Mestermann Stefan, Rudtke Laura, Brazdis Razvan-Marius, Tsaktanis Thanos, Kornhuber Johannes, Thürauf Norbert
Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
Behav Sci (Basel). 2024 Mar 14;14(3):237. doi: 10.3390/bs14030237.
Self-induced bloodletting (SBL) is a very rare form of self-injury (SI) seen primarily in adolescents and young adults with personality and eating disorders. It can result in complications like malaise, fatigue, or iron-deficiency anemia (Lasthénie de Ferjol syndrome, LFS), and poses a risk of accidental death or suicide. The condition often goes undetected due to patient concealment. There is no specific treatment established, and pharmacological strategies remain uncertain. We discuss the case of a 22-year-old female patient treated at our Psychiatry and Psychotherapy Department following a suicide attempt via SBL. She self-administered a venous cannula, losing 1.5 L of blood. Diagnosed with iron-deficiency anemia (LFS), she was initially treated with mirtazapine, risperidone, lithium, and later off-label high-dose clomipramine (300 mg/d). Clomipramine significantly reduced her SBL and suicidal thoughts, and her hemoglobin levels re-normalized under iron-substitution therapy. Despite improvement and later discharge, she attempted suicide by SBL again three months later, having stopped clomipramine due to adverse side effects. High-dose escitalopram was administered, leading to a decrease and eventual cessation of her SBL urges. This case demonstrates that patients with SBL/LFS can benefit from high-dose clomipramine or escitalopram. Despite its rarity, the consideration of high-dose serotonergic antidepressants is crucial in psychiatric diagnostics and treatment for patients affected by SBL/LFS.
自我诱导放血（SBL）是一种非常罕见的自我伤害形式，主要见于患有个性障碍和饮食失调的青少年及青年。它可能导致不适、疲劳或缺铁性贫血（费尔若尔缺铁症，LFS）等并发症，并存在意外死亡或自杀风险。由于患者隐瞒，这种情况往往未被发现。目前尚无既定的特效治疗方法，药物治疗策略仍不明确。我们讨论了一名22岁女性患者的病例，她在通过自我诱导放血自杀未遂后，在我们的精神科和心理治疗科接受治疗。她自行插入静脉套管，失血1.5升。被诊断为缺铁性贫血（LFS）后，她最初接受米氮平、利培酮、锂盐治疗，后来使用了超说明书剂量的高剂量氯米帕明（300毫克/天）。氯米帕明显著减少了她的自我诱导放血行为和自杀念头，并且在铁替代治疗下她的血红蛋白水平恢复正常。尽管病情有所改善并随后出院，但三个月后她因氯米帕明的不良反应停药，再次试图通过自我诱导放血自杀。于是给予高剂量艾司西酞普兰，这导致她自我诱导放血冲动减少并最终停止。该病例表明，患有自我诱导放血/费尔若尔缺铁症的患者可从高剂量氯米帕明或艾司西酞普兰中获益。尽管这种情况罕见，但在对受自我诱导放血/费尔若尔缺铁症影响的患者进行精神科诊断和治疗时，考虑使用高剂量血清素能抗抑郁药至关重要。
