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Comment by skissane | Hacker News Reader

Stumbling upon cases like this one really shocked me - “Penile self-amputation due to cannabis-induced psychosis: a case report”

https://jmedicalcasereports.biomedcentral.com/articles/10.11... (Edit: graphic images warning)

If you search PubMed, you will find case reports of other similar incidents. Now, no denying this is an extremely rare adverse effect, but still a quite frightening one. (Also worth stating, many of these reported cases of cannabis-induced psychotic penile self-amputation involve no known history of gender dysphoria.)

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I have a feeling that these individuals (I could only find two in my pubmed search) were suffering from schizophrenia, not cannabis-induced psychosis. Maybe you could make the argument that the cannabis caused the schizophrenia, but that's still a different diagnosis.

In the case you link the guy had smoked weed for two years prior with no apparent issues. Yes his psychosis resolved after he stopped using cannabis, but he was also treated from that point onward with anti-psychotics (the kind you would treat schizophrenia with). It was probably the anti-psychotics, not the cannabis cessation that made him not psychotic.

I hear this argument every time someone does something bad on psychedelics and cannabis. I’ve also heard that, if the patient had no history of schizophrenia or related disorders, they must have just had it latent and were bound to get it anyway.

Bottom line is there is no way for any individual to really know if they have latent schizophrenia anyway, and I think it’s a conveniently non-disprovable explanation for why psychedelics and cannabis aren’t bad.

I've long had this sense, that if I started smoking weed every day, I probably would develop psychosis sooner or later. I feel like my connection to reality is at times somewhat tenuous, and heavy cannabis could easily disturb it enough to break it entirely. I suppose I could be wrong, but that's a hypothesis I'm not going to test.

I do think some people can have that "latent" potential yet have the good fortune of never activating it – and cannabis definitely has the potential to do so (although most recreational drugs probably can given sufficiently heavy long-term use).

(I tried cannabis once, years ago, I could see why people like it but I didn't feel any great urge to repeat the experience – and worries like this also discourage me – which is probably for the best.)

I think calling cannabis bad or good is a false dichotomy. Sometimes peanuts kill children, that doesn't make peanuts "bad". Maybe cannabis causes schizophrenia in rare cases, does that make it "bad"?

In this specific case, the authors started him on a treatment for schizophrenia and he got better. Why continue him on this treatment if they thought it was simply the cannabis that caused it (as he would abstain from then on). Also, they increased his dose prior to discharge.

I'm not arguing that cannabis didn't cause his schizophrenia, just that this doesn't sound like cannabis induced psychosis, which is a different diagnosis with different prognosis.

> I could only find two in my pubmed search

See this paper – Veeder TA, Leo RJ. Male genital self-mutilation: a systematic review of psychiatric disorders and psychosocial factors. Gen Hosp Psychiatry. 2017 Jan-Feb;44:43-50. https://doi.org/10.1016/j.genhosppsych.2016.09.003 Epub 2016 Sep 14. PMID: 28041576.

To quote its abstract:

> Data were obtained from 173 cases: genital mutilation (n=21), penile amputation (n=62), castration (n=56) and combined amputation/castration (n=34). Common psychiatric disorders included schizophrenia spectrum (49%), substance use (18.5%), personality (15.9%) and gender dysphoric disorders (15.3%)

So, while it is almost 50% schizophrenia spectrum, substance use is the second most common cause (although personality disorders and gender dysphoria are not far behind, and the difference between the three might not be statistically significant.)

Thanks, I searched for cannabis specifically which would explain why this didn't show up. I imagine much of the substance use auto amputations are in people who do things like PCP.

Warning, there are some graphic images in that link.

Good point, I edited it to add a note. I should have warned people but I forgot.

Also, my mother is a doctor, and when I was a teenager (even tweenager) I used to love to read her medical journals and textbooks–it has made me rather immune to the unsightly images they sometimes contain–although, interestingly, images which I can view nonchalantly in a medical context will still freak me out if divorced from that context.

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