Hakan SEYİTHANOĞLU, İbrahim ALATAŞ, Erhan EMEL, Işıl UĞURAD, Ulviye ATILGANOĞLU, Selma Sönmez ERGUN, Meltem ARIKAN

Surgical repair of self-inflicted skin ulceration, cranialand dural defect created byachronic schizophrenic patient

Kronik flizofrenide stereotipik hareketler sıklıkla görülür. Zamanla bu hareketler yürüme veya izleme gibi yineleyici bir hareket biçimi olarak görülebildiği gibi, hasta için anlamlı veya anlamsız yineleyici davranışlara da dönüşebilir. Bu davranışlar kişinin kendine zarar verici, yaralama davranışlarına da dönüşebilir. Major kendini yaralama davranışında temel etkenin psikotik bozukluklar olduğu düşünülse de, ağır zeka gerilikleri, kişilik bozuklukları ve yeme bozukluklarını da gözardı etmemek gerekir. Bu sunumda, başında kötü bir ruhun yerleştiğine inanan ve ondan kurtulmak amacıyla başını sürekli olarak kaşıyarak saçlı deride, kranyumda ve durada defekt oluşturan, defektleri 2 aşamalı operasyonla onarılan ve kendine zarar vermenin en uç örneklerinden biri olan kronik şizofrenili bir olgu sunulmaktadır.

Kronik şizofreni olgusu tarafından oluşturulan cilt ülserasyonu, kranyal ve dural defektin cerrahi onarımı

Stereotyped behaviour is primarily seen in patients with chronic schizophrenia. Sometimes, it may take a motoric form and may be expressed in a repetitive pattern of walking or pacing. It may also be demonstrated in repetitive strong gestures, which may or may not have a magical meaning to the patient. These behaviours may also take the form of self-mutilation. Although major self-mutilative behaviours are basically thought to occur in psychotic disorders, severe mental retardation, personality disorders, and eating disorders should also be taken into consideration. The patient presented here believed that he had a bad soul on top of his head and in order to release this soul, he scratched his head continuously leading to recurrent trauma. Then, his scalp got infected due to this trauma which resulted in osteomyelitis of the cranial bone and infection of the dura mater with the exposure of the brain tissue. This case represents one of the most severe examples of self-mutilation in the literature. The patient was treated medically for his psychiatric illness and for his wound infection according to culture- antibiogram results, and surgically with a two-step operation in order to repair the dural, cranial, and scalp defect.

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1) Andreasen NC, Black DW. Introductory Textbook of Psychiatry, 3rd edition, London, American Psychiatric Publishing Inc, 2001, pp.213-215.
2) Burgess EA, Mayer MH, Hollinger J. Bone grafting and substitutes. In: Plastic Surgery: Indications, Operations and Outcomes. (Eds.) Achauer BM, Eriksson E, Guyuron B, Coleman III JJ, Russell RC, Vander Kolk CA, vol. 2, Mosby, St. Louis, 2000, pp. 657-671.
3) Cancro R, Lehmann HE. Schizophrenia: Clinical features. In: Kaplan&Sadock's Comprehensive Textbook of Psychiatry. 7th edition, Philadelphia, Lippincott Williams&Wilkins vol. 1, 1999, pp.1169-1199.
4) Cho YR, Gosain AK. Biomaterials in craniofacial reconstruction. Clin Plastic Surg 2004; 31: 377-385.
5) Delashaw JB, Percing JA. Cranial defect and their repair. In: Youmans Neurological Surgery: A comprehensive reference guide to diagnosis and management of neurosurgical problems. (Ed.) Youmans JR, 3rd edition, Philadelphia, WB Saunders Company, vol. 4, pp. 2290-2304, 1990.
6) Durham SR, McComb JG, Levy ML. Correction of large (> 25 cm2) cranial defects with “reinforced” hydroxyapatite cement: technique and complications. Neurosurgery 2003; 52 :842-845.
7) Eren I, Inanlı IK, Calıskan AM. Kendini yaralama davranışında risk faktörleri: Olgu sunumu. Türkiye'de Psikiatri 2005; 7: 129- 133.
8) Jackson IT. Craniofacial surgery. In: The unfavorable result in plastic surgery: Avoidance and treatment. (Eds.) Goldwyn RM, Cohen MN. Third edition, Philadelphia, Lippincott Williams& Wilkins, 2001, pp. 189-209.
9) Knoringer P. Treatment of bone infection in the area of the skull. Unfallchirurgie 1986; 12: 81-92.
10) Matic DB, Manson PN. Biomechanical analysis of hydroxyapatite cement cranioplasty. J Craniofac Surg 2004; 15: 415-422.
11) Ninan PT, Monce RM, Lewine RRJ. Schizophrenia and other psychotic disorders In: Clinical psychiatry for medical students. (Ed.) Stoudemire A. 3rd edition, Philadelphia, Lippincott-Raven, 1998, pp. 153-185.
12) Wang C-K, Lee JY. Monosymptomatic hypochondriacal psychosis complicated by self-inflicted skin ulceration, skull defect and brain abscess. Br J Dermatol 1997; 137: 299-302.
13) Wilhelmi BJ, Phillips LG. Surgical infections. In: The unfavorable result in plastic surgery: Avoidance and treatment. (Eds.) Goldwyn RM, Cohen MN. Third edition, Philadelphia, Lippincott Williams&Wilkins, pp.74-86, 2001.
14) Zook EG. Soft tissue coverage. In: The unfavorable result in plastic surgery: Avoidance and treatment. Eds: Goldwyn RM, Cohen MN. 3rd edition, Philadelphia, Lippincott Williams& Wilkins, 2001, pp. 87-102.