Zusammenfassung
Anliegen Anhand einer Kasuistik soll die Problematik der Behandlung von Patienten mit erheblichen
selbstbeigebrachten Verletzungen, jedoch ohne diagnostiziertes psychiatrisches Grundleiden
dargestellt werden. Methode Vorstellung einer entsprechenden Kasuistik schwerer Selbstverstümmelung. Schlussfolgerung Die Bedeutung interdisziplinärer Zusammenarbeit und Ausschöpfung aller bestehender
Möglichkeiten zur Diagnosestellung der Selbstbeibringung sowie des Grundleidens bei
Vorliegen einer Selbstverstümmelung sollen diskutiert werden.
Abstract
Introduction Self-mutilation is well-known in various psychiatric diseases and represents a challenge
for forensic pathologists as regards the differentiation of accidental versus self-inflicted
injuries, especially when a criminal charge is likely to emerge. Method A case of extraordinarily severe self-inflicted injuries is presented as well as
the related implications concerning clinical and ambulatory care for patients, whose
underlying motivation remains unknown. Results A 60 year-old worker exhibited an open scull fracture and 14 abdominal wounds with
protrusion of small intestine, from which a part of 160 cm length was completely removed
beforehand. The patient claimed the wounds having been caused accidentally. When examined
by a psychiatrist, disturbances in orientation, unrest and ill concentration were
found, but no symptoms related to psychosis, depression or suicidal behaviour. Discussion Although the need for more detailed examination seemed to be clearly evident, the
medical authorities did not take action. Consequently, no further psychiatric treatment
was initiated. The implications of this case on the background of the literature are
discussed.
Schlüsselwörter
Selbstverstümmelung - Selbstverletzung - psychiatrische Versorgung
Keywords
automutilation - self-inflicted injury - psychiatric treatment
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Dr. med. Iris Gehb
Institut für Rechtsmedizin des Universitätsklinikums Jena
Fürstengraben 23
07743 Jena
eMail: iris.gehb@med.uni-jena.de
