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Conundrums common in Tx of sexual predators. (Medication, Issues Often Arise).

SAN FRANCISCO -- Psychiatric treatment in civil commitment centers for sexual predators poses unique challenges for psychiatrists.

"There are some unusual legal and professional conundrums that you come up against in this type of treatment," said Dr. Mark McClung, who directs psychiatric treatment at the Special Commitment Center, McNeil Island, Wash., and is a psychiatrist in private practice in Seattle.

The SCC in Washington was created after the state legislature passed its sexually violent predator law in 1989, following several highly publicized sexual assaults and sexually motivated homicides. The legislature cited the need for a commitment law for a "small but extremely dangerous group of sexually violent predators" who did not have a mental disease under the existing involuntary commitment act.

There are currently 127 male and 1 female sexual predators on the SCC unit at McNeil Island, ranging in age from 18 to 70 years. Sixty percent of the residents, mostly rapists and pedophiles, have chosen to participate in sex offender treatment, and 30% are on psychotropic medication. Six have been released by court order and are living in different community settings, either assisted residential living or with family members, Dr. McClung said at the annual meeting of the American College of Forensic Psychiatry.

Antiandrogens are an accepted part of sexual offender treatment at SCC. Studies show these medications lower "reoffense" rates in sexual predators up to 9 years, Dr. McClung said. However, patients and their attorneys sometimes request or demand treatment with antiandrogens for the purpose of being released early, rather than recovery "Does an offender have an absolute right to be placed on antiandrogens?" Dr. McClung asked.

Such questions are difficult to resolve. He has found that antiandrogens are most helpful when administered near the of Fender's release date. The decision of whether to prescribe them should often be made on a case-by-case basis.

About 40 residents at SCC are receiving psychotropic medication for Axis I disorders, including paraphilia. A minority has compliance problems, and whether or not they should be involuntarily medicated has occasionally had to be resolved by the state's courts.
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Author:Boughton, Barbara
Publication:Clinical Psychiatry News
Date:Nov 1, 2002
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