Fragile X Syndrome Fragile x syndrome is characterised by large ears, velvety skin, flat feet, testicular enlargement after puberty, speech “cluttered” attentional deficit, hand flapping. Autistic traits. CGG repeats over two hundred. Support –MDT. Speech and language, physio, psychological techniques for teachers/parents, look at educational needs. family support –carers' assessment. Genetic Aberration A mutation on the X chromosome at the Xq27.3 site.  Fragile-X mental retardation -1 Gene FMR1 is a human gene that codes for a protein called Fragile-X mental retardation protein (FMRP) that may help regulate synaptic plasticity, important for learning and memory.  Prevalence 1 of every 1,000 males 1 of every 2,000 females Intellectual disability Mild to severe. Eighty per cent of boys with fragile X syndrome have an intelligence quotient lower than 80. Co-morbidities Attention deficit hyperactivity, learning disorders, autism spectrum disorders Physical Features long face, long ear

PYROMANIA The recurrent, deliberate, and purposeful setting of fires. Associated features Tension or affective arousal before setting the fires. Interest in fire and the actions and tools coupled with firefighting. Gratification, or relief setting fires or witnessing the aftermaths. Patients make substantial advance arrangements. Epidemiology Eight times more frequent in men compared to women Comorbidity Substance abuse disorders Affective disorders Other impulse control disorders Personality disturbances e.g. borderline personality disorder. Attention-deficit hyperactivity disorder Learning disabilities History of Enuresis Antisocial acts, such as truancy and delinquency Aetiology Psychosocial.  A symbol of sexuality.  Abnormal craving for power and social prestige  Retaliation about the absence of the father Volunteering as a firefighter to vent the frustration Promiscuity

Assessment and Management of The Risk of Violence in Schizophrenia Scenario A 21-year-old lady with the diagnosis of schizophrenia informs you she will kill her neighbour tomorrow as she has ruined her life. She tells not to disclose this to anyone. How will you assess the homicidal risk in this patient? What treatment and follow up recommendations will you make in this case? Clinical Assessment  Listen to the patient and develop a therapeutic relationship.  begin the assessment and enquire about her demographics.  Enquire about the issue that she brought up—she will kill her neighbour.  Elaborate on how she thinks her neighbour has ruined her life.  Explore her thoughts a nd whether the patient may have persecutory delusions Assess how much resentment she feels? Follow up with inquiry about her mood, esp. about irritability and depression How she plans to commit the act Has she threatened the person? Whether she has done so in the past If so, what provoked such an in