[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-443011-105":59,"doc-detail-443011-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","the-vanishing-organ-koros-syndrome-embedded-in-psychosis-and-manifesting-as-klingsors-syndrome","The vanishing organ: Koro’s syndrome embedded in psychosis and manifesting as Klingsor’s syndrome","","Clinical letter describing a rare intersection between culture-bound Koro-like symptoms and Klingsor syndrome within a primary psychotic disorder. A 35-year-old man presented after genital self-amputation and attempted drowning suicide, driven by delusional penile retraction and intense paranoid guilt. Psychiatric assessment identified persecutory and infidelity-related delusions with functional decline, with medical causes excluded and ICD-11 primary psychotic disorder diagnosed. Treatment used high-risk suicide protocol, risperidone, lorazepam, and supportive psychotherapy, followed by depot planning and multidisciplinary follow-up, emphasizing culturally sensitive, integrated management.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-vanishing-organ-koros-syndrome-embedded-in-psychosis-and-manifesting-as-klingsors-syndrome/443011/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-vanishing-organ-koros-syndrome-embedded-in-psychosis-and-manifesting-as-klingsors-syndrome/443011.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is Klingsor syndrome in this report?","Question",{"text":112,"@type":113},"Klingsor syndrome refers to genital self-amputation occurring in the setting of psychotic or delusional beliefs, as described in the letter’s introduction.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What psychiatric findings supported the diagnosis in the case?",{"text":117,"@type":113},"The patient showed progressive paranoid ideations, persecutory and infidelity-related delusions, and a firm delusional belief of penile shrinkage with functional decline; organic causes were ruled out.",{"name":119,"@type":110,"acceptedAnswer":120},"How was the patient managed and what was emphasized for future care?",{"text":121,"@type":113},"Management included high-risk suicide protocol, risperidone and lorazepam, daily supportive psychotherapy, surgical stabilization, and a plan for depot medication with close outpatient follow-up and multidisciplinary, culturally sensitive care.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},443011,1790812575,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Letters to Editor  \nThe vanishing organ: Koro’s syndrome embedded in psychosis and manifesting as Klingsor’s syndrome  \nTo the Editor,  \nSelf-mutilation involving the genitals is a rare and severe form of deliberate self-harm, often arising from profound psychiatric disturbances. Klingsor syndrome—a term derived from Wagner’s opera Parsifal—describes genital self-amputation (autopeotomy) in the context of psychotic or delusional beliefs. [1] While fewer than 200 cases of genital self-mutilation (GSM) have been reported worldwide, fewer than 25 explicitly meet the criteria for Klingsor syndrome. [2] Co-occurrence with culture-bound syndromes, such as Koro, is exceedingly rare. We report a unique case illustrating the intersection of Klingsor and Koro syndromes, presenting a significant diagnostic, and therapeutic challenge.  \nA 35-year-old married male driver with a 10th-grade education was brought to the emergency department after genital self-amputation and attempted suicide by drowning. He underwent emergency urological stump closure and was medically stabilized. A psychiatric evaluation revealed a 6-month history of progressive paranoid ideations (infidelity, persecution) and intense guilt over perceived past sexual misdeeds. He reported a firm, delusional belief of penile shrinkage, fearing retraction into his abdomen would cause his death (a Koro-like symptom), leading to severe socio-occupational dysfunction. Overwhelmed by delusional guilt, he enacted the self-amputation.  \nMental status examination revealed a poorly groomed man with active persecutory and infidelity-related delusions,  \nLetters to Editor  \nreduced psychomotor activity, and blunted affect. A comprehensive evaluation, including normal laboratory investigations and neurological exam, ruled out organic causes. A provisional diagnosis of a primary psychotic disorder (ICD-11: 6A20-6A25) was established, given the clear delusions and functional decline. A family history of psychiatric illness was noted in his father.  \nThe patient was managed in an inpatient unit under high-risk suicide protocol. Pharmacological management included risperidone (titrated to 6 mg/day) and lorazepam for agitation, supplemented with daily supportive psychotherapy. The consultation-liaison team reviewed him daily. His psychotic symptoms improved significantly. He was discharged with a plan for depot medication and close outpatient follow-up, but was subsequently lost to follow-up despite multiple attempts to contact him.  \nThis case is unique in its demonstration of Koro-like symptoms arising within a primary psychotic disorder. A review of the literature finds that while Koro-like symptoms secondary to schizophrenia are reported,[3] progression to actual self-amputation (Klingsor syndrome) is exceptionally rare. In most Koro cases, patients use physical maneuvers to prevent retraction. [4] In our patient, overriding delusional guilt, and psychosis reframed the organ as the source of suffering, leading to its removal. This convergence of a culture-bound fear with a psychotic drive represents a unique and dangerous psychopathological mechanism.  \nThe primary implication is that clinicians must assess for underlying psychotic disorders when Koro-like symptoms present, especially with functional decline, or bizarre delusions. Management requires an integrated, multidisciplinary approach. While immediate surgical stabilization is vital, psychiatric intervention with antipsychotics (e.g. , risperidone) to target the core psychosis is paramount. A robust, long-term follow-up plan, involving community health workers and family psychoeducation, is critical to ensure medication adherence, prevent relapse, and avoid further harm. This case underscores the need for culturally-sensitive, timely psychiatric intervention.  \nDeclaration of patient consent  \nThe authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their ","cbCaiuPfhOXM5nKQ","https://ap.wps.com/l/cbCaiuPfhOXM5nKQ","pdf",306150,"English","# Letters to Editor\n## Case report and clinical assessment\n## Treatment and follow-up\n## Clinical implications and management recommendations\n## Patient consent and declarations\n## References","[{\"question\":\"What is Klingsor syndrome in this report?\",\"answer\":\"Klingsor syndrome refers to genital self-amputation occurring in the setting of psychotic or delusional beliefs, as described in the letter’s introduction.\"},{\"question\":\"What psychiatric findings supported the diagnosis in the case?\",\"answer\":\"The patient showed progressive paranoid ideations, persecutory and infidelity-related delusions, and a firm delusional belief of penile shrinkage with functional decline; organic causes were ruled out.\"},{\"question\":\"How was the patient managed and what was emphasized for future care?\",\"answer\":\"Management included high-risk suicide protocol, risperidone and lorazepam, daily supportive psychotherapy, surgical stabilization, and a plan for depot medication with close outpatient follow-up and multidisciplinary, culturally sensitive care.\"}]","The vanishing organ: Koro’s syndrome embedded in psychosis and manifesting as Klingsor’s syndrome | PDF",1790702546]