Divalproex sodium in sex offenders with bipolar disorders and comorbid paraphilias: an open retrospective study

Background: This study evaluated divalproex response in sex offenders with a bipolar disorder. Methods: We reviewed the records of all sex offenders who participated in a residential rehabilitative program who received divalproex for treatment of a bipolar disorder. Patients’ mood symptoms and, when present, comorbid paraphilic symptoms, were retrospectively assessed using the CGI severity scale. Results: Sex offenders displayed significant improvement in manic symptoms with divalproex treatment. However, there was no significant improvement in paraphilic symptoms in the subset of patients admitting to these symptoms. Conclusion: Divalproex may be effective for manic symptoms in sex offenders with a bipolar disorder. However, for bipolar sex offenders with comorbid paraphilias, the drug may not be effective for paraphilic symptoms. Limitations: This study was limited by its retrospective, open-label design, lack of systematic means of assessing manic and paraphilic symptoms, and small sample size. Clinical relevance: Divalproex may be a helpful adjunct in the treatment of the subset of sex offenders who have a bipolar disorder.