OBJECTIVES: To investigate the differences in non-suicidal self-injury (NSSI) behaviors between only-child and non-only-child adolescents with mood disorders. METHODS: A three-stage sampling method was used to perform a cross-sectional survey of 529 adolescents, aged 12-18 years, who had mood disorders and NSSI behaviors. These adolescents were sampled from the outpatient service of 20 mental hospitals in 9 provinces of China from August to November 2020. A self-made questionnaire was used to collect general demographic data. The Functional Assessment of Self-Mutilation, Beck Scale for Suicide Ideation, Kessler Psychological Distress Scale, Stress Mindset Measure-General, Multidimensional Scale of Perceived Social Support, Multidimensional Students' Life Satisfaction Scales, and Rosenberg Self-Esteem Scale were used to collect the information on self-injury behaviors and psychological factors in these adolescents. RESULTS: A total of 529 adolescents with mood disorders and NSSI behaviors were surveyed, among whom 375 were only-child adolescents and 154 were non-only-child adolescents. Compared with the non-only-child group, the only-child group had a significantly higher total score of Functional Assessment of Self-Mutilation (P<0.05) .The type and frequency of self-injury in the only-child group were significantly higher than those in the non-only-child group (P<0.05). Psychological analysis showed that compared with the non-only-child group, the only-child group had a significantly lower score of self-esteem (P<0.05) and significantly higher scores of psychological distress and depressive symptoms (P<0.05). The multiple linear regression analysis showed that the score of suicidal ideation was positively correlated with the frequency of NSSI behaviors in both only-child and non-only-child adolescents with mood disorders (P<0.05); in the only-child adolescents, the level of self-esteem was negatively correlated with the frequency of NSSI behaviors (P<0.05), and the score of stress perception was positively correlated with the frequency of NSSI behaviors (P<0.05); in the non-only-child adolescents, the score of anxious emotion was positively correlated with the frequency of NSSI behaviors (P<0.05). CONCLUSIONS Among the adolescents with mood disorders and NSSI behaviors, the only-child adolescents tend to have a higher frequency of self-injury and poorer mental health, and therefore, the only-child adolescents with mood disorders and NSSI behaviors need more attention.
Adolescent ; Cross-Sectional Studies ; Humans ; Mood Disorders ; Risk Factors ; Self Mutilation ; Self-Injurious Behavior/psychology* ; Suicide, Attempted/psychology*

Lesch-Nyhan syndrome is a rare X-linked recessive metabolic disorder characterized by developmental delay, hyperuricemia, choreoathetosis, spasticity, mental retardation, and compulsive self-injurious behavior. This disorder results from a complete deficiency of the purine salvage enzyme, hypoxanthine-guanine phosphoribosyltransferase (HGPRT). This syndrome is often misdiagnosed to cerebral palsy and clinical manifestations are usually related to the degree of enzyme deficiency. Complete HGPRT deficiency presents with severe specific neurologic manifestation and nephrolithiasis leading to fatal kidney damage. This report highlighted the importance of clinical awareness leading to early diagnosis and therapy for prevention of the self mutilation and renal failure, even if we couldn't inhibit the progression of neuro-psychotic symptoms.
Cerebral Palsy ; Early Diagnosis ; Hyperuricemia ; Hypoxanthine Phosphoribosyltransferase ; Intellectual Disability ; Kidney ; Lesch-Nyhan Syndrome* ; Muscle Spasticity ; Nephrolithiasis ; Neurologic Manifestations ; Renal Insufficiency ; Self Mutilation ; Self-Injurious Behavior

The majority of penile amputations happen by self mutilation because of psychologic problem in adult and by surgical operation accident while doing circumcision in children. In the past when microsurgery was not developed, the survival of a replanted penis depended on sinusoidal blood flow of reapproximated penile tissues. This method resulted in many complications such as tissue necrosis, urethral fistula or stricture, loss of sensation, and erectile dysfunction. Recently, microsurgical method of replantation in the amputated penis could reduce complications that had happened before remarkably and about 40 cases of successful replantation has been reported. However, surgical procedures and results show differences by each and every surgeon. We describe the technique of microsurgical penile replantation and a case followed-up for 6 months. The patient was a 38-year-old man with a history of chronic schizophrenia who emasculated himself with a straw cutter. A particularly good functional result was achieved including restoration of sensation in the penile shaft and in the glans, recovery of normal urinary function, and return of erectile capacity.
Adult* ; Amputation ; Child ; Circumcision, Male ; Constriction, Pathologic ; Erectile Dysfunction ; Female ; Fistula ; Humans ; Male ; Microsurgery ; Necrosis ; Penis* ; Replantation* ; Schizophrenia ; Self Mutilation ; Sensation

PURPOSE: Self-inflicted wrist laceration is a common injury in the department of hand surgery. The aim of this study was to investigate the clinical characteristics and psychiatric features of self-inflicted wrist laceration using categorization according to wound severity. METHODS: We reviewed 71 patients from 2002 through 2012. All of the patients were grouped into four groups. Data regarding the following characteristics were collected: age, gender, size, structure involved, instruments used, history of previous self-inflicted injury, comorbidities in psychiatric and presentation of follow-up outpatient appointment to the department of plastic surgery and psychiatry. RESULTS: In these patients, approximately 64% of patients were female. About 80% of patients cut their wrist using a knife. And in grade 3-4 injury, percentage of glass injury was relatively high (22%), compared with other grades (3%). Unlike previous studies, patients in grade 3-4 tended to cut their wrist repeatedly. Focusing on psychiatric problems, approximately one quarter of patients had a previous history of self-infliction. In all patient groups, mood disorder was the most common disorder in patients who had a previous psychiatric disorder. But after operation, more than two thirds of patients had not visited department of psychiatry again. CONCLUSION: We identified some other differences among their characteristics. All patients in group also should be evaluated and surgically treated properly. A multidisciplinary approach is required for patients with wrist laceration due to self-injury in comparison to those with laceration due to other causes. Because many of them have previous self-injury experiences and psychiatric disease.
Comorbidity ; Female ; Follow-Up Studies ; Glass ; Hand ; Humans ; Lacerations* ; Mood Disorders ; Outpatients ; Retrospective Studies* ; Self Mutilation ; Suicide ; Surgery, Plastic ; Wounds and Injuries ; Wrist*

INTRODUCTIONIn Singapore, as strict laws are a strong deterrent against armed violence, little is known about the epidemiology of penetrating stab wound injuries. Our study aimed to investigate the epidemiology of stab wound injuries at a major trauma centre in Singapore and determine if there was a difference in severity between self-inflicted stab wound (SI) injuries and those inflicted by others (IO).

METHODSWe retrospectively reviewed all penetrating injuries at Tan Tock Seng Hospital, and identified and categorised all stab wound injuries as SI or IO. Basic demographic information, injury severity characteristics and outcome data were compared between these two groups. A review of all mortalities was performed, including recording the causes of death.

RESULTSBetween 2005 and 2010, there were a total of 149 stab wound injuries, of which 24 (16.1%) were SI and 125 (83.9%) were IO injuries. Patients tended to be young (mean age 34.1 ± 14.2 years). The mean Injury Severity Score was significantly different between the SI and IO groups (8.8 ± 6.5 vs. 12.3 ± 8.1; p = 0.03). In both groups, the majority underwent an operative procedure (83.3% vs. 85.6%) and had an average hospital stay of four days.

CONCLUSIONThe study confirms our hypothesis that SI injuries tend to be less severe than IO injuries and are more likely to occur at home rather than at a public area. This finding may be useful in the triage of patients with stab wound injuries.

Adult ; Female ; Follow-Up Studies ; Humans ; Incidence ; Injury Severity Score ; Length of Stay ; trends ; Male ; Retrospective Studies ; Self Mutilation ; diagnosis ; epidemiology ; Singapore ; epidemiology ; Trauma Centers ; Wounds, Stab ; diagnosis ; epidemiology

Hereditory Sensory Automnomic Neuropathy (HSAN) is a rare disorder. Five types of HSAN have been described by Dyck et al. Congenital insensitivity to pain with anhidrosis is classified HSAN Type IV. The clinical features include inability to sweat, causing defective thermoregulation, and congenital analgesia, which leads to orthopedic complications such as osteomyelitis, fractures, self mutilation and neuropathic arthropathies. Abnormal findings on nerve biopsy, virtual absence of unmyelinated nerve fibers, have been reported. We report a 5-year-old boy who presented with congenital insensitivity to pain, anhidrosis with fracture of lateral condyle of humerus and its complication.
Biopsy ; Body Temperature Regulation ; Child, Preschool ; Hereditary Sensory and Autonomic Neuropathies ; Humans ; Humerus* ; Hypohidrosis ; Male ; Nerve Fibers, Unmyelinated ; Orthopedics ; Osteomyelitis ; Pain Insensitivity, Congenital ; Self Mutilation ; Sweat

Congenital insensitivity to pain with anhidrosis (CIPA) is a very rare genetic disorder of the peripheral nervous system characterized by recurrent episodes of unexplained fever, generalized anhidrosis, insensitivity to pain and temperature, and accompanied by self-mutilating behavior and mental retardation. We report on a 16 month-old boy with CIPA who exhibited these characteristic clinical features. A sural nerve biopsy revealed markedly reduced numbers of unmyelinated and small myelinated fibers, consistent with the characteristic features of CIPA.
Atrophy ; Case Report ; Fingers ; Human ; Hypohidrosis/pathology* ; Hypohidrosis/complications ; Infant ; Korea ; Male ; Mental Retardation/pathology ; Mental Retardation/complications ; Microscopy, Electron ; Nerve Fibers/ultrastructure ; Nerve Fibers/pathology ; Pain Insensitivity, Congenital/pathology* ; Pain Insensitivity, Congenital/complications ; Self Mutilation/pathology ; Self Mutilation/etiology ; Sural Nerve/pathology ; Tongue

This case report describes a case of self-inflicted chronic bacterial keratoconjunctivitis involving the patient's own semen. A 20-year-old male soldier was referred to our clinic for the evaluation of refractory chronic bacterial conjunctivitis. Over the previous 4 months, he had been treated for copious mucous discharge, conjunctival injection, and superficial punctate keratitis in both eyes at an army hospital and a local eye clinic. Despite the use of topical and systemic antibiotics according to the results of conjunctival swab culture, there was no improvement. During the repeated smear and culture of conjunctival swabs, surprisingly, a few sperm were detected on Gram staining, revealing that the condition was self-inflicted bacterial keratoconjunctivitis involving the patient's own semen. Thus, in cases of chronic keratoconjunctivitis that do not respond to appropriate antibiotic treatment, self-inflicted disease or malingering should be considered.
Chronic Disease ; Conjunctiva/*injuries/microbiology/pathology ; Cornea/microbiology/*pathology ; Diagnosis, Differential ; Eye Infections, Bacterial/diagnosis/*etiology/microbiology ; Eye Injuries/*complications/diagnosis ; Humans ; Keratoconjunctivitis/diagnosis/*etiology/microbiology ; Male ; Self Mutilation/*complications/diagnosis ; *Semen ; Young Adult

To investigate the role of p38MAPK signal pathway in spinal cord and dorsal root ganglion (DRG) in rats with phantom limb pain and the effects of specific inhibitors.
 Methods: Healthy adult male SD rats (n=48) were cut off one side of the sciatic under anesthesia to establish a model of phantom limb pain. In addition, the healthy rats were taken as a sham group (group S, n=24). The animals were scored by observing the action of chewing (0=no chewing, 13=the worst chewing) after the operation and were sacrificed on the following day after the operation. The successful model of phantom limb pain were randomly divided into 2 groups: a phantom limb pain group (group P, n=24) and a phantom limb pain plus inhibitor group (group P+I, n=24). SB203580 was given to the rat at 0.8 mg/kg on every Monday until the rats were sacrificed, the rest of the rats received an equal amount of saline. Eight rats from each group were randomly taken for the determination of levels of P-p38MAPK in spinal cord and DRG before administration and on the 4th, 6th, 8th weekend following the administration, respectively.
 Results: In the sham group, no animal developed chewing. Meanwhile, rats in successful model of phantom limb pain group began chewing from the 2nd day after operation with scores at eight to eleven. The chewing scores in the P+I group were reduced after the treatment. Compared with group S, P-p38MAPK levels were elevated in groups of P and P+I (P<0.05 or P<0.01). Compared with group P, P-p38MAPK level was decreased in the group P+I (P<0.05 or P<0.01).
 Conclusion: P38MAPK signal pathway involves in the development of phantom limb pain.
Animals ; Disease Models, Animal ; Enzyme Inhibitors ; pharmacology ; Ganglia, Spinal ; enzymology ; Imidazoles ; pharmacology ; Male ; Mastication ; physiology ; Phantom Limb ; enzymology ; etiology ; physiopathology ; Pyridines ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Sciatic Nerve ; injuries ; Self Mutilation ; enzymology ; physiopathology ; Signal Transduction ; Spinal Cord ; enzymology ; p38 Mitogen-Activated Protein Kinases ; antagonists & inhibitors ; metabolism