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Lievesley R, Swaby H, Winder B, Norman C, Hocken K. "One a Day Keeps the Prison Away": Understanding the Experiences of Individuals Convicted of Sexual Offences Receiving Anti-Androgens for the Treatment of Problematic Sexual Arousal. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2141-2158. [PMID: 38594464 PMCID: PMC11176105 DOI: 10.1007/s10508-024-02847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
Problematic sexual arousal (PSA) is an umbrella term to describe a range of clinical presentations related to excessive sexual thinking (e.g., sexual preoccupation) and sexual behavior (e.g., hypersexuality). Although such concepts are known to affect sexual recidivism among individuals convicted of sexual offences, PSA is not routinely or directly targeted in offending behavior programs in England and Wales. However, in recent years, there have been moves to incorporate pharmacological interventions for addressing this among people with sexual offence histories. Although some work to understand the experiences of those taking SSRI medication for this purpose has emerged, little is known about the experiences of service users taking anti-androgen medication. In this study, we interviewed all individuals in prison taking anti-androgens for the treatment of problematic sexual arousal following convictions for sexual offences in England at the time of data collection (N = 10). Using a phenomenologically oriented thematic analysis, we established themes pertaining to "Differing needs: Motivations for treatment," "Medication as a risk management strategy," and how the medication helped the men in their pursuit of "Discovering a 'new me'." This work contributes important knowledge to inform the development of ethical and effective prescribing of anti-androgen medication with this population and offer recommendations for both future research and the development of clinical practice.
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Affiliation(s)
- Rebecca Lievesley
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK.
| | - Helen Swaby
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Belinda Winder
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Christine Norman
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Kerensa Hocken
- Midlands Psychology Services, His Majesty's Prison and Probation Service, Nottingham, UK
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Slack P, Aziz VM. Sexuality and sexual dysfunctions in older people: a forgotten problem. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2019.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
SUMMARYThis article considers sexuality in older adults and the associated stereotypes and stigmas that lead to this area being underappreciated. Normal physiological changes in ageing are discussed and how they can cause sexual dysfunction. The elderly population has a higher burden of comorbid physical illness and this review considers evidence on the interplay between physical health and sexual health. Mental illness is also strongly linked with sexual functioning and is discussed, as is the evidence on psychotropics and sexual side-effects. Attitudes on sexuality in long-term care settings are highlighted and approaches to managing sexual disinhibition are included.
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Edberg H, Chen Q, Andiné P, Larsson H, Hirvikoski T. Clinical Characteristics and Pharmacological Treatment of Individuals With and Without Intellectual Disability in Pre-trial Assessment-A Population-Based Study. Front Psychiatry 2020; 11:573989. [PMID: 33192702 PMCID: PMC7644565 DOI: 10.3389/fpsyt.2020.573989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The current lack of knowledge about intellectual disability (ID) in forensic psychiatric contexts can compromise the legal certainty of these individuals during the medico-legal process. To address ambiguous results in previous literature, the aim of the current study was to estimate the prevalence of ID in a pre-trial forensic psychiatric settings. Moreover, as little is known about the characteristics of offenders with ID, we conducted a clinical characterization of individuals with and without ID being subject to forensic psychiatric assessment. Methods: Using data from several Swedish national registers, we conducted a population-based retrospective observational study on 8,442 individuals being subject to pre-trial forensic psychiatric assessments in Sweden in 1997-2013. We performed univariate analyses to compare the characteristics of individuals with (n = 537) and without ID (n = 7,905). Results: The prevalence of ID was 6.4% in the Swedish pre-trial forensic psychiatric context during the observational period. Compared with individuals without ID, individuals with ID were younger at the time of assessment, had a lower educational level, and had less frequently started families. ID was associated with lower frequency of diagnosed psychotic and bipolar disorders. However, a similar prescription rate of antipsychotics, and a comparable rate of previous inpatient care was observed among individuals with and without ID. Individuals with ID had more often been prescribed anti-libidinal treatments often used for treating sexual disorders, although did not present a higher prevalence of sexual disorder. Conclusions: The prevalence of ID among pre-trial individuals being subject to forensic psychiatric assessment was more than twice as high as assumed in the general population. Our results suggest that individuals with ID received pharmacotherapy without clear indication. Remaining challenges in the clinical management of individuals with ID were indicated by the discrepancy between the occurrence of psychiatric diagnoses, pharmacological treatment patterns, and rates of inpatient care.
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Affiliation(s)
- Hanna Edberg
- Department of Women's and Children's Health, Paediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institute (KIND), Karolinska Institute, Stockholm, Sweden.,Northern Stockholm Psychiatric Clinic, Region Stockholm, Stockholm, Sweden.,Forensic Psychiatric Clinic, Region Stockholm, Stockholm, Sweden.,Center for Psychiatric Research, Region Stockholm, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Peter Andiné
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Tatja Hirvikoski
- Department of Women's and Children's Health, Paediatric Neuropsychiatry Unit, Centre for Neurodevelopmental Disorders at Karolinska Institute (KIND), Karolinska Institute, Stockholm, Sweden.,Center for Psychiatric Research, Region Stockholm, Stockholm, Sweden.,Habilitation and Health, Region Stockholm, Stockholm, Sweden
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