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All 13 posts | Subject: Amphetamine usage and genital self-mutilation | Please login to post | Down | |
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Rhodium (Chief Bee) 06-13-04 19:37 No 513189 
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Amphetamine usage and genital self-mutilation | ||||||
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CASE REPORT: Amphetamine usage and genital self-mutilation Joshua A. Israel & Kewchang Lee Addiction 97(9), 1215 (2002) Abstract Amphetamine usage has been associated with addiction, psychosis and self-injurious behavior. We report on two patients who severely and repeatedly mutilated their own genitalia while intoxicated on amphetamines and consider possible diagnostic etiologies. Introduction The stimulants cocaine and methamphetamine have few approved uses as medications, but are used frequently as illicit drugs of recreation and abuse in numerous forms, and their usage has been on the rise in the past decade (Derlett & Heischober 1990; Swan 1997). Methamphetamine is the most widely abused amphetamine-like drug (MMWR 1995). The psychostimulants dextroamphetamine, methylphenidate and pemoline are used in the treatment of narcolepsy, attention deficit hyperactivity disorder (ADHD), refractory depression and apathy in the medically ill (Masand & Tesar 1996). The stimulants, licit and illicit, are sympathomimetic amines with central and peripheral nervous system stimulant actions. These actions are mediated primarily by noradrenergic and dopaminergic neurons; increased neurotransmitter release, reuptake reduction and monoamine oxidase inhibition are all considered to be involved in the primary effects of these drugs (Seiden, Sabol & Ricuarte 1993). The precise mechanisms of action of the various stimulants remain to be fully elucidated, but it is known that methamphetamine triggers the release of dopamine into the ventral tegmental area (VTA) of the brain (Zickler 2001a), while cocaine blocks dopamine reuptake, resulting in accumulation of dopamine at the synaptic cleft, including in the VTA, resulting in increased sensations of pleasure (Zickler 2001b). These effects may also suppress activity of the pontine nucleus and locus coeruleus, thereby suppressing feelings of fear and panic (Boghdadi & Henning 1997). Stimulant usage has been associated with addiction, intoxication, paranoia, depression and prolonged psychosis (Sata 1992). Amphetamine usage in particular has also been associated with severe self-injurious behavior, including self-enucleation and self-amputation of the hands (Kratofil, Baberg & Dimsdale 1996), but repeated mutilation specific to the genital regions induced by amphetamine usage has, to our knowledge, been described previously only once in the medical literature (Kratofil et al. 1996). The literature on genital mutilation indicates that this disturbing act is likely to be under-reported but is rare nonetheless (Greilsheimer & Groves 1979; Martin & Gattaz 1991; Catalano et al. 1996). Documented episodes involving women are particularly rare, and the majority of all reported cases involve men (Coons, Ascher-Svanum & Bellis 1986; Alao, Yolles & Huslander 1999), with approximately 100 known cases published to date (Young & Feinsilver 1986; Walter & Streimer 1990; Kratofil et al. 1996; Romily & Isaac 1996; Agoub & Battas 2000; Bhatia & Arora 2001). The majority of cases have involved Caucasian men between the ages of 20-49 years with the diagnosis of primary psychosis (i.e. schizophrenia, schizophreniform disorder, manic psychosis) and/or alcohol abuse (Romily & Isaac 1996). Interestingly, no such cases have been connected definitively to cocaine abuse. We have recently become aware of two other patients who have mutilated their own genitalia severely and repeatedly while intoxicated on amphetamines. Case 1 A 44-year-old divorced, Caucasian male presented to the emergency department with bleeding from the rectum. Six days prior to admission he had nasally inhaled methamphetamine and cut 1 inches into his perineum and anus with a razor blade. The patient initially delayed seeking treatment out of shame. The patient was known to the surgical and psychiatric services for similar past presentations, and psychiatric consultation was called upon admission. The patient first came to medical attention at age 30, after he bisected his penis with a knife while intoxicated on amphetamines. Since that episode he had engaged in such behaviors numerous times, always under the influence of amphetamines, most often intranasal methamphetamine, occasionally along with intranasal cocaine. These episodes brought him intense, temporary sexual pleasure. He denied having suicidal thoughts at any time, nor any conscious wishes to harm himself. He was always regretful of the damage he caused, but felt he could not resist the pleasure that this self-mutilation brought him. Two years prior to the current presentation, while intoxicated on methamphetamine, he had taken a razor and cut through the remaining joined area at the base of his penis. He bisected his penis and testicles, and bisected his pelvis at the symphisus pubis to a depth that lacerated his bladder and bowel. His hospital course at that admission was complicated by fungemia, bacterial sepsis and acute renal failure, and he required numerous surgeries involving general surgery, urology and plastic surgery, leaving him with a colostomy and a urostomy. The patient's prior psychiatric treatments had included insight-oriented psychotherapy, Narcotics Anonymous, Alcoholics Anonymous and several prior prolonged in-patient admissions; he reported that none of these had been beneficial. He had no history of suicide attempts. Prior medication trials included risperidone, fluvoxamine, clonazepam, perphenazine and naltrexone. He had never had a robust response to any of these medications, and none of them prevented self-mutilation when he was under the influence of amphetamines. Psychiatric consultation at the current admission found the patient to be a neatly groomed male who was pleasant and cooperative with the interview. His speech was articulate with normal rate, tone and volume. His affect was mildly depressed, and his mood was depressed. He stated that he had not been depressed prior to this self-mutilating behavior, and he attributed his current mood to his shame and frustration over having injured himself. His thought content was without any overt psychotic symptoms. He reported intrusive thoughts of guilt, frustration and regret over his recent self-mutilation. He was without any suicidal ideation or desire for self-harm. He stated, 'I'm just really embarrassed'. He reported that he could not resist these behaviors because while he was intoxicated on amphetamines, genital mutilation was overwhelmingly sexually gratifying. At the time of the current admission, he reported that he had not used any amphetamines since the admission two years prior, and he had not had any episodes of self-injurious behavior during that time. He did report ongoing occasional use of marijuana and alcohol. The consulting psychiatrist recommended treating the patient with olanzapine 10 mg daily, and the patient reported that this 'helped with his thinking', with decreased intrusive thoughts of what he had done. His hospital course of reparative surgery was uneventful and at the time of discharge the patient declined any psychiatric interventions, and he was lost to follow-up. Case 2 A 46-year-old Caucasian male presented to the urology service with a chief complaint of 2 days of penile and scrotal pain, shaking chills, dysuria and pus draining from his urethra. Physical examination suggested a scrotal abscess and a urethral diverticulum. He was admitted for infection and drainage of an apparent scrotal abscess. Cystoscopy revealed a 1-inch bolt, with a screw attached, in the urethra. The patient underwent penile urethrotomy and bulbar urethrotomy. The postoperative course was complicated by ongoing penile infection and development of a urethro-cutaneous fistula in the midshaft of his penis requiring primary surgical repair. The patient had no prior psychiatric history, including no prior use of psychotropic medications. He had a history of alcohol abuse, but reported sobriety for 7 years prior to this admission. His medical history was remarkable for a prior basal skull fracture with a loss of consciousness in a motor vehicle accident. When interviewed, the patient admitted that he used methamphetamine intermittently and had done so on the day that his scrotum began to hurt. He reported that he did not remember inserting objects into his urethra. He stated that he 'might have' done so at other times in the past while intoxicated on amphetamines, but he declined to elaborate. On mental status examination, the patient was found to have poor dentition but an otherwise normal appearance, with good eye contact and engagement and normal speech. His affect was depressed and his mood was reported to be depressed secondary to the events that led to this hospitalization. His thought process was linear and logical, and his thought content was without any psychotic content. He was without suicidal ideation or desire for self-harm. At the time of his discharge, the patient agreed to follow -up treatment in a substance abuse program. At that first follow-up psychiatric visit, the patient reported that he had begun to wash his hands approximately 20 times a day and would return frequently to his house after leaving to make sure that he had locked the door and turned off the stove. He was begun on fluoxetine 20 mg daily with imipramine 50 mg nightly for insomnia. The patient had a mild improvement in obsessive compulsive disorder (OCD) symptoms on fluoxetine, but he requested that it be discontinued due to sexual side-effects. Sertraline was started and titrated up to 150 mg daily. He had an excellent response to this medication, with reduction in obsessive and compulsive behaviors. For the next year, the patient remained on sertraline and imipramine and had no presentations for genital mutilation. After 1 year, the patient declined to have his sertraline prescription renewed. He continued on imipramine 50 mg nightly, and denied any recurrence of OCD symptoms. Four months after discontinuing fluoxetine, the patient presented to the emergency department with a metal key ring around his scrotum and penis. He reported that 2 days prior to presentation he had used amphetamines and applied the ring to enhance his erection, and had not been able to remove it. On physical examination he was found to have an edematous scrotum and penis. The key ring was removed with a ring cutter and the patient's edema and pain resolved, although he was left with a penoscrotal scar in the pattern of the ring. Two months later, the patient presented to the emergency department, this time with the chief complaint of dysuria. After using amphetamines, the patient had inserted a plastic 'swizzle stick' into his urethra. A 17-cm plastic straw was removed via urethroscopy, without complications. Conclusion Just in our work in a single metropolitan area, we have found two patients who have repeatedly self-mutilated their own genitalia while under the influence of amphetamines, suggesting that this may be a more common phenomenon than described previously. In the first case, no clear Axis I disorder other than amphetamine abuse was notable. In the second case, OCD was present, but it is not clear if this second patient's mutilatory behaviors are best categorized along the OCD spectrum, similar to trichotillomania (Bienvenu et al. 2000) It is possible that the primary, relevant Axis I disorder in the second case is also amphetamine abuse, with OCD as a coincidental comorbidity. Amphetamine-induced self-mutilatory behaviors have been explored in animal models, with evidence showing that dopaminergic agonists can induce self-injurious behavior independently (Mueller et al. 1982; Gorea & Lombard 1984; Mueller, Hollingsworth & Pettit 1986) and that dopaminergic receptor antagonists can block these effects (Mueller & Nyhan 1982). It has also been documented that patients with primary psychotic disorders may be prone to self-mutilatory behaviors (Schlozman 1998). In addition to a primary dopaminergic hypothesis, there is some evidence that the REM-sleep deprivation that can occur in amphetamine addicts may be implicated in self-mutilating behaviors (Lara-Lemus et al. 1997). It has been shown in animal models that low dosages of amphetamines do not produce self-mutilatory behaviors, but higher dosages do have these effects (Mueller et al. 1986). This finding may explain why such behaviors presented in these patients after dosages sufficient to cause pleasurable intoxication, but have not been documented previously in patients receiving stimulants at the lower dosages commonly used to treat such conditions as narcolepsy and ADHD. These two patients caused themselves grave, permanent damage by their self-inflicted genital injuries. Further understanding and research towards treatment of such behaviors would be a valuable addition to the knowledge base of addiction and psychiatry. References • Agoub, M. & Battas, O. (2000) Male genital self-mutilation in patients with schizophrenia. Canadian Journal of Psychiatry, 45, 670. • Alao, A. O., Yolles, J. C. & Huslander, W. (1999) Female genital self-mutilation. Psychiatric Services, 50, 971. • Bhatia, M. S. & Arora, S. (2001) Penile self-mutilation. British Journal of Psychiatry, 178, 86-87. • Bienvenu, O. J., Samuels, J. F., Riddle, M. A., Hoehn-Saric, R., Liang, K. Y., Cullen, B. A., Grodos, M. A. & Nestadt, G. (2000) The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biological Psychiatry, 48, 287-293. • Boghdadi, M. S. & Henning, R. J. (1997) Cocaine: pathophysiology and clinical toxicology. Heart and Lung, the Journal of Acute and Critical Care, 26, 466-485. • Catalano, G., Morejon, M., Alberts, V. A. & Catalano, M. C. (1996) Report of a case of genital self-mutilation and review of the literature, with special emphasis on the effects of the media. Journal of Sex and Marital Therapy, 22, 35-46. • Coons, P. M., Ascher-Svanum, H. & Bellis, K. (1986) Self-amputation of the female breast. Psychosomatics, 27, 667-668. • Derlett, R. W. & Heischober, B. (1990) Methamphetamine. Stimulant of the 1990s? Western Journal of Medicine, 153, 625-628. • Gorea, E. & Lombard, M.-C. (1984) The possible participation of a dopaminergic system in mutilation behavior in rats with forelimb deafferentiation. Neuroscience Letters, 48, 75-80. • Greilsheimer, H. & Groves, J. E. (1979) Male genital mutilation. Archives of General Psychiatry, 36, 441-446. • Kratofil, P. H., Baberg, H. T. & Dimsdale, J. E. (1996) Self-mutilation and severe self-injurious behavior associated with amphetamine psychosis. General Hospital Psychiatry, 18, 117-120. • Lara-Lemus, A., Perez de la Mora, M., Mendez-Franco, J., Palomero -Rivero, M. & Drucker-Colin, R. (1997) Effects of REM sleep deprivation on the d-amphetamine-induced self-mutilating behavior. Brain Research, 770, 60-64. • Martin, T. & Gattaz, W. F. (1991) Psychiatric aspects of male genital self-mutilation. Psychopathology, 24, 170-178. • Masand, P. S. & Tesar, G. E. (1996) Use of stimulants in the medically ill. Psychiatric Clinics of North America, 19, 515-547. • Morbidity and Mortality Weekly Report (MMWR) (1995) Increasing morbidity and mortality associated with abuse of methamphetamineUnited States, 1991-94. Morbidity and Mortality Weekly Report, 44, 882-886. • Mueller, K., Hollingsworth, E. & Pettit, H. (1986) Repeated pemoline produces self-injurious behavior in adult and weanling rats. Pharmacology Biochemistry and Behavior, 25, 933-938. • Mueller, K. & Nyhan, W. L. (1982) Pharmacologic control of pemoline-induced self-injurious behavior in rats. Pharmacology Biochemistry and Behavior, 16, 957-963. • Mueller, K., Saboda, S., Palmour, R. & Nyhan, W. L. (1982) Self-injurious behavior produced in rats by daily caffeine and continuous amphetamine. Pharmacology Biochemistry and Behavior, 17, 613-617. • Romily, C. S. & Isaac, M. T. (1996) Male genital self-mutilation. British Journal of Hospital Medicine, 55, 427-431. • Sata, M. (1992) A lasting vulnerability to psychosis in patients with previous methamphetamine psychosis. Annals of the New York Academy of Sciences, 654, 160-170. • Schlozman, S. C. (1998) Upper extremity self-amputation and re-implantation: 2 case reports and a review of the literature. Journal of Clinical Psychiatry, 59, 681-686. • Seiden, L. S., Sabol, E. S. & Ricuarte, G. A. (1993) Amphetamine: effects on catecholamine systems and behavior. Annual Review of Pharmacology and Toxicity, 32, 639-677. • Swan, S. (1997) Response to escalating methamphetamine abuse builds on NIDA-founded research. NIDA Notes, 11, 5-19. • Walter, G. & Streimer, J. (1990) Genital self-mutilation: attempted foreskin reconstruction. British Journal of Psychiatry, 156, 125-127. • Young, L. D. & Feinsilver, D. L. (1986) Male genital self-mutilation: combined surgical and psychiatric care. Psychosomatics, 27, 513-517. • Zickler, P. (2001a) Methamphetamine, cocaine abusers have different patterns of drug use, suffer different cognitive impairments. NIDA Notes, 16, 11-12. • Zickler, P. (2001b) Altered cellular activity may be first step in progression to cocaine addiction. NIDA Notes, 16, 10. The Hive - Clandestine Chemists Without Borders |
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CharlieBigpotato (goat) 06-14-04 13:19 No 513306 
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thanks for sharing? | ||||||
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embezzler (Hive Addict) 06-14-04 14:53 No 513318 
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It is important that we at least hear of that | ||||||
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Swim remembers some street pills here that drove kids crazy, one of them took his own eye out with a srewdriver the pills were called snowballs and were sold as extacy but swim believes there may have been a dissociative hallucinogen in the mix. What i find strange is that people who cut their ballsack open would ever take the drugs again. chemically enhanced. |
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Bond_DoubleBond (Hive Bee) 06-14-04 19:58 No 513367 |
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deep psychological issues | ||||||
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Two years prior to the current presentation, while intoxicated on methamphetamine, he had taken a razor and cut through the remaining joined area at the base of his penis. He bisected his penis and testicles, and bisected his pelvis at the symphisus pubis to a depth that lacerated his bladder and bowel. rarely is such the case, but bond is SPEECHLESS after reading that. goddam. |
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methyl_ethyl (Guardian) 06-14-04 20:29 No 513372 
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Self Mutilation with Amphetamine Psychosis | ||||||
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Self Mutilation and Severe Self-Injurious Behavior Associated With Amphetamine Psychosis Paul H. Kratofil, D.O., Henning T. Bberg, and Joel E. Dimsdale, M.D. General Hospital Psychiatry 18, 117-120, 1996 Abstract: Amphetamine abuse is widespread and is frequently encountered in general hospital settings. We have recently seen amphetamine-induced transient psychosis associtated with severe self injurious behavior and self mutilation. In the setting of bizarre and/or severe self-injurious behaviour, screeening for amphetamines is indicated. Unipolar Mania, It's good for life... 
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ApprenticeCook (Hive Bee) 06-15-04 02:58 No 513446 |
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thanks.... i think.... | ||||||
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thanks.... i think.... The dude cut his own penis and ballsack.... wonder if it could be repaired or he fucked it up enough for a amputation? Wouldnt that suck coming down... having nothing left downstairs! 
Its just my opinion, but no-one listens to me anyway, and rightly so... |
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jemma_jamerson (Hive Addict) 06-15-04 03:05 No 513447 |
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wtf | ||||||
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these fucks are nuts i thought the articles were going to reveal how you would wank or fuck for days, and accidently mutilate your my happy because of the obcessive behaviour, and coninous use thats what happens to the majority pf people that use methamphetamine isnt it? well to those that dont do it in moderation  i guess thats the same thing as this, as they are un controlled burst of self mutilation, un consciously, FEAR MY GEAR epistemologicide http://www.holology.com http://www.counterorder.com |
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Xaja (Newbee) 06-16-04 02:22 No 513697 |
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Jesus Christ | ||||||
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biotechdude (Hive Bee) 06-17-04 00:22 No 513857 |
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foreplay | ||||||
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Maybe they should have a wank....and THEN see if they still feel like carving the roast. Seriously though, these were 2 disturbed individuals. Very unfortunate 
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ChemoSabe (Hive Addict) 06-21-04 09:33 No 514575 
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Still Shuddering | ||||||
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I think it was that huge news series on meth put out by the Sacramento Bee (no connection to the Hive) which had some LE (law enforcement) pages stating that some of the things which would send up a red flag for meth use suspicion with them were discovery of excessive pornography or signs of masturbatory mutilation. Or words to that general effect. I thought this article would be similar but it takes the idea I had way beyond where I thought it would go. At a few points I just had to stop reading and shudder and skip to the next paragraph. I'd consider a shuddering emoticon appropriate here if there were one. Here's a generalized link to the Sacramento Bee meth pages http://www.methvalley.com/ He was just another tree in the forest whom nobody heard when he finally fell |
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Drug_Phreak (Hive Bee) 08-12-04 23:08 No 525117 |
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The powers that be always blame drugs instead... | ||||||
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The powers that be always blame drugs instead of the individual(s) in situations like this. I would be willing to put money on it that these people would have done these things regardless. Drugs don't cause people to act like this... the same way a gun doesn't cause someone to commit murder. I think if more people did drugs this world would be a better place. Crank is part of this complete breakfast. |
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CharlieBigpotato (Bizarre pHomme de Terra) 08-13-04 06:43 No 525207
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i don't want to google for this: | ||||||
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but i'm vaguely curious how self-mutilation cases, in general, break down, as per drug use, or other factors. i self mutilated th inside of my cheek once on novacaine. it was accidental, but still..i would think opiates and anesthetics are the way to go beefore removing silly appendages. the hive seems to bee a tad morbid of late. i want to see a fluffy bunny. |
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Rhodium (Chief Bee) 09-02-04 07:46 No 529071
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Self-Extraction of Teeth Involving GHB | ||||||
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Self-Extraction of Teeth Involving γ-Hydroxybutyric Acid I.A. Pretty, R. C. Hall, Journal of Forensic Sciences 49(5), (2004) DOI:10.1520/JFS2004133 Abstract A case involving self-extraction of teeth linked to the abuse of gamma-hydroxybutyric acid (GHB) is reported. A 28-year-old woman and her 29-year-old boyfriend were discovered by paramedics following an extensive period of GHB use. The paramedics were alerted by a neighbor who had heard screaming from the house. On presentation to the accident and emergency department, it was noted that the female had 18 fresh extraction sockets visible intra-orally. At the scene, a mirror, a pair of pliers, and a bowl containing human teeth were found. Charges of assault were taken to the courts against the boyfriend who was subsequently acquitted. Odontological evidence centered on whether or not it was possible to self-extract the teeth using the pliers found. This case is the first to describe possible oral self-mutilation under the influence of GHB and odontologists should always consider self-injury as an explanation for intra- and perio-oral injuries of unknown origin. Keywords: dentistry, drugs, extraction, forensic science, GHB, odontology, self, teeth, treatment The Hive - Clandestine Chemists Without Borders |
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