266 M e d . Sci. Law ( 1 9 7 6 ) Vol. 16, No. 4 Shoplifting, Depression and an Unusual Intracranial Lesion (A Case Report) DEREK CHISWICK, MB ChB, MRCPsych Royal Edinburgh Hospital, Edinburgh SUMMARY A case is reported of shoplifting occurring in a depres­ sive illness of suicidal intensity. In addition, there was present an unusually large intracranial lesion, the differential diagnosis of which is discussed, although its exact nature remains uncertain. CASE HISTORY A 66-year-old widow was admitted to a regional poisoning treatment centre having consumed 50 M o g a d o n tablets (250 mg nitrazepam). After conserva­ tive treatment she was transferred to a psychiatric hospital. Three weeks previously she had been arrested for shoplifting at a local supermarket and her shame was such that she had wished to end her life. She was employed as a resident housekeeper to a wealthy family where she was held in high regard. She was a highly conscientious w o m a n and her meticulously planned and executed suicidal bid would doubtless have succeeded, had she taken a hypnotic more toxic than nitrazepam. In the previous 5 years she had experienced black­ outs on twelve-sixteen occasions, when she would suddenly, without warning, lose consciousness for 1-2 minutes. She had sustained injuries in these episodes but there had been no convulsions or in­ continence. Her general practitioner had prescribed a small dose of imipraminc. T w o years prior to the selfpoisoning she had undergone a cholecystectomy and choledocholithotomy following an episode of obstruct­ ive jaundice. H e r blackouts had occurred whilst in hospital on that occasion and a skull X-ray showed a right parietal calcified mass but no further action was taken. A Since the cholecystectomy she had been depressed and apathetic, withdrawing from her m a n y social interests. There had been insomnia and weight loss of 4'5 kg. She could recall in detail the shoplifting episode but could offer no explanation lor her actions. T h e items she had stolen were not those which she normally purchased, and she had ample money in her purse to pay for them. Although failing to declare the goods at the check-out, she made no elaborate attempts to conceal them. It was her first offence of any description. B Examination by a neurologist revealed only minimal abnormalities, namely some diminution of two-point Fig. 1: Skull X-rays. A, Anterior view. B, Right lateral view. C h i s w i c k : Unusual Intracranial Lesion discrimination in the left lower leg and some asym­ metry of optokinetic nystagmus. Skull X-rays {Fig. J A, B) revealed a densely calcified ovoid mass at the vertex and just to the right of the midline, measuring approximately 50 m m X 40 m m X 30 m m . T h e lesion was unchanged in size or density from its appearance 2 years earlier. A brain scan using """technetium pertechnetate {Fig. 2A-C) showed increased uptake of the agent in a position corresponding to the lesion. Echoencephalography showed no shift of midline structures, and the electroencephalogram was feature­ less and within normal limits. Treated with amitriptyline and supportive psycho­ therapy, she made an excellent recovery from her depression, and the shoplifting charge was dropped on psychiatric evidence. T h e blackouts were treated with 267 calcified h a e m a t o m a o r calcified abscess. T h e site is i n d e e d t y p i c a l of t h e p a r a s a g i t t a l m e n i n g i o m a , b u t t h e d e g r e e of a c t i v i t y o n t h e b r a i n s c a n is less t h a n w o u l d n o r m a l l y b e e x p e c t e d from this lesion. S h o p l i f t i n g is r e c o g n i z e d as a n o c c a s i o n a l f e a t u r e of d e p r e s s i v e illness a n d p s y c h i a t r i s t s h a v e stressed t h e n e e d to identify s u c h cases. I n their extensive review Gibbens a n d Prince (1962) r e p o r t e d t h a t n o less t h a n 20-8 p e r c e n t of first offenders h a d s o m e p s y c h i a t r i c disability a n d they d r e w particular atten­ tion to t h e a s s o c i a t i o n b e t w e e n s h o p l i f t i n g A phenytoin symptomatically, and were reduced in frequency. Neurosurgical exploration was not recom­ m e n d e d in view of the age of the patient and the chronic, benign nature of the lesion. At follow-up 1 year later she was very well and was continuing in her previous employment. DISCUSSION T h e r e l a t i v e p a u c i t y of n e u r o l o g i c a l s y m p ­ t o m s a n d signs, in s p i t e of t h e l a r g e size of t h e i n t r a c r a n i a l calcified lesion, is i n t e r e s t i n g . I n r e l a t i o n to t h e s h o p l i f t i n g , t h e p r e s e n c e of t h e lesion s e e m s c o i n c i d e n t a l , a l t h o u g h t h e r e is a r e m o t e possibility t h a t t h e e p i s o d e r e p r e ­ sented a psychomotor attack. Pathological i n t r a c r a n i a l c a l c i f i c a t i o n is a s s o c i a t e d w i t h c h r o n i c lesions w h o s e o r i g i n s a r e m o s t u s u a l l y n e o p l a s t i c , v a s c u l a r o r infective a n d o c c a s i o n ­ ally m e t a b o l i c ( S u t t o n a n d G r a i n g e r , 1 9 6 9 ) , T h e differential d i a g n o s i s t h e r e f o r e i n c l u d e s parasagittal meningioma, dural osteoma. C Fig. 2: Brain s c a n s . A, Posterior v i e w . B, Right lateral v i e w . C, Vertex v i e w . 268 M e d . Sci. Law ( 1 9 7 6 ) Vol. 16, No. 4 a n d depression in m i d d l e - a g e d f e m a l e offend­ ers. M o r e r e c e n d y G i b b e n s et al. (1971) r e m a r k e d u p o n the frequency o f a m i x e d variety o f physical a n d m e n t a l s y m p t o m s in s u c h w o m e n . T h e case described here s h o w s m a n y similarities to the 'typical case history' w h i c h t h e y describe. Psychodynamic theories o f shoplifting abound and have been reviewed elsewhere ( W o d d i s , 1 9 5 7 ; G i b b e n s a n d Prince, 1962). P e r h a p s t h e least c o n t e n t i o u s theory is that t h e act represents a cry for h e l p in a suicidal subject a n d the serious suicidal risk t h a t m a n y of these unfortunate p e o p l e present has b e e n stressed (Batchelor, 1969). T h e r e is a strong c a s e for seeking a psychiatric o p i n i o n o n all m i d d l e - a g e d f e m a l e first offenders, for w i t h i n this g r o u p there is likely to b e a pro­ p o r t i o n o f w o m e n w i t h serious, y e t e m i n e n t l y treatable, psychiatric illness. ACKNOWLEDGEMENTS T h e author wishes to thank D r E. B. Ritson and D r E. H . Jellinek for permission to report a patient under their care, a n d Professor R. E. Kendell for his helpful advice. REFERENCES Batchelor I. R. C. (1969) Henderson and Gillespie's Textbook of Psychiatry. 10th ed. L o n d o n , Oxford University Press, p . 540. Gibbens T . C . N . , Palmer C . a n d Prince J . (1971) Mental health aspects of shoplifting. Br. Med. J. 3, 612-615. Gibbens T. C. N . a n d Prince J . (1962) Shoplifting. L o n d o n , Institute for the Study and Treatment of Delinquency. Sutton D . and Grainger R. G. (1969) A Textbook of Radiology. Baltimore, Williams a n d Wilkins, p . 9 9 3 . Woddis G. M . (1957) Depression and Crime. Br. J. Delinquency 8, 8 5 - 9 4 .