Ten-year cardiovascular disease risk and related factors in lifetime marijuana use with comorbid methamphetamine-associated psychotic disorder: a QRISK®3 study.

BACKGROUND: Methamphetamine use and related direct and indirect problems are increasing all over the world. The coexistence of lifetime marijuana use (LMU) and methamphetamine use disorder (MUD) may also be accompanied by psychotic symptoms (MAP). Methamphetamine and marijuana use are known to pose risks for cardiovascular diseases (CVDs). However, ten-year CVD risk and inflammation markers of LMU-MUD (non-psychosis group) and LMU-MAP (psychosis group) subjects and the relationship of various sociodemographic and clinical variables with these markers have not yet been examined. METHODS: Thirty-two male subjects were included in non-psychosis group and 72 male subjects in psychosis group. Sociodemographic and clinical characteristics were recorded. Psychotic symptom severity of psychosis group subjects was measured. The ten-year CVD risk was calculated using QRISK®3 model. RESULTS: Age, cigarettes/pack-years, alcohol use onset age, drug use onset age, methamphetamine use onset age, duration of methamphetamine use, education and marital status of the groups were similar (p > 0.05). There was a statistical difference between the non-psychosis and psychosis groups in terms of self-mutilation history (p < 0.001), suicidal attempt history (p = 0.007), homicidal attempt history (p = 0.002), psychiatric hospitalization history (p = 0.010). Ten-year QRISK®3 score was 4.90 ± 9.30 in the psychosis group, while it was 1.60 ± 1.43 in the non-psychosis group (p = 0.004). The mean heart age of the psychosis group was 14 years higher than their chronological age, while the mean heart age of the non-psychosis group was 8 years higher. Neutrophil to lymphocyte ratio (NLR) (p = 0.003) was higher in the psychosis group. A significant correlation was detected between ten-year QRISK®3 and positive psychotic symptoms in the psychosis group (r = 0.274, p = 0.020). Regression analysis showed that self-mutilation history, NLR and relative risk obtained from QRISK®3 can be used to distinguish non-psychosis group and psychosis group subjects (sensitivity = 91.7; Nagelkerke R2 0.438; p = 0.001). CONCLUSIONS: This study is important as it demonstrates for the first time that among the subjects using marijuana and methamphetamine, those with psychotic symptoms have a higher NLR and ten-year CVD risk.

Self-inflicted penile and testicular amputation: A very rare case report and treatment dilemma in the absence of microsurgical service.

INTRODUCTION AND IMPORTANCE: Genital self-mutilation is a rare urologic surgical emergency that is usually encountered in patients with underlying psychiatric illness. Because of shortage of published data and variance in management schemes worldwide, these conditions can present a significant management dilemma. CASE PRESENTATION: In this case report we present this rare phenomenon, where a known schizophrenic patient presented after he amputated both of his testes and penis under the influence of command hallucination. After 15 h of the incident, macroscopic replantation of the severed genitalia was done and psychiatric evaluation and management initiated simultaneously. But the replantation failed after 9th post operative day. DISCUSSION: Initial management of patients presenting with genital amputation should be resuscitation. The severed organ has to be washed with sterile saline and placed in "double bag". There are multiple factors for the success of replantation, the major ones are cooling of the amputated organ and precise microsurgical replantation. CONCLUSION: Early intervention and microscopic replantation are crucial for the successful outcome.

Self-inflicted tourniquet application resulted with two fasciotomies: Case report of an initially omitted Munchausen case.

INTRODUCTION: Compartment syndrome is an emergency which requires prompt intervention. While main challenge typically revolves around determining necessity for fasciotomy in suspected cases, etiology is often pronounced, leaving little room for differential diagnosis. CASE REPORT: We report a case with unconventional presentation and clinical course, ultimately diagnosed as Munchausen Syndrome. DISCUSSION: It has been reported that individuals with Munchausen syndrome are successful at manipulating healthcare professionals. They often study the symptoms of their sickness, examination findings, and findings that may alert doctors, mastering their techniques over time. CONCLUSION: It is of importance to consider Munchausen Syndrome as a potential cause, particularly in cases where clinical history and course of symptoms do not align with our experiences and cannot be reconciled with other possible diagnostic patterns.

Genital self-mutilation in psychiatric patients: A case report.

INTRODUCTION: Genital self-mutilation presents significant surgical challenges, particularly when complicated by psychiatric disorders. This case highlights the critical role of surgical intervention in the management of self-inflicted severe penile injuries and underscores the need to integrate surgical and psychiatric care to optimise results. CASE PRESENTATION: A 43-year-old man, with progressive psychiatric issues, self-inflicted penile amputation. He arrived late in the emergency room with a poorly preserved amputated penis, complicating potential reimplantation. The surgeons extensively debrided and created a urethrostomy on the anterior scrotum wall, preparing for future phalloplasty. This planning ensured tissue viability and minimised postoperative complications. Early psychiatric evaluations revealed hebephrenic schizophrenia. Unfortunately, after psychiatric stabilisation, he was lost to follow-up and was not present for phalloplasty. DISCUSSION: Severe penile lesions require restoration of appearance, preservation of functions, and minimisation of complications. The surgical approach depends on the hospital capabilities, expertise, and patient condition, our patient's case required an anterior urethral anastomosis of the scrotum wall in consideration of phalloplasty. Pairing surgical intervention with immediate psychiatric care is crucial for optimal outcomes. However, the loss of follow-up postpsychiatric discharge in our patient highlights the need for improved monitoring to ensure adherence to treatment. CONCLUSIONS: This case highlights the interaction between severe genital trauma, psychiatric instability, and surgical management in patients who engage in self-genital mutilation. It underscores the importance of a multidisciplinary approach that involves both surgical and psychiatric. Enhanced strategies for psychiatric involvement and monitoring are crucial, especially for people scheduled for complex reconstructive surgeries such as phalloplasty.

A rare case of congenital insensitivity to pain with anhidrosis.

A 22-month-old girl of consanguineous parents was admitted with a high-grade fever. She was found to have insensitivity to painful stimuli and an absence of perspiration. She also displayed self-mutilating behaviour and was insensitive to cold/hot water on her body. On examination, there was loss of the tip of the tongue, missing teeth, generalised xerosis, and several ulcers at sites of minor trauma. She also had dysplastic nails and digital ulcers. Sensory examination demonstrated a complete lack of awareness of pain and temperature, vibration and fine touch were intact and lacrimation was normal. Differential diagnoses of hereditary sensory and autonomic neuropathy (HSAN), Lesch-Nyhan syndrome, hypohidrotic ectodermal dysplasia and leprosy were considered. Results of routine blood investigations including serum uric acid were normal. On performing clinical exome sequencing, the diagnosis of congenital insensitivity to pain with anhidrosis (CIPA) of autosomal recessive inheritance was confirmed. A novel, predicted to be pathogenic variant detected at exon 16 of the NTRK1 gene resulting in congenital insensitivity to pain with anhidrosis is reported.Abbreviations: CIPA: congenital Insensitivity to pain with anhidrosis; HSAN: hereditary sensory and autonomic neuropathy; NGF: nerve growth factor; NTRK1: neurotrophic tyrosine kinase receptor 1 gene; TrKA: tropomyosin receptor kinase A.

O nascimento das automutilações como categoria nosográfica / The birth of self-mutilations as a nosographic category

O objetivo do presente artigo é analisar o fenômeno das automutilações, trazendo à luz a complexidade desse campo de estudos e visando apresentar a construção de uma categoria nosográfica para as automutilações. Elas se caracterizam pelo ato de ferir o próprio corpo voluntariamente, sem intenção consciente de morte, e podem se apresentar de diversas formas, configurando diferentes tipos de comportamentos. Partindo das discussões existentes na literatura sobre o fenômeno, inicialmente circunscritas à psiquiatria e, posteriormente apropriadas pela psicanálise, apresentamos um percurso histórico do conceito, contextualizando suas aparições em diferentes cenas e formas psicopatológicas. Buscamos ainda fomentar uma discussão acerca do estatuto do fenômeno automutilatório: trata-se apenas de um sintoma, prevalente em diferentes quadros clínicos, ou estaríamos falando de uma síndrome, entidade clínica diferenciada que afunila e congrega outros comportamentos? Nesse cenário, destacamos o caráter transnosográfico das automutilações, uma vez que o fenômeno perpassa diversos quadros clínicos na forma de sintoma, ao mesmo tempo em que começa a se configurar como uma entidade nosográfica separada de outras doenças.

The aim of this article is to analyze the phenomenon of self-mutilations, to highlight the complexity of this field of study, and to present the construction of a nosographic category for self-mutilation. They are characterized by the act of voluntarily injuring one's own body, without a conscious intention of death, and they can manifest in different ways, configuring different types of behavior. Based on existing discussions in the literature on the phenomenon, initially limited to psychiatry and later appropriated by psychoanalysis, we present a historical trajectory of the concept, contextualizing its appearances in different psychopathological scenes and forms. We also seek to encourage a discussion about the statute of the self-mutilating phenomenon: would it be just a symptom, prevalent in different clinical conditions, or would we be talking about a syndrome, a differentiated clinical entity that narrows down and brings together other behaviors? In this scenario, we highlight the transnosographic character of self-mutilation, since the phenomenon permeates several clinical conditions in the form of symptoms, while at the same time it can be configured as a nosographic entity separate from other diseases.

Hospital-presenting self-harm among older adults living in Ireland: a 13-year trend analysis from the National Self-Harm Registry Ireland.

OBJECTIVES: To examine trends in rates of self-harm among emergency department (ED) presenting older adults in Ireland over a 13-year period. DESIGN: Population-based study using data from the National Self-Harm Registry Ireland. SETTING: National hospital EDs. PARTICIPANTS: Older adults aged 60 years and over presenting with self-harm to hospital EDs in Ireland between January 1, 2007 and December 31, 2019. MEASUREMENTS: ED self-harm presentations. RESULTS: Between 2007 and 2019, there were 6931 presentations of self-harm in older adults. The average annual self-harm rate was 57.8 per 100,000 among older adults aged 60 years and over. Female rates were 1.1 times higher compared to their male counterparts (61.4 vs 53.9 per 100,000). Throughout the study time frame, females aged 60-69 years had the highest rates (88.1 per 100,000), while females aged 80 years and over had the lowest rates (18.7 per 100,000). Intentional drug overdose was the most commonly used method (75.5%), and alcohol was involved in 30.3% of presentations. Between the austerity and recession years (2007-2012), self-harm presentations were 7% higher compared to 2013-2019 (incidence rate ratio (IRR): 1.07 95% CI 1.02-1.13, p = 0.01). CONCLUSIONS: Findings indicate that self-harm in older adults remains a concern with approximately 533 presentations per year in Ireland. While in younger age groups, females report higher rates of self-harm, this gender difference was reversed in the oldest age group (80 years and over), with higher rates of self-harm among males. Austerity/recession years (2007-2012) had significantly higher rates of self-harm compared to subsequent years.

Lesch-Nyhan syndrome: a case report.

Lesch-Nyhan syndrome (LNS) is a rare X-linked recessive disorder caused by a mutation in the hypoxanthine phosphoribosyltransferase 1 (HPRT1) gene. This syndrome is characterized by excessive production of uric acid, mental retardation, self-mutilation, choreoathetosis, and spasticity. The most distinctive symptom is compulsive self-mutilation. For patients with LNS, different methods have been tried to reduce self-biting behaviors including restraints, behavioral treatment, medications, deep brain stimulation, tooth extraction and botulinum toxin A injection. In this report, we present a case of LNS undergoing cheiloplasty due to self-mutilation and tooth extraction of the left deciduous maxillary canine.

Suicide by sharp force associated with major self-mutilation and self-cannibalism.

Self-stabbing and self-cutting represents an uncommon method of suicide. We present a case of a 30-year-old man who was found dead in the forest. The body was naked and showed multiple cut and stab wounds on different parts of the body (face, neck, chest, abdomen, and extremities). A single-edged kitchen knife was found approximately 20 m from the body. Parts of both ears, the fifth toe of the right foot, and the scrotum were cut off. At the autopsy, two of the severed body parts-the toe and the part of the left ear-were found in the stomach. The cause of death was asphyxiation due to blood aspiration resulting from a cut throat injury. A police investigation uncovered a history of substance abuse and two previous suicidal attempts using a knife. Upon complex analysis of all the evidence, the manner of death was ruled a suicide, which was preceded by actions of major self-mutilation and self-cannibalism, both considered rare behavioral patterns.

Replantation of an Amputated Hand at Wrist Level Due to Self-Mutilation: Considerations in Management.

Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illnesses. Limb amputations are grievous injuries that radically decrease the quality of life. Controversy exists as to the advisability of replantation of the self-amputated limb. We report a case of self-amputation of the hand in a 54-year-old gentleman in a fit of psychosis. He underwent replantation of the hand and was given timely psychiatric help. Interdisciplinary management helped in improving the mood of the patient and he cooperated well with the rehabilitation schedule. Recent literature encourages surgeons to replant the limb and treat the mental illness with close observation for warning signs. We conclude that replantation along with early initiation of psychiatry treatment can help the patient overcome psychosis, realize the implications of his actions, and provide the motivation to perform physiotherapy to achieve the optimum outcome possible in the replanted hand.

Successful penile reimplantation after 8 h post penile self-mutilation: A case report.

Key Clinical Message: Penile self-mutilation may result from a suicidal attempt during a major depression crisis. The management of this urological emergency should be multidisciplinary. A macroscopic penile reimplantation performed meticulously by a urological surgeon may yield an excellent cosmetic and functional outcome. Abstract: Penile self-mutilation is an infrequent form of self-harming behavior seen primarily in patients with schizophrenia spectrum disorders and rarely reported in those with major depressive disorders.We herewith present a major depression related case of penile self-mutilation successfully managed by macroscopic penile reimplantation performed 8 h after the incident.

Self-inflicted bilateral ocular injury with scissors in a psychiatric patient.

A young male was brought to the ophthalmic emergency by his family with severe bleeding from both eyes after self-inflicted injury with scissors in a fit of mania. He had a history of schizophrenia and has been on irregular treatment for the past 10 years. Both eyes were severely damaged with avulsion of all extraocular muscles in one eye and a large corneoscleral laceration in the other. We report this unique case of oedipism or self-enucleation where a sharp instrument was used. Self-inflicted injury to the eyes is a rather uncommon phenomenon described in psychiatric patients. It can range from minor abrasions to severe ocular mutilation and loss of sight. The strict observation of these patients while admitted to the hospital and a multidisciplinary approach to ensure their future safety are imperative.

The Relationship Between Nonsuicidal Self-injury and Attachment: Protocol for a Systematic Review and Meta-analysis.

BACKGROUND: The prevalence of nonsuicidal self-injury (NSSI) is a major concern in public health. Two main factors (individual and environmental) cause NSSI. Studies addressing NSSI often consider it as an emotion regulation strategy. Studying NSSI within the framework of attachment theory is reasonable since the capacities to regulate emotion come into existence in the framework of attachment in the first periods of a child's growth. Primary studies addressing this topic are not frequent, and no systematic review has been conducted. OBJECTIVE: This systematic review and meta-analysis protocol aims to investigate the relationship between NSSI and attachment style and finding its relationship based on study design, study type, different types of attachments, and gender. METHODS: All studies on the relationship between NSSI and attachment will be included in this systematic review. We will include observational studies (cross-sectional, cohort, and case control) through searches in electronic databases via PubMed, CINAHL, Embase, Web of Science, ProQuest, Scopus, PsycINFO, and Google Scholar as complementary search. Qualitative studies, case studies, case series, and letters to the editor will be excluded. There will be no language limitation. Moreover, there will be no limitations regarding the study participants' age, gender, nationality, sexual orientation, and psychological problems. Funnel plots were examined if 10 or more studies are included, and the Begg and Egger statistical tests were used to assess the risk of bias. All similar data will be combined through the "metan" command by Stata statistical package (StataCorp). A fixed-effects or random-effects model, considering methodological similarities or differences, will be selected to determine a combination model. RESULTS: We will summarize the selection of the eligible studies using a flowchart. The results will be presented in a table of evidence. The results of the meta-analysis will be depicted using diagrams and tables. CONCLUSIONS: It seems necessary to carry out such systematic and comprehensive meta-analysis to present a summary of the published articles in terms of the relationship between NSSI and attachment. The results from this review will be used to improve our knowledge of the role of the upbringing of children and NSSI behavior and will help design appropriate interventions to address NSSI. TRIAL REGISTRATION: PROSPERO CRD42021226455; https://tinyurl.com/yc77wny8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40808.

Association Between Internet Searches Related to Suicide/Self-harm and Adolescent Suicide Death in South Korea in 2016-2020: Secondary Data Analysis.

BACKGROUND: Previous studies have investigated the association between suicide and internet search volumes of terms related to suicide or self-harm. However, the results varied by people's age, period, and country, and no study has exclusively investigated suicide or self-harm rates among adolescents. OBJECTIVE: This study aims to determine the association between the internet search volumes of terms related to suicide/self-harm and the number of suicides among South Korean adolescents. We investigated gender differences in this association and the time lag between the internet search volumes of the terms and the connected suicide deaths. METHODS: We selected 26 search terms related to suicide and self-harm among South Korean adolescents, and the search volumes of these terms for adolescents aged 13-18 years were obtained from the leading internet search engine in South Korea (Naver Datalab). A data set was constructed by combining data from Naver Datalab and the number of suicide deaths of adolescents on a daily basis from January 1, 2016, to December 31, 2020. Spearman rank correlation and multivariate Poisson regression analyses were performed to identify the association between the search volumes of the terms and the suicide deaths during that period. The time lag between suicide death and the increasing trend in the search volumes of the related terms was estimated from the cross-correlation coefficients. RESULTS: Significant correlations were observed within the search volumes of the 26 terms related to suicide/self-harm. The internet search volumes of several terms were associated with the number of suicide deaths among South Korean adolescents, and this association differed by gender. The search volume for "dropout" showed a statistically significant correlation with the number of suicides in all adolescent population groups. The correlation between the internet search volume for "dropout" and the connected suicide deaths was the strongest for a time lag of 0 days. In females, self-harm and academic score showed significant associations with suicide deaths, but academic score showed a negative correlation, and the time lags with the strongest correlations were 0 and -11 days, respectively. In the total population, self-harm and suicide method were associated with the number of suicides, and the time lags with the strongest correlations were +7 and 0 days, respectively. CONCLUSIONS: This study identifies a correlation between suicides and internet search volumes related to suicide/self-harm among South Korean adolescents, but the relatively weak correlation (incidence rate ratio 0.990-1.068) should be interpreted with caution.

Congenital insensitivity to pain associated with PRDM12 mutation: Two case reports and a literature review.

Background: PRDM12 is a newly discovered gene responsible for congenital insensitivity to pain (CIP). Its clinical manifestations are various and not widely known. Methods: The clinical data of two infants diagnosed with CIP associated with PRDM12 mutation were collected. A literature review was performed, and the clinical characteristics of 20 cases diagnosed with a mutation of PRDM12 were summarized and analyzed. Results: Two patients had pain insensitivity, tongue and lip defects, and corneal ulcers. The genomic analysis results showed that variants of PRDM12 were detected in the two families. The case 1 patient carried heterozygous variations of c.682+1G > A and c.502C > T (p.R168C), which were inherited from her father and mother, respectively. We enrolled 22 patients diagnosed with CIP through a literature review together with our cases. There were 16 male (72.7%) and 6 female (27.3%) patients. The age of onset ranged from 6 months to 57 years. The prevalence of clinic manifestation was 14 cases with insensitivity to pain (63.6%), 19 cases with self-mutilation behaviors (86.4%), 11 cases with tongue and lip defects (50%), 5 cases with mid-facial lesions (22.7%), 6 cases with distal phalanx injury (27.3%), 11 cases of recurrent infection (50%), 3 cases (13.6%) with anhidrosis, and 5 cases (22.7%) with global developmental delay. The prevalence of ocular symptoms was 11 cases (50%) with reduced tear secretion, 6 cases (27.3%) with decreased corneal sensitivity, 7 cases (31.8%) with disappeared corneal reflexes, 5.5 cases (25%, 0.5 indicated a single eye) with corneal opacity, 5 cases (22.7%) with corneal ulceration, and 1 case (4.5%) with a corneal scar. Conclusion: The syndrome caused by PRDM12 mutation is a clinically distinct and diagnosable disease that requires joint multidisciplinary management to control the development of the disease and minimize the occurrence of complications.

Male genital trauma caused by self-mutilation: A first case series report in Indonesia.

INTRODUCTION AND IMPORTANCE: Genital self-mutilation (GSM) is a rare phenomenon with a spectrum ranging from a superficial laceration to complete amputation of the external genitalia. These could result in severe impairment of genitourinary functions. Psychotic disorder adds to the complexity of the patients. Since GSM is underreported, we report the first case series in Indonesia. CASE PRESENTATION: Four included patients comprised different injuries to the external genitalia, from a superficial laceration to penile amputation. Notably, these patients exhibited psychotic traits. Initial management consisted of bleeding control, debridement, and primary suturing. Depending on the extent of the injury, the repair comprised of spermatic cord ligation, penile reconstruction using a skin flap, defect closure with urethral spatulation, and exploration. We successfully managed all the patients surgically before undergoing psychotherapy to improve the patient's overall well-being and to reduce the risk of similar reoccurrence of GSM behavior. CLINICAL DISCUSSION: The majority of GSM cases were associated with psychotic disorders. The current reports' injuries include penile laceration, total penile amputation, unilateral castration, and combined injury to the penis and scrotum. Although most GSM is not life-threatening, it may cause emergent, complex, and serious complications such as massive hemorrhage and severe infections. Appropriate investigations with systematic treatment strategies are required, especially in complex cases. CONCLUSION: The incidence of genital self-mutilation necessitates a prompt evaluation of organ viability and the possibility of preserving tissue for optimal urinary and sexual outcomes. Interdisciplinary collaboration is required as the primary concern for management in cases of genital self-mutilation involving male genitalia and underlying psychological disorders.

A Rare and Complex Case of Non-suicidal Self-Mutilation in a Patient With Schizophrenia.

The literature describing acts of non-suicidal self-mutilation (NSSM) in the adult population is limited. Of the cases that document NSSM, a disproportionate number of these individuals have a history of psychiatric illnesses. Although the motivation to perform NSSM varies across patients, the literature suggests that past self-injurious behaviors, extreme religious delusions, and command hallucinations are the most significant risk factors. The primary forms of NSSM include ocular, genital, and limb mutilation. Limb mutilation is the least common of the three and typically occurs proximal to the wrist or hand. Here, we present a rare case involving a 42-year-old man with schizophrenia who was hospitalized due to osteomyelitis of his autoamputated digits. This case is unique in involving multiple digits of the hand and using a rare amputation method. We aim to compare this case with the existing body of work on NSSM and identify factors that may predispose patients to act on these extreme impulses. We also highlight a novel interventional program that reduces psychiatric and medical comorbidities.

Violência autoprovocada no Espírito Santo: uma análise dos casos notificados / Self-inflicted violence in Espírito Santo: an analysis of reported cases / Violencia autoinfligida en Espírito Santo: un análisis de los casos notificados

Objetivo: identificar a frequência de casos notificados de violência autoprovocada no Espírito Santo entre os anos de 2011 a 2018 e os fatores associados. Método: trata-se de um estudo transversal que utilizou todos os casos notificados de violência autoprovocada registrados no Sistema de Informação de Agravos de Notificação entre 2011 e 2018 no estado do Espírito Santo. A análise multivariada foi realizada pela Regressão de Poisson e o estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: a prevalência da violência autoprovocada foi de 25,1% (IC95%: 24,6-25,5). O grupo de 10 a 19 anos de idade teve uma prevalência cerca de 19 vezes maior de notificação de violência autoprovocada, assim como, pessoas de raça/cor branca (RP: 1,26) e com deficiência/transtornos (RP: 2,85) apresentaram maior frequência desse agravo. Foi observado maior prevalência entre aqueles sem suspeita de uso de álcool (RP: 2,36), com a ocorrência cerca de 4 vezes maior na residência, e, um aumento em cerca de 50% dos casos sem caráter de repetição. Conclusão: a violência autoprovocada no Espírito Santo se apresentou elevada no período estudado e esteve associada a características da vítima e do evento. Profissionais de saúde são fundamentais no processo de rastreio desse agravo e consequentemente em traçar estratégias de prevenção e proteção das vítimas.(AU)

Objective: to analyze the prevalence of reported cases of self-inflicted violence and associated factors in Espírito Santo between 2011 and 2018.Method: this is a cross-sectional study that used all reported cases of self-inflicted violence registered in the Sistema de Informação de Agravos de Notificação between 2011 and 2018, in the state of Espírito Santo. Multivariate analysis was performed using Poisson Regression.Results: the prevalence of self-inflicted violence was 25.1%. The 10 to 19-year-old group had a prevalence of approximately 19 times greater self-inflicted violence report, as did people of white race/color (PR: 1.26) and people with disabilities/disorders (PR: 2.85) showed a higher frequency of this problem. A higher prevalence was observed among those without suspected alcohol use (PR: 2.36), with an occurrence approximately four times higher in the home, and an increase in approximately 50% of non-repeating cases.Conclusion: reports of self-inflicted violence in Espírito Santo were high during the period studied and were associated with characteristics of the victim and the event. Health professionals are fundamental in the process of tracking this problem and consequently in the process of designing prevention and protection strategies for victims.(AU)

Objetivo: analizar la prevalencia de casos notificados de violencia autoinfligida en Espírito Santo entre los años 2011 y 2018, así como los factores asociados. Método: se trata de un estudio transversal que utilizó todos los casos notificados de violencia autoinfligida registrados en el Sistema de Información de Agravios de Notificación entre 2011 y 2018 en el estado de Espírito Santo. El análisis multivariado se llevó a cabo mediante la Regresión de Poisson. Resultados: la prevalencia de la violencia autoinfligida fue del 25,1%. El grupo de 10 a 19 años de edad presentó una prevalencia aproximadamente 19 veces mayor de notificación de violencia autoinfligida. Asimismo, las personas de raza/color blanco (RP: 1,26) y con discapacidad/trastornos (RP: 2,85) mostraron una mayor frecuencia de este agravio. Se observó una mayor prevalencia entre aquellos sin sospecha de uso de alcohol (RP: 2,36), con una ocurrencia aproximadamente cuatro veces mayor en la residencia, y un aumento de alrededor del 50% en los casos sin carácter repetitivo. Conclusión: las notificaciones de violencia autoinfligida en Espírito Santo fueron elevadas en el período estudiado y se asociaron con características de la víctima y del evento. Los profesionales de la salud desempeñan un papel fundamental en el proceso de detección de este agravio y, consecuentemente, en el diseño de estrategias de prevención y protección de las víctimas.(AU)

Characteristics associated with non-suicidal self-injury among veterans seeking military sexual trauma-related mental healthcare.

Military sexual trauma (MST) is a serious issue among Veterans; it is associated with increased rates of posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), both of which are correlated with poorer mental health outcomes, including increased suicide risk. Additional insight into the characteristics associated with NSSI among Veterans with MST can help identify individuals at increased risk for suicide and other negative outcomes and improve care for Veterans with a history of MST. The current study was comprised of 327 Veterans referred for MST-related mental health services at a VHA hospital. Participants completed a semi-structured interview for clinical symptoms, including NSSI behaviors. Results of a retrospective chart review revealed a high endorsement of lifetime NSSI (26.9%) with cutting behaviors identified as the most frequently endorsed method. Logistic regression showed personality features, history of cumulative sexual trauma, and younger age were uniquely related to lifetime NSSI. These results corroborate previous findings that show elevated rates of NSSI among Veterans with exposure to trauma. This study expands upon previous findings by examining risk factors specific to treatment-seeking Veterans with a history of MST, which can aid clinical care and risk management procedures in Veteran healthcare.