Assuntos
Hiperuricemia/etiologia , Hiperuricemia/história , Síndrome de Lesch-Nyhan/diagnóstico , Síndrome de Lesch-Nyhan/história , Automutilação/etiologia , Automutilação/história , Marcadores Genéticos , História do Século XX , História do Século XXI , Humanos , Síndrome de Lesch-Nyhan/fisiopatologia , Fenótipo , Prognóstico , Índice de Gravidade de DoençaRESUMO
The objective of this article is to highlight the complexity of the phenomenon of self-mutilation, or self-injury, among individuals with Borderline Personality Disorder. The practice of self-mutilation in this population is strikingly common, with some authors estimating the prevalence to be up to 75%. Particularly noteworthy is the high percentage of patients with Borderline Personality Disorder who state that the act of self-injury has an analgesic effect. This article lays out a few theories that support this finding. Frequently, patients who self-mutilate do not aim to commit suicide but rather, to relieve internal tension. However, clinical interventions are often largely centered on interpreting the self-injurious act as a suicide attempt, with complex therapeutic consequences. A clinical vignette is presented to highlight the aforementioned issues.
Assuntos
Transtorno da Personalidade Borderline , Automutilação , Adulto , Transtorno da Personalidade Borderline/complicações , Transtorno da Personalidade Borderline/terapia , Feminino , Humanos , Dor , Automutilação/etiologiaRESUMO
The objective of this article is to highlight the complexity of the phenomenon of self-mutilation, or self-injury, among individuals with Borderline Personality Disorder. The practice of self-mutilation in this population is strikingly common, with some authors estimating the prevalence to be up to 75
. Particularly noteworthy is the high percentage of patients with Borderline Personality Disorder who state that the act of self-injury has an analgesic effect. This article lays out a few theories that support this finding. Frequently, patients who self-mutilate do not aim to commit suicide but rather, to relieve internal tension. However, clinical interventions are often largely centered on interpreting the self-injurious act as a suicide attempt, with complex therapeutic consequences. A clinical vignette is presented to highlight the aforementioned issues.
Assuntos
Transtorno da Personalidade Borderline , Automutilação , Adulto , Transtorno da Personalidade Borderline/complicações , Transtorno da Personalidade Borderline/terapia , Feminino , Humanos , Dor , Automutilação/etiologiaRESUMO
The objective of this article is to highlight the complexity of the phenomenon of self-mutilation, or self-injury, among individuals with Borderline Personality Disorder. The practice of self-mutilation in this population is strikingly common, with some authors estimating the prevalence to be up to 75
. Particularly noteworthy is the high percentage of patients with Borderline Personality Disorder who state that the act of self-injury has an analgesic effect. This article lays out a few theories that support this finding. Frequently, patients who self-mutilate do not aim to commit suicide but rather, to relieve internal tension. However, clinical interventions are often largely centered on interpreting the self-injurious act as a suicide attempt, with complex therapeutic consequences. A clinical vignette is presented to highlight the aforementioned issues.
Assuntos
Automutilação , Transtorno da Personalidade Borderline , Adulto , Automutilação/etiologia , Dor , Feminino , Humanos , Transtorno da Personalidade Borderline/complicações , Transtorno da Personalidade Borderline/terapiaRESUMO
Acute transverse myelitis (ATM) is an inflammatory disorder that affects the spinal cord. It is characterized by signs and symptoms of neurologic dysfunction in the motor and sensory tracts of the spinal cord bilaterally, resulting in weakness, sensory loss, and autonomic dysfunction with acute or subacute onset. We report on a child who had ATM and respiratory distress requiring ventilatory assistance who presented with severe self-mutilation involving his lips. Other findings included bruxism that had caused mobility of the primary teeth. Comprehensive dental care was carried out under sedation. The management of the lip trauma was achieved by the use of a soft, plastic mouth guard, and corticosteroid ointment.
Assuntos
Mordeduras Humanas/etiologia , Assistência Odontológica para a Pessoa com Deficiência , Lábio/lesões , Mielite/complicações , Automutilação/etiologia , Mordeduras Humanas/prevenção & controle , Bruxismo/etiologia , Bruxismo/prevenção & controle , Traumatismos Faciais/prevenção & controle , Humanos , Lactente , Masculino , Protetores BucaisRESUMO
Congenital insensitivity to pain with anhidrosis is a rare autosomal-recessive disorder characterized by unexplained fever episodes, anhidrosis, pain insensitivity, self-mutilating behavior, and mental retardation. The lack of sensitivity to pain results in traumatic lesions, such as ulcers, fractures, burns, bites, scars, and digital amputations. Several methods have been suggested to treat these patients; however, appropriate management is difficult, especially when the mutilation is particularly severe. This report describes the case of a 2-year-old female patient who had severe self-mutilating injuries to her tongue, hands, lips, and oral mucosa caused by biting. The patient presented digital amputation and also a premature loss of a permanent tooth germ during the treatment. The dental management is described and discussed. It is important to include the dentist on the multidisciplinary team to reduce the frequency and severity of the self-inflicted lesions in these patients, also to prevent complications.
Assuntos
Mordeduras Humanas/etiologia , Úlceras Orais/etiologia , Insensibilidade Congênita à Dor/complicações , Mordeduras Humanas/complicações , Mordeduras Humanas/prevenção & controle , Pré-Escolar , Consanguinidade , Feminino , Traumatismos dos Dedos/etiologia , Humanos , Hipo-Hidrose/complicações , Lábio/lesões , Mucosa Bucal/lesões , Equipe de Assistência ao Paciente , Automutilação/etiologia , Síndrome , Língua/lesões , Extração DentáriaRESUMO
Lesch-Nyhan syndrome (LNS) is a rare X-linked recessive disorder involving purine metabolism caused by the congenital absence of hypoxanthine guanine phosphoribosyl transferase. A characteristic feature of LNS is the appearance of intractable self-injurious behavior, usually in the form of severe lip and finger biting. The mechanism behind this severe self-mutilating behavior is unknown, and is one of the main challenges in the management of this condition. We here report the case of a 30-year-old man with a confirmed diagnosis of LNS who was successfully treated for self-mutilation of his lips with repeated botulinum toxin A (BTX-A) injections in the facial perioral muscles. Our findings suggest that treatment with BTX-A helped reduce self-abusive behavior in this patient. Our case illustrates that BTX-A injections can be a useful therapeutic approach in patients with self-abusive behavior.
Assuntos
Antidiscinéticos/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Síndrome de Lesch-Nyhan/complicações , Automutilação/tratamento farmacológico , Adulto , Face , Humanos , Injeções Intramusculares , Lábio/lesões , Masculino , Automutilação/etiologia , Resultado do Tratamento , CicatrizaçãoRESUMO
Se reportan los hallazgos encontrados a partir de NeuroSPECT en trastornos del ánimo, incluyendo trastorno bipolar, depresión mayor y auto-mutilación. Se compararon los resultados de una muestra de 29 pacientes con trastorno afectivo en espectro bipolar complicado con conductas auto-mutilatorias, un grupo de 20 pacientes bipolares sin auto-mutilación y 22 pacientes depresivos sin auto-mutilación. Dentro de los hallazgos destaca la asociación entre trastornos del ánimo y auto-mutilación con hiper-perfusión talámica bilateral en el segmento dorso-ventral-anterior, asociado a hipo-perfusión en corteza peri-límbica (áreas 32, 24 y 23 de Brodmann). Los múltiples reportes que relacionan, tanto en animales como en humanos, las conductas auto-mutilatorias con fenómenos de hipo-algesia, anestesia o disestesias, permiten hipotetizar la participación de una disfunción en circuitos tálamo-peri-límbicos asociados a vías nocioceptivas y a conciencia somato-psíquica y su relación con fenómenos auto-mutilatorios.
We report NeuroSPECT findings in mood disorders, including bipolar disorder, major depression and self-mutilation. We compare results in 29 patients with bipolar disorder complicated by self-mutilation, a group of 20 patients with bipolar disorder uncomplicated and 22 patients with mayor depression uncomplicated by self-mutilation. Among the NeuroSPECT findings we report the association of mood disorders and self-mutilation with hyperperfusion of the anterior-dorsal-ventral segment of both thalami concomitant with hypoperfusion in perilimbic cortex, namely areas 32, 24 (anterior cingulate gyrus) and 23 of Brodmann. Multiple reports in the literature relate both, in animals and man, self-mutilation with phenomena of hypoalghesia, anesthesia, or dysestesias and are the basis for our hypothesis linking dysfunction of limbic-thalamic circuits, associated with nocioceptive fibers, somato-psychic consciousness and self-mutilation phenomena.
Assuntos
Animais , Humanos , Tomografia Computadorizada de Emissão de Fóton Único , Transtorno Bipolar , Transtorno Bipolar/fisiopatologia , Transtorno Depressivo Maior , Transtorno Depressivo Maior/fisiopatologia , Automutilação/etiologia , Córtex Cerebral , Córtex Cerebral/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Compostos Radiofarmacêuticos , Transtorno Bipolar/complicações , Transtorno Depressivo Maior/complicações , Tálamo , Tálamo/fisiologiaRESUMO
Moebius syndrome (MS) is a rare disorder mainly characterized by bi- or unilateral palsy of the facial and abducens nerves. Among the various orofacial characteristics related to this syndrome, the following are pointed out, difficulty with sucking, tongue malformation, mandibular hypoplasia, saliva drooling, arched palate and micrognathia. In spite of the diversity of oral features described for these patients, self-inflicted oral trauma has not yet been reported. Therefore, the purposes of the present report were to describe an unusual case of a baby with Moebius syndrome who had a parafunctional habit that resulted in a persistent traumatic lesion of the lower lip, and discuss the treatment performed.
Assuntos
Lábio/lesões , Síndrome de Möbius/complicações , Automutilação/etiologia , Mordeduras Humanas/etiologia , Humanos , Lactente , MasculinoRESUMO
Congenital Insensitivity-to-pain with anhidrosis (CIPA) is a rare disorder in which pain perception is absent from birth, despite the fact that all other sensory modalities remain intact or minimally impaired and tendon reflexes are present. The challenge in dentistry is to manage the self-mutilation behavior avoiding serious damages especially to oral structures, hands and fingers. A Brazilian case of CIPA is presented and discussed with clinical documentation of the oral-related problems over a 4-year follow-up. A conservative treatment (mouthguard-like appliance) was proposed with the objective to avoid full mouth extraction.