Enucleation in Psychosis Associated with Aqueductal Stenosis

Abstract

Reports of self-enucleation are frequent in medical literature, but cases of enucleation towards another are rare.We report the case of a man, 20 years of age, who suffered from psychosis with hydrocephalus and aqueductal stenosis that required a forensic psychiatric investigation to ascertain whether he was of unsound mind when he assaulted and enucleated the right eye of an officer and led to the surgical enucleation of the victim's left eye. Based on his clinical interviews and hospitalization record, we conclude that at the time of the assault, he was suffering from a delusional disorder with religious and demonic content, visual and auditory hallucinations, illusion phenomena, delusional interpretations, imaginative elements, a feeling of terror, and command hallucinations that compelled him to perform the act of aggression.

Self-Inflicted Eye Injuries in First-Episode and Previously Treated Psychosis

“…Of interest, the patients who injured another person's eyes were reported to have believed that the victim's eyes were a threat to them and three of the five subjects were in FEP [15,16].…”

Attempted auto-enucleation in two incarcerated young men with psychosis

“…Consequently, anti-psychotic medication can be extremely effective in preventing self-mutilation 2 . Though schizophrenia is the classic disorder causing psychosis, self-mutilation has been observed in acute transient psychotic disorder, 6 psychotic depression with paranoid delusions, 7 psychosis associated with aqueductal stenosis, 8 and drug-related psychosis secondary to both PCP and amphetamine abuse 9,10 …”

Kendi Gözüne Yönelik Zarar Verme Davranışı Sonucu Gelişen Körlük: Üç Şizofreni Olgusu

“…Psikotik hastalarda görülen kendine zarar verme davranışları genelde emir veren dini içerikli varsanılara veya sanrılara bağlıdır; suçluluk duygusuyla kendine ceza verme ve cinsel içerikli günah işleme en yaygın temalardır (6).…”

“…İntihar amacıyla yapılmayan çok ağır tahrip edici formları vardır. Bu tür hastalarda amputasyon, enükleasyon (gözünü çıkarma), bıçaklama, kendini hadım etme hatta kendi etini yeme ve kendini ameliyat etme gibi kendini yaralamanın nadir örnekleri de bildirilmiştir (6).…”

“…Literatürde görülen self enükleasyon olguları genellikle psikotik ve sıklıkla da şizofreni hastalarıdır. Self enükleasyon bildirilmiş diğer olgular; bipolar bozukluk, obsesif kompulsif bozukluk, madde kullanımına bağlı psikotik bozukluk, posttravmatik stres bozukluğu ve depresyon tanıları almıştır (6). Organik bozukluklardan epilepsi, ensefalit, demans hastalarında da göze yönelik zarar verme davranışı bildirilmiştir (7,8).…”