We report the case of a 40-year-old Spanish patient who suffered a paranoid personality disorder with a long history of mental disorder since she was eight years old.
It does not present a systematized delirium or alterations of sense perception (so it is not a typical case) although a great state of anxiety.
She remains hospitalized since 1984, when she presented a delusional disorder to the psychiatric outpatient clinic probably related to psychosis, as she then consumed drugs.
This is an autonomous patient who participates in the programs of the institution, although occasionally he had management problems due to episodes of agitation that lasted several days and during which his clinical picture was exacerbated, increasing verbal anxiety and showing great aggression.
After an autolytic episode in which both eyes were self-evised with the fingers, and on the following day, attempts to settle the genitals appeared to be more stable.
The psychiatric team that treats him has interpreted it as follows: the patient felt a great feeling of guilt for something that has not been discovered because he rejects certain topics in his conversation.
After the aggressive attack has been released and so far there is no great anxiety or aggressive episodes (self-reporting in 2001).
In this case, it is not a consequence of a seizure, but what is called "a step to the Act" (acting out).
These are acts that are performed without going through consciousness.
After a period of grief in which he did not recognize what he had done, he has now assimilated it, although he still does not speak of motivation.
The mechanism of action was by pressing the eyes with their fingers until they click, and then, by using their own fingers to pieces.
When the patient arrived at the emergency department of our hospital, under general anesthesia, we found that only part of the sclera remained with various muscles located near its insertion in the sclera.
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The rest of the ocular structures were unknown.
Two prostheses could be inserted by suturing the sclera.
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Orbital fractures and neurological alterations were not detected.
She woke up from general anesthesia when trying, unsuccessfully, to identify the genitals.
The latter is described in other cases in the literature.
