title: Self-amputation of the hand: issues in diagnosis and general hospital management.
abstract: OBJECTIVE
  To detail a diagnostic dilemma of intentional hand amputation in a man with a history of substance misuse and associated psychosis, depression and traumatic brain injury and to highlight issues in joint psychiatric and surgical management of such a complex patient in a general hospital setting.
  
  
  CONCLUSIONS
  Deliberate limb self-amputation is a rare event with the majority of reported cases occurring during an episode of psychosis. This case illustrates the diagnostic utility of the literature supporting that a person who has self-inflicted amputation of a limb should be treated as psychotic until proven otherwise. The presence of a traumatic brain injury, with associated cognitive and psychosocial sequelae, affected diagnosis and management. Early and ongoing involvement of consultation-liaison psychiatry collaborating with a multidisciplinary general hospital team may improve mental and physical health outcomes for such patients.
authors.affiliation: Trainee in Psychiatry, South Eastern Sydney Local Health District, NSW, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Crawford
authors.affiliation: Staff Specialist Psychiatrist, Consultation-Liaison Psychiatry and Conjoint Senior Lecturer, South Eastern Sydney Local Health District, NSW, and; Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia a.wand@unsw.edu.au.
authors.forename: Anne Pf
authors.initials: AP
authors.lastname: Wand
authors.affiliation: Staff Specialist Psychiatrist, Consultation-Liaison Psychiatry and Conjoint Lecturer, South Eastern Sydney Local Health District, NSW, and; Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000671:Amputation, Surgical / Q000523:psychology*; D019468:Disease Management; D006769:Hospitals, General; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis*; D012017:Referral and Consultation; D016728:Self-Injurious Behavior / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult
keywords: amputation; consultation-liaison; psychosis; self-mutilation; traumatic brain injury