2-Fluorodeschloroketamine consumption: About two deaths and a case of self-mutilation.

2-Fluorodeschloroketamine (2-FDCK) is a new psychoactive substance (NPS), close to the ketamine structure. Few cases of 2-FDCK intake are described in the forensic literature, especially concerning death cases. We report here a case of self-mutilation (Case 1) and two forensic deaths linked to 2-FDCK consumption. The second case involved a man found dead in the street, having been stabbed. The third case was a man found dead following a suspected overdose and in an advanced state of putrefaction. For all three cases, biological fluids such as blood and urine were analyzed, as was hair for the two fatal cases. The aim of this study was to identify and quantify 2-FDCK and its main metabolites in different matrices. Biological fluids and hair were analyzed by liquid chromatography coupled with tandem mass spectrometry after decontamination and extraction. Seized products were analyzed by gas chromatography-mass spectrometry and assayed, when possible, by ultra-performance liquid chromatography with diode-array detection. 2-FDCK was detected and quantified in the peripheral blood of Cases 1, 2 and 3 (457, 758 and 5885 µg/L, respectively), as were its main metabolites nor-2-FDCK, dihydro-nor-2-FDCK and dihydro-2-FDCK. In the 1 cm long hair of Cases 2 and 3, 2-FDCK was also detected (approximately 4149 and 79824 pg/mg, respectively). Deschloroketamine (DCK) was found in the biological fluids of Cases 1, 2 and 3 (10, 8 and 350 µg/L, respectively), as well as in hair of Cases 2 and 3 (65 and around 8119 pg/mg, respectively). In Case 3, as a small bag containing DCK powder was seized from his home, we can assume that DCK was taken. On the contrary, to our knowledge, it has not been established that Case 2 took DCK alone, so we can assume that it may be the first case to report DCK from 2-FDCK metabolism in fluids as well as in hair.

Oral self-inflicted accidental trauma in patients with neurological disorders: a case report of dental management in infants with cerebellar hypoplasia.

Self-inflicted oral injuries, accidental or otherwise, can cause major consequences. Measures need to be taken to protect individuals from chronic self-injurious behaviour; however, there are no official guidelines on the subject. The purpose of this article is to show the case of a 1-year-old patient with neurological disorders who, following the eruption of deciduous teeth, had self-inflicted a traumatic ulcer on his tongue and lower lip. Following a multidisciplinary approach involving several operating units of our hospital to make a diagnosis, an oral device was designed to completely cover the dental elements to prevent recurrence of the trauma and to prevent further worsening of the injuries already caused. The purpose of this work is to demonstrate that although the surgical approach, such as extraction of the dental elements, may be the quickest solution in situations similar to the one presented, the high biological cost and irreversibility of the result lead to seeking alternatives and more conservative solutions such as the one described.

Retraumatización en los servicios de salud mental: una revisión y propuesta de actuación alternativa / Retraumatization in Mental Health Services: A Review and Alternative Proposals

Las experiencias traumáticas son muy frecuentes entre las personas que acu-den a los servicios de salud mental. Hay evidencia de que las circunstancias vitales de las personas juegan un papel fundamental en el desarrollo y el mantenimiento de los problemas psicológicos, emocionales y conductuales. Sin embargo, las experiencias trau-máticas se infradetectan en los servicios de salud mental y, con frecuencia, ni los servi-cios ni las prácticas que se realizan en ellos están adaptadas a esta realidad. Existe una diversidad de prácticas, desde el modelo de comprensión de lo que le ocurre a la persona hasta experiencias relacionadas con el trato o la coerción, que pueden retraumatizar. Se realiza una revisión narrativa sobre la presencia del trauma en las personas que acuden a los servicios de salud mental, las prácticas retraumatizantes y las propuestas para avanzar hacia servicios conscientes del trauma. (AU)

Traumatic experiences are very common among people attending mental heal-th services. There is evidence that people's life circumstances play a fundamental role in the development and maintenance of psychological, emotional and behavioral problems. However, traumatic experiences are underdetected in mental health services and, fre-quently, neither the services nor the practices carried out in them are adapted to this rea-lity. There is a diversity of practices, from the model of understanding what is happening to the person to experiences related to treatment or coerción, that can retraumatize. A narrative review on the presence of trauma in people attending mental health services is carried out. Retraumatizing practices and some proposals to move towards trauma-informed services are examined. (AU)

Treatment of a Ballistic Radius Fracture with Segmental Bone Loss Using the Masquelet Technique in a Child: A Case Report.

CASE: A 4-year-old boy sustained an accidental self-inflicted gunshot wound to the left forearm. Radiographs revealed a comminuted mid-diaphyseal ballistic radius fracture with a critical-sized bone defect. The fracture was treated with the placement of a flexible intramedullary nail and antibiotic cement spacer, followed by second-stage bone grafting and open reduction and internal fixation of the radius 6 weeks later. Four months after the second-stage procedure, the radial defect healed appropriately without complications. CONCLUSION: In this case of a pediatric comminuted mid-diaphyseal radius fracture with bone loss, the induced membrane technique resulted in healing across a critical-sized bone defect.

[The therapeutic mediation device in the clinic of adolescent action]. / Le dispositif à médiations thérapeutiques dans la clinique de l'agir adolescent.

The pathologies of the adolescent act illustrate the overflow so characteristic of the "modernity" of a world in perpetual evolution. Through compulsive bodily symptoms that are as noisy as they are enigmatic (self-mutilation, suicide attempts, addictions, fast sex, eating disorders), adolescents are always in search of transitional and containing spaces, which are indispensable for symbolizing and calming destructuring intrapsychic conflicts. Therapeutic mediations, adapted to the different singularities, offer a space through which integration and subjectivation processes are possible.

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)

Genital Mutilation in Males.

PURPOSE OF THE REVIEW: Genital mutilation in males can range from minor injuries (cuts from a blade) to severe urological emergencies (testicular or penile amputation). Due to the rarity of these events, there is a lack of extensive reports, as most of the available literature is regarding single cases. Genital mutilation has been associated with psychotic and non-psychotic causes, psychiatric conditions, drug consumption, sexual practices, or even cultural or religious beliefs. It is crucial to perform a psychiatric evaluation of these patients to obtain the best therapeutic approach. This manuscript serves as a review of the currently available knowledge regarding male genital mutilation. RECENT FINDINGS: A great variety of reasons have been associated with genital mutilation. Previous authors have distinguished between those that present with a clear mental health precursor from cases with no psychotic background. Nevertheless, sometimes, it is difficult to make this distinction. Recently, reconstructive techniques for amputation cases have moved towards a microsurgical approach in order to improve outcomes. A holistic therapeutic approach must be performed to increase the chances of effective treatment. Close collaboration between urologists, psychiatrists, and emergency doctors is essential to ensure the best care for patients performing genital mutilation. Future publications must evaluate differences in treatment options and the impact that these have on the long-term well-being of patients undergoing genital self-mutilation.

Disparities in disposition from trauma centers to inpatient psychiatric treatment in a national sample of patients with self-inflicted injury.

BACKGROUND: Surgery providers are integral to the treatment of patients with self-inflicted injuries. Patient disposition (eg, home, inpatient psychiatric treatment, rehabilitation) is important to long-term outcomes, but little is known about factors influencing disposition after discharge following traumatic self-inflicted injury. We tested whether patient or injury characteristics were associated with disposition after treatment for self-inflicted injury. METHODS: National Trauma Data Bank query for self-inflicted injuries from 2010 to 2018. RESULTS: There were 77,731 patients treated for self-inflicted injuries during the study period. Discharge home was the most common disposition (45%), and those without insurance were less likely to discharge to inpatient psychiatric treatment than those with insurance. Racial minority patients were less likely to discharge to inpatient psychiatric treatment (18.9%) than nonminority patients (23.8%, P < .001). Additionally, patients discharged to inpatient psychiatric treatment had significantly lower injury severity score (7.24 ± 7.5) than those who did not (8.69 ± 9.1, P < .001). CONCLUSION: Racial/ethnic minority patients and those without insurance were significantly less likely to discharge to an inpatient psychiatric facility after treatment at a trauma center for self-inflicted injury. Future research is needed to evaluate the internal factors (eg, trauma center practices) and external factors (eg, inpatient psychiatric facilities not accepting patients with wound care needs) driving disposition variability.

[Conservative therapy after self-mutilation of the scrotum resulting in bilateral testicular underperfusion]. / Konservative Therapie nach Automutilation des Skrotums mit Folge einer beidseitigen testikulären Minderperfusion.

We report the case of a patient with massive penile and scrotal swelling due to use of a compression ring with auto-erotic intent and under the influence of addictive substances. Based on the patient history, the mechanical pressure on the scrotum was about 30 hours (h). The Doppler sonogram showed no central perfusion in either testicle. Conservative treatment with antibiotics and analgesics was initiated with a slight increase in inflammatory parameters and local edema and necrosis formation. Follow-up showed regression of swelling, healing of necrosis and improvement of laboratory parameters. Testosterone substitution therapy was necessary due to the bilateral testicular atrophy that developed.

Tiros na escola: algumas referências para a psicologia na assistência à comunidade escolar / School shotting: some references for psychology in school comunity support / Tíros em la escuela: algunas referencias para la psicología em la asistencia à comunidad escolar

A atuação em situações de emergências e desastres apresentam-se como um dos grandes desafios na atuação dos profissionais da Psicologia, demandando intervenções singulares, desde o primeiro contato com as vítimas e o com entorno afetado pelo ocorrido, passando pelo trabalho interdisciplinar e interinstitucional junto aos órgãos públicos de segurança, justiça, assistência e saúde. O presente artigo tem como objetivo apresentar, por meio da experiência na assistência às vítimas na Escola Estadual Raul Brasil, as particularidades e adversidades enfrentadas durante o primeiro semestre de intervenções emergenciais que antecederam a contratação de psicólogos por parte do poder público municipal para continuidade das ações. Por meio de relatos de experiência em intervenções psicológicas, obtidos em diferentes instituições para a assistência às vítimas, este trabalho também visa apresentar alternativas que possam servir de referências para a intervenção do psicólogo e da psicóloga em situações de emergências e desastres, especialmente ocorridas na comunidade escolar. Observou-se que a realização do trabalho interdisciplinar e interinstitucional somado à participação da direção da escola no planejamento das ações e a realização de plantões psicológicos e rodas de conversa junto à comunidade escolar foram fundamentais para a assistência às vítimas do ocorrido.(AU)

Timely response to emergency and disaster situations is a major challenge for Psychology professionals and require particular interventions, from initial contact with the victims and the affected environment to interdisciplinary and interinstitutional collaboration with public security, justice, assistance and health agencies. Based on the experience of providing assistance to the victims of the State School Raul Brasil, this paper presents the adversities and specificities faced during the first semester of emergency interventions implemented before psychologists were hired by municipal officials for the continuity of care. By analyzing experience reports on psychological interventions obtained from different institutions for victim assistance, this paper proposes alternatives to be used as reference for psychological intervention in emergency and disaster situations, especially those experienced by the school community. Interdisciplinary and interinstitutional collaboration with the school board for planning actions and offering psychological services and conversation circles for the school community was fundamental to assist the victims.(AU)

La actuación en situaciones de emergencias es uno de los grandes desafíos a los profesionales de la psicología, pues demanda intervenciones singulares desde el primer contacto con las víctimas y con el contexto afectado por lo ocurrido, pasando por la interdisciplinaridad e interinstitucionalidad junto a los organismos públicos de seguridad, justicia, asistencia y salud. Este artículo tiene como objetivo presentar, por medio de la experiencia de la asistencia a las víctimas del colegio estadual Raul Brasil (en São Paulo, Brasil), las particularidades y adversidades enfrentadas durante el primer semestre de las intervenciones de emergencia que antecedieron la contratación de psicólogos por parte del municipio para continuidad de las acciones. Por medio de reportes de experiencia en intervenciones psicológicas, obtenidos en diferentes instituciones para la asistencia a las víctimas, este estudio también pretende presentar alternativas que puedan servir de referencia en la intervención de psicólogos y psicólogas en situaciones de emergencia y desastres, especialmente ocurridas en la comunidad escolar. Se verificó que la realización del trabajo interdisciplinar e interinstitucional, la participación de la dirección del colegio en la implementación de acciones y la realización de guardias psicológicas y círculos de conversación con la comunidad escolar fueron fundamentales para una asistencia a las víctimas.(AU)

Sentimentos e percepções do luto de sobreviventes ao suicídio de jovens / Feelings and perceptions of grief among survivors of youth suicide / Sentimientos y percepciones de duelo entre sobrevivientes de suicidio de jóvenes

Sobreviventes ao suicídio são pessoas que têm suas vidas profundamente afetadas e apresentam sofrimento psicológico, físico ou social após serem expostas a esse fato. O objetivo deste estudo foi analisar a experiência de sobreviventes ao suicídio de jovens, a partir do luto. Participaram sete sobreviventes entre familiares, amigos e parceiros amorosos de jovens que cometeram suicídio. A análise de conteúdo de entrevistas narrativas apontou que os participantes utilizam explicações racionalizadas ou dissociadas, criando uma distância entre o evento e eles mesmos. Como formas de lidar com o sofrimento podem buscar o isolamento, apoio entre amigos, prática religiosa e/ou a dedicação ao trabalho. Reafirma-se a dimensão do luto diante dessa experiência, além da importância da prevenção ao suicídio e da posvenção aos sobreviventes.(AU)

Suicide survivors are people who have their lives deeply affected; they experience psychological, physical, and social suffering following the occurrence. The aim of this study is to analyze the experience of survivors of youth suicide attempts, based on grief. Seven survivors participated among family, friends, and romantic partners of young people who committed suicide. The content analysis of narrative interviews showed that the participants use rationalized or dissociated explanations, creating a distance between the event and themselves. As ways to deal with suffering, they seek isolation, support among friends, religious practice, and/or dedication to work. The dimension of grief in the face of this experience is reaffirmed, as well as the importance of suicide prevention and postvention for survivors.(AU)

Este artículo tiene como objetivo presentar la construcción metodológica desarrollada en una investigación de maestría, en la que sostenemos la escritura de escenas como método de investigación de la escucha clínica. Las escenas del trabajo en cuestión se recogieron a lo largo del tiempo desde la experiencia en un proyecto de extensión universitario de atención a la niñez y adolescencia en situación de vulnerabilidad social aplicado en una comunidad periférica. En este texto, presentamos los interrogantes que se elaboraron en torno a la elección por el trabajo con escenas y compartimos el rescate histórico de las mismas como un método de escribir la clínica y la reanudación del análisis a partir de la tradición psicoanalítica. Amparadas en el psicoanálisis y en lecturas y contribuciones del filósofo francés Jacques Derrida, nos basaremos en la noción de que la escena se constituye como un lugar de producción, engendrando la configuración particular de elementos significantes en los procesos de subjetivación y de construcción social. La escena no es aquí una representación de lo que pasa en la clínica, sino un modo de producir escucha y sus procesos de investigación.(AU)

Significados e ações frente à automutilação no contexto educacional brasileiro: revisão sistemática / The meanings and practices regarding self-mutilation in the brazilian educational context: a systematic review

Buscou-se descrever como a automutilação é compreendida pelas instituições de ensino e quais são as ações realizadas frente ao fenômeno, a partir de uma revisão sistemática de literatura. Em busca no Portal BVS, SciELO e no Catálogo de Teses da Capes, utilizando os descritores automutilação, autolesão, comportamento autolesivo e comportamento autodestrutivo, selecionou-se 20 documentos que foram submetidos à análise de conteúdo. Identificou-se que os estudos são recentes, predominantemente qualitativos, influenciados pela Análise do Comportamento e Psicanálise, e desenvolvidos junto a adolescentes de escolas públicas. A automutilação foi compreendida como decorrente de condições fisiológicas, forma de dar sentido ao sofrimento, resultado de contágio social, tentativa de comunicação, manifestação de ideação suicida e comportamento de indivíduos com desenvolvimento atípico. Há poucos relatos de intervenção frente ao problema, abarcando práticas clínicas, preventivas e de formação profissional. Destaca-se a necessidade da ampliação de práticas nas escolas compreendendo a automutilação numa perspectiva social e coletiva.

Se buscó describir cómo la automutilación es comprendida por las instituciones de enseñanza y cuáles las acciones realizadas frente al fenómeno, a partir de una revisión sistemática de literatura. En búsqueda en el Portal BVS, SciELO y en el Catálogo de Tesis de la Capes, utilizándose los descriptores automutilación, autolesión, comportamiento autolesivo y comportamiento autodestructivo, se seleccionó 20 documentos que se sometieron al análisis de contenido. Se identificó que los estudios son recientes, predominantemente cualitativos, influenciados por el Análisis del Comportamiento y Psicoanálisis, y desarrollados junto a adolescentes de escuelas públicas. La automutilación fue comprendida como resultante de condiciones fisiológicas, forma de dar sentido al sufrimiento, resultado de contagio social, tentativa de comunicación, manifestación de ideación suicida y comportamiento de individuos con desarrollo atípico. Hay pocos relatos de intervención frente al problema, abarcando prácticas clínicas, preventivas y de formación profesional. Se destaca la necesidad de la ampliación de prácticas en las escuelas comprendiendo la automutilación en una perspectiva social y colectiva.

In this article we sought to describe how self-mutilation is understood by educational institutions and what are the actions taken in the face of the phenomenon, based on a systematic literature review. Searching the BVS Portal, SciELO and the Capes Theses Catalog, using the index terms self-mutilation, self-injury, self-injurious behavior and self-destructive behavior, 20 documents were selected and submitted to content analysis. It was identified that the studies are recent, predominantly qualitative, influenced by Behavior Analysis and Psychoanalysis, and developed with adolescents from public schools. Self-mutilation was understood as resulting from physiological conditions, way of giving meaning to suffering, result of social contagion, communication attempt, manifestation of suicidal ideation and behavior of individuals with atypical development. There are few reports of intervention in the face of the problem, covering clinical, preventive and professional training practices. The need to implement interventions in schools, based on social and collective understandings of self-mutilation, is highlighted.