P0253 - Case study: Sucessful of treatment in a severe self-mutilation case

Abstract

Self-mutilation behavior (SMB) is defined as all behaviors involving deliberate infliction of direct physical harm to one's own body without any intent to die. This case report describes the successful treatment of severe SMB in a 23-year-old woman, with multiple comorbidities. The patient was admitted to the multiple impulse-control disorder outpatient unit for treatment of SMB. This patient was submitted to the SCID-I/P, SCID-II/P, Y-BOCS, DY-BOCS, and Functional Assessment of Self-Mutilation (FASM) for diagnosis of SMB as well as comorbidities. The most frequently SMB presented was skin cutting which was associated with relief of intolerable affects. Others comorbidities presented by her were Obsessive-Compulsive Disorder(OCD), Social phobia, Bulimia, and Depression Disorder(DD) with high levels of anxiety. The patient was submitted to an interdisciplinary treatment. Treatment included cognitive-behavior therapy(CBT), nutritional orientation, and psychopharmacology which begun with venlafaxine (150mg/d) followed by fluoxetine(80mg/day), and carbamazepine(400mg/day), without success. After ten months of treatment the patient was stabilized in terms of DD, bulimic behaviors, and anxiety. OCD symptoms were mild, and SMB became rare. At this time the patient was taking ziprazidone(160mg/day), sertraline(200mg/day), and topiramate(100mg/day). These medications were maintained as well as CBT, with emphasis in social skill, and problem-solving techniques. After three more months of treatment she had stopped cutting herself and the OCD symptoms disappeared.

Conclusion:

the collection of treatment modalities implemented by multidisciplinary team may serve as a guide to treat severe SMB. In addition, the association of drugs with different site of action, but all for impulse control, may contribute for the efficacy observed here.