http://jppbr.
DOI: 10.
21776/ub.
eISSN: 2723-083X pISSN: 2723-0821 Journal of Psychiatry Psychology and Behavioral Research Vol.
No.
September 2023
JPPBR
BILATERAL SELF-ENUCLEATION IN THE FIRST
PSYCHOSIS EPISODE IN A PERSON WITH DEPRIVED OF
LIBERTY: CASE REPORT
Daniela Arias Mariyo1.
Alejandro Rojas Urrea2.
Tania Astrid Adame2.
Lyanne Paola Mesa Huerfano2.
Lorena Garcya Agudelo3 Correspondence: danielaariasmarino@gmail.
Sp.
Bioethics.
Hospital Regional de la Orinoquia.
Yopal.
Colombia.
Hospital Regional de la Orinoquia.
Yopal.
Colombia.
3Sp.
Epidemiology.
Hospital Regional de la Orinoquia.
Yopal.
Colombia
CASE REPORT
OPEN ACCESS
ABSTRACT
Introduction Ae Self-mutilation is an uncommon manifestation of diverse mental disorders and is more frequent in the first psychotic episode.
The ocular, genital, and limb regions are the main areas affected.
Methods Ae Presented the case of a 25-year-old male deprived of liberty who committed bilateral self-enucleation using a razor blade secondary to a first psychosis episode.
Results Ae Patient did the auto-mutilation associated with magical and religious delusions, but there was no clinical evidence to consider it an organic mental disorder.
Discuss Ae Self-multilation during the first episode of psychosis is highly related to schizophrenia spectrum pathologies.
Delusions, especially auditory delusions and substance abuse, should be a red flag of psychosis.
Conclusion Ae Knowledge about the consequences of psychiatric pathologies has a relevant impact on morbidity and mortality, especially in vulnerable populations.
The case demonstrated the necessity of prompt treatment and psychiatric intervention to avert personal and nonpersonal injuries.
Keywords: self-enucleation, self-mutilation, psychosis, self-harm, case report.
Article History:
Received: June 05, 2023 Accepted: August 18, 2023 Published: September 30, 2023 Cite this as:.
Mariyo.
Urrea.
Adame.
Huerfano.
Agudelo.
Bilateral SelfEnucleation in the First Psychosis Episode in a Person with Deprived of Liberty: Case Report.
Journal of Psychiatry Psychology and Behavioral Research.
:7-9.
atmosphere, and other inherent conditions like substance In response to stressful environments and feelings of hopelessness and helplessness, self-harm may be used as a maladaptive coping mechanism to provide relief.
Research estimates that about 30% of incarcerated people engage in selfharm behaviors in comparison to 4% in the general population, and despite that, it is most common to engage in minor selfmutilation.
on the other hand, major self-mutilation could indicate an important health disorder.
Among prisoners, personality disorders prevalence is around 40Ae70%, depression's prevalence is around 10-12%, and psychosis prevalence is 4%.
All these mental disorders have an association with drug abuse, which is particularly high in prisoners, with a prevalence between 10 and 60%.
INTRODUCTION
Non-suicidal major self-mutilation (NSMSM) is an uncommon manifestation of severe mental disorders, but with enormous complications, it drastically limits the quality of life for patients considering the physical disability and the underlying mental problem.
1,2 Frequently, schizophrenia spectrum psychosis is related to NSMSM,1 and some of the risk factors associated are extreme religious hallucinations, command hallucinations, and a previous history of self-injury.
Although the medical literature about the NSMSM is limited, the ocular, genital, and limb regions are the main areas 1 Additionally, self-injury seems to be more likely to occur in the first psychotic episode,3 especially in ocular injuries, where it has been described more frequently in the first episode of psychosis in comparison with previously treated psychosis.
Prisoners are an at-risk population considering mental disorders related to deprivation of liberty, an unfriendly METHOD Presented the case of a 25-year-old male deprived of liberty in a prison without psychiatric history who committed bilateral self-enucleation using a razor blade in the middle of extreme religious delusions.
This study was approved by the hospital's research ethics committee (Hospital Regional de la Orinoquya.
Casanare.
Colombi.
with registration number 019 of June 12.
Figure 1.
Non-contrast computed tomography of the orbits shows the absence of eyeballs .
reen arrow.
, edema .
ed arrow.
, and emphysema .
lue arrow.
in the orbital cavities.
CASE REPORT
A 25-year-old male deprived of liberty in prison sentenced for grand theft since August 2020 by the court without pathologic history who presented two weeks of changes in behavior, aggression, loss of contact with reality, and auditory and visual hallucinations without psychiatric intervention.
The patient was brought to the emergency room by the penitentiary workers after committing self-ocular trauma with an apparent razor blade.
Patient said AuThe devil gouged out my eyes".
Vital signs with blood pressure 140/90 mmHg, cardiac frequency 88 per minute, respiratory frequency 22 per minute, temperature 36 degrees Celsius, ophthalmology exam with bilateral palpebral edema with opening limitation, bilateral exposed ocular tissue, active bleeding, without light perception, and hypotension to digital pressure.
A computed tomography (CT) scan of the orbits showed the absence of eyeballs, edema, and emphysema in the orbital cavities, as well as involvement of soft tissues, extraocular muscles, and optic nerves (Figure .
The patient required bilateral ocular evisceration by the ophthalmologist due to the inability to save any eye.
Additionally, the laboratories revealed urine drug tests positive for opiates and tetrahydrocannabinol (THC), human immunodeficiency virus (HIV) test negative and treponemal test negative, creatinine slightly elevated .
06 mg/dL), serum glucose elevated .
3 mg/dL), and a complete blood count (CBC) reported leukocytosis .
440 mm.
, neutrophilia .
2%), hemoglobin .
4 g/dL), hematocrit .
1%), and platelets .
000 mm.
The patient claimed that "They sent me the devil to be blind," "They did witchcraft to me," and "They smeared shit on me" during the initial psychiatric examination.
He refused to give a complete narrative or provide details.
The mental sphere showed mystical, magical, and paranoid delusions and poor The doctor started pharmacological treatment with clozapine 25 mg at night and clonazepam 0.
5 mg every 12 hours after making the diagnosis of an acute psychotic During the second psychiatric exam, the patient refused again to narrate the event.
he said.
AuI canAot talk about Ay The mental sphere exam showed a patient without desire to talk, an evasive and suspicious attitude, bradypsychia, and mystical, magical, and paranoid delusions.
RESULT
The final assessment prior to referral showed a less evasive patient with laxity in mystical, magical, and paranoid Finally, the patient was referred to a mental health unit to continue management.
The patientAos drug test was positive for THC and opiates, even though it is impossible to say whether they were the direct cause of the psychotic event because the dose, previous consumption, exposure time, and age of first exposure are all unknown.
In addition, urine drug tests were performed after initial pharmacological therapy, which included morphine administration.
Drug use can lead to mental disorders such as schizophrenia.
Even though the details of substance abuse are not fully established, drug use is clearly a risk factor for the development of mental disorders.
DISCUSS
Notice that some authors have been studying eye selfmutilation during the first episode of psychosis.
Large et al.
concluded that self-enucleation is usually unilateral and associated with religious delusions, particularly the right eye mutilation related to the gospel of Matthew, where the removal of the right eye is recommended if it is compromised to avoid the whole-body commitment and prevent going to hell.
Additionally, it is extremely rare to have bilateral selfenucleation and normally requires a high level of 7,8 Other authors also considered these events the results of psychosexual conflicts like Freud's Oedipal Complex.
9,10
Considering that, psychosis must be suspected in cases of selfharm when the self-inflicted injuries are highly harmful with no lethal intention, entail cultural or religious symbolic content, or lack any instrumentalization content.
11 In the case presented, the patient did the auto-mutilation associated with magical and religious delusions, but there was no clinical evidence to consider it an organic mental disorder.
The psychosis spectrum is associated with multiple medical conditions like schizophrenia spectrum disorders or environmental factors like substance abuse, including cannabis, hallucinogens like lysergic acid diethylamide and phencyclidine, and stimulants, including amphetamine and 10,12 Capuzzi et al.
, in a cross-sectional study, which included male prisoners, they found a higher frequency of cocaine and opioid consumption with psychotic symptoms in comparison with those without symptoms.
Untreated psychosis secondary to schizophrenia has been primarily associated with eye self-mutilation, and more frequently in the first episode, this event is congruent with the clinical case presented.
Additionally, the anamnesis showed that our patient had auditory delusions, which are highly related to schizophrenia.
14 For these reasons, this case could perfectly be one of the different pathologies of the schizophrenia spectrum disorders that could be associated with The distinction between them could be a challenge, but nonetheless, it is important to establish a prognosis and contribute to epidemiology statistics.
CONCLUSION
Knowledge about the consequences of psychiatric pathologies has a relevant impact on morbidity and mortality, especially in vulnerable populations.
The case demonstrated the necessity of prompt treatment and psychiatric intervention to avert personal and non-personal injuries.
Financial support: the authors declare no financial support.
Conflicts of interest: the authors declared there was no conflict of interest.
REFERENCES