Resolution of Inappropriate Sexual Behavior in an Elderly Male with Intellectual Disability with Memantine: Case Report, and Review of the Literature

BackgroundMemantine is a non-competitive N-methyl-d-aspartate receptor antagonist approved for the treatment of moderate to severe Alzheimer's disease (AD). However, given its involvement of glutamate pathways, monotherapy as well as combination with other medications has been found to be effective in a number of psychiatric conditions (1). Resolution of new onset inappropriate sexual behavior (ISB) with memantine in a 67 year old male with intellectual disability (ID) is presented.Case presentationA 67 year old, white male with ID with a full scale IQ of 68, was treated in psychiatry long term for intermittent agitation and anxiety. At age 65, he manifested ISB which was not controlled with non pharmacologic measures and various medications. ISB resolved when memantine was added to his concurrent psychotropics and gradually increased to 10 mg BID. There was a recurrence of ISB after two years which remitted when memantine was increased to 25 mg. Based on clinical follow ups and serial MOCAs over three years, it was determined that this patient did not have a major neurocognitve disorder.ConclusionISB and its treatment is an understudied subject in individuals with intellectual disability. Resolution of new onset ISB in a 67 year old male with intellectual disability and comorbid mood disorder, is a previously unreported therapeutic effect of memantine. His ISB resolved with the addition of memantine 20 mg daily after multiple failed trials of various classes of psychotropics. Two years later, reemergence of ISB subsided with memantine 25 mg which is a higher than the recommended dose of this medication. Additional studies would be helpful in determining the maximum dose of this medication given its therapeutic efficacy at 25 mg daily which was well tolerated with stable medical tests.

Fetal Alcohol Spectrum Disorder — Study Review

Fetal alcohol syndrome is regarded as a spectrum. Fetal alcohol spectrum disorder (FASD) might be surprisingly common, especially in vulnerable populations. Mental health problems, substance abuse, inappropriate sexual behavior, school and legal problems and unemployment might cooccur with FASD. Treatment of comorbidities might be helpful, however effects of stimulants in FASD are controversial. Women who drink during pregnancy might suffer from nutritional deficiencies, therefore try of compensation might be helpful for both mother and child. Moreover, nutrient of children with FASD might play an important role as a potential supportive therapy. In addition, physical exercise therapy might be beneficial for both mother and children because of neurogenesis induction potential. There is no established therapy for FASD, therefore further studies should focus on formulating one. (JNNN 2020;9(3):119–122) Key Words: alcohol ingestion, brain development pathology, FAS, pregnancy

Body, Sexuality, and Passive Victimhood in the Post-1989 Reimagining of the Polish City of Wałbrzych

This article explores how the changes in commemorative culture in postcommunist Poland, namely, the loss of status of the traditional self-sacrificial martyr/hero at the expense of the passive victim, have produced new models for individual and collective identification based on vulnerability and suffering. Through the analysis of Pilgrim/Majewski’s surrealist plays The Peregrinations of the Black Iza of Wałbrzych (2009) and The Testimonies of the Ups Downs Ups Ups Ups Downs and so on of Antek Kochanek (2012), I examine the artistic transformations of two nearly forgotten city legends into victims of communist gender oppression and cultural icons of tolerance and inclusiveness for the purposes of reinventing the Lower Silesian Town of Wałbrzych’s postcollapse identity. I argue that Pilgrim/Majewski’s plays challenge the centering of Wałbrzych’s post-1989 identity discourse on the traumatic loss of the coal-mining industry by undermining hegemonic male heterosexuality’s exclusive claim on collective trauma and inscribing female and queer trauma into collective suffering. By heroizing two marginal characters with “socially inappropriate” sexual behavior, the playwright brings to the fore alternative subjectivities predicated on gender, sexuality, and the body, thus advocating for a more inclusive, polyvalent citizenship. More broadly, the author questions essentialist understandings of the self as a set of immutable core attributes (hinting at Wałbrzych’s clinging to its traditional identity as a coal-mining center) and promotes the social constructivist approach to identity as a fluid entity, a product of human definition and interpretation shaped by cultural and historical contexts.

Sex Offending Behaviors and Adults

Sex-related behavior can present challenges in the community and present serious impacts on individuals with special needs. When considering sex offender types of behavior, special considerations are made for supervision, prevention, and education for the individual and the community at large. William is an elderly gentleman who presents with inappropriate sexual behavior resulting in both child and adult victims. The following chapter discusses his history along with some unique challenges related to his sexual behavior, interventions considered as part of his treatment plan, and some lessons learned from working with William and his unique considerations.

Enhancing Pro-Social Desired Behaviors to Reduce At-Risk Sexual Behaviors in Community Settings

There is a misconception that people with significant disabilities have little or no interest in sex or sexual relationships. This misconception often leads to the teaching of social sexual education on the back burner for practitioners, educators, and caregivers. This chapter discusses the self-monitoring strategies taught to a teenage girl with a diagnosis of autism spectrum disorder that engaged in inappropriate sexual behavior toward herself and others while in community settings. Mia is a 16-year-old female with a diagnosis of ASD. Mia significantly struggled to respond to the norms that dictate the social conventions regarding appropriate social interactions which led to the emergence of inappropriate sexual behaviors including public masturbation and the inappropriate touching of others. Using person-centered planning and a quality-of-life assessment tool, Mia's multidisciplinary team was able to identify prosocial, desired behaviors to assist Mia in achieving ultimate outcomes and place her in least-restrictive environments across community settings.