Automutilación en Trastorno Borderline de Personalidad. ¿El dolor como auto tratamiento? Un caso clínico / [Self mutilation in borderline personality disorder. Pain as a self-treatment? A case report].

The objective of this article is to highlight the complexity of the phenomenon of self-mutilation, or self-injury, among individuals with Borderline Personality Disorder. The practice of self-mutilation in this population is strikingly common, with some authors estimating the prevalence to be up to 75

. Particularly noteworthy is the high percentage of patients with Borderline Personality Disorder who state that the act of self-injury has an analgesic effect. This article lays out a few theories that support this finding. Frequently, patients who self-mutilate do not aim to commit suicide but rather, to relieve internal tension. However, clinical interventions are often largely centered on interpreting the self-injurious act as a suicide attempt, with complex therapeutic consequences. A clinical vignette is presented to highlight the aforementioned issues.

Alteraciones neuro-funcionales en trastornos del ánimo que cursan con conductas auto-mutilatorias: estudio de perfusión regional cerebral a partir de la técnica de Neuro-SPECT Tc99-HMPAO / Neuro functional alterations in mood disorders with self-injurious behavior: study of regional cerebral perfusion through Tc-99m HMPAO NeuroSPECT

Se reportan los hallazgos encontrados a partir de NeuroSPECT en trastornos del ánimo, incluyendo trastorno bipolar, depresión mayor y auto-mutilación. Se compararon los resultados de una muestra de 29 pacientes con trastorno afectivo en espectro bipolar complicado con conductas auto-mutilatorias, un grupo de 20 pacientes bipolares sin auto-mutilación y 22 pacientes depresivos sin auto-mutilación. Dentro de los hallazgos destaca la asociación entre trastornos del ánimo y auto-mutilación con hiper-perfusión talámica bilateral en el segmento dorso-ventral-anterior, asociado a hipo-perfusión en corteza peri-límbica (áreas 32, 24 y 23 de Brodmann). Los múltiples reportes que relacionan, tanto en animales como en humanos, las conductas auto-mutilatorias con fenómenos de hipo-algesia, anestesia o disestesias, permiten hipotetizar la participación de una disfunción en circuitos tálamo-peri-límbicos asociados a vías nocioceptivas y a conciencia somato-psíquica y su relación con fenómenos auto-mutilatorios.

We report NeuroSPECT findings in mood disorders, including bipolar disorder, major depression and self-mutilation. We compare results in 29 patients with bipolar disorder complicated by self-mutilation, a group of 20 patients with bipolar disorder uncomplicated and 22 patients with mayor depression uncomplicated by self-mutilation. Among the NeuroSPECT findings we report the association of mood disorders and self-mutilation with hyperperfusion of the anterior-dorsal-ventral segment of both thalami concomitant with hypoperfusion in perilimbic cortex, namely areas 32, 24 (anterior cingulate gyrus) and 23 of Brodmann. Multiple reports in the literature relate both, in animals and man, self-mutilation with phenomena of hypoalghesia, anesthesia, or dysestesias and are the basis for our hypothesis linking dysfunction of limbic-thalamic circuits, associated with nocioceptive fibers, somato-psychic consciousness and self-mutilation phenomena.

Dental management of patients suffering from [Lowe syndrome]

Lowe syndrome [LS] is an x-linked recessive disorder of unknown etiology resulting in ocular, cerebral and renal disorder. It is X linked recessive disorder, caused by a defective gene on Chromosome number Xq 26. Males are more affected than females. Clinical features are bilateral congenital cataract [100%], Glaucoma, Infantile hypotonia, gross motor developmental delay, reduced or absent deep tendon reflexes, muscle wasting, moderate to severe mental retardation, frequent high pitched scream seizures, growth failure, Rickets, Joint hyper mobility and renal manifestations. Prognosis is poor for normal life style. There are developmental delays, visual problems and progressive mental retardation. The patient dies in the first decade of complication of Fanconi syndrome if treatment is not provided. Lifespan can be extended with supportive therapy. A case of LS with dental management, although not ideal is presented. Mentally retarded patients needs regular dental visits to reduce avoidable dental pain

Unusual self-inflicted penetrating craniocerebral injury by a nail.

Penetrating injuries of the brain caused by a nail are rare. An interesting case of a patient with schizophrenia who attempted suicide by a self-inflicted penetrating intracranial injury using a nail is reported here. The literature related to this unusual case is reviewed.

Congenital insensitivity to pain with anhidrosis: a case report

Congenital insensitivity to pain with anhidrosis (CIPA) is a very rare genetic disorder of the peripheral nervous system characterized by recurrent episodes of unexplained fever, generalized anhidrosis, insensitivity to pain and temperature, and accompanied by self-mutilating behavior and mental retardation. We report on a 16 month-old boy with CIPA who exhibited these characteristic clinical features. A sural nerve biopsy revealed markedly reduced numbers of unmyelinated and small myelinated fibers, consistent with the characteristic features of CIPA.