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Psychosurgery, the surgical alteration or permanent removal of brain tissue to alleviate severe psychological conditions, stands as one of the most radical and controversial treatments in the history of mental health care. Its development and application have evolved significantly, marked by dramatic shifts in scientific understanding and ethical perspectives.
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Self-Trephination in Cranial Excoriation Disorder.

Coleman P Riordan1, Brittany Owusu-Adjei1,2, Rrita Daci1,2

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Self-trephination, a rare condition involving self-induced skull holes due to compulsive skin picking, presents a severe neurosurgical emergency. Prompt treatment combining antibiotics, surgery, and psychiatric care is crucial for survival.

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Area of Science:

  • Neurosurgery
  • Psychiatry
  • Dermatology

Background:

  • Self-trephination, the creation of skull holes, is rarely self-inflicted.
  • Excoriation disorder involves compulsive skin picking, potentially leading to severe self-harm.
  • Untreated excoriation disorder poses significant health risks.

Purpose of the Study:

  • Describe patients with self-trephination from cranial excoriation.
  • Review clinical presentation, risk factors, and interventions for self-trephination.
  • Analyze complications, treatments, and mortality associated with this condition.

Main Methods:

  • Case series of 5 patients with self-trephination due to cranial excoriation.
  • Review of clinical characteristics, comorbidities, and treatment outcomes.
  • Analysis of surgical and nonsurgical interventions and their efficacy.

Main Results:

  • Self-trephination involves self-inflicted destruction of scalp and skull, breaching the intracranial compartment.
  • Patients frequently exhibit psychiatric comorbidities and brain injury.
  • Treatment failures are common due to poor adherence.

Conclusions:

  • Self-trephination in cranial excoriation disorder is a life-threatening neuropsychological emergency.
  • Requires immediate antibiotics, surgical debridement, and wound repair.
  • Effective psychiatric management, including antidepressants and behavioral therapy, is essential.