Major self-mutilation in the first episode of psychosis

Area of Science:

• Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• Major self-mutilation (MSM) is a severe complication of mental illness.
• MSM is frequently associated with psychotic disorders, especially schizophrenia spectrum disorders.
• The timing of MSM within the course of psychotic illness is not well understood.

Purpose of the Study:

• To determine the proportion of MSM cases occurring during the first episode of psychosis (FEP).
• To investigate if symptoms in FEP-MSM differ from later-onset MSM.
• To identify the primary cause of MSM in relation to psychosis onset.

Main Methods:

• Systematic review of published case reports detailing MSM.
• Inclusion criteria: eye/testicle removal, penile severance, limb amputation, and schizophrenia spectrum psychosis diagnosis.
• Analysis of patient treatment status and illness stage at the time of MSM.

Main Results:

• Of 189 MSM cases, 75.6% had psychotic illness, and 83.2% of those had schizophrenia spectrum psychosis.
• Among treated schizophrenia spectrum psychosis patients, 53.5% of MSM cases occurred during FEP.
• Symptoms in FEP-MSM patients were similar to those with later-onset MSM.

Conclusions:

• First-episode psychosis, particularly schizophrenia, is a significant cause of MSM.
• MSM in FEP suggests acute psychosis is a critical period for this complication.
• Earlier intervention for psychotic disorders may reduce the incidence of severe self-mutilation.