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Indian Journal of Medical Sciences, Vol. 60, No. 1, January, 2006, pp. 28-29 Letter To Editor Mania associated with multiple paraphilias Mendhekar DN, Mehta R Department of Psychiatry, G. B. Pant Hospital, New Delhi-110 002 Code Number: ms06006 Although hyper-sexuality is a common symptom of mania, paraphilias are rarely reported in literature. This case report highlights unusual sexual bahaviour in the form of multiple types of paraphilias in the current episode of mania. A 60 years old male presented with history of being irritable and hypersexual, demanding, expressing grandiose ideas, wearing ladies clothes, increased energy levels and disturbed biological functions of 6 months duration. He was a famous ladies tailor in the locality and his main job was to take measurement of girls and ladies. In 1997 during first episode of mania, which lasted for 2 months, he started misbehaving with lady customers. Since that time his community deserted him and he was forced to close the shop. Six months later his wife passed away. He tried his best to improve his relations with neighbors without any success. He had second episode of mania in 1999 that lasted for 4 months. He would stop taking medicines as soon as he recovered from the illness. In the current (third) episode of mania, in 2003, the patient started wearing ladies clothes including underwear and bra. He also started applying cosmetics and changed his hairstyle similar to that of opposite sex. When the family members prevented him for doing so, he stole the ladies clothes from relative′s house. Ultimately the relatives had to keep all the ladies clothes under lock and key. Then, sometimes, he would grab the ladies′ clothes from the shop. When dressed in females′ clothes he would enjoy comments made by the people on the road. He made sexual advances toward females in the neighborhood. Twice, he was caught in a compromising position with a neighborhood lady, who was mentally retarded. 4-5 times he was also found engaged in sexual intercourse with a pet dog. He was caught thrice while performing sexual act with a 5 years old girl. He was diagnosed as a case of bipolar affective disorder, currently mania with psychotic features. All his investigations were found to be within normal limits including test for HIV, thyroid function test and CT brain. He was treated successfully with carbamazepine 800 mg/day and risperidone 4mg/day. Patient was followed for 12 months without relapse of psychiatric symptoms. We could find only one case report of transvestism associated with mania in existing literature, which was treated successfully with lithium.[1] A controlled study of the elderly male sexual offenders has described association with personality factors rather than mental illness.[2] Nelson et al. in a retrospective study of sex offenders with bipolar disorder showed that divalproex helped to improve the manic symptoms but not effective for the paraphilic symptoms.[3] Our case also showed the effectiveness of combination of carbamazepine and risperidone in the treatment of mania with superimposed multiple sexual perversions. Our case demonstrates the occurrence of symptoms such as transvestism, pedophilia, and bestiality during the episode of mania, which resolves with the resolution of manic symptoms. In a case of mania where hyper sexuality is one of core symptom,[4] lack of proper sexual outlet, social boycott and ladies fashion related occupation might be the contributory factors for exhibiting abnormal sexual behavior. References
Copyright 2006 - Indian Journal of Medical Sciences |
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