Determinants of psychiatric illness in young people.
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The case of a man presenting with paedophilia who has found to be hyperprolactinaemic is described. There is possibly a link between paedophilia and endocrine disorders.
We report OCD and paraphilia in two male members of triplets (the two males being monozygotic twins), and discuss the possible aetiological factors for this previously unreported occurrence. We suggest that patients presenting with paraphilia should be examined for OCD and that a detailed sexual history should be obtained in all patients with OCD.
In a sample of 261 state hospital sexual offenders, Minnesota Multiphasic Personality Inventory (MMPI) profiles did not differ for offenders with adult victims versus offenders with child victims when offender age was controlled. MMPI 2-point analyses for the whole sample revealed five common codes that were independent of victim maturity. The sample was randomly divided in half and subjected to a cluster-analytic procedure which revealed two MMPI clusters. The first cluster was unelevated, with Scale 4 as its high point. The second cluster had multiple elevations, with Scales 8, 4, 2, and 7 as the highest scales. These clusters were replicated in a cluster analysis of the second half of the sample. However, when the sample was recombined, the two clusters were not externally validated basis on demographic and criminological variables. The results suggest that common psychological variables among sexual offenders may have more discriminative value than victim maturity in developing sexual offender taxonomies.
The case of a 33-year-old White male with a history of sexual assault is presented. His Rorschach is analyzed and interpreted using both psychostructural (Exner, 1986) and psychodynamic (Cooper & Arnow, 1986; Kwawer, 1980; Meloy & Gacono, in press-b) methodologies. Findings are used to understand the presence and interaction of both psychopathic character and psychotic personality organization in this mentally ill, sadistic, and sexually predatory young man.
The evaluation and assessment of sexual offenders is different than any other type of evaluation, and most clinicians are not properly trained to interview this population. This article addresses the clinical and ethical issues particular to the interview, assessment, and evaluation of these types of offenders. It offers both practical information regarding the interview itself, along with an overview of classification systems, paraphilias, and assessment techniques used with this population. In addition, issues related to risk assessment and risk management are also addressed, and an introduction to the use of actuarial risk assessment instruments is provided.
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OBJECTIVE: Obsessive-compulsive disorder (OCD) is often a chronic and disabling illness with high comorbidity. Serotonin reuptake inhibitors (SRIs) are effective in treating OCD. However, 40% to 60% of patients with OCD do not respond adequately to SRIs. This study aims to identify the clinical predictors of nonresponse to SRIs in OCD by comparing SRI responders and nonresponders. METHOD: 122 subjects with a diagnosis of DSM-IV OCD of at least 1 year's duration and with treatment history of adequate trials with at least 2 SRIs were recruited from December 2002 to March 2004. Of these, 67 were SRI responders and 55 were SRI nonresponders; they were compared on various clinical parameters. Nonresponse was defined as a score of >/=3 on the Clinical Global Impressions-Improvement sub-scale (CGI-I) after at least 2 adequate trials with SRIs. Response was defined as a score of 1 or 2 on the CGI-I. RESULTS: In regression analysis, baseline severity of OCD (p = .049), comorbid major depressive disorder (p = .005), presence of sexual obsessions (p = .002), and washing (p = .008) and miscellaneous compulsions (p = .013) were identified as predictors of nonresponse to SRIs. Early age at onset showed a trend toward prediction of nonresponse (p = .056). In the univariate analysis, mixed OCD (p = .001) and poor insight (p = .023) were associated with nonresponse. CONCLUSION: This study has identified clinical predictors of nonresponse to SRIs. These predictors may have to be taken into consideration and assessed carefully when SRIs are prescribed to treat OCD. Future studies should aim at identifying treatment modalities that are effective in SRI nonresponders.
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BACKGROUND: Recent reports suggest that individuals with nonparaphilic compulsive sexual behavior can be treated pharmacologically with selective serotonin reuptake inhibitors (SSRIs) to control sexual obsessions and compulsions. However, these medications have produced sexual side effects that may limit long-term use, particularly as individuals strive to reestablish healthy sexual relationships. Nefazodone is an antidepressant that is not associated with the sexual side effects of other SSRIs. We examined retrospective data from our clinic to investigate whether nefazodone has utility in the treatment of nonparaphilic compulsive sexual behavior. METHOD: Fourteen subjects who met DSM-IV criteria for sexual disorder NOS as well as criteria used by our research group for nonparaphilic compulsive sexual behavior and who had been treated with nefazodone were selected from patient charts at our clinic. The treating physician abstracted information from the charts regarding comorbid psychiatric conditions, medication, dosage, treatment response, and side effects. RESULTS: In this study, the mean dosage of nefazodone was 200 mg/day. Of the subjects who remained on long-term nefazodone therapy, 6 (55%) reported good control of sexual obsessions and compulsions, and 5 (45%) reported a remission of sexual obsessions and compulsions. CONCLUSION: Results from this preliminary retrospective study suggest that nefazodone decreases the frequency of sexual obsessions and compulsions but does not produce the undesired sexual side effects caused by SSRI treatment.