A 39-year-old man with a 10-year history of heavy cannabis use and undiagnosed schizoaffective disorder self-eviscerated his intestines during a psychotic episode.
Emergency physicians, psychiatrists, and surgeons managing psychosis-related self-harm.
10 years undiagnosedpatient functioned in society with paranoia and heavy cannabis use before catastrophic psychotic episode
What the researchers found
The patient had functioned normally in society for 10 years despite paranoia associated with significant cannabis use, until an acute psychotic episode led to self-evisceration requiring emergency surgery.
Why it matters
This extreme case illustrates how schizoaffective disorder can go undiagnosed for years, particularly when cannabis use may mask or complicate psychiatric symptoms.
The numbers in context
39-year-old male, 10-year history of paranoia with significant cannabis use. Required emergent exploratory laparotomy with partial colectomy. Two-week hospital course. Symptoms remitted on olanzapine and valproic acid.
How the study worked
Case report with detailed clinical description, surgical management, psychiatric assessment, and discussion of related literature.
Who was studied
Single 39-year-old male patient with undiagnosed schizoaffective disorder and significant cannabis use history.
What this study cannot tell us
Single case report cannot establish causation between cannabis use and schizoaffective disorder. Patient history relies on post-episode recall. No pre-morbid psychiatric assessment available.
How to read the evidence
Single case report; lowest level of evidence but illustrates an extreme clinical scenario.
When this study was published
Recent case report.
The bigger picture
This case adds to growing literature on the relationship between cannabis use and schizophrenia spectrum disorders, and the potential for high-functioning individuals with undiagnosed psychotic disorders to experience catastrophic acute episodes.
Replication
Case report; discusses similar cases in the literature.
Funding
Not specified in abstract
Conflicts of interest
Not specified in abstract
Questions still open
- Could earlier screening have identified this patient before the acute episode?
- What role did cannabis play in masking or exacerbating the underlying disorder?
Read the original research
Self-Evisceration of Intestines as the Initial Presentation of Schizoaffective Disorder.
Case reports in psychiatry, 2023, 4334552
Citation
Hamlin, Stephanie; Sharma, Dana L; Kablinger, Anita S. (2023). Self-Evisceration of Intestines as the Initial Presentation of Schizoaffective Disorder.. Case reports in psychiatry, 2023, 4334552. https://doi.org/10.1155/2023/4334552