Prevention of suicide in older adults.

the evaluation, were exacerbated when the patient was observed indirectly. He had normal intelligence (IQ 74), had never used illegal substances, and denied any psychiatric or criminal family history. The patient adequately modulated affect, and endorsed guilt and shame for the offense he had committed. The diagnoses of Tourette’s disorder and OCD increased the manifestations of acts that were not necessarily subjugated to volition, making commission of the sexual offense more impulsive and disorganized (committed in the presence of others). This modus operandi is distinct from that of sexual aggressors, whose practices involve premeditation and dissimulation, absence of guilt, and high odds of recidivism. The judge accepted the expert’s report, considered the patient not guilty by reason of insanity, and ordered regular outpatient treatment in the community. Identifying the clinical repercussions of Tourette’s disorder, as well as understanding its forensic psychiatric implications, can improve referral and treatment and prevent double stigmatization.