Successful treatment of paraphilic coercive disorder (a rapist) with fluoxetine hydrochloride

Article Abstract:

Paraphilic coercive disorder is a proposed category for psychiatric diagnosis, categorizing rapists. Criteria for inclusion consist of recurrent sexually arousing fantasies and intense urges that involve coercion of another into a sexual act. The person would have had to act on these fantasies or be markedly distressed by them to be differentiated from sexual sadists. Legal and social concerns have excluded this diagnostic category thus far. A case is presented of a 30-year-old white male who was evaluated after attempting to rape his mother. He had previous treatment for alcohol and marijuana abuse but no psychiatric history, although he complained of chronic anxiety and depression. He was diagnosed as suffering from major depression after the attempted rape and upon interview it became clear that he met the criteria for several psychiatric diagnoses at various times in his life. These included depression, social phobia, chronic low-level depression (dysthymia), pathological gambling and stealing, and alcohol and marijuana dependence. He fit the proposed diagnosis of paraphilic coercive disorder as well. He was treated with outpatient psychotherapy after the attack, combined with fluoxetine hydrochloride, an antidepressant. He took 20 mg fluoxetine hydrochloride every other day and symptoms of paraphilic coercive disorder began to decrease. During six weeks of treatment the dosage was raised to 40 mg fluoxetine hydrochloride per day, after which the patient reported normal, noncoercive sexual fantasies. It is recommended that male rapists who meet the proposed diagnostic criteria for paraphilic coercive disorder be offered a trial of fluoxetine hydrochloride medication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Fluoxetine, Rapists

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Central serotonin and impulsive aggression

Article Abstract:

Studies focusing on the role of serotonin (also called 5-HT) in impulsive, aggressive behavior are reviewed. Serotonin is one of approximately 30 chemical substances (neurotransmitters) thought to transmit messages between brain cells (neurons). It is processed through a series of steps from the amino acid tryptophan, and then is chemically altered (metabolized) into 5-hydroxyindoleacetic acid (5-HIAA). Autopsies of suicide victims have revealed significant reductions in brainstem serotonin and in levels of 5-HIAA in the cerebrospinal fluid (CSF; clear fluid which bathes the brain and spinal cord). Reduced CSF 5-HIAA levels have also been reported in patients with various psychiatric diagnoses who have attempted suicide. Since suicidal behavior is thought of as aggressive behavior turned inward, it is not yet known whether vulnerability to committing suicide is related to reduced serotonin activity or whether low concentrations of CSF 5-HIAA affect aggressive responses. Many studies show that low levels of CSF 5-HIAA are related to levels of aggression, irritability, hostility, and criminal activity. Low CSF 5-HIAA has also been reported in individuals with childhood behavioral disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Behavior disorders in children, Childhood mental disorders, Aggressiveness (Psychology), Serotonin, Serotonin metabolism

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