Case 39 - The psychotic sex offender with grandiosity and mania

Summary

Patient Intake

• 33-year-old man diagnosed with schizoaffective disorder, bipolar type, polysubstance abuse in remission in a controlled environment and antisocial personality disorder

• Diagnosed as conduct disorder prior to age 18 with criminal activity, then after age 18 as a psychotic and mood disorder for the past 15 years, with intermittent assaultive behavior, grandiose and grossly disorganized thinking and behavior

• Truancy, fighting, abuse of alcohol, methamphetamine and other drugs, continuing minor criminal activity

• Dropped out of college age at 21 when drinking heavily and initially diagnosed as bipolar disorder and treated with lithium and carbamazepine (Tegretol); also later diagnosed as schizoaffective

• Developed deviant sexual fantasies involving coerced sexual activity with adult women linked to grandiose delusions associated with hypersexuality in the context of mania but also without empathy or remorse

• Then became intoxicated and joined a group in a park which raped and sodomized a woman; following arrest his charges were reduced to assault with a deadly weapon

• Was convicted of this charge, sentenced to state prison, but required psychiatric treatment so that at the time of parole he was declared to be a mentally disordered offender and hospitalized in a forensic facility