Acute Onset of Schizophrenia following Autocastration

Abstract

ex clud ing in di vidu als ex press ing no opin ion rep re sent equally invalid methods of in flat ing the ap par ent ac cep tance of dis so cia tive dis or ders and do not make a large nu meri cal dif fer ence, in any case.Sim ply stated, one may choose to in terpret our find ings as show ing that the glass is ei ther half-full or half-empty (as we have noted be fore [3]), but by any standard one can not claim that there is any con sen sus one way or the other on the diag nos tic status or sci en tific va lid ity of the dis so cia tive dis or ders. Auto cas tra tion is a rare form of geni tal self-mutilation tra di tion ally as so ci ated with pa tients suf fer ing from acute psycho sis, es pe cially those har bour ing re ligious de lu sions and hav ing other risk fac tors (1). We pres ent a case of auto castra tion oc cur ring dur ing the pro drome of schizo phre nia, with florid psy cho sis emerg ing only af ter the act. We dis cuss pos si ble neu ro en do cri nal and neu ro transmit ter in ter ac tions un der ly ing the ap pearance of this schizophrenia-like psy cho sis af ter cas tra tion. Ref er ences Case ReportThe pa tient, a 26-year-old mar ried man, was ad mit ted with a re cent psy chotic exac er ba tion of a 5-year ill ness char ac ter ized by sus pi cious ness, hear ing sounds, un pro voked ir ri ta bil ity, un predict able vio lence, in ap pro pri ate mood states, awk ward pos tures, and pro gressive per son al ity de te rio ra tion. He was diag nosed with un dif fer en ti ated schizo phre nia ac cord ing to the ICD-10 cri te ria. Al though he had a his tory of sexual abuse and pe do philic be hav iour dating from early ado les cence, he did not dis play any traits sug gest ing a per son al ity dis or der. The first changes in his de meanour were no ticed when, fol low ing the loss of his job in 1995, he be came sad and aloof. He also ex pe ri enced sleep dis turbance that gradu ally wors ened over the next 6 months. To ward the end of this 6-month pe riod, he be came more re lig ious as well. Dur ing this time, how ever, there was no de pres sive cog ni tion or overt psycho sis. As his sleep de te rio rated, he consulted many gen eral prac ti tio ners, but with out much re lief. One day, dis tressed be cause of this lack of sleep, the pa tient im pul sively de cided to com mit sui cide. He went to a lonely hill, where he first thought of stab bing him self but then instead cas trated him self, be liev ing this to be more le thal. Us ing a knife, he completely ex cised the scro tum at its base and then threw the tes tes away, but left his penis un touched. He felt no pain dur ing the act. For tu nately, he was res cued and the re main ing part of the scro tum was sutured. Fol low ing re cu pera tion in a hos pital, he was dis charged af ter 15 days. The tes tes were not re at tached, nor was he started on tes tos ter one. As as sessed by a psy chia trist, the pa tient had no psy chotic symp toms dur ing the hos pi tal stay, and his only rea son for com mit ting the act was a genu ine wish to die, p...

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