An offender with a history of repeated arson admits to deliberate fi re-setting, which is preceded by a certain degree of arousal. He has had a fascination with fire since childhood and achieves a sense of gratification when setting fires. He does not have antisocial personality disorder or substance use.
The most appropriate diagnosis is:
B. Pyromania is an extremely rare disorder that presents with repeated fi re-setting. It is recognized as a category in both ICD-10 and DSM-IV, under impulse control disorders. The diagnostic criteria include tension or affective arousal before the act of setting the fire, fascination with, interest in, curiosity about, or attraction to fire and its situational contexts, as well as pleasure, gratification, or relief when setting fires or when witnessing or participating in the aftermath of a fire.
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During the proceedings of a court trial it becomes evident that a murder victim had the habit of achieving sexual excitement from being humiliated and beaten after being bound and verbally abused.
This is consistent with:
C. Masochism refers to a paraphilia characterized by persistent interest in sexual activities that demean, humiliate, or cause suffering to self. Masochism requires a partner who complies by dominating and inflicting suffering. In contrast, sadism refers to a paraphilia wherein sexual arousal and gratification are obtained by inflicting pain and suffering upon the partner. Hence a sadist and a masochist can be mutual partners. Voyeurism is characterized by achieving gratification by watching people undressing or having sexual intercourse. It is the most common paraphilia reported. Fetishism refers to compulsive sexual interest in inanimate objects that are often worn by or associated with sexual partners. Hypoxyphilia (autoerotic asphyxiation) is not separately coded as a paraphilia in ICD/DSM; it refers to a specific form of masochism in which sexual arousal is attained by self-suffocation, e.g. via hanging while masturbating.
In people with kleptomania which of the following medications has been demonstrated to be the most useful in double-blinded randomized controlled trials?
E. Kleptomania is considered by some as part of the obsessive–compulsive spectrum. Extending the effectiveness of selective serotonin reuptake inhibitors (SSRI) in obsessive compulsive spectrum disorders, several case series of successful SSRI use in kleptomania have appeared. A response rate of nearly 80% at week 7 was reported for kleptomania in an open-label trial of escitalopram; this was not maintained to the same degree in a subsequent double-blind placebo-controlled discontinuation trial. Naltrexone and mood stabilizers have also been studied in open-label trials for kleptomania, with variable benefits. To date, no strong evidence from randomized controlled trials exists to support pharmacological interventions in kleptomania.
The proportion of adults with a history of childhood conduct disorder who satisfy the criteria for antisocial personality disorder in cross-sectional interviews is:
A. Traditionally it was thought that 40% of those with conduct disorder experience lifetime persistence of traits that are termed as antisocial personality disorder. But this has been now challenged to be an underestimate; data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the USA suggests that nearly 75% of adults who were retrospectively identified to have had conduct disorder as children satisfied current criteria for antisocial personality disorder. Although this is a retrospective design, the estimates are from a more representative sample than older retrospective studies.
Among all homicides committed by those with psychotic illnesses, the proportion committed by those with a first episode psychosis and receiving no treatment is:
C. The prevalence of schizophrenic disorders in the general population is below 1%, but patients with schizophrenia constitute between 5% and 20% of all homicide offenders. An increased risk of homicide has been associated with the fi rst episode of psychosis. A metaanalysis of studies reporting homicide offences in psychotic patients showed that 38.5% of homicides occurred during the first episode of psychosis, prior to initial treatment. The rate ratio of homicide in the first episode of psychosis was 15.5 times the annual rate of homicide after treatment for psychosis. Nearly 40% of patients with schizophrenia who commit homicides do not have any history of psychiatric care.
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