Fabian M. Saleh

Juvenile sex offenders: a complex population

ABSTRACT: Individuals who engage in sexual offending behavior represent a heterogeneous population. Recent research has found some success in categorizing sexual offenders based on a number of variables, particularly the type of victim. For example, differences have been found between those offenders who victimize adults when compared with those who victimize children. However, the research in this area has been conducted predominantly with adult samples. As the adult sex offender literature has progressed, it has become evident that risk assessment, treatment effectiveness, and risk management are dependent on such offender characteristics. Unfortunately, the relevance to juveniles of characteristics deemed to be important with adult sex offenders is limited due to the complexity of developmental processes, particularly with respect to mental disorders and personality formation. As such, the formulation and implementation of treatment and risk management strategies that will be effective with juvenile sex offenders are challenging. The goal of this paper is to review some of the complexities inherent in the juvenile sex offender population by focusing on specific areas of complication, including: classification systems, comorbid paraphilias and other mental illnesses, and maladaptive personality traits.

Sex Hormones, Neurotransmitters, and Psychopharmacological Treatments in Men with Paraphilic Disorders

SUMMARY Paraphilic disorders are psychiatric syndromes primarily characterized by deviant sexual thoughts, cravings, urges, and/or behaviors. Paraphilic men may engage in inappropriate sexual behaviors when cravings for socially unacceptable sexual acts become overpowering. These often chronic disorders may not only cause emotional distress and social embarrassment to the afflicted patient but also to the targets of their paraphilic focus. The primary objective of this article is to examine and review data on the efficacy and tolerability of the testosterone-lowering agents medroxprogesterone acetate, cyproterone acetate, and leuprolide acetate. The secondary goal is to review data on less conventional and more innovative pharmacological treatments, particularly the serotonin-specific reuptake inhibitors.

Treatment of paraphilia in young adults with leuprolide acetate: a preliminary case report series.

Some juveniles who engage in sexual offenses may have a paraphilia, a psychiatric disorder characterized by a pervasive pattern of deviant and impairing sexual fantasies, thoughts, and/or behaviors. Though there is no known cure for these conditions, paraphilias can be effectively managed using a multimodal treatment approach. This may include the use of psychotherapeutic and pharmacological treatment interventions, including antiandrogen medications. One such agent, leuprolide acetate (leuprolide), a luteinizing hormone-releasing-hormone agonist, has been shown to be effective in reducing paraphilic symptoms in adult patients. To date, however, there is no published data on its use and effectiveness in adolescent and young adult paraphilic patients. This study consists of a case report series of six young adult patients treated with leuprolide. All subjects had been diagnosed with at least one paraphilia (i.e., Pedophilia, Sexual Sadism, Frotteurism, and Paraphilia Not Otherwise Specified). All subjects had been refractory to treatment in a residential program for adolescent sex offenders prior to initiation of leuprolide. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide. Clinicians rated four as much improved and two as moderately improved. The treatment was well tolerated in all six subjects. This preliminary case series supports the conclusion that leuprolide deserves further examination as a potentially safe and effective component in the treatment of young adult patients with paraphilia.

Clinical Considerations of Paraphilic Sex Offenders with Comorbid Psychiatric Conditions

Clinical work with paraphilic sex offenders can be further complicated by the presence of additional comorbid psychiatric conditions. This article reviews the prevalence of Axis I and Axis II disorders among paraphilic as well as non-paraphilic sex offenders. The presence of a co-occurring mental disorder informs the need for careful, comprehensive, and individualized clinical conceptualizations of these types of cases. Considerations for assessment and treatment in working with paraphilic sex offenders who present with comorbid mental illness will be offered.

The Management of Sex Offenders: Perspectives for Psychiatry

&NA; In the effort to identify and manage sex offenders, the differences between legal and medical/psychiatric terminology and approaches are readily apparent. This article discusses the different definitions and approaches of the two fields and considers both the behaviors that create risk to others and the strategies for reducing that risk. Particular attention is paid to the subcategory of paraphilic sex offenders. Treatment goals, modalities, and efficacies are discussed, as are evolving legal strategies for risk control and the need for interaction between law and medicine/psychiatry in order to accomplish common goals of risk management.

A hypersexual paraphilic patient treated with leuprolide acetate: a single case report.

This article presents the case of a young adult paraphilic patient with no comorbid psychiatric or medical pathology. This patients history is notable for hypersexuality and exhibitionistic behaviors. He was treated with the Luteinizing Hormone–releasing Hormone (LHRH) agonist leuprolide acetate. Shortly after he commenced treatment, his sexual drive and his urge to expose himself diminished significantly. Serial penile plethysmograph and hormonal profile data will also be reviewed.

Sexual deviancy: diagnostic and neurobiological considerations.

SUMMARY Individuals who engage in sexual offenses may be afflicted with a paraphilic disorder or sexual deviation syndrome. Paraphilias are psychiatric disorders characterized by deviant and culturally non-sanctioned sexual fantasies, thoughts, and/or behaviors. A proportion of these individuals may also suffer from symptoms of mental illness that can go unrecognized. Although the etiology and pathophysiology of paraphilic disorders continue to be under investigation, data from empirical, biomedical, and psychopharmacological studies suggest abnormalities at a biological level. This article will discuss and review clinical and neurobiological characteristics of the paraphilias. To this end, we will begin with a general exploration and overview of basic principles that are germane to the subject matter and will conclude with an examination of the most recent relevant research findings.

Sexual Behavior Among Persons With Cognitive Impairments

Although the cognitively impaired are frequently included in heterogeneous studies of problematic sexual behavior, the epidemiology, etiology, and approach to assessment and treatment of persons with dementia and intellectual disability are distinct from those of the general population. The incidence of inappropriate sexual behavior among the intellectually disabled is 15–33%; however, the nature tends to be more socially inappropriate than with violative intent. Limited sociosexual education is a large contributor, and better addressing this area offers a target for prevention and treatment. A thorough clinical assessment of problematic sexual behaviors in the cognitively impaired requires understanding the patient’s internal experience, which can be challenging. Assessment tools validated for the general population have not been validated for this population. Very few studies have assessed treatment approaches specifically among the cognitively impaired; however, research does suggest utility in habilitative, psychotherapeutic, and pharmacologic approaches which have been validated among the general population.

Repetition blindness in schizophrenic patients

Abstract Repetition blindness is the failure to report the detection of repeated items in rapid visually presented lists. It can be explained in terms of either a processing limitation or an active inhibitory process. In two studies conducted in either English or German language we set out to induce repetition blindness under various conditions in a total of 47 control subjects and 30 schizophrenic patients. The patients displayed the phenomenon to at least the same degree as normal control subjects. These results render unlikely accounts of repetition blindness which involve processes known to be dysfunctional in schizophrenic patients. Moreover, the study provides an example of how the performance of schizophrenic patients can constrain theories of normal cognition.

Suicide Across the Lifespan

Introduction Suicide risk assessment is an essential part of general and forensic psychiatric practice. Psychiatrists must be able to evaluate specific clinical, demographic, and psychosocial risk factors in this process. Age represents an important demographic riskfactor for suicide. In the United States, suicide rates among adolescents and young adults have been increasing, with rates that are almost three times higher than in the 1950s. Results Recent reports show an increase in suiciderates in middle aged populations as well. Suicide rates remain highest for older adults. The relationship between age and suiciderisk is complex, and psychiatrists need to recognize the psychosocial andbiological risk factors associated with different age groups. Method/Objective/Aims The presenter will review suicide risk assessment in the context of different stages of life: adolescence and young adulthood, mid-adulthood, and advanced age, outlining the risk factors unique to the different stages. The presentation will also address how cultural factors and gender may affect risk assessment across different age groups. Conclusion The presenter will discuss the management of suicidal risk as it pertains to the different age groups.