Schizophrenia Bulletin Advance Access published online on May 20, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbn040
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Major Self-mutilation in the First Episode of Psychosis
2 Private Practice, Paddington, New South Wales, Australia
3 Sutherland Hospital, Kingsway, Caringbah 2229, New South Wales, Australia
4 Rural Clinical School, Faculty of Medicine University of New South Wales, Australia
5 North Coast Area Health Service, New South Wales, Australia
6 Rotary Ambassadorial Scholar, Evanston, IL
7 Clinical Research Unit for Anxiety Disorders, School of Psychiatry, UNSW, Darlinghurst, New South Wales, Australia
1 To whom correspondence should be addressed; Private Practice, Paddington, PO Box 110, Double Bay, NSW 1360, New South Wales, Australia; e-mail: mmbl{at}bigpond.com.
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.
Keywords: self-mutilation / schizophrenia / first-episode psychosis
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