Deliberate ingestion of foreign bodies as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Tromans, Samuel; Chester, Verity; Wells, Harriet; Alexander, Regi

doi:10.1080/14789949.2018.1530287

Cited by 4 publications

(15 citation statements)

References 30 publications

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“…Furthermore, most of the literature has been written by specialists in emergency medicine, gastroenterology, and surgery, and it typically focuses on rates of complications and surgical techniques for removal of foreign bodies. 1,5,7 Many of these reports overlook important areas such as patient intentions, psychological meaning, or psychopathology. 1 The few published psychiatry case reports discuss diagnoses associated with this condition, but management is not as thoroughly discussed.…”

Section: Introductionmentioning

confidence: 99%

“…Although 80% to 90% of ingested foreign bodies pass spontaneously, ∼10% to 20% of FBI cases require endoscopic removal, and ∼1% require surgical removal 3,4. Urgent intervention becomes necessary when patients develop significant complications, such as bezoars, impactions, abscesses, fistulas, perforations, and infections with FBIs 1,2. One study found that FBI may account for as many as 1500 fatalities per year in the United States 4.…”

Section: Introductionmentioning

confidence: 99%

“…Research on FBI has been largely limited to case reports and case series. Furthermore, most of the literature has been written by specialists in emergency medicine, gastroenterology, and surgery, and it typically focuses on rates of complications and surgical techniques for removal of foreign bodies 1,5,7. Many of these reports overlook important areas such as patient intentions, psychological meaning, or psychopathology 1.…”

Section: Introductionmentioning

confidence: 99%

“…One retrospective study from Rhode Island Hospital calculated $2,018,073 in costs for 33 different patients identified in 305 recurrent FBI cases over a period of 8 years 5. On average, surgery costs about $45,000 per patient 1…”

Section: Introductionmentioning

confidence: 99%

“…One review study identified the incidence of FBIs to be 1 in 1900 inmates in Ohio State correctional facilities between 2006 and 2010 6. An understanding of the patient’s motivational drive and the perceived function of the FBI may help guide a clinician toward a more informed therapeutic plan 1…”

Section: Introductionmentioning

confidence: 99%

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Management Challenges of Recurrent Foreign Body Ingestions in a Psychiatric Patient: A Case Report

Jaini

Haliburton

Rush

2023

Journal of Psychiatric Practice

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Intentional foreign body ingestions (FBIs) are commonly seen in adult patients with intellectual disabilities, substance use, severe psychiatric conditions, or external motivations, but these cases are rarely reported in the psychiatric literature. We present the case of a patient with an extensive history of FBIs and suicide attempts and a multitude of psychiatric diagnoses including borderline personality disorder, major depressive disorder, posttraumatic stress disorder from significant abuse in foster care, obsessive-compulsive disorder, and pica. During the single hospitalization described in this report, she had multiple incidents of self-harm, aggression, and 9 FBIs. A multidisciplinary team involving psychiatry, emergency medicine, gastroenterology, surgery, internal medicine, nursing, social work, behavioral health technicians, case management, chaplain, the legal department, police officers, and hospital maintenance was necessary for care coordination. Interventions included 8 endoscopies and an abdominal surgery to retrieve swallowed foreign bodies, pain management, psychopharmacological and psychotherapeutic interventions for agitation, and environmental precautions to minimize the risk of ingestion. Ultimately, to prevent further trauma and limit additional opportunities for FBI, a collaborative decision was made with the patient to discharge her to her home with outpatient psychologist and psychiatrist support. This case describes the complexities of hospital management of a patient with intentional recurrent FBI, highlighting the importance of a critical assessment of risk versus benefit for prolonging hospitalization. Development of practical management protocols and risk assessments for continued hospitalization is necessary for patients with recurrent intentional FBIs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management Challenges of Recurrent Foreign Body Ingestions in a Psychiatric Patient: A Case Report

Jaini

Haliburton

Rush

2023

Journal of Psychiatric Practice

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Exposure to workplace trauma for forensic mental health nurses: A scoping review

Newman

Roche

Elliott

2021

International Journal of Nursing Studies

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Self-harming behaviors and forensic system-related factors: an analysis of the Ontario review board database

Kaggwa,

Chaimowitz,

Erb

et al. 2023

BMC Psychiatry

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Background In Canada, ensuring public safety, and the safety and well-being of accused individuals under the jurisdiction of the provincial review board are very important. While previous studies have reported a significant risk of self-harming behaviors (non-suicidal self-injury and suicide attempt) in forensic psychiatric settings, no large population study has assessed any relationship between forensic system-related factors and self-harming behaviors. A better understanding of these factors can help clinicians implement protective measures to mitigate self-harming behaviors or actions. Methods Using the Ontario Review Board (ORB) database covering 2014–2015 period (n = 1211, mean age = 42.5 ± 13.37 years, males = 86.1%), we analyzed the prevalence and factors associated with self-harming behaviors, emphasizing the characterization of the forensic system-related factors (ORB status, legal status, type of offense, previous criminal history, and victim relationship). The relationships between the forensic system-related factors and self-harming behaviors were explored using five separate logistic regression models, controlling for clinical and sociodemographic characteristics. Results Approximately 4% of the individuals in the forensic system over the study period engaged in self-harming behaviors Among the studied patients, individuals determined to be unfit to stand trial and inpatients were significantly more likely to have self-harming behaviors. There was no significant relationship between the type of offence, victim relationship, and previous criminal history with self-harming behavior. Conclusion Forensic psychiatry inpatients should have close observation, screening, monitoring, and individual tailored management strategies for self-harming behaviors. The findings of this study indicate that forensic system-related factors, especially those that pertain to the status of individuals in the forensic system (i.e., unfit to stand trial and being an inpatient) are more responsible for self-harming behaviors among forensic patients in Ontario.

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Deliberate ingestion of foreign bodies as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Cited by 4 publications

References 30 publications

Management Challenges of Recurrent Foreign Body Ingestions in a Psychiatric Patient: A Case Report

Management Challenges of Recurrent Foreign Body Ingestions in a Psychiatric Patient: A Case Report

Exposure to workplace trauma for forensic mental health nurses: A scoping review

Self-harming behaviors and forensic system-related factors: an analysis of the Ontario review board database

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