Swallowing metal things

Abstract

Dear editor, In psychiatric literature, patients who swallows foreign things is not rare. Surgeons usually witness these after perforation or they are diagnosed totally by coincidence. Only few of them relapse, but when it relapses, they urged to the psychiatrists. Foreign body swallowing mostly done for self-injury or/and can be a sign of psychotic syndrome. Abraham reported a schizoid patient, who swallow metal objects and nail1. Kuzon reported a similar case, which swallowed magnetic iron objects and nails2. A young man with a lot of needles in his colon also reported by Eryılmaz3. In our case, M.S swallows keys. Case M.S. 18 years old, single, male, high school student, lives with his parents. Our patient came to us with his mother's will an it was the first time for him to consult for a psychiatric treatment. He is complaining about not being happy in his life; he does not get along with his dad. He usually skips the school and does not go home. His mother is not sure whether he uses drug or not. In psychiatric examination he was depressive but easily cooperated and well orientated. He had problems with sleeping and eating. He had concentration problems also. He was aware of his disorder but he didn't want to live with his father. In his story, he is running away from school and home. He can’t sleep well and he does not enjoy in life. The patient tells that last year he came to Istanbul without saying anything to his parents. He did scavenging for 2 weeks. Later, he called his mother and said his location. Since then, he was not get along with his father. He said his dad used violence towards him. He tried to retake his classes but fails. In this periodic time, his mother told us that he is using drugs. He smokes 15 cigarettes per day. He gets a score of 32 from Hamilton test. Sertraline (50 mg/day) and olanzapine (5mg/day) were prescribed to him. After 3 weeks we increase sertraline to 100 mg. Two weeks after the treatment he was sent to general surgery for consultation. He was complaining about a stomach ache: when the doctors do some x-ray, two door keys was found in his stomach. The doctor thought that these keys can be thrown out of body naturally. But later he realized that there are other metal objects. EEG and MRI results are normal. After one week he takes another x-ray and the doctor tells that there is one more key in his stomach and intestine. He grew in a crowded and careless family. He has five brothers and a younger sister. He told that his father doesn’t like him since his childhood. His dad used violence towards him and his older brothers. He learned sexual content from his high school friends but he is not sexually experienced. He told that he used drugs couple of times since high school and he cut himself 2 or 3 times just because he was bored. He ran away from home and did some garbage collection job for living at the age of 16. Rorschach test shows us that he has borderline traits. He has connections with reality and lasts the joining to collective thinking. On the other hand, he is close the schizoid level. In the second stage of treatment he tried to suicide by taking all the pills together. Later, he ran away from hospital and went to his home. In 2 days, he came back and tried to suicide again. He stayed in intensive care unit for 3 days. He could not be traced because he and his family did not attend the appointments. In this report we talk about the psychiatric disorder of an 18 years old boy, who swallows keys and other metal things. Sincerely,