This report describes the case of a 31-year-old male lumberjack with severe self-inflicted injuries, including the amputation of both auricles and the penis, under the influence of cannabinoids, mitragynine, and 7-hydroxymitragynine. Emergency surgery was performed, and psychiatric evaluation revealed substance-induced psychosis. The patient's motivation for reconstructive penile surgery led to abstinence from the substance use and cooperation with treatment. Five months after hospitalization, successful penile reconstruction was completed. The patient remained abstinent and was engaged in regular psychiatric follow-ups, showing no signs of acute psychopathology. This case underscores the importance of using a multidisciplinary approach to manage severe self-harm behaviors, and highlights the critical role of patient motivation in achieving positive outcomes.

Department of Psychiatry Most Hospital Krajska Zdravotni Most Czechia

Department of Reconstructive and Plastic Surgery Krajská Zdravotní Masaryk Hospital Ústí nad Labem Czechia

Department of Sexology Krajská Zdravotní Masaryk Hospital Ústí nad Labem Czechia

Department of Urology Krajská Zdravotní Hospital Litoměřice Litoměřice Czechia

Department of Urology Most Hospital Krajska Zdravotni Most Czechia

Faculty of Health Studies Jan Evangelista Purkyně University Ústí nad Labem Czechia

Psychiatric Clinic of The Faculty of Health Studies Jan Evangelista Purkyně University Krajská Zdravotní Masaryk Hospital Ústí nad Labem Czechia

Zobrazit více v PubMed

Greilsheimer H, Groves JE. Male genital self-mutilation. Arch Gen Psychiatry. (1979) 36:441–6. doi: 10.1001/archpsyc.1979.01780040083009 PubMed DOI

Becker H, Hartmann U. Genital self-injury behavior–phenomenologic and differential diagnosis considerations from the psychiatric viewpoint. Fortschr Neurol Psychiatr. (1997) 65:71–8. doi: 10.1055/s-2007-996311 PubMed DOI

Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. The CARE guidelines: consensus-based clinical case reporting guideline development. BMJ Case Rep. (2013) 2013:bcr2013201554. doi: 0.7453/gahmj.2013.008 PubMed PMC

Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, et al. . CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. (2017) :89:218–35. doi: 10.1016/j.jclinepi.2017.04.026 PubMed DOI

Luethi D, Liechti ME. Designer drugs: mechanism of action and adverse effects. Arch Toxicol. (2020) 94:1085–133. doi: 10.1007/s00204-020-02693-7 PubMed DOI PMC

Khan MK, Usmani MA, Hanif SA. A case of self amputation of penis by cannabis induced psychosis. J Forensic Leg Med. (2012) 19:355–7. doi: 10.1016/j.jflm.2012.02.023 PubMed DOI

Jones NP. Self-enucleation and psychosis. Br J Ophthalmol. (1990) 74:571–3. doi: 10.1136/bjo.74.9.571 PubMed DOI PMC

Scheftel S, Nathan AS, Razin AM, Mezan P. A case of radical facial self-mutilation. An unprecedented event and its impact. Bull Menninger Clin. (1986) 50:525–40. PubMed

Coons PM, Ascher-Svanum H, Bellis K. Self-amputation of the female breast. Psychosomatics. (1986) 27:667–8. doi: 10.1016/S0033-3182(86)72638-8 PubMed DOI

Koops E, Püschel K. Self-mutilation and autophagia. Arch Kriminol. (1990) 186:29–36. PubMed

Henquet C, Di Forti M, Morrison P, Kuepper R, Murray RM. Gene-environment interplay between cannabis and psychosis. Schizophr Bull. (2008) 34:1111–21:6. doi: 10.1093/schbul/sbn108 PubMed DOI PMC

Awad M, Burke HH, Oakman SA. Kratom-induced psychiatric decompensation and paranoid delusions. Cureus. (2024) 16:2. doi: 10.7759/cureus.54626 PubMed DOI PMC

Hjorthøj C, Larsen MO, Starzer MSK, Nordentoft M. Annual incidence of cannabis-induced psychosis, other substance-induced psychoses and dually diagnosed schizophrenia and cannabis use disorder in Denmark from 1994 to 2016. psychol Med. (2021) 51:617–22:4. doi: 10.1017/S0033291719003532 PubMed DOI

Harvey SB, Dean K, Morgan C, Walsh E, Demjaha A, Dazzan P, et al. . Self-harm in first-episode psychosis. Br J Psychiatry. (2008) 192:178–84. doi: 10.1192/bjp.bp.107.037192 PubMed DOI