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Multiple self-inserted pins and nails in pericardium in a patient of schizophrenia: Case report and review.

Soren S - Ind Psychiatry J (2015 Jan-Jun)

Bottom Line: Second attempts are rare.Majority of the patients (85%) are managed by surgery and recover from the injury.The condition has a low mortality rate of 5%.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand, India.

ABSTRACT
This report is the case of multiple self-inserted pins and nails in chest and pericardial cavity in a young male suffering from schizophrenia. This act of self-mutilation was done to get relief from burning sensation in chest and palpitations. Review of the relevant literature revealed that self-inflicted intra-cardiac needle injuries occur mainly in young and middle-aged adults suffering from psychiatric disorders, commonly depression, schizophrenia, and substance use disorders. In one-fourth of the patients, it is due to deliberate self-harm. About 70% use a single needle but 30% may use multiple needles. Second attempts are rare. Majority of the patients (85%) are managed by surgery and recover from the injury. The condition has a low mortality rate of 5%.

No MeSH data available.


Related in: MedlinePlus

Picture of patient showing scar at site of insertion of pins and needles and midline thoracotomy scar
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Figure 1: Picture of patient showing scar at site of insertion of pins and needles and midline thoracotomy scar

Mentions: A 26-year-old Hindu male educated up to class 8th without any past and family history of psychiatric disorders, well-adjusted pre-morbidly, presented to the hospital with the history of being treated by cardiothoracic surgeon for multiple self-inserted nails in pericardium. History revealed that the patient had continuous illness of 4 years characterized by symptoms of muttering and smiling to self, being suspicious towards family members, decreased sleep, aimless wandering behavior, aggressive and assaultive behavior against family members, which was mostly unprovoked, poor self-care, and impaired biological functions. Mental status examination revealed blunted effect and prominent auditory hallucination in the form of people discussing among themselves about him and his actions. For the above symptoms, he was seen by a psychiatrist two years back, but the patient did not show much improvement as he remained poorly compliant to prescribed medications. In the mean time, the patient started having self-injurious behavior in the form of piercing nails and safety pins in his chest wall just adjacent to his left nipple. This behavior was not evident to his parents as he would do this mostly when he would be alone. His injury was noted by his uncle when he had fever and was taken to a doctor who noticed an infective swelling over left chest wall on the side of nipple. When inquired about any chest injury, the patient admitted about his self-mutilating behavior of piercing his chest wall with nails and safety pins. Radiological examination of the chest showed multiple foreign body in the chest wall and pericardial cavity. He was referred to a cardiothoracic surgeon for treatment. After being treated for foreign body in chest and pericardial cavity, patient's guardian came to the hospital for treatment of psychiatric symptoms. On asking the reason for the self-mutilating behavior, patient told that he did it to relieve his feeling of burning sensation in left side of chest and palpitation. The patient did not attribute his self-injury behavior as a response to auditory hallucination. He also said that he did not have much perception of pain during this behavior. Physical examination revealed multiple scar mark over left chest wall and postoperative scar marks over sternum [Figure 1]. Patient was prescribed with tablet trifluperazine 10 mg and trihexyphenidyl 2 mg, and was asked to follow up after 1 month. After 1 month of treatment, patient showed good improvement in psychopathology, and there were no reports of self-injurious behavior during this period.


Multiple self-inserted pins and nails in pericardium in a patient of schizophrenia: Case report and review.

Soren S - Ind Psychiatry J (2015 Jan-Jun)

Picture of patient showing scar at site of insertion of pins and needles and midline thoracotomy scar
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4525439&req=5

Figure 1: Picture of patient showing scar at site of insertion of pins and needles and midline thoracotomy scar
Mentions: A 26-year-old Hindu male educated up to class 8th without any past and family history of psychiatric disorders, well-adjusted pre-morbidly, presented to the hospital with the history of being treated by cardiothoracic surgeon for multiple self-inserted nails in pericardium. History revealed that the patient had continuous illness of 4 years characterized by symptoms of muttering and smiling to self, being suspicious towards family members, decreased sleep, aimless wandering behavior, aggressive and assaultive behavior against family members, which was mostly unprovoked, poor self-care, and impaired biological functions. Mental status examination revealed blunted effect and prominent auditory hallucination in the form of people discussing among themselves about him and his actions. For the above symptoms, he was seen by a psychiatrist two years back, but the patient did not show much improvement as he remained poorly compliant to prescribed medications. In the mean time, the patient started having self-injurious behavior in the form of piercing nails and safety pins in his chest wall just adjacent to his left nipple. This behavior was not evident to his parents as he would do this mostly when he would be alone. His injury was noted by his uncle when he had fever and was taken to a doctor who noticed an infective swelling over left chest wall on the side of nipple. When inquired about any chest injury, the patient admitted about his self-mutilating behavior of piercing his chest wall with nails and safety pins. Radiological examination of the chest showed multiple foreign body in the chest wall and pericardial cavity. He was referred to a cardiothoracic surgeon for treatment. After being treated for foreign body in chest and pericardial cavity, patient's guardian came to the hospital for treatment of psychiatric symptoms. On asking the reason for the self-mutilating behavior, patient told that he did it to relieve his feeling of burning sensation in left side of chest and palpitation. The patient did not attribute his self-injury behavior as a response to auditory hallucination. He also said that he did not have much perception of pain during this behavior. Physical examination revealed multiple scar mark over left chest wall and postoperative scar marks over sternum [Figure 1]. Patient was prescribed with tablet trifluperazine 10 mg and trihexyphenidyl 2 mg, and was asked to follow up after 1 month. After 1 month of treatment, patient showed good improvement in psychopathology, and there were no reports of self-injurious behavior during this period.

Bottom Line: Second attempts are rare.Majority of the patients (85%) are managed by surgery and recover from the injury.The condition has a low mortality rate of 5%.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand, India.

ABSTRACT
This report is the case of multiple self-inserted pins and nails in chest and pericardial cavity in a young male suffering from schizophrenia. This act of self-mutilation was done to get relief from burning sensation in chest and palpitations. Review of the relevant literature revealed that self-inflicted intra-cardiac needle injuries occur mainly in young and middle-aged adults suffering from psychiatric disorders, commonly depression, schizophrenia, and substance use disorders. In one-fourth of the patients, it is due to deliberate self-harm. About 70% use a single needle but 30% may use multiple needles. Second attempts are rare. Majority of the patients (85%) are managed by surgery and recover from the injury. The condition has a low mortality rate of 5%.

No MeSH data available.


Related in: MedlinePlus