title: Command Hallucinations and self-amputation of the penis and hand during a first psychotic break.
abstract: An unusual case is presented of a psychotic young man who experienced command auditory hallucinations which directed him to amputate his right hand and distal penis to atone for a "terrible sexual transgression." The existing literature on genital self-mutilation is reviewed as well as some recent work on factors that might be used to predict an episode of self-mutilation. In patients who are felt to be at extremely high risk, careful monitoring and rapid medication schedules might be effective in preventing such an incident.
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D006212:Hallucinations / Q000523:psychology*; D006225:Hand; D006801:Humans; D008297:Male; D010413:Penis; D012563:Schizophrenia, Paranoid / Q000523:psychology*; D012652:Self Mutilation / Q000523:psychology*