Paraphilias Follow-up

  • Author: Guy E Brannon, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Oct 28, 2010
 

Further Inpatient Care

Patients may require further inpatient care if they represent a danger to themselves, to others, or if they are gravely disabled.

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Further Outpatient Care

For the best results, patients require medication management and psychotherapy.

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Inpatient & Outpatient Medications

If the patient began medication therapy in the hospital, continue the same therapy and adjust as needed. If not, select medications and discuss the risks, benefits, adverse effects, and alternatives with the patient. Obtain informed consent before starting medication therapy.

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Transfer

If patients are charged with a crime or have been arrested, they may be incarcerated.

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Deterrence/Prevention

  • Education
  • Legal ramifications
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Complications

  • Adverse medication effects
  • Noncompliance with medications and therapy
  • Pedophilia on the Internet
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Prognosis

  • Patients with a good prognosis have the following characteristics:
    • Cooperative attitude
    • Normal sex life
    • Motivated outlook, with a desire to change
    • Voluntary approach to treatment
  • Patients with a poor prognosis have the following characteristics:
    • Early onset of paraphilia
    • Legal charges pending
    • Unmotivated attitude
    • Uncooperative attitude
    • Paraphilia as the only sexual activity or outlet
    • Comorbidity
    • Lack of remorse over acts
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Patient Education

  • Sex education, social skills training, coping skills training, and relapse prevention are important.
  • Both the patient and the family should be educated regarding paraphilias. The family may need to be involved in a support group (eg, church). If the patient is on medication the family needs to be informed of potential problems such as side effects and drug interactions. If the patient is married, marital counseling needs to be part of the treatment plan. The family also needs to be aware of local laws in regard to paraphilias. If the patient is on probation, the family needs to be aware of court dates, if applicable, probation, and if the patient will need to be listed on the sexual offenders listing the community.
  • Community notification of a sex offender may be required for some patients with paraphilias. It is important to point out that many patients with paraphilias have no legal charges and even health care workers are not required to report all paraphilias while others require mandatory reporting such as pedophilia. Some patients may find this notification as a deterrent to the paraphilia while others may not. Some experts suggest that, while required, it may hamper some patients who are trying to obtain help for their illness. This will continue to be a matter of community concern and debate for the unforeseeable future. The patient should address these concerns with the treatment team. Intensive community supervision is important.
  • Family education is important in the treatment of paraphilias. The family should receive education about the disorder, medications, side effects, and medication compliance, the importance of psychotherapy, and what to do in case of an emergency. The family will need contact information regarding community support programs for the patient and the family.
  • Helpful Web sites are available.
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Contributor Information and Disclosures
Author

Guy E Brannon, MD  Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company

Guy E Brannon, MD is a member of the following medical societies: American Medical Association, American Medical Writers Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Clinical Research Professionals, Louisiana State Medical Society, and Southern Medical Association

Disclosure: AstraZeneca Grant/research funds Other; Janssen Grant/research funds Other; Pfizer Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Eli Lilly Grant/research funds Other; Forrest Grant/research funds Other

Specialty Editor Board

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

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