velasco M, Gómez-del Barrio A, Santos-Carrasco I, Carrasco-Díaz Á, Carrasco JL. Transdiagnostic Study of Impulsivity and Self-Injurious Behaviour in Unstable and Impulsive Disorders. Actas Esp Psiquiatr 2023; 51:120-128. [PMID: 37489556 PMCID: PMC10803848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 07/26/2023]
Abstract
High comorbidity between borderline personality disorder (BPD) and eating disorders (ED) shows the necessity of developing transdiagnostic models, where impulsivity could play a relevant role in the manifestations of self-injurious behaviour.
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Affiliation(s)
- Marina Díaz-Marsa
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Alejandra Gálvez-Merlín
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana I. Guillen
- Departamento de Personalidad, Evaluación y Psicología Clínica, Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro de la Torre-Luque
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - José M. López-Villatoro
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Andrés Gómez-del Barrio
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Unidad de Trastornos de la Conducta Alimentaria, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Investigación Valdecilla (IDIVAL) Santander, Spain
| | - Isabel Santos-Carrasco
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Hospital Universitario Infanta Cristina, Madrid, Spain
| | | | - José L. Carrasco
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Walker TD, Nusbaum KB, Gilkey TW, Trinidad JC, Kaffenberger BH. Factitial dermatitis in the hospital setting. Arch Dermatol Res 2023; 315:617-620. [PMID: 35076761 DOI: 10.1007/s00403-022-02322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/23/2021] [Accepted: 01/05/2022] [Indexed: 11/02/2022]
Abstract
Factitial Dermatitis (FD) is a notoriously difficult disease to diagnose, as patients produce self-induced cutaneous lesions and provide an inadequate or inaccurate history. We performed a cross-sectional study, querying an inpatient consultation database of all patients admitted to the Ohio State University Wexner Medical Center from 2012 to 2017 with a dermatologic ICD as a discharge diagnosis. Our exhaustive keyword search produced 189 candidates. Consult notes were thoroughly examined, and 32 patients were found to meet case definition of FD. Our analysis of this cohort revealed a significantly greater proportion of cases in the female population. Lesions were more often found to involve the skin on the upper extremities. Isolated secondary skin changes such as erosions, ulcers and excoriations in the absence primary morphologies were also significant in our cohort. As FD is difficult to identify, further understanding of its presentation pattern will decrease time to diagnosis and improve both hospital resource allocation and patient care.
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Affiliation(s)
- Trent D Walker
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kelsey B Nusbaum
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ty W Gilkey
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John Christopher Trinidad
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, 1328 Dublin Road, Suite 100, Columbus, OH, 43212, USA.
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8
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Northrup JB, Goodwin MS, Peura CB, Chen Q, Taylor BJ, Siegel MS, Mazefsky CA. Mapping the time course of overt emotion dysregulation, self-injurious behavior, and aggression in psychiatrically hospitalized autistic youth: A naturalistic study. Autism Res 2022; 15:1855-1867. [PMID: 35751466 PMCID: PMC9560956 DOI: 10.1002/aur.2773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/06/2022] [Indexed: 12/28/2022]
Abstract
Challenges with emotion dysregulation, self-injurious behavior (SIB), and aggression are common in autistic individuals. Prior research on the relationships between these behaviors is limited mainly to cross-sectional correlations of parent-report data. Understanding how emotion dysregulation, SIB, and aggression present and relate to one another in real-time could add to our understanding of the context and function of these behaviors. The present study examined the real-time occurrence and temporal relationships between these behaviors in 53 psychiatrically hospitalized autistic youth. Over 500 hours of behavioral observation occurred during everyday activities in the hospital. Start and stop times for instances of overt emotion dysregulation, SIB, and aggression were coded live using a custom mobile phone app. Results indicated large individual variability in the frequency and duration of these behaviors and their co-occurrence. Both SIB and aggression co-occurred with overt emotion dysregulation at above-chance levels, suggesting a role for emotional distress in the occurrence of these behaviors. However, there was substantial variability within and between individuals in co-occurrence, and SIB and aggression often (and for some individuals, almost always) occurred without overt emotion dysregulation. Relatedly, cross-recurrence quantitative analysis revealed that SIB and aggression preceded emotion dysregulation more often than emotion dysregulation preceded SIB and aggression. Future research, perhaps using ambulatory psychophysiological measures, is needed to understand whether emotion dysregulation may sometimes be present but not easily observed during SIB and aggression. LAY SUMMARY: This study provides insight into how overt emotion dysregulation (i.e., visible distress), aggression, and self-injury unfold in real-time for autistic individuals. Participants were 53 autistic youth staying in a psychiatric hospital. Research staff observed participants in everyday activities on the hospital unit and noted instances of aggression, self-injurious behavior, and emotion dysregulation. Results suggest that aggression and self-injury sometimes occur with visible signs of distress but also often occur without visible distress. In addition, observable distress was more common in the moments after these behaviors than in the moments before.
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Affiliation(s)
- Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew S Goodwin
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Christine B Peura
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Qi Chen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Briana J Taylor
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Matthew S Siegel
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Burke TA, Hamilton JL, Seigel D, Kautz M, Liu RT, Alloy LB, Barker DH. Sleep irregularity and nonsuicidal self-injurious urges and behaviors. Sleep 2022; 45:zsac084. [PMID: 35397476 PMCID: PMC9189944 DOI: 10.1093/sleep/zsac084] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/05/2022] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVES The objectives of this study were to examine the relationships between sleep regularity and nonsuicidal self-injury (NSSI), including lifetime NSSI history and daily NSSI urges. METHODS Undergraduate students (N = 119; 18-26 years), approximately half of whom endorsed a lifetime history of repetitive NSSI, completed a 10-day actigraphy and ecological momentary assessment (EMA) protocol. A Sleep Regularity Index was calculated for all participants using scored epoch by epoch data to capture rapid changes in sleep schedules. Participants responded to EMA prompts assessing NSSI urge severity and negative affect three times daily over the 10-day assessment period. RESULTS Results indicate that individuals with a repetitive NSSI history were more likely to experience sleep irregularity than those without a history of NSSI. Findings also suggest that sleep irregularity was associated with more intense urges to engage in NSSI on a daily basis, even after accounting for average daily sleep duration, sleep timing, negative affect, and NSSI history. Neither sleep duration nor sleep timing was associated with NSSI history nor daily NSSI urge intensity. CONCLUSIONS Findings suggest that sleep irregularity is linked with NSSI, including NSSI history and intensity of urges to engage in NSSI. The present study not only supports the growing evidence linking sleep disturbance with the risk for self-injury but also demonstrates this relationship using actigraphy and real-time assessments of NSSI urge severity. Findings highlight the importance of delineating the nuances in sleep irregularity that are proximally associated with NSSI risk and identifying targets for intervention.
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Affiliation(s)
- Taylor A Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - David Seigel
- Graduate School of Applied and Professional Psychology, Rutgers University
Piscataway, NJ, USA
| | - Marin Kautz
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lauren B Alloy
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - David H Barker
- Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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Mürner-Lavanchy I, Koenig J, Reichl C, Brunner R, Kaess M. Altered Resting-State Networks in Adolescent Non-Suicidal Self-Injury - A Graph Theory Analysis. Soc Cogn Affect Neurosci 2022; 17:819-827. [PMID: 35086140 PMCID: PMC9433841 DOI: 10.1093/scan/nsac007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 11/21/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
Non-suicidal self-injury (NSSI) is a highly prevalent transdiagnostic symptom and risk marker for mental health problems among adolescents. Research on the neurobiological mechanisms underlying NSSI is needed to clarify the neural correlates associated with the behavior. We examined resting-state functional connectivity in n = 33 female adolescents aged 12–17 years engaging in NSSI, and in n = 29 age-matched healthy controls using graph theory. Mixed linear models were evaluated with the Bayes Factor to determine group differences on global and regional network measures and associations between network measures and clinical characteristics in patients. Adolescents engaging in NSSI demonstrated longer average characteristic path lengths and a smaller number of weighted hubs globally. Regional measures indicated lower efficiency and worse integration in (orbito)frontal regions and higher weighted coreness in the pericalcarine gyrus. In patients, higher orbitofrontal weighted local efficiency was associated with NSSI during the past month while lower pericalcarine nodal efficiency was associated with suicidal thoughts in the past year. Higher right but lower left pericalcarine weighted hubness was associated with more suicide attempts during the past year. Using a graph-based technique to identify functional connectivity networks, this study adds to the growing understanding of the neurobiology of NSSI.
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Affiliation(s)
- Ines Mürner-Lavanchy
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 60 3000, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 60 3000, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg 69115, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne 50931, Germany
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 60 3000, Switzerland
| | - Romuald Brunner
- Clinic and Policlinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg 93053, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern 60 3000, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg 69115, Germany
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Abstract
A woman in her 30s with underlying Graves' disease, who recently completed radioactive iodine treatment, presented with 2 weeks of acutely altered behaviour associated with auditory hallucinations and religious preoccupations. Laboratory investigation demonstrated elevated free thyroxine levels and suppressed thyroid-stimulating hormone levels. Additionally, there was a presence of antithyroid peroxidase antibodies consistent with autoimmune thyroid disease. She responded to antipsychotics and achieved biochemical euthyroidism. Subsequently, antipsychotic was tapered off during outpatient follow-up at the patient's own request, with supplement thyroxine continuing. After 1 week, acute hallucinations and religious preoccupations re-emerged, driving her to inflict self-injuries by swallowing coins and nails and banging her head against the wall, sustaining laceration wounds. Furthermore, she hammered a roofing nail into the external genitalia, embedded in the symphysis pubis. After supplemental thyroxine was stopped and olanzapine was started, she achieved biochemical euthyroid followed by remission of psychosis within 1 week. This case illustrates the importance of elucidating organic causes of psychosis as they are easily and swiftly reversible.
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Affiliation(s)
- Haw Huo Wong
- Department of Psychological Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nicholas Tze Ping Pang
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
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12
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Redinger S, Pearson RM, Houle B, Norris SA, Rochat TJ. Thoughts of self-harm in early and late pregnancy in urban South Africa: Investigating prevalence, predictors and screening options. S Afr Med J 2021; 111:627-634. [PMID: 34382545 DOI: 10.7196/samj.2021.v111i7.15058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Thoughts of self-harm (TSH) are an important marker of mental health risk, and risk for attempted and completed suicide. While there is increasing attention being paid to mental health problems in pregnancy in South Africa (SA), TSH have received less attention despite some cross-sectional studies suggesting that prevalence may be high (12 - 39%). There is a dearth of longitudinal research to inform prevention and treatment. OBJECTIVES To examine the rates of TSH across pregnancy in a longitudinal SA cohort and to investigate factors associated with the onset and persistence of TSH, as well as the relationship between TSH, depression and/or anxiety. METHODS Women were enrolled in a prospective pregnancy cohort (S1000) in Soweto, SA between 2014 and 2016, and assessed using validated screening measures (Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Index short form) in early and later pregnancy. Data were available for 649 women. TSH were determined using EPDS item 10. Logistic regression and bifactor models were used to determine factors associated with TSH across pregnancy. RESULTS Of the 649 women, 18% reported TSH at some stage during their pregnancy. Prevalence of TSH was slightly higher in early pregnancy (12.5%) than later in pregnancy (11.6%). TSH were associated with a history of mental illness (adjusted odds ratio (aOR) 4.17; 95% confidence interval (CI) 1.3 - 13.7; p=0.020), concurrent depression (aOR 4.8; 95%CI 2.7 - 8.6; p<0.001); marital stress (aOR 1.74; 95% CI 1.0 - 3.0; p=0.040); and practical support (aOR 0.43; 95% CI 0.2 - 1.0; p=0.040) using a multivariate logistic regression. Bifactor analysis examining depression and anxiety scales showed that TSH contributed the highest variance to a shared depression and anxiety factor in early pregnancy. Logistic regressions showed that early depression was a strong predictor of later reports of TSH. CONCLUSIONS The present study shows that the risk of TSH during pregnancy is relatively common, and starts early during pregnancy. Screening approaches could be simplified to encourage healthcare practitioners working in busy and over-burdened public healthcare settings to engage in identifying at-risk women. Efforts in improving early identification of mental health risk in pregnancy should be matched with strengthening of current treatment and referral options. Since practical support and a good marital relationship reduce the risk of TSH, these may be important avenues of focus for designing interventions.
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Affiliation(s)
- S Redinger
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Koller CR, Wang S, Sandoval V, Yousif A, Hsieh TC, Raheem OA. Self-Induced Trauma to the Genitalia: a Review of the Literature and Management Schemes. Curr Urol Rep 2021; 22:18. [PMID: 33534050 DOI: 10.1007/s11934-021-01034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Self-induced genital trauma is rare, and prompt and evidence-based early intervention can improve the urinary and sexual function of these complex patients. This review has surveyed current literature and treatment trends to evaluate the clinical approach to managing genital trauma. RECENT FINDINGS A literature review was performed regarding self-induced genitalia trauma and trauma management between 2000 and 2019 using MEDLINE® database, the Cochrane Library® Central Search, Web of Science, and Google Scholar. In total, 42 articles were considered relevant and included in this review. Self-induced trauma can be appropriately managed with a multidisciplinary approach. Treatment goals are to preserve urinary, sexual, and reproductive function. Specific evaluation includes mechanism of injury, imaging, and determining the extent of injury and surgical repair, if indicated. Due to the rarity of these injuries and their emergent nature, much of the management is based on retrospective data. Further research is needed to improve long-term functional outcomes in trauma patients.
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Affiliation(s)
- Christopher R Koller
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA
| | - Shuhong Wang
- Department of Andrology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Victor Sandoval
- Department of Urology, Hospital Valentin Gomez Farias, Guadalajara, Mexico
| | - Ayad Yousif
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA.
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Latina D, Bauducco S, Tilton‐Weaver L. Insomnia symptoms and non-suicidal self-injury in adolescence: understanding temporal relations and mechanisms. J Sleep Res 2021; 30:e13190. [PMID: 32893426 PMCID: PMC7900995 DOI: 10.1111/jsr.13190] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/09/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
We propose a theoretical model of insomnia symptoms and non-suicidal self-injury (NSSI) that posits bidirectional linkages. We hypothesised that heightened depressive symptoms and impulsivity that result from insomnia increase NSSI. We also posit that the shame associated with NSSI triggers repetitive negative thinking, in turn increasing insomnia. Using three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1,457; Mage = 13.2, SD = 0.43; 52.7% boys), we assessed the mediating role of depressive symptoms, impulsivity, rumination, and worry on the link between insomnia and NSSI. After controlling for depressive symptoms, we found that insomnia was related to increases in NSSI from the second to the third time point (ß23 = 0.09, p = .01). NSSI was consistently related to increased insomnia (ß12 = 0.09, p = .01; ß23 = 0.11, p < .001). In addition, depressive symptoms (ßind = 0.01, p = .02), but not impulsivity (ßind = 0.01, p = .09), mediated the path from insomnia to increased NSSI. Neither worry (ßind = 0.00, p = .59) nor rumination (ßind = 0.00, p = .96) mediated the link between NSSI and increased insomnia. We conclude that NSSI and insomnia maintain each other over time. Thus, screening adolescents for insomnia symptoms may help identify those at risk of NSSI. Although depression seems to explain why insomnia is a risk factor for NSSI, further studies should investigate why NSSI plays a role in the maintenance of insomnia. This understanding will lay the foundation for intervention.
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Affiliation(s)
- Delia Latina
- Center for Lifespan Developmental ResearchÖrebro UniversityÖrebroSweden
- Department of Child and Adolescents Psychiatry and PsychotherapyUniversity of UlmUlmGermany
| | - Serena Bauducco
- Center for Health and Medical PsychologyÖrebro UniversityÖrebroSweden
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Masnec S, Vidas Pauk S, Jurilj M, Kalauz M, Kuzman T, Škegro I, Jukić T, Jandroković S, Seiwerth S, Barišić Kutija M. Enterococcus Faecalis Corneal Ulcers with Endophthalmitis and Consequent Bilateral Blindness as a Result of Unrecognised Intentional Self-Injury - A Case Report. Psychiatr Danub 2021; 33:676-680. [PMID: 34718300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sanja Masnec
- Department of Ophthalmology, Zagreb University Hospital Center, Kišpatićeva 12, 10000 Zagreb, Croatia
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Ferreri MM, Ferrerri MM, Loze JY, Rouillon F, Limosin F. Clozapine treatment of a borderline personality disorder with severe self-mutilating behaviours. Eur Psychiatry 2020; 19:177-8. [PMID: 15158928 DOI: 10.1016/j.eurpsy.2003.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2003] [Accepted: 11/20/2003] [Indexed: 10/26/2022] Open
Affiliation(s)
- Mélanie M Ferreri
- Service de Psychiatrie, Hôpital Albert Chenevier, 40 rue de Mesly, 94010 Créteil cedex, France
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18
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Kuriya B, Vigod S, Luo J, Widdifield J, Haroon N. The risk of deliberate self-harm following a diagnosis of rheumatoid arthritis or ankylosing spondylitis: A population-based cohort study. PLoS One 2020; 15:e0229273. [PMID: 32084192 PMCID: PMC7034875 DOI: 10.1371/journal.pone.0229273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/03/2020] [Indexed: 11/27/2022] Open
Abstract
Objective Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with mental illness. The risk of serious mental illness, including deliberate self-harm (DSH), in these conditions is not well known. We aimed to determine if RA or AS independently increases the risk for DSH. Methods We conducted retrospective, population-based cohort studies using administrative health data for the province of Ontario, Canada between April 1, 2002 and March 31, 2014. Individuals with incident RA (N = 53,240) or AS (N = 13,964) were separately matched 1:4 by age, sex, and year with comparators without RA or AS. The outcome was a first DSH attempt identified using emergency department data. We estimated hazard ratios (HR) and 95% confidence intervals (95% CI) for risk of DSH in RA and AS versus comparators, adjusting for demographic, clinical and health service utilization variables. Results Subjects with AS were significantly more likely to self-harm (crude incidence rate [IR] of 0.68/1,000 person years [PY] versus 0.32/1,000 PY in comparators), with an adjusted HR of 1.59 (95% CI 1.15 to 2.21). DSH was increased for RA subjects (IR 0.35/1,000 PY) versus comparators (IR 0.24/1,000 PY) only before (HR 1.43, 95% CI 1.16 to 1.74), but not after covariate adjustment (HR 1.07, 95% CI 0.86 to 1.33). Conclusions AS carries an increased risk for DSH but no such risk was observed in RA. Further evaluation of at-risk AS subjects is needed, including the longitudinal effects of disease and arthritis therapies on self-harm behaviour. This will inform whether specific risk-reduction strategies for DSH in inflammatory arthritis are needed.
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Affiliation(s)
- Bindee Kuriya
- Sinai Health System, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Simone Vigod
- Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Jin Luo
- ICES, Toronto, Ontario, Canada
| | - Jessica Widdifield
- ICES, Toronto, Ontario, Canada
- Holland Musculoskeletal Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nigil Haroon
- Krembil Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Donahue C, Sarkar B, Narsule C, Taha A, Rosenblatt M. Management of an Anterior Abdominal Stab Wound in a Hostile Abdomen. Am Surg 2020; 86:e79-e80. [PMID: 32167052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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20
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Styles CE, Hoad VC, Denham-Ricks P, Brown D, Seed CR. Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission. Emerg Infect Dis 2019; 25:1996-1997. [PMID: 31538922 PMCID: PMC6759259 DOI: 10.3201/eid2510.190484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Camm-Crosbie L, Bradley L, Shaw R, Baron-Cohen S, Cassidy S. 'People like me don't get support': Autistic adults' experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism 2019; 23:1431-1441. [PMID: 30497279 PMCID: PMC6625034 DOI: 10.1177/1362361318816053] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autistic people are at high risk of mental health problems, self-injury and suicidality. However, no studies have explored autistic peoples' experiences of treatment and support for these difficulties. In partnership with a steering group of autistic adults, an online survey was developed to explore these individuals' experiences of treatment and support for mental health problems, self-injury and suicidality for the first time. A total of 200 autistic adults (122 females, 77 males and 1 unreported) aged 18-67 (mean = 38.9 years, standard deviation = 11.5), without co-occurring intellectual disability, completed the online survey. Thematic analysis of open-ended questions resulted in an overarching theme that individually tailored treatment and support was both beneficial and desirable, which consisted of three underlying themes: (1) difficulties in accessing treatment and support; (2) lack of understanding and knowledge of autistic people with co-occurring mental health difficulties and (3) appropriate treatment and support, or lack of, impacted autistic people's well-being and likelihood of seeing suicide as their future. Findings demonstrate an urgent need for autism treatment pathways in mental health services.
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Affiliation(s)
| | | | - Rebecca Shaw
- Coventry and Warwickshire Partnership
NHS Trust, UK
| | - Simon Baron-Cohen
- University of Cambridge, UK
- Cambridgeshire and Peterborough NHS
Foundation Trust, UK
| | - Sarah Cassidy
- Coventry University, UK
- University of Cambridge, UK
- University of Nottingham, UK
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22
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Vidales Mostajo GS, Abril Barreda MJ. [Biodegradable stent as treatment of refractory benign esophageal stricture (RBES)]. Rev Gastroenterol Peru 2019; 39:164-170. [PMID: 31333234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 26-year-old female patient, from La Paz-Bolivia. She came with a disease period of 15 months characterized by progressive dysphagia. One month before the onset of the symptomatology she ingested bleach with autolytic intentions. In the study of diagnostic upper gastrointestinal endoscopy at 25 centimeters of the dental arch was evidenced a stenosis of about 3 mm in diameter, central and with adjacent esophageal epithelium of a preserved appearance. In the x-ray of contrasted esophagus at the level of the middle third of the esophagus was evidenced a stenosis, short tubular, with a smooth border, of approximately 2 cm in length. Treatment was initiated using axial mechanical dilatations with Savary Guilliard bougies with an interval between sessions of 2 to 3 weeks and with 8 sessions in total. In the last session the largest bougie used was 12.8 mm. It is then that taking into account the diagnostic criteria of Kochman, the diagnosis of refractory caustic esophageal stenosis was made. During the period of realization of the dilations with bougies the patient became pregnant, which made difficult the accomplishment of the procedures for the routine use of fluoroscopic control. At 14 weeks of pregnancy, a SX-ELLA uncovered biodegradable esophageal stent of 10 cm length was implanted. We present the case as an alternative and novel management for this type of pathology.
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Affiliation(s)
| | - Miguel J Abril Barreda
- WGO La Paz Training Center, Instituto de Gastroenterología Boliviano Japonés. La Paz, Bolivia
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Ricketts EJ, Rozenman M, Snorrason Í, Pérez JB, Peng MG, Kim J, Piacentini J. Confirmatory factor analysis of the SLEEP-50 Questionnaire in Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder. Psychiatry Res 2019; 273:197-205. [PMID: 30654305 PMCID: PMC6561822 DOI: 10.1016/j.psychres.2019.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/17/2018] [Accepted: 01/05/2019] [Indexed: 11/29/2022]
Abstract
The study objective was to perform a confirmatory factor analysis of the SLEEP-50 Questionnaire (SLEEP-50) in Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder and compare sleep complaints in adults with Trichotillomania, Excoriation Disorder and non-affected controls. Participants were 234 adults with Trichotillomania, 170 with Excoriation Disorder, and 146 non-affected controls. Participants rated sleep using the SLEEP-50 and Pittsburgh Sleep Quality Index (PSQI). Confirmatory factor analysis was used to assess fit of the originally-proposed SLEEP-50 factors within Trichotillomania and Excoriation Disorder. Findings revealed acceptable to good fit of the original factors. Internal consistency was excellent in Trichotillomania and good in Excoriation Disorder for the total score and poor to good for subscales. Convergent validity was strong for the total and weak to strong for subscales in both groups. Findings suggest greater sleep complaints in Trichotillomania and Excoriation Disorder than in the general population. Trichotillomania and Excoriation Disorder groups reported greater rates of sleep apnea, narcolepsy, restless leg syndrome/periodic limb movement disorder, circadian rhythms sleep disorder, and sleep-related affective disorder relative to controls. There were no significant differences for insomnia, sleep state misperception, sleepwalking, nightmares, or hypersomnia. Results underscore the importance of clinical assessment of sleep disorders in Trichotillomania and Excoriation Disorder.
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Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA.
| | - Michelle Rozenman
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA; Department of Psychology, University of Denver, Denver, CO, USA
| | - Ívar Snorrason
- Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Jocelyn B Pérez
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - Micalla G Peng
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - Jessica Kim
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, CA, USA
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Vergara GA, Stewart JG, Cosby EA, Lincoln SH, Auerbach RP. Non-Suicidal self-injury and suicide in depressed Adolescents: Impact of peer victimization and bullying. J Affect Disord 2019; 245:744-749. [PMID: 30448758 PMCID: PMC6351200 DOI: 10.1016/j.jad.2018.11.084] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/02/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND While prior research has demonstrated that peer victimization and bully perpetration contribute to non-suicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs), it remains unclear whether these interpersonal processes differentiate self-injuring adolescent suicide ideators and attempters. METHODS The study included adolescents aged 13-18 years (n = 223; M = 15.31, SD = 1.34) recruited from an acute inpatient program. Participants were divided into two groups: (1) NSSISI (n = 106): endorsed past year NSSI, current suicide ideation, and no lifetime suicide attempts and (2) NSSISI+SA (n = 117): endorsed past year NSSI, current suicide ideation, and lifetime suicide attempts. Adolescents completed clinical interviews (i.e., mental disorders, NSSI, and STBs) and self-report measures assessing peer victimization, bully perpetration, and depression severity. RESULTS NSSISI+SA youth reported higher levels of peer victimization and bully perpetration than NSSISI youth (ps < 0.01, ds = 0.36-0.37). Among the NSSISI+SA youth, bully perpetration was associated with a greater number of past month suicide attempts (p = 0.02, RR = 1.07). Only peer victimization was associated with greater NSSI behaviors in the past month (p = 0.04, RR = 1.01). LIMITATIONS The study is cross-sectional, and reports of peer victimization and bully perpetration rely on self-report assessment. CONCLUSIONS Peer victimization and bully perpetration differentiated adolescent suicide ideators and attempters, highlighting the need to address bully perpetration in addition to peer victimization in suicide interventions and research.
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Affiliation(s)
- Genesis A Vergara
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Jeremy G Stewart
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Elizabeth A Cosby
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Sarah Hope Lincoln
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Randy P Auerbach
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Columbia University, New York, NY, USA; Division of Clinical Developmental Neuroscience, Sackler Institute, New York, NY, USA.
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Mitchell H, Abel KM, Dunlop BJ, Walker T, Ranote S, Robinson L, Edgar F, Millington T, Meacock R, Shaw J, Gutridge K. Acceptability and feasibility pilot randomised controlled trial of medical skin camouflage for recovery of women prisoners with self-harm scarring (COVER): the study protocol. BMJ Open 2019; 9:e021891. [PMID: 30782675 PMCID: PMC6340434 DOI: 10.1136/bmjopen-2018-021891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Self-harm in prison is a major public health concern. Less than 5% of UK prisoners are women, but they carry out more than a fifth of prison self-harm. Scars resulting from self-harm can be traumatising and stigmatising, yet there has been little focus on recovery of women prisoners with self-harm scarring. Medical skin camouflage (MSC) clinics treat individuals with disfiguring skin conditions, with evidence of improved well-being, self-esteem and social interactions. Only one community study has piloted the use of MSC for self-harm scarring. METHODS AND ANALYSIS We describe an acceptability and feasibility pilot randomised controlled trial; the first to examine MSC for women prisoners who self-harm. We aim to randomise 20-25 women prisoners to a 6-week MSC intervention and 20-25 to a waitlist control (to receive the MSC after the study period). We aim to train at least 6-10 long-term prisoners with personal experience of self-harm to deliver the intervention. Before and after intervention, we will pilot collection of women-centred outcomes, including quality of life, well-being and self-esteem. We will pilot collection of self-harm incidents during the intervention, resources used to manage/treat self-harm and follow-up of women at 12 weeks from baseline. Data on recruitment, retention and dropout will be recorded. We aim for the acceptability of the intervention to prison staff and women prisoners to be explored in qualitative interviews and focus groups. ETHICS AND DISSEMINATION Ethical approval for COVER has been granted by the North East-York Research Ethics Committee (REC) for phases 1 and 2 (reference: 16/NE/0030) and West of Scotland REC 3 for phases 3 and 4 (reference: 16/WS/0155). Informed consent will be the primary consideration; it will be made clear that participation will have no effect on life in prison or eligibility for parole. Due to the nature of the study, disclosures of serious self-harm may need to be reported to prison officials. We aim for findings to be disseminated via events at the study prison, presentations at national/international conferences, journal publications, prison governor meetings and university/National Health Service trust communications. TRIAL REGISTRATION NUMBER NCT02638974; Pre-results.
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Affiliation(s)
- Heather Mitchell
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Kathryn M Abel
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Brendan James Dunlop
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Tammi Walker
- Department of Psychology, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Sandeep Ranote
- North West Boroughs Healthcare NHS Foundation Trust, Warrington, United Kingdom
| | - Louise Robinson
- Lancashire Care NHS Foundation Trust, Preston, UK
- Centre for Mental Health and Risk, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Fiona Edgar
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Mental Health and Criminal Justice Group, University of Central Lancashire, Preston, UK
| | - Tracy Millington
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jenny Shaw
- Offender Health Research Network, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
| | - Kerry Gutridge
- Centre for Women’s Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Harner A, Young L. Nonoperative Management of Intra-Abdominal Foreign Bodies: Selected Cases Involving Recurrent Self-Harm. Am Surg 2019; 85:e18-e20. [PMID: 30760362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Tudela Torras M, Abad Más L. [Reduction of dysfunctional self-injurious and self-stimulatory behaviors in autism disorders spectrum through occupational therapy]. Medicina (B Aires) 2019; 79:38-43. [PMID: 30776278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Self-stimulatory and self-injurious behaviors are very frequent in neurodevelopmental disorders, being a source of anxiety and suffering for persons who have that behavior and their families. Sometimes these behaviors are so intense and frequent that it becomes a selfintegrity risk. A bibliographic review was conducted on the different approaches that have been developed until today; in addition, this article explains the methodology applied in our clinic, with a data collection on the effect of therapy on self-injurious and self-stimulatory behaviors in 20 cases, as a starting point for future research. The sensory integration model that complements pharmacological and behavioral cognitive treatment is highlighted, since it considers sensory needs relevant and trains the capacity for functional self-regulation.
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Affiliation(s)
- María Tudela Torras
- RED CENIT, Centros de Desarrollo Cognitivo (CEDECO), Centros de Integración Sensorial (CIS), Valencia, España. E-mail:
| | - Luis Abad Más
- RED CENIT, Centros de Desarrollo Cognitivo (CEDECO), Centros de Integración Sensorial (CIS), Valencia, España
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Benson SS, Dimian AF, Elmquist M, Simacek J, McComas JJ, Symons FJ. Coaching parents to assess and treat self-injurious behaviour via telehealth. J Intellect Disabil Res 2018; 62:1114-1123. [PMID: 29205605 PMCID: PMC6540986 DOI: 10.1111/jir.12456] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/11/2017] [Accepted: 11/10/2017] [Indexed: 05/31/2023]
Abstract
The application of telehealth technology to conduct functional analysis (FA) and functional communication training (FCT) is emerging for children with developmental disabilities and behaviour support needs. The current study was designed to extend FA + FCT for self-injurious behaviour by using telehealth in home with parents as interventionists receiving real-time remote coaching. Two families with school-aged boys with developmental disabilities associated with intellectual disability participated, one with cerebral palsy and the other with autism spectrum disorder. Results indicated that parent-implemented FA + FCT via telehealth was effective for reducing self-injurious behaviour and increasing mands (communication requests) for both children. Both families successfully implemented the FA + FCT protocol with 95% overall fidelity via telehealth-supported coaching. Results are discussed in terms of their relationship to previous research, limitations and future directions.
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Affiliation(s)
- S S Benson
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - A F Dimian
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - M Elmquist
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - J Simacek
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - J J McComas
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - F J Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
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Bradley V, Hiersteiner D, Rotholz D, Maloney J, Li H, Bonardi A, Bershadsky J. Personal characteristics and outcomes of individuals with developmental disabilities who need support for self-injurious behaviour. J Intellect Disabil Res 2018; 62:1043-1057. [PMID: 30022570 DOI: 10.1111/jir.12518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/09/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND For people with intellectual and developmental disabilities, self-injurious behaviour (SIB) can have serious negative effects on both health and quality of life. This descriptive analysis will provide information on the characteristics and outcomes of a subsample of individuals who are identified as needing some or extensive support for SIB in the National Core Indicators Adult Consumer Survey sample. METHODS The data for this analysis come from states that participated in the 2015-2016 data collection cycle of National Core Indicators Adult Consumer Survey which is a face-to-face survey of adults receiving services through state developmental disability agencies. RESULTS The characteristics and outcomes of individuals who need at least some support for SIB differ from those of individuals with intellectual and developmental disabilities who do not need support for SIB. Individuals with SIB support needs, for example, tend to live in more structured settings, have fewer relationships, less inclusion in their communities and poorer employment outcomes. CONCLUSIONS The exploratory descriptive analysis concludes with suggested recommendations for more standardised definitions of SIB in public systems, enhanced behaviour plan protocols and the need for additional research.
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Affiliation(s)
- V Bradley
- Human Services Research Institute, Cambridge, MA, USA
| | - D Hiersteiner
- Human Services Research Institute, Cambridge, MA, USA
| | - D Rotholz
- Department of Pediatrics, Center for Disability Resources, School of Medicine, Columbia, SC, USA
| | - J Maloney
- Human Services Research Institute, Cambridge, MA, USA
| | - H Li
- Human Services Research Institute, Cambridge, MA, USA
| | - A Bonardi
- Human Services Research Institute, Cambridge, MA, USA
| | - J Bershadsky
- Human Services Research Institute, Cambridge, MA, USA
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Hall SS, Hustyi KM, Barnett RP. Examining the influence of social-environmental variables on self-injurious behaviour in adolescent boys with fragile X syndrome. J Intellect Disabil Res 2018; 62:1072-1085. [PMID: 29693293 PMCID: PMC6609101 DOI: 10.1111/jir.12489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 02/07/2018] [Accepted: 03/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Individuals with fragile X syndrome (FXS), the most common known inherited form of intellectual disability, are at increased risk for showing specific forms of self-injurious behaviour (SIB) such as hand biting and head hitting, suggesting that biological factors associated with the syndrome confers increased risk for SIB. Few studies, however, have examined the extent to which social-environmental variables can influence the occurrence of these behaviours in this population. METHOD Twenty-two adolescent boys with FXS, aged 10 to 18 years were systematically exposed to seven environmental conditions in functional analyses of SIB conducted over 2 days at our research centre. RESULTS Fourteen (63.6%) boys with FXS engaged in SIB during the functional analyses. Ten (45.5%) boys engaged in SIB that was maintained by social-environmental variables, that is, gaining access to attention/tangibles and/or escaping from social interaction, task demands and/or transition demands. For two boys, SIB was undifferentiated across conditions, and for two boys, SIB appeared to be maintained by automatic reinforcement. CONCLUSIONS Social-environmental variables appeared to maintain SIB in a significant proportion of boys with FXS. Given that pharmacological treatments for SIB have limited efficacy in this population, the potential role of social-environmental factors on SIB should be examined before pharmacological treatments are implemented for these behaviours.
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Affiliation(s)
- S S Hall
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
| | - K M Hustyi
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
| | - R P Barnett
- Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, CA, USA
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Hagopian LP, Frank-Crawford MA. Classification of self-injurious behaviour across the continuum of relative environmental-biological influence. J Intellect Disabil Res 2018; 62:1108-1113. [PMID: 29027294 PMCID: PMC5899071 DOI: 10.1111/jir.12430] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/21/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
Self-injurious behaviour (SIB) is generally considered to be the product of interactions between dysfunction stemming from the primary developmental disability and experiences that occasion and reinforce SIB. As a result of these complex interactions, SIB presents as a heterogeneous problem. Recent research delineating subtypes of SIB that are nonsocially mediated, including one that is amenable to change and one that is highly invariant, enables classification of SIB across a broader continuum of relative environmental-biological influence. Directly examining how the functional classes of SIB differ has the potential to structure research, will improve our understanding this problem, and lead to more targeted behavioural and pharmacological interventions. Recognising that SIB is not a single entity but is composed of distinct functional classes would better align research with conceptual models that view SIB as the product of interactions between environmental and biological variables.
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Affiliation(s)
- Louis P. Hagopian
- Department of Behavioral Psychology, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
- University of Maryland, Baltimore County
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Richards C, Symons F. Self-injurious behaviour in people with intellectual disabilities. J Intellect Disabil Res 2018; 62:993-996. [PMID: 30450802 DOI: 10.1111/jir.12557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Affiliation(s)
- C Richards
- School of Psychology, University of Birmingham, Birmingham, UK
| | - F Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
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Rooker GW, Hausman NL, Fisher AB, Gregory MK, Lawell JL, Hagopian LP. Classification of injuries observed in functional classes of self-injurious behaviour. J Intellect Disabil Res 2018; 62:1086-1096. [PMID: 30043452 PMCID: PMC7273834 DOI: 10.1111/jir.12535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/26/2018] [Accepted: 06/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Limited research has examined how the functions of self-injurious behaviour (SIB) relate to the production of injuries and the location, type or severity of those injuries. METHODS Clinical and medical records were coded for 64 individuals hospitalised for SIB. When injuries were present, the physical properties of SIB and injuries were assessed across groups of individuals with automatically and socially maintained SIB. RESULTS Injuries were observed for 35 of the individuals who engaged in SIB. Individuals who engaged in a single form of SIB were more likely to have injuries (P < .05). Individuals with SIB maintained by automatic reinforcement had significantly more severe injuries to the head than those in the social group (q < .05, P = .0132, H = 12.54). CONCLUSION Although results are preliminary, the results provide evidence that the function of SIB may influence the severity and location of injuries produced.
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Affiliation(s)
- G W Rooker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - N L Hausman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychology, University of Maryland, Baltimore, MD, USA
| | - A B Fisher
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - M K Gregory
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - J L Lawell
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
| | - L P Hagopian
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Behavioral Psychology, The Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychology, University of Maryland, Baltimore, MD, USA
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Wijana MB, Enebrink P, Liljedahl SI, Ghaderi A. Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents. BMC Psychiatry 2018; 18:371. [PMID: 30477463 PMCID: PMC6258142 DOI: 10.1186/s12888-018-1947-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/02/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families. METHODS Forty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress. RESULTS From pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups. CONCLUSIONS The adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group. TRIAL REGISTRATION This study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593-31/5).
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Affiliation(s)
- Moa Bråthén Wijana
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Fisher WW, Greer BD, Fuhrman AM, Saini V, Simmons CA. Minimizing resurgence of destructive behavior using behavioral momentum theory. J Appl Behav Anal 2018; 51:831-853. [PMID: 30252145 PMCID: PMC6188838 DOI: 10.1002/jaba.499] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/07/2017] [Indexed: 11/06/2022]
Abstract
The resurgence of destructive behavior can occur during functional communication training (FCT) if the alternative response contacts a challenge (e.g., extinction). Behavioral momentum theory (BMT) suggests that refinements to FCT could mitigate resurgence of destructive behavior during periods of extinction. Following a functional analysis and treatment with FCT, we combined three refinements to FCT (i.e., the use of a lean schedule of reinforcement for destructive behavior during baseline, a lean schedule for the alternative response during FCT, and an increase in the duration of treatment) and compared the magnitude of resurgence relative to a condition in which FCT was implemented in a traditional manner. Results suggested that the combination of these three refinements to FCT was successful in decreasing the resurgence of destructive behavior during an extinction challenge. We discuss the implications of these findings, as well as areas for future research.
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Affiliation(s)
- Wayne W. Fisher
- University of Nebraska Medical Center's Munroe‐Meyer Institute
| | - Brian D. Greer
- University of Nebraska Medical Center's Munroe‐Meyer Institute
| | | | - Valdeep Saini
- University of Nebraska Medical Center's Munroe‐Meyer Institute
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Cottini M, Pergolini A, Ranocchi F, Musumeci F. The Role of Heart Team Approach in Penetrating Cardiac Trauma: Case Report and Review of the Literature. Braz J Cardiovasc Surg 2018; 33:99-103. [PMID: 29617508 PMCID: PMC5873782 DOI: 10.21470/1678-9741-2017-0150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/06/2017] [Indexed: 11/04/2022] Open
Abstract
Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.
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Affiliation(s)
- Marzia Cottini
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Amedeo Pergolini
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Federico Ranocchi
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - Francesco Musumeci
- Department of Heart and Vessels, Cardiac Surgery Unit and Heart
Transplantation Center, "S. Camillo-Forlanini" Hospital, Rome, Italy
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Abstract
Reports of laser-induced ocular injuries have become more frequent in recent years, especially due to high-energy laser pointers. The article presents for the first time in the German literature a case of self-inflicted laser-induced maculopathy in an adolescent. In addition to the clinical findings, the results of funduscopy and spectral domain optical coherence tomography (SD-OCT) follow-up are presented.
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Affiliation(s)
- B Hohberger
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland.
| | - A Bergua
- Augenklinik am Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Deutschland
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Akram B, Tariq A, Rafi Z. Non-suicidal self-injury among children with hearing loss and intellectual disability. J PAK MED ASSOC 2017; 67:1506-1511. [PMID: 28955065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To find the prevalence and to identify the predictors of non-suicidal self-injury among school-going children.. METHODS This cross-sectional study was conducted at the University of Gujrat, Gujrat Pakistan, from September 2015 to October 2016, and comprised children with intellectual disability and hearing loss. Participants were recruited from schools for special children located in Gujranwala, Jhelum and Gujrat. Multistage stratified sampling technique was used. RESULTS Of the 325 children, 178(50.4%) had intellectual disability and 175(49.6%) had hearing loss. Findings indicated that the prevalence of self-injurious behaviour was higher in children with intellectual disability 48(27%) compared to their counterparts with hearing loss 3(2%). Neural network, when administered on whole data set, indicated type of disability 0.474(100%), education/training 0.99(20.9%) and access of counselling 0.114(24%) as important predictors of non-suicidal self-injury in both groups. On the other hand, the degree of disability (hearing loss 0.42[100%]; intellectual disability 0.32[100%]), education/ training (hearing loss 0.18[43%]; intellectual disability 0.27[84.5%]) and access of counselling (hearing loss 0.175[41.8%]; intellectual disability 0.256[78.7%]) were important predictors of non-suicidal self-injury among the participants, when neural network was run on the split files on the basis of disability. CONCLUSIONS The prevalence of non-suicidal self-injury among children with intellectual disability was higher as compared to those with hearing loss.
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Affiliation(s)
- Bushra Akram
- Psychology Department, University of Gujrat, Pakistan
| | - Amina Tariq
- Psychology Department, University of Gujrat, Pakistan
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39
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Abstract
After a review of foundational contributions to the concept of identity, including Erikson's, the author discusses the research methods and findings of the Personality Disorders Institute of the Joan and Sanford I. Weill Medical College of Cornell University regarding the concepts of normal identity and identity diffusion, toward an elucidation of the psychopathology of personality disorders--their etiology, diagnosis, and treatment. The application of an object relations theory model to analyze the development of identity clarifies the relationship of individual identity with the social and cultural frame that influences identity formation and may amplify the effects of pathological identity development. Detailed excerpts are presented from a diagnostic structural interview at the Personality Disorders Institute.
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40
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Qureshi AU, Farooq MS, Qureshi SS, Bilal T, Ali AA. Penile Shaft Strangulation with Wrought Iron Metallic Pipe. J Coll Physicians Surg Pak 2017; 27:440-441. [PMID: 28818168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/23/2017] [Indexed: 06/07/2023]
Abstract
Penile strangulation due to any solid encircling ornament or metal is rarely reported. Venous outflow obstruction due to any constricting item around the shaft leads to venous congestion, urinary obstruction, and rarely gangrene of the penile shaft skin. We report a case presenting with penile near-strangulation due to iron-lead metallic junction pipe which was cut using a heavy electric metal cutter.
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Affiliation(s)
| | | | | | - Tasneem Bilal
- Trainee Registrar, South Surgical Ward, Mayo Hospital, Lahore
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41
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Varela-Besteiro O, Serrano-Troncoso E, Rodríguez-Vicente V, Curet-Santisteban M, Conangla-Roselló G, Cecilia-Costa R, Carulla-Roig M, Matalí-Costa JL, Dolz-Abadia M. Suicidal ideation and self-injurious behavior in adolescents with eating disorders. Actas Esp Psiquiatr 2017; 45:157-166. [PMID: 28745388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The presence of suicidal thoughts and self-injurious behaviors in patients with eating disorders (ED) is well-known; however, this association is currently not defined empirically. The aim of the study is to determine the prevalence of suicidal ideation and self-harm in adolescents with eating disorders. A second objective is to study the association between self-injurious behavior and suicidal ideation, severity of eating disorder symptoms and symptoms of depression and anxiety, motivation to change and perfectionism. METHODOLOGY We evaluated 109 patients (mean age, 14.74 years (SD: 1.53); 87.2% female) using the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI-II), the State-Trait Anxiety Inventory (STAI), the Child and Adolescent Perfectionism Scale (CAPS) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). RESULTS Forty-seven patients (43.1%) had suicidal ideation and 34 (31.2%), self-injurious behavior. The presence of suicidal ideation did not discriminate between patients with or without self-injurious behavior. Patients who self-harm had significantly higher scores on all scales of the EDI-2, except for “maturity fears”, in the total scores of BDI-II, STAI and CAPS. An association between selfinjurious behavior and motivation to change was found. CONCLUSIONS A significant percentage of adolescents with eating disorders present suicidal ideation and selfinjurious behavior, making the psychopathological profile of these patients more severe. The presence of suicidal ideation in adolescents with eating disorders does not necessarily imply that they have self-injurious behavior; rather, such behavior could be a result of the need to regulate intense negative emotions.
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Affiliation(s)
- Olalla Varela-Besteiro
- Unitat de TCA. Servei de Psiquiatria i Psicologia. Hospital Sant Joan de Déu, Barcelona Hospital Universitari Arnau de Vilanova-Gestió de Serveis Sanitaris, Lleida
| | | | | | | | | | - Raquel Cecilia-Costa
- Unitat de TCA. Servei de Psiquiatria i Psicologia. Hospital Sant Joan de Déu, Barcelona
| | - Marta Carulla-Roig
- Unitat de TCA. Servei de Psiquiatria i Psicologia. Hospital Sant Joan de Déu, Barcelona
| | - Josep L Matalí-Costa
- Unitat de TCA. Servei de Psiquiatria i Psicologia. Hospital Sant Joan de Déu, Barcelona
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Borhan F, Borhan N, O'Riordan B. An unusual case of multiple self-inflicted punctures to the precordium. Ir Med J 2017; 110:588. [PMID: 28952678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sewing needles, albeit a rare case of penetrating cardiac injury, are potentially life-threatening. We report a case of successful intra-cardiac needle removal from a 32 year old who inserted multiple needles into the chest and abdomen.
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Affiliation(s)
- F Borhan
- Department of Emergency Medicine, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - N Borhan
- Department of Emergency Medicine, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - B O'Riordan
- Department of Emergency Medicine, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
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Lusk JD, Sadeh N, Wolf EJ, Miller MW. Reckless Self-Destructive Behavior and PTSD in Veterans: The Mediating Role of New Adverse Events. J Trauma Stress 2017; 30:270-278. [PMID: 28471014 PMCID: PMC5482753 DOI: 10.1002/jts.22182] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 01/24/2017] [Accepted: 02/04/2017] [Indexed: 11/05/2022]
Abstract
The addition of self-destructive and reckless behavior as a symptom of posttraumatic stress disorder (PTSD) in DSM-5 has stimulated renewed interest in understanding relationships between these behaviors and trauma-related psychopathology. This study examined the relationship between reckless and self-destructive behaviors (RSDB), intervening exposure to new adverse events, and later PTSD severity in a sample of trauma-exposed veterans. At baseline, participants were assessed for RSDB (past 5 years) and current PTSD severity (N = 222). PTSD severity was then reassessed approximately 4 years later (N = 148). Overall, RSDB were reported by 74.4% of the sample, with 61.3% engaging in multiple forms of RSDB. The most commonly endorsed behaviors included alcohol/drug abuse (42.8%), driving while intoxicated (29.4%), gambling (24.7%), and aggression (23.1%). There was a positive correlation between RSDB and PTSD severity at both the baseline (r = .16, p = .031) and follow-up assessment (r = .24, p = .005). Path models indicated that exposure to new adverse events fully mediated the effect of Time 1 RSDB on PTSD symptoms at Time 2 (indirect association: β = .05, p = .046). Results suggest that RSDB are common among trauma-exposed veterans and may perpetuate PTSD symptoms by increasing exposure to new adverse events.
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Affiliation(s)
- Joanna D. Lusk
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
| | - Naomi Sadeh
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
- University of Delaware, Department of Psychological and Brain Sciences
| | - Erika J. Wolf
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
| | - Mark W. Miller
- National Center for PTSD at VA Boston Healthcare System
- Boston University School of Medicine, Department of Psychiatry
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Castellví P, Lucas-Romero E, Miranda-Mendizábal A, Parés-Badell O, Almenara J, Alonso I, Blasco MJ, Cebrià A, Gabilondo A, Gili M, Lagares C, Piqueras JA, Roca M, Rodríguez-Marín J, Rodríguez-Jimenez T, Soto-Sanz V, Alonso J. Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis. J Affect Disord 2017; 215:37-48. [PMID: 28315579 DOI: 10.1016/j.jad.2017.03.035] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/09/2017] [Accepted: 03/10/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt. METHODS We searched 6 databases until June 2015. INCLUSION CRITERIA 1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated. RESULTS From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%. LIMITATIONS There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts. CONCLUSIONS Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.
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Affiliation(s)
- P Castellví
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - E Lucas-Romero
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - A Miranda-Mendizábal
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - O Parés-Badell
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J Almenara
- Area of Preventive Medicine and Public Health. University of Cadiz, Spain
| | - I Alonso
- Morales Meseguer Hospital, Murcia, Spain
| | - M J Blasco
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - A Cebrià
- Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - A Gabilondo
- Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, Spain; Mental Health and Psychiatric Care Research Unit. BioDonosti Health Research Institute, Spain
| | - M Gili
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain; Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - C Lagares
- Department of Statistics and Operative Research. University of Cádiz. Spain
| | - J A Piqueras
- Department of Health Psychology, Miguel Hernandez University of Elche, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain; Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca, Spain
| | - J Rodríguez-Marín
- Department of Health Psychology, Miguel Hernandez University of Elche, Spain
| | - T Rodríguez-Jimenez
- Department of Health Psychology, Miguel Hernandez University of Elche, Spain
| | - V Soto-Sanz
- Department of Health Psychology, Miguel Hernandez University of Elche, Spain
| | - J Alonso
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health & Experimental Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
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45
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Bentley KH, Nock MK, Sauer-Zavala S, Gorman BS, Barlow DH. A functional analysis of two transdiagnostic, emotion-focused interventions on nonsuicidal self-injury. J Consult Clin Psychol 2017; 85:632-646. [PMID: 28394171 DOI: 10.1037/ccp0000205] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Nonsuicidal self-injury (NSSI) is prevalent and associated with clinically significant consequences. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the critical components for NSSI treatment remain largely unknown. The aim of this study was to examine the specific effects of mindful emotion awareness training and cognitive reappraisal, 2 transdiagnostic treatment strategies that purportedly address the functional processes thought to maintain self-injurious behavior, on NSSI urges and acts. METHOD Using a counterbalanced, combined series (multiple baseline and data-driven phase change) aggregated single-case experimental design, the unique and combined impact of these 2 4-week interventions was evaluated among 10 diagnostically heterogeneous self-injuring adults. Ecological momentary assessment was used to provide daily ratings of NSSI urges and acts during all study phases. RESULTS Eight of 10 participants demonstrated clinically meaningful reductions in NSSI; 6 participants responded to 1 intervention alone, whereas 2 participants responded after the addition of the alternative intervention. Group analyses indicated statistically significant overall effects of study phase on NSSI, with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in self-reported levels of anxiety and depression, and large improvements in mindful emotion awareness and cognitive reappraisal skills. CONCLUSIONS Findings suggest that brief mindful emotion awareness and cognitive reappraisal interventions can lead to reductions in NSSI urges and acts. Transdiagnostic, emotion-focused therapeutic strategies delivered in time-limited formats may serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals. (PsycINFO Database Record
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Hamm B, Khokhar N, Jimenez XF. Refractory Self-Injurious Behavior in Severe Intellectual Disability Responsive to Topiramate: A Case Report. Psychosomatics 2017; 58:209-212. [PMID: 28189287 DOI: 10.1016/j.psym.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Brandon Hamm
- Department of Psychiatry, A. Cleveland Clinic, Cleveland, OH.
| | - Naveed Khokhar
- Department of Psychiatry, A. Cleveland Clinic, Cleveland, OH
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Knorr AC, Tull MT, Anestis MD, Dixon-Gordon KL, Bennett MF, Gratz KL. The Interactive Effect of Major Depression and Nonsuicidal Self-Injury on Current Suicide Risk and Lifetime Suicide Attempts. Arch Suicide Res 2016; 20:539-52. [PMID: 26953789 PMCID: PMC5072359 DOI: 10.1080/13811118.2016.1158679] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED This study examined the main and interactive effects of MDD and lifetime nonsuicidal self-injury (NSSI) on current suicide risk and past suicide attempts. We predicted that individuals with a history of NSSI and current MDD would be at greater suicide risk than those with either risk factor alone. An interaction between lifetime MDD and NSSI was hypothesized for past suicide attempts. 204 substance dependent inpatients completed self-report measures and a diagnostic interview. Patients with both a history of NSSI and current MDD, relative to all other groups, had the greatest suicide risk. No support was found for the lifetime MDD by NSSI interaction. CONCLUSION Findings suggest the relevance of both NSSI and MDD in suicide risk.
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Affiliation(s)
- Anne C. Knorr
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Matthew T. Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael D. Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Mary F. Bennett
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kim L. Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, USA
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48
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Xu M, Wen J, Zhu X, Chen P, Wang C. A rare self-injurious case of multiple penetrating brain injury by nails in a young patient with depressive disorder. Acta Neurol Belg 2015; 115:767-9. [PMID: 25739361 DOI: 10.1007/s13760-015-0439-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Min Xu
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
- School of Clinical Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Jinkun Wen
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
| | - Xun Zhu
- School of Clinical Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Pin Chen
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
| | - Cunzu Wang
- Department of Neurosurgery, Northern Jiangsu Province Hospital, Yangzhou, 225001, Jiangsu, China.
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49
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Pal DK. Charging of the penis: an unusual method for sexual gratification. Int J Adolesc Med Health 2015; 27:457-458. [PMID: 25503664 DOI: 10.1515/ijamh-2014-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/17/2014] [Indexed: 06/04/2023]
Abstract
The presence of a foreign object in the bladder or urethra may cause a serious problem to the patient. Most of the cases are self-inserted as a result of sexual gratification. Here, we present a rare case of self introduction of the wire of a mobile charger within the bladder and urethra for sexual gratification. This case has yet to be reported in any previous work.
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50
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George NM, Whitaker J, Vieira G, Geronimo JT, Bellinger DA, Fletcher CA, Garner JP. Antioxidant Therapies for Ulcerative Dermatitis: A Potential Model for Skin Picking Disorder. PLoS One 2015; 10:e0132092. [PMID: 26167859 PMCID: PMC4500395 DOI: 10.1371/journal.pone.0132092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/10/2015] [Indexed: 01/04/2023] Open
Abstract
Skin Picking Disorder affects 4% of the general population, with serious quality of life impacts, and potentially life threatening complications. Standard psychoactive medications do not help most patients. Similarly, Mouse Ulcerative Dermatitis (skin lesions caused by excessive abnormal grooming behavior) is very common in widely used inbred strains of mice, and represents a serious animal welfare issue and cause of mortality. Treatment options for Ulcerative Dermatitis are largely palliative and ineffective. We have proposed mouse Ulcerative Dermatitis as a model for human Skin Picking Disorder based on similar epidemiology, behavior, and its comorbidity and mechanistic overlap with hair pulling (trichotillomania). We predicted that mouse Ulcerative Dermatitis would be treated by N-Acetylcysteine, as this compound is highly effective in treating both Skin Picking Disorder and Trichotillomania. Furthermore, we hypothesized that N-Acetylcysteine’s mode of action is as a precursor to the production of the endogenous antioxidant glutathione in the brain, and therefore intranasal glutathione would also treat Ulcerative Dermatitis. Accordingly, we show in a heterogenous prospective trial, the significant reduction in Ulcerative Dermatitis lesion severity in mice receiving either N-acetylcysteine (oral administration) or glutathione (intranasal). The majority of mice treated with N-acetylcysteine improved slowly throughout the course of the study. Roughly half of the mice treated with glutathione showed complete resolution of lesion within 2-4 weeks, while the remainder did not respond. These findings are the first to show that the use of N-acetylcysteine and Glutathione can be curative for mouse Ulcerative Dermatitis. These findings lend additional support for mouse Ulcerative Dermatitis as a model of Skin Picking Disorder and also support oxidative stress and glutathione synthesis as the mechanism of action for these compounds. As N-Acetylcysteine is poorly tolerated by many patients, intranasal glutathione warrants further study as potential therapy in Skin Picking, trichotillomania and other body-focused repetitive behavior disorders.
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Affiliation(s)
- Nneka M. George
- Department of Pathology and Laboratory Medicine, Division of Laboratory Animal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Julia Whitaker
- Department of Pathology and Laboratory Medicine, Division of Laboratory Animal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Giovana Vieira
- Department of Animal Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Jerome T. Geronimo
- Department of Comparative Medicine, Stanford University, Stanford, California, United States of America
| | - Dwight A. Bellinger
- Department of Pathology and Laboratory Medicine, Division of Laboratory Animal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Craig A. Fletcher
- Department of Pathology and Laboratory Medicine, Division of Laboratory Animal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph P. Garner
- Department of Comparative Medicine, Stanford University, Stanford, California, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
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