BAIKUNTHANATH MISHRA & NILAMADHAB KAR lethal and he himself did not seek help may indicate suicidal intention. Nonetheless the impairment in his judgement was significant. There was no sexual conflicts, dysfunction,guilt.or personality disorder as previously reported. There were no obsessions regarding sex or religious psychotic features. Rituals like circumcision are not observed in his religion. He described that while he was engaged in amputating he did not think of suicide. He understood that the act was potentially lethal.However with a past history of suicide attempt and current suicidal idea it is difficult to imagine such a deliberate injurious act of probable grave consequences without the intent to die. The patient had experienced multiple events related to genito-urinary system like orchidectomy at an early age,benign hypertrophy of prostrate, obstructive urinary symptoms precipitated by imipramine and recent invasive investigations of urinary system. His vulnerability towards self harm had been established by past suicidal attempt and suicidal ideas in the current depressive episode. In the above background and with grossly impaired judgement, the urinary symptoms could possibly have precipitated the cognition to amputate the genitals to get rid of the symptoms and have lead to the subsequent behaviour. REFERENCES Aboseilf, S.,Gomez, R.& McAninch J.W.(1993).Genital self-mutilation The Journal of Urolology 150(4), 1143-6. Becker, H. & Hartmann U(1997) Genital self-injury behaviour- phenomenologic and differential diagnosis considerations from the psychiatric viewpoint. Fortschritte-der-Neurologie- psychiatric, 65(2),71-8. Becker, M.,Hofner, K., Lassner, F., Pallua, N. & Berger, A.(1997) Replantation of the complete external genitals. Plastic and Reconstructive Surgery;99(4), 1165-8. Conancher, G.N.,Villeneuve, D.,& Kane G.(1991) Penile self-mutilation presenting as rational attempted suicide. Canadian Journal of Psychiatry, 36(9), 682-5. Feldman, M.D.(1988) More on female genital self-mutilation. Psychosomatics,29C\), 141. Krasucki, C.,Kemp, R. & David, A. (1995) A case study of female genital self-mutilation in schizophrenia.British Journal of Medical Psychology, 68(pt.2), 179-86. Martin, T. &Gattaz, W.F.(1991) Psychiatric aspects of male genital sellf- mutilation. Psychopathology. 24(3). 170-8. Nakaya, M.(1996) On background factors of male genital self-mutilation. Psychopathology, 29(4),242-8. Schweitzer, 1.(1990) Genital self- amputation and the Klingsor syndrome. Australian and New Zealand Journal ofPsychiatry, 24(4), 566-9. Shimizu, A.,Mizuta, 1.(1995) Male genital self mutilation: A case report. British Journal of Medical Psyc/io/ogy,68(pt.2), 187-9. Yang, J.G. & Bullard, M.J.(1993) Failed suicide or successful male genital self- amputation? American Journal of flsyc/Mafry,150(2),350-1. Wise TN,Dietrich AM.segall E:(1989) Female genital self-mutilation: Case reports and literature review. Journal of Sex and Marital 777erapy,15(4),269-74. BAIKUNTHANATH MISHRA.DPM.MD.Assistant Professor, Psychiatry,Mental Health Institute,Cuttack. NILAMADHAB KAR', DPM, MD.DNB.Associate Professor .Department of Psychiatry,Kasturba Medical College, Manipal.576119. (emailnmadhab@yahoo.com) * Correspondence 344