Autophagia syndrome, self eating disorder, case study, basic needs affected, care and treatment, social reintegration plan.

1. STUDENT NAME
AVJOT KAUR
PRESENTATION TOPIC
AUTOPHAGIA SYNDROME

2. AUTOPHAGIA SYNDROME
MENTAL ILLNESS

3. DEFINITION
• Autophagia occurs when one is compelled to inflict pain
upon oneself by biting and/or devouring portions of
one's body. It is sometimes seen with schizophrenia,
psychosis and Lesch–Nyhan syndrome.
• This disorder will often feel a sense of tension or arousal
before committing the act, and then experience
pleasure, gratification or relief at the time of committing
the act. Once the act has been completed, the individual
may or may not feel regret, self-reproach, or guilt

4. SCENARIO:-
Mr. David, 60, has been admitted in Albert
Prevost Mental Health Hospital since a
month. He is diagnosed with Autophagia
syndrome associated with Schizophrenia.
At the time of admission he complained
about insomnia. He is married and he also
has auditory hallucinations. Diabetic
neuropathy has detected by investigations
that effects on his limbs. He is having strong
urges to bite himself since last 3 months
and has eaten his fingertips. There has been
few underlying problems seen such
as nutritional deficiency, implusive
behaviour and disordered thinking that
impairs daily functioning.

5. Patient' Information:-
• Name- David Thomson
• Age – 66 yrs.
• Occupation- Unemployed
• Marital status- Married
• Medical History-
• Diabetes Mellitus since 15 years.
• Self-biting Urges started 3 months ago.
• - Electromyography showed severe peripheral nerve damage
in both hands and feet caused by severe diabetic neuropathy.
• Schizophreniadiagnosed 2 years ago.
Smoking- Yes
Alcohol- Non
Any drug use- Non

6. INTERVIEW WITH PATIENT
mbkbk
Here is small interaction with the patient. The was trying hard to explain his situation since his wife
came and gave me rest informatiom.
Me- Good morning Mr. Thomson. How are you??
Him- I am fine. Morning.
Me- I am Avjot kaur. I am a health care assistant. I am here to help you.
Him- Okay.
Me- Mr. Thomson, How was your last night?? Did you sleep well?
Him- mmm.... it was better than other night before yesterday.
Me- You had your breakfast?
Him- yes.
Me- That is good. I would like to know some information from you About your health conditions. Itcan
be very helpful with your Treatment.
Him- Uhun... okay......
Me- Would you allow me to ask few questions?
Him- (pause for a while) I can try.
Me- How long have you been experience self bitingurges??
Him- mmm...... I can say fews months ago. When I feel tense and stressedout. I can not control myself to
control these urges.

7. • Me- Do you have any idea how exactly it started like what made you do that?
• Him- Nothing... (he was trying hard to expain it to me that he had auditory hallucinations) i suddenly
heared that someone was taking about me. All the activities i was doingthey were comentring
everything.
• Me- They?? Was it more than one voice?
• Him- Yes.... They were in my head female and male voices. They wanted me to do something. They
stressed me out all the time.
• Me- Can you tell me what exactly they wanted
you to do??
• Him- they were continously talking with each
others
• Me- How your family found this habit when they
got to know?
• Him- My wife.... when eventually she found that
I was Behaving bit strange she got worried. I told
her that I could not resist myself not to do it. It
went out of my control.
Me- Okay.. Then what she did to help you out?

8. Him- She made an appointment with a doctor and he referred Me to psychiatrist.
I told her not to worry about I was alright.
Me- Do you remember from how long you are diabetic?
Him- (started thinking but sound like he was not really sure) Many years ago.
(Then His wife entered in the room)
Wife- Oh.. Sorry did I interrupt you?
Me- No mam... it is nice to see you I was just asking for a bit
previous information. It's good that you are here.
( Since it was Difficult for the patient to remember all the information I
decided to ask few question from his wife and co relate with patient information.
Him- Oh honey... I am glad that you are here.
(then they hugged each other and she asked about his health)
Her- Is there something I can help you with?
Me- oh.. Yes.. It would be better. I was just asking, since how long he had diabetes??
Her- (Thinking with rolled up eyes) aa...I guess around 15 yrs. then he started taking insulin 6 yrs. ago.
Me- Do you remember when was the first time he met with psychiatrist?
Her- Yes.. It was 2 yrs. ago when he diagnosed with Schizophrenia. He always looked confused and exhausted. His
behavior was changed suddenly. He always refused to go out and meet our friends. He liked being at home all the
time. I was shocked when i saw him biting himself.

9. Me- What were the others changes you realised was
not normal?
Her- He was never comfortable at night. Always staring
at the roof Sometimes I got scared. At the time of
day he sound lazy and Feel sleepy. I had
to repeat myself to get his attention. He started
biting his nails and skin as well very badly.
Sometimes he put my hair in his mouth and
started chewing them. Due to lack of concentration,
He lost his job.
Me- Okay... When was the first time he told you
about the voices?
Her- After few weeks I realized he is focusing on other things then I asked
Him that what was up. Then he told me someone making me do that weird thing that
i have just explained you. He told me he was continuously hearing voices that are
discussing about my all actions.

10. Withoutwasting my timei bookedan appointmentwithdoctor thenHe referredhim
to the psychiatrist.
Me- When it got worse??
Her-Last month,Hisbehavior sound more impulsive.He completelyisolate himselfin
the roomand alwaysseemslike he hasAnxiety.He alwaysbite himselfand his diabetes
was not in control.WhenI toldhimnot to do that he gotirritatedand feel relieved
afterbiting. He injuredhisfingertipsby bitingthem. Woundsweregettingworse
because of uncontrolleddiabetes. I haveseenwoundsappeared on hisfeetas well.
ThenI took himhospital and that’s howwe are here.
Me- My lastquestionis Before startingthiscondition didsomething happened that
you think couldbe the reasonof all of it??Like any temper changesany injury on
head?
Her-No... thisstartedall of sudden.
Me- Thank you very much mamfor giving me such your precisiontime. I appreciate
you. This informationis veryuseful.

11. Behavior-
• Impulsive Behaviour. This behavior started as serious
nail biting and continued as severe fingertips eating.
• Little Confused.
• Take a bit longer to answer.
• Lack of concentration.
• Takes time to remember previous things but was accurate.
• Sometimes irritated and anxious.
• Psychological help needed since 2 yrs.

12. BASIC NEEDS THAT AFFECTED
EAT AND DRINK ADEQUATELY
Physical Dimension-
- Look physically weak because of not having proper meal.
- CONGINITIVE DIMENSIONS-
- Feel hunger but try to eat his own flesh.
- Unaware of being sick without having
nutrition diet.
- Emotional Dimensions-
Feel relieved and satisfy after biting himself.

13. SLEEP AND REST
PHYSICAL DIMENSIONS-
- Look tired and exhausted due to lack of sleep.
COGINITIVE DIMENSIONS-
- Cannot get enough sleep due to auditory hallucinations which results
- daytime sleepiness
- lack of concentration.
EMOTIONAL DIMENSIONS-
- Get easily irritated and feel uncomfortable.
This Photo by Unknown author is licensed under CC BY-NC-ND.

14. AVOID
DANGERS IN
THE
ENVIRONMENT
AND AVOID
INJURING
OTHERS
PHYSICAL DIMENSION-
Self-Injury can be more dangerous by biting.
Wound Infection.
CONGNITIVE DIMENSIONS--
Sense of relieved and satisfaction after biting. By
doing it again and again critical situation could be
occur.
- impulsive behaviour may lead to serious injury.

15. COMMUNICATE WITH OTHERS IN EXPRESSING EMOTIONS,
NEEDS, FEARS OR OPINIONS
• Emotional Dimensions-
• - anxiety and distress while taking
to someone.
• Cognitive Dimensions-
- sense of being shamed in front of
others due to impulsive behaviour.
- feeling of being judged by others
due to physical injuries.
• Social Dimensions-
- social isolation because do to want
anybody to see them in this
condition.
- Do not rely on others.

16. Movement and maintain normal
body posture
• PHYSICAL DIMENSIONS-
- Not able to walk by himslf without any support.
• EMOTIONAL DIMENSION-
- Gets irritated when unable to do activities by his
own.
• CONGINITIVE DIMENSION-
- Feel sense of low self esteem.
- Less confident.
- always think of not being independent.
• SOCIAL DIMENSIONS-
- Dependent on others for moving himself from one place to another.

17. OBSERVE THE CONDITION OF PATIENT
- Insomnia ( difficulty in sleeping)
- Need assistance to fulfil daily activities due to injuries on
hand.
- lack of appetite.
- Talking to himself sometime.
- excessive hand movements while talking.
- distress and anxiety
- mood swifting quickly

18. MAIN MENIFESTATION AND SUBJECTIVE SYMPTOMS
• Lack of concentration – Have to Repeat the sentence to get his
attention and make him understand.
• Impulsive Behaviour- Not Feeling comfortable and always looking at his
surroundings and his hands and feet. He is moving on bed to make himself
comfortable.
• Arousal of urges- Was trying to bite his should and forearm to make himself
relieved.
• Talking to himself- Seems like he was trying to interact with voices and make
them stop talking to him.

19. Accurate establishment of links between these manifestations and their
consequences for the patient and his or her family and social environment
• Lack of concentration- due to this patient does not listen you and
make you understand. Family or friends thinks that talking to him is a
waste of time.
• Talking to himself- Patient gets distracted easily. Others think that he
is crazy may be he has his own company so he doesn't need us.
• Impulsive behaviour- Patient swift his emotions frequently. Family
and friends get easily irritated when they found him out of the loop.
• Self-eating Disorder- Patient can lead himself towards serious
condition. Family and friends afraid of being injured by him too.

20. What are their expectations regarding the
care provided on site?
• To treat them as humanly as we can.
• Empathetic behaviour.
• Active listener.
• Treat them respectfully.
• Be visible and available so they can feel more secure.
• Assistantwith all daily activities.
• Do not show them negative attention or do not argue.
• Problem solving behaviour.
• Good observation of any changes in behaviour.
• Be polite and patient. Good verbal and non-verbal
communication skills.
• Respect his dignity.

21. How do you plan to approach
your patient?
• Being friendly yet professional.
• Gentle touch to get his attention.
• Address him properly by his last name and respectfully.
• Interduce myself and tell him that I am here for his help.
• Being polite and patient
• Don’t try to argue or give reasons to
• Keep safe distance facing back to the door.
• Being respectful Being a good care giver and understanding his
needs.
• Show him compassion and understanding.
• build confidence.

22. How do you expect to have good communicationwith
your patient?
• Greet him first and then ask for his health and ask if he needs
anything.
• while talking maintain good body gestures or facial
Expressions.
• While asking questions Gently touch his arm to make him feel
that you care for him
• Distance yourself from the patient to give him space.
• Ask open questions to know more information.
• Give him time to finish the sentence.
• Listen him attentively.
•
This Photo by Unknown author is licensed under CC BY-SA-NC.

23. You must present a social reintegration plan. Which professionals should be involved
in his social reintegration.
• Encourage the patient to socialise. We can take
steps to spend time with him and encourage him
to re-join social occasions.
• Spend some time thinking about the
patient's interests and hobbies such as Do you
have mutual friends or know of other Club
members who also know the person well? Perhaps
they know more about the person’s interests.
• Ask his family if there is an upcoming event that
might be of interest to the patient and he can join
friends and relative.
• Consider any obstacles that mightprevent the
person from attending such as transport barrier or
if he is having difficulties with walking ( dibetic
neuropathy.)
This Photo by Unknown author is licensed under CC BY-SA.

24. • Encouragethe patientto deal withhisfearof beingsocializedueto sickness.
• Invite a friendof himto makehimfeel better.
• Talk withhisfamily to co-operatewithhimand tell themhowto deal with theobstacles
that may occur during interaction withhelp of professional.
• Behavioral therapy will helpto control hisimpulsesand urgesthat wouldbe given by
psychologist.
• Grouptherapy will be useful for him. Arrange a meeting withthehelp of social worker,
with other peoplewho have sameproblemsin their lives. It can be helpful when people
will sharetheir experiencesthathowthey returnedto their normal lifeafter this
challenge.
• Motivational therapy helps a lot to bringa patient back to the social life easily .
• Diversiontherapyto control hisurgesand diverthismind to something else.
• These therapiesgivenby therapistor psychologist.
• Phyicianwill help to prescribe the medicine and other instructionthatcanhelp himto
deal himobstaclesand improve hiscondition.

25. Community services :-
- AMI-Quebec
5800 Décarie Blvd, Montreal, Quebec H3X 2J5
- Canadian Mental Health Association -
Quebec Division and Montreal Branch
55 Avenue du Mont-Royal O bureau
605, Montréal, QC H2T 2S6
• -CLSC
11441 Boulevard Lacordaire
Montreal Qc H1G 4J9
514-384-2000

26. • MENTAL HEALTH RESOURCES
• The CISSS de Laval has many services for people with mental health
problems and offers individual services or tailored groups to help you
in your recovery.
• FIRST-LINE SERVICES
• Individual support, group support or self-managementsupport
offered at 5 sites in the Laval territory. The goal of this service is to
help you cope with your distress, get support in the recovery process,
and develop tools to deal with the impact of the disease. Other goals
are to help you access the right type of specialized service and to
refer you and your family to resources that meet your needs.
• AMBULATORY AND SPECIALIZED SECOND-LINE SERVICES
• These varied services can provide you with support as close to
home as possible. They include variable support, assertive community
treatment (ACT) provided by a mobile team, an outpatient clinic, a
day hospital, and a geriatric psychiatry service for seniors.

27. • INPATIENT PSYCHIATRIC UNIT SERVICES
• This unit provides short-term hospitalization for
adults who have a severe psychiatric disorder, whose
mental health has deteriorated, or who are
experiencing temporary psychological distress. The goal
of hospitalization is to help people stabilize from a crisis
or to reduce the symptoms that prevent their from
functioning normally.
• RESIDENTIAL RESSOURCES SERVICES
• Residential resources services are temporary (or
permanent) environments that are as close as possible
to a person’s natural living environment. This service is
for people who have a serious and persistent mental
disorder that prevents them from living independently.
The service helps people develop and maintain their
independence and ability to get involved in society.

28. ALBERTPREVOST
MENTALHEALTH
HOSPITAL
6555, boulevard
Gouin Ouest
Montreal (Quebec)
H4K 1B3
514338-3227

29. • An interdisciplinary team offers a varied
program linked to individualized intervention
plans, mainly through group activities.
• The frequency of visits is determined by the
team according to the needs of the person. It
generally varies from 1 to 2 times a week. The
attendance time of the person followed at the
day centre is, for information, from 10 a.m. to
3 p.m. (including dinner) but may vary
depending on the person's needs.
• Post-hospital services
• Care and services
• Housing assistance service
Abulatory Services
The Reference Service offers services such as:
• telephonesupport;
• assistance in finding accommodation;
• support during housing visits.

30. Psychological
Services
• Psychosocialneeds assessment, personal and family support
services
• Respite guarding needs assessmentservices
• Referral services to specialized rehabilitation services
• Referral services to appropriate resources
• How do I get these services?
• These services are offered by referral, after evaluation by a
health professional.
• Are you worried, are there signs that there maybe a problem
with you, your child or someone close to you?
• Have you, your child or one of your loved ones been
diagnosed with an intellectual disability and have not yet
received an orientation service adapted to your needs?
• Talk to your doctor or contact the PsychosocialReception of
your CLSC.

31. • On the phone (single number): 514 940-3300
• In person :
• CLSC of Montreal-North
• CLSC of Saint-Laurent
• CLSC de Villeray
• General timetable
• Monday to Friday: 8 a.m. to 8 p.m.
Saturday, Sunday and holidays : 8 a.m. to 4 p.m.
• Community services mayalso be available to you. Talk
about it with a worker from your CLSC.
• Specialized services
• When specialized services are required, your CLSC
workers, a family doctor or any other health
professional, can refer you to a rehabilitation center or
any other specialized service.
• If the need is confirmed, a service request will be made
to the establishmentserving your sector. Unless
otherwise specified, the establishmentwill communicate
with you.
OTHER
SERVICES

32. the emergency measures taken by the staff who
must deal with patients in crisis (operations)
In case of patient crisis such as patient do hyperactivities
and try to hit someone,
First step – Refer the patient to Physician to verify if there is
external injury that causes this condition.
- If there is not any physical cause then he refers patient to
the Psychiatristto do further evaluation.
- After that he does drug plan according to his conditions.
- In emergency measures, Hand cuff and restrain facilities if
case patient gets hyper again.
- Emergency drugs should be there such as sedatives,
analgesics that can be administer by nurse and prescribed by
physician.
- First aid trained staffif patient caused physical injury.
- As a healthcare we should observe patient if there is any
change of behaviour seen and immediately report to the
nurse about his condition.
This Photo by Unknown author is licensed under CC BY-NC.

33. What are the
rights of patients
by law in Quebec
establishments,
Consider the
legislation and
policies
applicable to
these clients?
• Autophagia (eating one's own body) is not classified as a
mental disorder or a symptom of a mental disorder in the
Diagnosticand StatisticalManual of MentalDisorders (DSM),
the diagnostic manual used in the United States. However,
autophagia could be classified under the DSM's section
"Impulse-control disorders not elsewhere classified". Impulse-
control disorders involve failing to resist an impulse, drive, or
temptation to perform an act that is harmful to the person or
to others.
• Psychiatry and Justice
When a mentally ill person commits a minor offense, access to
the appropriate mental health services is important. It is crucial
that police officers be made aware that the individual is
suffering from a mental illness, so that medical rather than
criminal attention is received. Entering a detention centre and
appearing before the courts should be avoided whenever
possible.

34. Interpretation.
1. The provisions of this Act complement the provisions of the
Civil Code concerning the confinement in a health and social
services institution of persons whose mental statepresents a
danger to themselves or to others, and the provisions concerning
the psychiatric assessmentcarried out to determine the
necessity for such confinement.
PSYCHIATRIC EXAMINATION
-The psychiatric examinationto which a person is required to
submit by law or by a court decision mustbe carried out by a
psychiatrist.
-The person who carries out the examinationmay not be the
spouse, a close relative or relative by marriage or a civil union or
the representative of the person undergoing the examinationor
of the person who requested the examination.
- The report made following a psychiatric examinationmust be
signed by the examining physician.
• Court Locations
• Montreal
Palais de Justice
1, rue Notre-Dame Est
Montreal, Quebec
H2Y 1B6
Tel. 514-393-2721
• Laval
Palais de Justice de Laval
2800 boul. Saint-MartinO.
Laval, Quebec H7T 2S9
Tel. 450-686-5001

35. PREVENTIVE CONFINEMENT AND TEMPORARY CONFINEMENT
- Only an institution operating a local community service center equipped with the necessary facilities or
a hospital center may be required to place a person under preventive confinement or temporary
confinement for psychiatric examination.
-The physician who places the person under confinement must immediately inform the director of
professional services or, where there is no such director, the executive director of the institution.
- On the expiry of the 72 hour period, the person must be released, unless a court has
ordered an extension of the confinement for psychiatric assessment.
-A peace officer may, without the authorization of the court, take a person against his will to an
institution described in section 6
(1) at the request of a member of a crisis intervention unit who considers that the mental state of the
person presents a grave and immediate danger to himself or to others;
(2) at the request of the person having parental authority, the tutor to a minor or any of the persons
mentioned in article 15 of the Civil Code, where no member of a crisis intervention unit is available in
due time to assess the situation.
CONFINEMENT AUTHORIZED BY A COURT PURSUANT TO ARTICLE 30 OF THE CIVIL CODE
- Only an institution operating a hospital centre, rehabilitation centre, residential and long-term care
centre or reception centre that is equipped with the necessary facilities for receiving and treating
mentally ill persons

36. This Photo by Unknown author is licensed under CC BY-SA.
- Where the court has set a durationof confinementexceeding 21 days,
the person under confinement must be examinedperiodically to ascertain
whether continuedconfinement is necessary.
( 1) 21 daysfrom the date of the decision made by the court pursuant to
article 30 of the Civil Code;
(2) every three months thereafter.
- The psychiatricexamination reportsshall be kept by the institutionas part of
the person's record.
- A person under confinement may, at his request, be transferred to another
institution,if the organizationand resources of that institutionpermit of such
a transfer. Subject to the same condition,the attendingphysicianmay transfer
the person to another institutionwhich he considersbetter able to meet the
person's needs.
- Confinementends, with no further formality,
(1) as soon as a certificate attesting that confinement is no longer justified has
been issued by the attendingphysician;
(2) on the expiry of a time limit prescribed by section 10, if no psychiatric
examination reporthas been produced by that time;
(3) on the expiry of the time fixed in the judgment ordering confinement;
(4) upon a decision to that effect by the AdministrativeTribunal ofQuébec or a
court of justice.

37. RIGHTS AND REMEDIES:-
- The peace officer or person remains responsible for that person until he is taken in charge by
the institution.
- As soon as the person has been taken in charge by the institution, or as soon as he seems
able to understand the information, the institution must inform him of the place where he is
being confined, of the reasons for the confinement and of his right to contact his close relatives and
an advocate immediately.
- A prohibition or restriction as to communication can only be temporary. It must be set out in writing
and contain reasons, and it must be given to the person under confinement and noted in his record.
- The person under confinement mustbe immediately informed by the institution of the end of the confinement.
ADMINISTRATIVE TRIBUNAL OF QUÉBEC:-
- The institution in which a person is under confinement mustinform the Administrative Tribunal of Québec,
without delay, of the conclusions of each of the psychiatric examinationreports required by section 10, and of the
end of the confinement.
MISCELLANEOUS PROVISIONS:-
- Any institution which, owing to its organizationor resources, is unable to provide for a psychiatric examinationor
place a person under confinement, mustimmediately direct any person for whom such services are required to
another institution equipped with the necessary facilities.

38. Duties of the health care assistant
• Serving meals and helping to feed patients.
• Helping patient to move around.
• Toileting.
• Making beds.
• Talking to patients and making them comfortable.
It will also help patients to ease loneliness and feelings of
Isolation.
• The job revolves around helping clients with their
immediate needs such as washing, dressing and
maintaining their hygiene, as well as helping them with
basic day-to-day or administrative tasks like paying bills.
• Assistmentally impaired or emotionally disturbed
patients, working under direction of nursing and
medical staff. May assistwith daily living activities, lead patients in educational and recreational activities, or
accompany patients to and from examinations and treatments

39. • Listen and provide emotional support and
encouragement to psychiatric patients.
• Serve meals or feed patients needing assistanceor
persuasion.
• Work as part of a team that may include
psychiatrists, psychologists, psychiatricnurses, or
social workers.
• it is also their responsibility to Clean and disinfect
rooms and furnishings to maintaina safe and
orderly environment.
• Provide patients with assistancein bathing,
dressing, or grooming, demonstrating these skills as
necessary.
• In mental health, a lot of it is to do with
interpersonal reaction and relationships and there
is no way that you can hide behind anything to do
with that. It is very reliant on therapeutic use of self

40. What are your skills that will make you the ideal employee?
• A healthcare assistant must be Caring, friendly and respectful. Able to get on with all kinds of
patient.
• Good at listening and observing to spot someone's needs even when the patient is unable to ask for
help.
• HCA should have Passion for the job. At the end of the day, it’s not just a job, it’s a commitment to
helping others. It can be demanding and challenging, but also rewarding, so you need to really love
what you do.
• Good communication skills must be there. Because we working with people day in, day out, building
relationships. We need to be able to listen and consult with our patients and their families,
understand their needs and be able to explain their care plan in a way that makes sense to them so
they feel valued and supported.
• HCA should be Able to multitask because Working in healthcare, we may find our self for multiple
patients at the one time.
• Fit and active- It’s pretty much a given if you’re working in a healthcare role that you will be on your
feet for most of the day. You may also need to lift heavy objects from time-to-time and assist your
patients with getting around. So, it’s important to be physically fit.

41. • Good problem solving skills- The family of a
patient could disagree with your care
recommendationsor treatment schedules could
change at the last minute. A good healthcare
worker will be able to work through a problem
calmly and rationally and come up with a solution
that everyone (and most importantly, your
patient), is happy with.
• Empathy and compassion- Above all else, a good
health professional can show compassion to their
patients and provide comfort when they need it.
At times, your patients may find themselves in
difficult or frustrating situations and they need
someone to listen, to understand and respect
their wishes or point of view. If you respond
kindly, with empathy and understanding, it will
have a positive impact on your patient.