1812 – Complex Neuropsychiatric Symptoms After Suicidal Attempt By Double Gunshot To The Head
Bibliographic record
Abstract
Cranioencephalic trauma and resulting traumatic brain injury are sometimes associated with hard to manage psychiatric symptoms, requiring interpretation from an integrated neuropsychiatric perspective. We present the case of a 49-year-old man with no known psychiatric history who attempted suicide by gunshot to the head resulting in severe cranioencephalic trauma (GCS=7) and subsequent admission to our hospital's Neurosurgery ward. Brain-CT showed two intracranial projectiles, in left temporal and right occipital topography, as well as multiple haemorragic foci. He was transferred to our Psychiatry ward, as there was no neurosurgical indication and he repeatedly attempted suicide. At admission, he presented with level of consciousness fluctuations, temporospatial disorientation, anosognosia and difficult to assess depressive symptoms. Brief neuropsychological evaluation showed deficits on visual-perceptive abilities, executive functions, logical reasoning, and immediate verbal memory, with a MoCA (Montreal Cognitive Assessment) total score under the normative values. Some language capacities (i.e. naming and repetition) were found to be preserved. Neuroophthalmological evaluation evidenced damage to the anterior left optic tract and a right campimetric defect. The EEG revealed no epileptic activity. At the 34th day of hospitalization, after accidental choking, he began to exhibit delirium with accompanying psychotic symptoms. Presently, two-and-a-half months after admission, we observe remission of delirium, coherent and organized speech, an alexithymic pattern of response, ideative perseverance and no suicidal ideation. The noteworthiness of this case resides on the scarcity of published reports and on the difficulty it presents in terms of therapeutic and post-discharge management, originating from the hard-to-interpret symptoms and uncertain prognosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".