The Surgical Management of Patients Who Deliberately Self-Harm

Abstract

INTRODUCTION Deliberate self-harm is a common problem that often requires orthopaedic treatment. Patients with injuries due to deliberate self-harm are often referred to our unit. This study assessed the type of treatment required and the cost of treatment. PATIENTS AND METHODS We undertook a retrospective survey of deliberate self-harm patients with known ICD-10 psychiatric disorders admitted for orthopaedic care from a medium-secure, female-only, psychiatric unit. Data were collected on admission rate, duration of stay, surgical interventions and complications. RESULTS Over a 36-month period there were 73 admissions for 15 patients (mean age, 25.1 years) requiring 65 operative interventions, a mean of 4.3 (range, 0-9) per patient. Over 50% of patients were admitted more than 3 times, totalling 416 hospital bed-days and 80% had methicillin-resistant Staphylococcus aureus (MRSA) isolated. The orthopaedic treatment costs for these patients was £453,000 during the period studied. DISCUSSION The significant resources required to manage this patient cohort demonstrates the need for a co-ordinated management policy. We recommend day-case surgery for infected wounds only. Postoperatively, wounds should be protected with plaster of Paris. All patients with deliberate self-harm should be regarded as being infected with MRSA.

Selbstverletzendes Verhalten und komorbide psychische Störungen: ein Überblick

“…Differenzierte Analysen zeigen, dass dieselben spezifischen Diagnosen wie bei den Jugendlichen vorlagen. Dennoch trat eine generalisierte Angststörung bei den Jugendlichen viermal so häufig [17,18,21,29,32,33] und eine posttraumatische Belastungsstörung [17,18,21,33,29,34] fast doppelt so häufig auf wie bei Erwachsenen. In einem ähnlichen Größenverhältnis stehen Alkoholmissbrauch und Alkoholabhängigkeitsstörung (2,5-fach höhere Rate bei Jugendlichen) [17,18,21,29,32] und erwartungsgemäß externalisierende Störungen, die primär in der Kindheit und Jugend diagnostiziert werden, bei Erwachsenen und Jugendlichen (3,9-fach höhere Rate bei Jugendlichen).…”

A Systematic Approach to Effectively Treat Chronic Wounds Caused by Self-Harm: Two Case Reports

“…Finally, a self-care "rescue pack" can provide early patientled intervention, by not only preventing cutaneous wound aggravation, but also by empowering patients to sustain their safety [8]. Rescue packs may contain gloves, dressing materials, and a wound-care leaflet that enables patients or guardians to effectively manage wounds by themselves.…”

“…Meltzer [7] reported that approximately 50% of people with schizophrenia experience self-injury. Additionally, common risk factors associated with self-injurious behaviors include major depressive disorder with psychotic features and manic episode of bipolar I disorder [8]. Although there are various psychological drivers of self-destruction, most forms result in cutaneous wounds.…”

Foreign bodies in the sigmoid colon of a psychiatric patient following self-mutilation: a case report

“…Evidence of self-mutilation and drug use have been reported in patients with severe psychiatric disorders and in incarcerated felons [ 8 – 10 ]. Therefore, self-mutilation should always be considered by emergency room physicians in cases of injuries in patients with unusual behavior and psychiatric disorders as well as incarcerated individuals [ 11 , 12 ].…”