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Self-mutilation and sleep stage in the Lesch-Nyhan syndrome.

Correlation of self-mutilation and sleep stage in the Lesch-Nyhan syndrome was studied by a polygraphic method. Five patients and three control boys were monitored with EEG, EOG, EMG, ECG and respiration throughout the night. The results were as follows: 1. The sleep-time of the patients was much disturbed during the night. 2. Decreased REM density was noticed with low DQ of the patients. 3. Self-mutilation during sleep-time was observed a lot in stages 1, 2, and REM in two cases. 4. No correlation was observed between body movement and self-mutilation in the Lesch-Nyhan syndrome. These data suggested functional disorders of the frontal lobe in the patients.

Adolescent

[Unusual self mutilation with the purpose of obtaining illegal insurance benefits].

In this unusual form of self mutilation the fracture of the phalanx has been carried out--upon request--by foreign person (inderect self mutilation), in order to obtain illegal accident insurance money. Short survey of the relevant literature is given and the possibilities are outlined, which facilitate at the primary wound dressing the establishment of suspicious cases.

Absenteeism

Self-mutilation of the eye.

While the act of self-enucleation is rare, other self-inflicted eye injuries may be more common. Six patients are reported who have documented histories of ocular self-mutilation. Several common factors are observed in these patients and in other cases reported in the literature: (1) the patient was judged to be psychotic; (2) the patient had a tyrannical conscience; (3) a source of guilt was present; (4) this guilt was displaced to the eye; and (5) an attempt at self-inflicted eye injury was followed by relief from anxiety when completed or by frustration when injury was prevented.

Adult

The pathology of self-mutilation and destructive acts: a forensic study and review.

Self-destructive behavior of man and its consequences may be presented in various forms, including self-mutilation, injury, and malingering, and with various manifestations, including the Munchausen syndrome, polysurgery, purposeful accidents, impotence, and frigidity. The general subject of focal suicide has been a relatively unknown and unrecognized entity for different reasons, including the fact that most physicians are trained to approach a case in a manner which treats the patient-physician relationship as one of honor and faith regarding the authenticity of the complaints of the patient. The maturity of years and experience may be required before the physician becomes aware of the motivation of patients' behavior. It is hoped that this article will provide new insight into areas which may be unfamiliar to the forensic practitioner and clinician but which might enable them to learn about the background of an unexpected death or the possibilities of motivation in civil suits alleging professional negligence or malpractice.

Forensic Medicine

Male genital self-mutilation.

Men who intentionally mutilate or remove their own genitals are likely to be psychotic at the time of the act, to have a number of goals and aims relating to conflicts about the male role, and to be vulnerable to sociocultural and psychological forces in a causal network as yet unknown. However, from a review of the cases of 53 male self-mutilators, it appears that a significant number involve individuals not psychotic at the time of the act but rather having character disorders and rageful feelings toward themselves or women, and transsexual males who premeditate their own gender conversion surgery. The psychiatric consultant's role in the management of such an individual in the general hospital setting includes not only care of a patient with a psychotic or impulse disorder but also involves support of the house staff, who are distressed by the fear, guilt, hopelessness, anger, and revulsion that the patient's act of genital self-mutilation causes.

Adult

Self-mutilation of the penis in C57BL/6N mice.

A major cause of male reproductive failure in a C57BL/6N mouse production colony is self-inflicted mutilation of the penis. The extent of the damage ranged from loss of the distal end to loss of the entire penis. From January 1974 to August 1976, 645 adult male mice with mutilated penis were removed from this colony--where the monthly census was 9500 mice, mated 1 male to 4 females using a continuous mating system. On necropsy, it was observed that the substance blocking the urethra in the penile stump resulted in urine retention, grossly distending the urinary bladder. Proteus mirabilis and other bacteria isolated from the urethral plugs were considered secondary invaders.

Animals

Auto-mutilation in animals and its relevance to self-injury in man.

Self-mutilation in non-human mammals is a well-established, although not a widely known phenomenon, which has been reported under zoo and laboratory conditions. In macaque monkeys, laboratory rearing and isolation are important predisposing factors, and the more serious self-injury is initiated by some immediate stimulating event. It is commonly accompanied by behaviour normally shown by the animal in a fighting context. Lower mammals are also known to mutilate themselves under laboratory conditions after administration of drugs wich probably cause increased sympathetic activity. The implications of this behaviour for an understanding of states of self-injury in man are discussed.

Aggression

Hypoxanthine guanine phosphoribosyltransferase (HGPRT) in Gilles de la Tourette syndrome.

Hypoxanthine guanine phosphoribosyltransferase (HGPRT) and adenosine phosphoribosyltransferase (APRT) were examined from 11 individuals with Gilles de la Tourette syndrome, 10 of their first- or second-degree relatives, and 3 normal controls. It has been suggested that in some self-mutilating Tourette patients, HGPRT shows a time-related loss of activity at 4 degrees C, and an unusual isoelectrofocusing pattern. Although 3 patients experienced self-mutilation, no consistent abnormalities were found in the temperature-stability of their HGPRT at 4 degrees C and 70 degrees C, or in isoelectrofocusing of HGPRT purified by immunoprecipitation. An alteration of the purine metabolic pathway in Tourette syndrome has not been established.

Female