The Development of In Vivo Measures to Assess the Impact of Sex-Drive Reducing Medications in an Offender with an Intellectual Disability.
The ability to adequately evaluate medications in the treatment of paraphilias has been limited by reliance upon self-report as a measure of effectiveness over periods of time that may be too short to detect reoffending. One solution to this shortcoming is the development of valid, long-term, stable assessment measures. The purpose of this case study was to analyze the effects of Prozac and Provera on an array of behaviors germane to the successful treatment of paraphilias, including: (a) sexual arousal in the laboratory and natural environment, (b) sexual thoughts (deviant and nondeviant) accompanied by arousal in the natural environment, and (c) overt actions in the community associated with increased risk of reoffending over a 31-month period for an exhibitionist with an intellectual disability. Despite the ineffectiveness of the medications, the measures demonstrated long-term, differentiated significant clinical responding; further underscored the importance of assessing deviant sexual arousal and adherence to relapse-prevention procedures in the natural environment; and provided a new methodology to assess sexual preoccupations and sexual arousal. Use of these in vivo measures raises questions regarding their potential to improve the predictability of risk assessments, and serve as an aide in the analysis of whether a treatment procedure is effective for an individual.
Parsons State Hospital and Training Center, 2601 Gabriel, Parsons, KS, 67357, USA. Jerry.Rea@pshtc.ks.gov.|University of Kansas Life Span Institute at Parsons, Lawrence, KS, USA. Jerry.Rea@pshtc.ks.gov.
Jerry A
JA
Rea
Parsons State Hospital and Training Center, 2601 Gabriel, Parsons, KS, 67357, USA.
Michael R
MR
Dixon
Department of Psychology, Wichita State University, Wichita, KS, USA.
Robert D
RD
Zettle
Parsons State Hospital and Training Center, 2601 Gabriel, Parsons, KS, 67357, USA.
Kasey L
KL
Wright
D000328:Adult; D003272:Contraceptive Agents, Male / Q000494:pharmacology / Q000627:therapeutic use; D057237:Criminals; D005084:Exhibitionism / Q000188:drug therapy / Q000517:prevention & control; D005473:Fluoxetine / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008607:Intellectual Disability / Q000150:complications*; D007989:Libido / Q000187:drug effects*; D008297:Male; D017258:Medroxyprogesterone Acetate / Q000494:pharmacology / Q000627:therapeutic use; D011594:Psychometrics; D018570:Risk Assessment / Q000379:methods*; D012742:Sex Offenses / Q000517:prevention & control*; D012725:Sexual Behavior / Q000187:drug effects; D055815:Young Adult
D003272:Contraceptive Agents, Male; D005473:Fluoxetine; D017258:Medroxyprogesterone Acetate
Deviant sexual arousal; Intellectual disability; Paraphilias; Sexual preoccupation