گزارش یک مورد قطع آلت تناسلی در یک بیمار مبتلا به سایکوز

زمینه و هدف: قطع عضو، یکی از انواع شدید آسیب به خود است که به قصد صدمه به بدن، انجام می‌گیرد. چشم، دستگاه ژنیتال و دست، اعضای مهمی هستند که مورد هدف قرار می‌گیرند. تاکنون، قطع آلت تناسلی توسط خود، در جهان کمتر گزارش شده است و شایع‌ترین علت آن اختلالات سایکولوژیک و در راس آن‌ها سایکوزها هستند.معرفی بیمار: مرد ساله مجرد، مبتلا به اختلال دوقطبی، که از دوران نوجوانی تحت درمان قرار داشت. وی سابقه سوء‌مصرف مواد و همین‌طور روابط جنسی متعدد را داشت. از دو ماه پیش، توهمات شنوایی بیمار مبنی بر قطع آلت تناسلی شروع شده بود که در نهایت در روز حادثه، منجر به این اقدام شد.نتیجه‌گیری: به‌نظر می‌رسد مجموعه عواملی مانند ابتلای بیمار به سایکوز به‌دنبال اختلال دوقطبی، سوء‌مصرف مواد، عقب‌ماندگی ذهنی، داشتن روابط جنسی متعدد و همین‌طور رابطه قوی عاطفی با مادر می‌تواند به‌عنوان محرک برای اقدام به قطع آلت تناسلی باشد.

A case report of genital self-mutilation in a patient with psychosis

Background: Selfmutilation is one of the most extreme types of selfharm, which is done deliberately to hurt the body, regardless of suicidal intent. In selfmutilation, the most important targets are the eyes, genital tract, and hands. So far, genital selfmutilation (GSM) has been less frequently reported around the world. According to our study, this is the first case of GSM reported in Iran. The most common cause of GSM is psychological disorder, especially psychosis.Case Presentation: The patient was an unmarried 32yearold man, who was hospitalized in RasulAkram Hospital in December 2018 for severe bleeding caused by GSM. He was diagnosed with type I bipolar disorder, which was treated from the late adolescence. Also, a history of drug abuse (amphetamine, opium, cannabis, alcohol) and multiple sexual relationships with different partners was reported. He abused tramadol tablets daily nowadays. His IQ was normal. He had lots of abrasions, scars and lacerations due to suicidal attempts in the past years. Two months before GSM, his auditory hallucinations about genital selfmutilation had started. He committed GSM after having sexual intercourse and was transferred to our hospital by an ambulance with severe hemorrhage, scrotum damage, and presentation of both testes, for which he received appropriate treatments.Conclusion: It seems that a set of factors, such as patient's history of psychosis following bipolar disorder, substance abuse, mental retardation, multiple sexual relationships, and strong emotional relationship with the mother can contribute to selfinjury that may lead to genital selfmutilation. It should be noted that genital selfmutilation cases are less likely to be reported in Iran, considering the cultural and religious background. Therefore, the pathology of this devastating phenomenon should be more thoroughly examined.