Penile Self-Amputation in a Patient with Schizophrenia, while on Clozapine Augmentation with Modafinil: A Case Report

  • NRK Anish Psychiatrist, Government Mental Health Centre, Trivandrum
  • Anil Prabhakaran Head, Dept. of Psychiatry, Medical College, Thiruvananthapuram
  • Vidhukumar Karunakaran Head, Dept. of Psychiatry, Medical College, Ernakulam
Keywords: Penile self amputation, self-mutilation in schizophrenia, modafinil


Genital self mutilation is extremely rare and is seen in psychotic illnesses with associated risk factors like commanding hallucinations, religious delusions, past suicide attempts, depression, personality disorder, substance abuse or gender identity problems. We report a case of total penile self amputation in a 23 year old male without any of these risk factors. He was diagnosed with schizophrenia and was well maintained on clozapine 150 mg with with (an sos) prescription of modafinil 100mg in the morning. In human clinical trials, modafinil has no evidence for self mutilatory behaviour.


Helen S, Richard EP, Michael F jnr, David MQ. Genital self mutilation. Int J Urol 2006; 13: 1358–60.
Schweitzer I. Genital self amputation and the Klingsor syndrome. Aust N Z J Psychiatry 1990; 24(4): 566-9.
Hall DC, Lawson BZ, Wilson LG. Command hallucination and self amputation of penis and hand during a first psychotic break. J Clin Psychiatry 1981; 42(8):322-4.
Rana A, Johnson D. Sequential self-castration and amputation of the penis. Br J Urol 1993; 71:750.
Vafaei B. Two case reports of self mutilation or van gogh syndrome. Acta Med Iran 2003; 41:199-201.
Ames D. Autocastration and biblical delusions in schizophrenia. Br J Psychiatry 1987; 150:347.
Aboseif S, Gomez R, McAninch JW. Genital self mutilation. J Urol 1993; 150:1143-6.
Kratofil PH, Baberg HT, Dimsdale JE. Self-mutilation and severe self-injurious behavior associated with amphetamine psychosis. Gen Hosp Psychiatry 1996; 18(2):117-20.
Israel JA, Lee K. Amphetamine usage and genital self mutilation. Addiction 2002; 97(9):1215-8.
Thomas NW, Ram CK. Amputee fetishism and genital mutilation: Case report and literature review. J Sex Marital Ther 2000; 26: 339–44.