An uncommon case of random fire-setting behavior associated with Todd paralysis: a case report.

BACKGROUND: The association between fire-setting behavior and psychiatric or medical disorders remains poorly understood. Although a link between fire-setting behavior and various organic brain disorders has been established, associations between fire setting and focal brain lesions have not yet been reported. Here, we describe the case of a 24-year-old first time arsonist who suffered Todd's paralysis prior to the onset of a bizarre and random fire-setting behavior. CASE PRESENTATION: A case of a 24-year-old man with a sudden onset of a bizarre and random fire-setting behavior is reported. The man, who had been arrested on felony arson charges, complained of difficulties concentrating and of recent memory disturbances with leg weakness. A video-EEG recording demonstrated a close relationship between the focal motor impairment and a clear-cut epileptic ictal discharge involving the bilateral motor cortical areas. The SPECT result was statistically analyzed by comparing with standard SPECT images obtained from our institute (easy Z-score imaging system; eZIS). eZIS revealed hypoperfusion in cingulate cortex, basal ganglia and hyperperfusion in frontal cortex,. A neuropsychological test battery revealed lower than normal scores for executive function, attention, and memory, consistent with frontal lobe dysfunction. CONCLUSION: The fire-setting behavior and Todd's paralysis, together with an unremarkable performance on tests measuring executive function fifteen months prior, suggested a causal relationship between this organic brain lesion and the fire-setting behavior. The case describes a rare and as yet unreported association between random, impulse-driven fire-setting behavior and damage to the brain and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism.

Attention Deficit/Hyperactivity Disorder and pediatric burn injury: important considerations regarding premorbid risk.

PURPOSE OF REVIEW: The purpose of this review is to provide an overview of the literature on the effects of Attention Deficit/Hyperactivity Disorder on pediatric burn injury, to identify specific considerations and trends relevant to this topic, and to call attention to areas for future research. RECENT FINDINGS: There is growing evidence for increased risk of burn injury in children with Attention Deficit/Hyperactivity Disorder and externalizing behavioral disorders. Research indicates increased risk of burn morbidity and poorer adjustment following burn injury in these patients. Evidence suggests that stimulant treatment may be useful for reducing risk of burn injury and questions the use of 'drug holidays'. Research suggests prevention measures specific to this population, including increased supervision. Primary care providers can further educate patients and families regarding increased risk for injury due to Attention Deficit/Hyperactivity Disorder or symptoms of impulsivity and inattention that accompany other behavioral disorders, neurological conditions, and disabilities. SUMMARY: Information regarding the risk of burn injury in children with symptoms of Attention Deficit/Hyperactivity Disorder is gradually gaining more attention. There is continued need for further investigation in this area, as well as critical assessment of intervention programs for this subgroup of individuals.

Personality and neuropsychological function in violent, sexual and arson offenders.

We aimed to test the hypothesis that incarcerated offender populations will not differ in neuropsychological test performance if patients are matched on age, intelligence and personality profile, particularly if impulsive aggressive traits and confounds such as substance misuse and performance anxiety are controlled for. 27 violent offenders, 20 sex offenders and 13 arson offenders detained in maximum security hospitals completed dimensional assessments of personality function and were assessed on a battery of frontal and temporal neuropsychological tests. All patients completed a variety of self-report measures of cognitive, affective and behavioural dispositions relevant to offender populations. Trait impulsivity was further assessed and composite impulsivity scores were derived. Assessments of emotional state were administered prior to neuropsychological testing. All patients met the criteria for a DSM-III-R personality disorder diagnosis. There were no significant group differences in age, IQ, or educational attainment. There were no differences in the personality profile of the offender group although sex offenders scored higher on trait anxiety, depression and tension measures. Groups did not significantly differ in their performance on neuropsychological tests apart from poorer perseverative error scores on the Wisconsin Card Sort Test in arsonists, which could not be accounted for by state anxiety or depression scores.

Fire-settng behavior associated with Klinefelter syndrome.

This is a report on a male patient with a previous history of psychotic disorder who was arrested for arson. During the following hospitalization in a psychiatric unit, a genetic syndrome, namely Klinefelter syndrome (47,XXY), was diagnosed. The association between firesetting behavior and Klinefelter syndrome is reviewed, and the underlying explanatory hypothesis is discussed.

Investigation of a murder case involving arson.

In some religious societies, the value of life seems to be different from that in western nonreligious societies. Violating the family honor could result in killing. This article presents a case in which a Moslem Israeli citizen killed his daughter. Professional field work, together with forensic laboratory examinations, led to life imprisonment of the father.

Adult lifetime prevalence of firesetting behaviors in a state hospital population.

Hospital records of all patients under age 65 years old on the census of Worcester State Hospital (WSH) on October 25, 1988 (n = 279) were reviewed for indications of firesetting behaviors during the individuals' adult lifetime. The prevalence of firesetting behaviors was found to be 27.2%. The prevalence of firesetting episodes, a subset of firesetting behaviors, was found to be 17.6%. A stepwise discriminant function analysis was used to determine whether any factors significantly differentiated the members of the firesetting behavior group from the remainder of the population. This analysis revealed that the number of WSH admissions, the number of admissions to other inpatient facilities, and a history of injurious behavior to self are significant positive predictors of membership in the firesetting behaviors group. The results of the WSH analysis are very similar to those found at Northampton State Hospital in 1983. These high prevalence rates have implication for treatment, education, record keeping, and liability.

The incidence of fire setting and associated psychopathology of children attending a child psychiatric outpatients.

Fire setting can be a serious form of anti-social behaviour. A study of 79 consecutive out-patient attenders at a Child Guidance Clinic found a rate of 15 (18.9%). The number of fires set ranged from 1 to 20 (mean 9.9). Conduct disorder was found in 8 (53.3%) of the fire setters.

Dual diagnosis patients in the urban psychiatric emergency room.

Substance abuse among the mentally ill has become increasingly prominent. This article describes the problems presented by dual diagnosis patients in the urban, publicly funded, psychiatric emergency room. When such patients become acutely ill, neither the public health system nor the mental health clinician is adequately prepared to provide care. The inability to effectively treat these patients has become strikingly clear in recent years. In 1986, the Psychiatric Emergency Service at San Francisco General Hospital began to overflow with patients who required overnight stays. The intoxicated substance abusers with acute psychiatric complaints were the most difficult to manage clinically and administratively. Suggestions are offered for innovative approaches to this group of public patients: dual training of clinicians, flexible treatment programs prepared to deal with the whole person, and public funding that reflects patients' needs rather than clinicians' preferences.

Female arsonists: a clinical study.

This paper is a detailed study of a sample of 15 female arsonists. A review of the literature suggests that arson is seen more frequently in males with female firesetters usually comprising 10 to 18% of the samples of firesetters studied. As a result, female arsonists have been studied less often, and only a few authors have reported on their clinical features. This retrospective study demonstrates that female arsonists do not fall in any particular age group and are mostly either single or separated. Some psychosexual aspects of their behavior also appear to be clinically relevant. In contrast to previous studies, they were more often diagnosed as personality disordered and an association with suicidal behavior was found. Their motivations for the firesetting behavior were also considered. Finally, this paper compares some demographic, clinical, and other differences between male and female arsonists. The study also suggests that poor impulse control may be a prerequisite to this type of criminal behavior. The identification of psychopathic traits in the arsonist has important medico-legal implications.

Child firesetters: a study of three populations.

Child firesetting constitutes a serious and widespread problem, yet little definitive evidence exists distinguishing child firesetters from their nonfiresetting peers. The authors studied the characteristics of 186 firesetters and 165 age- and sex-matched controls at two state psychiatric hospitals for children, six community mental health centers, and a children's medical hospital. Their findings failed to corroborate results of other studies that have suggested correlations between firesetting and enuresis, sexual conflicts, low intelligence, large family size, economic deprivation, adoption, and a diagnosis of psychosis. However, the study did support the finding, reported in other studies, that firesetters tend to have conduct problems, such as disobedience and aggressiveness, and it also found that firesetters experienced significantly more emotional neglect and physical abuse. The results underscore the importance of parental nurturing and early intervention for children who are abused and neglected.

Firesetting in the adult psychiatric population.

Firesetting by adult psychiatric patients is a symptom found in many primary disorders; it is rarely a reflection of the classic disorder, pyromania, as historically defined. The author emphasizes the importance of clinically addressing firesetting behavior and presents six case examples that illustrate the association of firesetting behavior with schizophrenic, affective, and personality disorders as well as with alcohol abuse and mental retardation. Current understanding of the phenomenon indicates that firesetters have significant social deficits, and successful therapeutic interventions based on a social learning model are beginning to be documented.

Diagnosis and childhood firesetting.

This paper presents findings on the relationship of childhood firesetting and DSM-III diagnosis in a representative sample of child psychiatric outpatients (N = 204). Childhood firesetting and the DSM-III diagnosis of conduct disorder are strongly related; they show a significant interaction effect with lessened competence as measured by activities and increased externalizing (undercontrolled) behavior.

Kleine-Levin syndrome associated with fire setting.

Kleine-Levin syndrome is characterized by periodic hypersomnia associated with megaphagia and striking behavioral and psychiatric symptoms; it occurs primarily in adolescent boys. We treated a 17-year-old boy who had typical recurring somnolent episodes. His bizarre behavior included fire setting and stealing, both of which may have represented compulsions. His EEG during a sleepy episode was diffusely abnormal with generalized slowing of background activity; as he awoke and improved clinically, his EEG returned to normal. Between episodes, his EEG was normal. The relationship between Kleine-Levin syndrome and other sleep disorders is discussed. The neurochemistry and neurocircuitry that may provide the requisite substrate for this complex and fascinating neuropsychiatric disorder are briefly reviewed.