Automutilation after consumption of hallucinogenic mushrooms

Two young men, 25 and 32 years old, presented with severe automutilation by knife wounds after consumption of hallucinogenic mushrooms. The first patient had also used cocaine, cannabis and alcohol, while the second patient had only used the hallucinogenic mushrooms. Both patients were treated symptomatically and survived despite their severe stab wounds. Psilocybin-containing mushrooms are used as mind-altering drugs. These drugs may sometimes induce 'bad trips', a psychotic reaction accompanied by fear, panic, and dangerous behaviour, especially when used in combination with other drugs and alcohol or by psychiatrically unstable patients. During a bad trip, patients may hurt themselves. Because the duration of the psychotic and sympathicomimetic effects of psilocybin after ingestion of mushrooms is short (up to 6 h), and since psilocin itself causes no permanent organ toxicity, the treatment of psilocybin intoxication is only symptomatic. The diagnosis ofpsilocybin intoxication is hampered by the lack of routinely available, rapid and sensitive, analytical methods for the quantification ofpsilocybin and its active metabolite psilocin.