Self amputation of the hand: issues in diagnosis and general hospital management
Objectives: To detail a diagnostic dilemma of intentional hand amputation in a man with a history of substance misuse and associated psychosis, depression and traumatic brain injury and to highlight issues in joint psychiatric and surgical management of such a complex patient in a general hospital setting. Conclusions: Deliberate limb self amputation is a rare event with the majority of reported cases occurring during an episode of psychosis. This case illustrates the diagnostic utility of the literature supporting that a person who has self inflicted amputation of a limb should be treated as psychotic until proven otherwise. The presence of a traumatic brain injury, with associated cognitive and psychosocial sequelae, affected diagnosis and management. Early and ongoing involvement of consultation liaison psychiatry collaborating with a multidisciplinary general hospital team may improve mental and physical health outcomes for such patients.
Australasian psychiatry bulletin of Royal Australian and New Zealand College of Psychiatrists