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Limb Self-Amputation Without Replantation: A Case Report and Management Considerations

2018; Elsevier BV; Volume: 60; Issue: 3 Linguagem: Inglês

10.1016/j.psym.2018.06.011

1545-7206

Jack Van Bezooyen, Elon E. Richman, Cody M. Browning, Ann C. Schwartz, Robert O. Cotes,

Body Image and Dysmorphia Studies

Background Major self-mutilation describes severe acts of harm to oneself, generally leading to permanent damage and loss of function in the absence of suicidal intent. The most common presentations include limb amputation, genital amputation, or auto-enucleation. Coordination of care is multidisciplinary with psychiatrists playing a pivotal role. Little literature is available with respect to managing care of patients who do not undergo replantation of a self-amputated limb. Case Presentation The authors present the case of a 20-year-old male patient after self-amputation of his upper extremity in the context of a psychotic spectrum illness and religiously preoccupied thought content. This is the first reported case to our knowledge of a patient who self-amputated an extremity and did not have replantation despite presenting with the limb in an appropriate time window. His treatment course highlights the challenges associated with these occurrences. Discussion While self-amputation most often occurs in the context of psychosis, we assert that if replantation does not occur, these individuals will have similar outcomes as their non-psychotic counterparts. Management should focus on psychiatric consultation early on to provide supportive psychotherapy and medication management. Chaplaincy consultation should be pursued early in the treatment course for hyperreligious patients. Cognitive behavioral therapy for psychosis, insight oriented therapies, family therapy, and a focus on improving resilience can also be helpful as the individual becomes more psychiatrically stable.