title: Major self-mutilation in the first episode of psychosis.
abstract: Major self-mutilation (MSM) is a rare but catastrophic complication of severe mental illness. Most people who inflict MSM have a psychotic disorder, usually a schizophrenia spectrum psychosis. It is not known when in the course of psychotic illness, MSM is most likely to occur. In this study, the proportion of patients in first episode of psychosis (FEP) was assessed using the results of a systematic review of published case reports. Histories of patients who had removed an eye or a testicle, severed their penis, or amputated a portion of a limb and were diagnosed with a schizophrenia spectrum psychosis were included. A psychotic illness was documented in 143 of 189 cases (75.6%) of MSM, of whom 119 of 143 (83.2%) were diagnosed with a schizophrenia spectrum psychosis. The treatment status of a schizophrenia spectrum psychosis could be ascertained in 101 of the case reports, of which 54 were in the FEP (53.5%, 95% confidence interval = 43.7%-63.2%). Patients who inflict MSM in FEP exhibited similar symptoms to those who inflict MSM later in their illness. Acute psychosis, in particular first-episode schizophrenia, appears to be the major cause of MSM. Although MSM is extremely uncommon, earlier treatment of psychotic illness may reduce the incidence of MSM.
authors.affiliation: mmbl@bigpond.com
authors.forename: Matthew
authors.initials: M
authors.lastname: Large
authors.forename: Nick
authors.initials: N
authors.lastname: Babidge
authors.forename: Doug
authors.initials: D
authors.lastname: Andrews
authors.forename: Philip
authors.initials: P
authors.lastname: Storey
authors.forename: Olav
authors.initials: O
authors.lastname: Nielssen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000523:psychology / Q000706:statistics & numerical data; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003702:Delusions / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D005131:Eye Injuries / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000293:injuries; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D012652:Self Mutilation / Q000453:epidemiology / Q000523:psychology*; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D013737:Testis / Q000293:injuries; D013850:Thinking / Q000187:drug effects; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents