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首页> 外文期刊>Harvard review of psychiatry >Acting Out or Acting In: A Case of Dangerous, Sexual, Self-Injurious Behavior
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Acting Out or Acting In: A Case of Dangerous, Sexual, Self-Injurious Behavior

机译：Acting Out or Acting In: A Case of Dangerous, Sexual, Self-Injurious Behavior

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CASE HISTORY.History of Present Illness:Mr. Z is a middle-aged, cisgender-identifying gay man with a history of major depressive disorder (MDD), posttraumatic stress disorder (PTSD), one prior suicide attempt, HIV (undetectable viral load, on antiretroviral therapy), chronic lower back pain, and history of rectal foreign body perforation in 2014, transported from home to the Emergency Department by ambulance in the setting of acute onset hematochezia. Upon evaluation by Emergency Medical Services, the patient reported falling on a broomstick two hours prior to calling 911. Per the EMS medical report, the patient reported that this was a suicide attempt and that he “would rather die than go to the hospital again.” In the Emergency Department, a CT abdomen/pelvis identified a large right pelvic hematoma, moderate volume pneumoperitoneum, and hemoperitoneum, consistent with bowel perforation at the right sigmoid distal colon/rectosigmoid junction. Mr. Z subsequently underwent an exploratory laparotomy with resultant sigmoid colectomy and primary anastomosis. The consultation liaison (C/L) psychiatry team was consulted in the surgical intensive care unit (ICU) on postoperative day 1 for a safety assessment, given the concern that the patient’s injury occurred in the setting of a suicide attempt.

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