Bocchi A., Toschi S., Caleff i E., Papadia F.

Division of Plastic Surgery, University of Parma, Italy

SUMMARY. Self-inflicted burns represent a great problem because they are often deep and extensive, and the patients generally have a history of mental illness and difficult family relations. The authors describe the benefits of appropriate psychological and psychiatric support for these patients.

Self-inflicted bums represent a problem of great complexity for the plastic surgeon for the following reasons:

1. In most cases they are extensive full-thickness lesions. They are often flame burns, and the lack of "success" of the self-inflicted injury is usually due to chance and early aid.
2. Most of the hospitalized patients have a history of mental ilness, alchoholism or drug abuse, which makes the prognosis worse. They seldom or never collaborate during therapy.
3. Family support, so important from the psychological viewpoint, is often lacking because most of the patients live in affective isolation.

Between 1988 and 1992 eight patients with self-inflicted bums were admitted to our Burn Unit, equivalent to 1.8% of the total number of bum patients (438).

This figure is lower than the average percentage described in the literature. There were however 11 other patients in whom attempted suicide was suspected on the basis of the clinical history (4.3% of the total).
In all eight patients the injury was caused by flame (while in the group of 11 two patients were burned by boiling water).
Six of the eight patients (75%) died, from 1 to 75 days after injury. In seven cases the patients had a history of mental illness, were under treatment with psychotropic drugs or were hospitalized in a psychiatric ward.
The extent of the bum varied from 15 to 100%. Some patients tried to explain their attempted suicide as a desire to expiate a fault or to follow their religious beliefs.
Five patients had previously attempted suicide.
The local and general bum therapy followed our habitual protocol, with the following additional measures:

1. Treatment with psychotropic drugs under psychiatric control.
2. Hydrotherapy and medication with the support of a psychiatrist, to give the patient adequate clinical and psychological support.
3. Contact with the patient's family in order to give information about the patient's health and to invite them to visit him.

Results and discussion

The psychiatric and,psychological support helped to create a certain degree of collaboration in five patients and it was possible to dress them without the psychiatrist's support.
It was more difficult to get collaboration from the family, who in some cases promised to take care of the patient but did not in fact do so.
The high incidence of mortality is due to the extent of the lesions, and to the advanced age and previous diseases of some of the patients, as shown in Table 1.

Conclusion

The average mortality rate in self-inflicted burn patients is higher than that in patients comparable for age, depth and burn extent who did not attempt suicide. The previous diseases, the wish to die and the lack of collaboration make the prognosis worse.
Psychiatric and psychological support helps to maintain the patient quiet and to facilitate the work of the physicians and nurses.

RESUME. Les brûlures infligées volontairement à soi-même représentent un grand problème parce qu'elles sont souvent profondes et étendues, et les patients ont généralement une histoire de maladies mentales et de rapports difficiles avec leur famille. Les auteurs décrivent les avantages d'un support psychologique et psychiatrique approprié pour ces patients.

BIBLIOGRAPHY

1. Bassetto F., Banon D., Matano P., Baldo M., Silvestri A.: 11 fuoco come mezzo d'autosoppressione. Atti 37' Congresso Società Italiana di Chirurgia Plastica, Genova, 1988.
2. Davidson T.I., Brown L.C.: Self-inflicted burns: a 5 years retrospective study. Bums, 11: 157, 1985.
3. Klasen H.J., Van der Tempel G.L., Heckert J. et al.: Attempted suicide by means of burns. Burns, 15: 37, 1989.
4. Lochaitis A., Iliopoulou E., Parker J.M., Poniros N., Panayotaki D.: Burns as a result of violence and self-inflicted injury. Ann. Medit. Burns Club, 4: 219-221, 1991.