A comparison of treatment of paraphilias with three serotonin reuptake inhibitors: A retrospective study (original) (raw)
Related papers
2020
Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care. Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990À2018 for SSRIs) (1969À2018 for hormonal treatments), supplemented by other sources, including published reviews. Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders. Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2001
There has been increasing interest in the treatment of sexual disorders in recent years. Sexual disorders are classified in DSM-IV as sexual dysfunctions, paraphilias, and gender identity disorders. The sexual dysfunctions are nondeviant or nonparaphillic. The sexual dysfunction disorders should include "hyperactive sexual desire disorder" under sexual desire disorders. Further, there should be a specifier for paraphilias of "with hypersexuality" or "without hypersexuality." There is still incomplete understanding of the neurobiology of sexual disorders although functional neuroanatomy and neoropharmcological research has exposed the neurotransmitters, receptors, and hormones that are involved in sexual desire. Various pharmacological agents including serotonin reuptake inhibitors, antiandrogens, LHRH agonists, and others have been documented as reducing sexual desire. An algorithm for the use of these drugs in the treatment of the paraphilias as well n...
Pharmacological treatment of paraphilias
The Israel journal of psychiatry and related sciences, 2012
The psychiatrist's main role is to provide care to the paraphilic patient and to reduce personal distress. However, in cases of paraphilia associated with sexual offences, reducing paraphilic behavior is critical in an approach to preventing sexual violence and reducing victimization. This review will focus on this specific population. We discuss the recently published recommendations for the treatment of paraphilias of the World Federation of Societies of Biological Psychiatry which were based on a review of the available literature about pharmacological treatment of paraphilias (1970-2010). Antiandrogens, and mostly GnRH analogues, significantly reduce the intensity and frequency of deviant sexual arousal and behavior, although informed consent is necessary in all cases. GnRH analogue treatment constitutes the most promising treatment for sex offenders at high risk of sexual violence, such as pedophiles or serial rapists. SSRIs remain an interesting option in adolescents, in p...
Drug treatment of paraphilic and nonparaphilic sexual disorders
Clinical Therapeutics, 2009
Background: Paraphilias are characterized by recurrent, intense, sexually arousing fantasies, urges, or behaviors, over a period of ::::6 months, generally involving nonhuman objects, suffering or humiliation of oneself or one's partner, or children or other nonconsenting persons. These fantasies, urges, and behaviors produce clinically significant distress or impairments in social, occupational, and other important areas of functioning. Objective: The goal of this article was to provide an in-depth review of the clinical pharmacology of the main antiandrogens (cyproterone acetate, medroxyprogesterone acetate [MPA], and the luteinizing hormone-releasing hormone [LHRH] agonists) used in the treatment of the paraphilias, as well as a discussion of the relevant clinical case reports, case series, and controlled trials. Treatment recommendations are also provided. Methods: Relevant publications were identified through a search of the English-language literature indexed on MEDLINE/PubMed (1966-September 2008) using the search terms paraphilia. sex offendel:. hypersexuality. sexual behaviors_. fetish. transvestic fetishism. sexual addiction. sexual compulsivism. selective serotonin reuptake inhibitors_. tricyclic antidepres-sants_. antiandrogens_. cyproterone acetate_. medroxyprogesterone acetate_. LHRH agonists_. and estrogens. Additional publications were identified from the bibliographies of retrieved publications. Results: In vitro and in vivo (animal) studies have revealed that serotonin and prolactin inhibit sexual arousal, while norepinephrine (via acadrenoceptor activation), dopamine, acetylcholine (via muscarinic receptor activation), enkephalins, oxytocin, gonadotropinreleasing hormone, follicle-stimulating hormone, luteinizing hormone, testosterone/dihydrotestosterone, and estrogen/progesterone stimulate it. Most of the currently used pharmacologic treatments of the paraphilias
The Psychiatric quarterly, 1999
The paraphilias have been mostly ignored by psychiatry, even though psychiatrists are ideally suited to treat and diagnose these disorders by virtue of their medical and psychological training. The sexual deviations require an understanding of both biological and psychological causation and skills in psychological and pharmacological treatments. More recently the Supreme Court of the United States in Kansas v Hendricks (1997) upheld the constitutionality of the civil commitment of sexually deviant individuals for psychiatric treatment. As the various states adopt statutes based on Hendricks, psychiatry will be forced to take an active interest in the diagnosis and the management of the paraphilias. This paper outlines briefly where the field is in the understanding of the natural history, diagnosis, and treatment of the paraphilias.
World Journal of Biological Psychiatry, 2010
Objectives. The treatment of eating disorders is a complex process that relies not only on the use of psychotropic drugs but should include also nutritional counselling, psychotherapy and the treatment of the medical complications, where they are present. In this review recommendations for the pharmacological treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED)) are presented, based on the available literature. Methods. The guidelines for the pharmacological treatment of eating disorders are based on studies published between 1977 and 2010. A search of the literature included: anorexia nervosa bulimia nervosa, eating disorder and binge eating disorder. Many compounds have been studied in the therapy of eating disorders (AN: -fenfl uramine, naltrexone). Results. In AN 20 randomized controlled trials (RCT) could be identifi ed. For zinc supplementation there is a grade B evidence for AN. For olanzapine there is a category grade B evidence for weight gain. For the other atypical antipsychotics there is grade C evidence. In BN 36 RCT could be identifi ed. For tricyclic antidepressants a grade A evidence exists with a moderate-risk-benefi t ratio. For fl uoxetine a category grade A evidence exists with a good risk-benefi t ratio. For topiramate a grade 2 recommendation can be made. In BED 26 RCT could be identifi ed. For the SSRI sertraline and the antiepileptic topiramate a grade A evidence exists, with different recommendation grades. Conclusions. Additional research is needed for the improvement of the treatment of eating disorders. Especially for anorexia nervosa there is a need for further pharmacological treatment strategies.
Treatment of a compulsive paraphiliac with buspirone
Annals of Sex Research, 1992
This report provides an illustration of the potential value of drugs which enhance the effects of serotonin in the treatment of a compulsive paraphilia. A 37-year old m a n who had a long history of little control over urges to expose and to engage in obscene telephone calling, was placed on an open trial of buspirone. Buspirone proved very effective and this outcome, along with other reports of the beneficial effects of serotonin enhancers, encourages further research. Most interesting and notable was the observation that benefits continue to be maintained at 30 m o n t h s after withdrawal of treatment.
Treatment of sexual paraphilias: a review of the 1999-2000 literature
Current Opinion in Psychiatry, 2000
Treatment research on the paraphilias is limited and confounded by the larger treatment literature on sex offenders. Research suggests that sex offenders can benefit from treatment. Antiandrogen and cognitive±behavioural techniques appear to have the best likelihood of reducing recidivism. Data regarding the effectiveness of selective serotonin reuptake inhibitors and other psychotropic medication are too limited for allowing conclusions to be made. Curr Opin Psychiatry 13:569±573.
Paraphilia without symptoms of primary psychiatric disorder: a case report
Journal of Medical Case Reports
Background Paraphilias are recurrent and arousing fantasies, thoughts, and behaviors that cause distress to sufferers and surrounding people. This case report details the challenge of managing multiple paraphilias with compulsive sexual behavior. Case presentation A 48-year-old Malay man presented with compulsive sexual behavior, encompassing voyeuristic, frotteurism, and exhibitionistic behavior, increasing progressively over the years, with accompanying overvalued ideas of erotomania. Despite the high level of dysfunction occupationally and socially, there were no apparent psychotic, manic, or depressive symptoms. An organic workup was unremarkable, and he was diagnosed with multiple paraphilias. Treatment with selective serotonin reuptake inhibitors was commenced, and psychologically he was managed with techniques specific to compulsive sexual behavior. Conclusion Though rare in the literature, both paraphilic disorders and compulsive sexual behaviors are very distressing to suff...
Sexual fantasies: The boundary between physiology and psychopathology. Clinical evidence
Journal of Sexual and Reproductive Health Care, 2021
Purpose: In order to study in-depth the paraphiliac universe of the patient, avoiding diagnostic errors in terms of sexuality, sexual fantasies and disorders codified by the DSM-V, this research work focused on the importance of the exact identification of relevant sexual behaviours, in order to facilitate the relationship with the patient and the therapeutic pathway. Methods: Clinical interview with the administration of the "Perrotta Integrative Clinica Interview" (PICI-1) and "Perrotta Individual Sexual Matrix Questionnaire" (PSM-1). Results: Once the questionnaire was completed, it was tested on a population sample of 122 subjects (69 male and 53 female), demonstrating diagnostic error in 22.13% of cases (27 total) and in particular in the two youngest groups of both sexes (14-24 years and 25-35 years), reaching 37% error in females and 40.7% in males. Conclusions: The present research work has laid the foundations for a more accurate and detailed investigation of the diagnostic universe linked to paraphiliac disorder, demonstrating that: 1) At the diagnostic stage, it is always possible to commit an interpretative error by mistaking a simple paraphilia for paraphiliac disorder, also taking into account the psychological disorders present in comorbidity. 2) The MMPI-II identifies some characteristics that can be traced back to paraphiliac disorder and other related personality disorders but does not specify in detail the paraphiliac universe of the patient and therefore the exact therapeutic intervention to be carried out in psychotherapy. 3) The PICI-1TA fully absorbs the results of the MMPI-II and notes its critical aspects, such as the absence of the indications of the specific personality traits, useful in the diagnostic and therapeutic phases, without however listing in detail the paraphiliac universe of the patient. 4) The PSM-1, if associated with the PICI-1TA, allows to identify of the primary disorder, the characterizing secondary traits and the whole paraphiliac universe of the patient, for the purposes of the clinical diagnostic profile and of the specific targeted therapeutic intervention to be carried out, giving also information about the medical history and other possible associated sexual disorders. 5) The PSM-1 was able to detect, on a sample of population n. 122, n. 27 (16 male and 11 female) diagnostic errors (22.13%) in the phase of centring of the patient, depowering the diagnosis of paraphiliac disorder to simple paraphilia to be managed in a framework more deprived of judgment. 6) The PSM-1, unlike other psychosexual tests and questionnaires, allows to analyse at the same time with precision the following aspects: a) personal and family psychophysical history; b) information about orientation, gender and related sexual disorders; c) the paraphiliac universe, with specific indications of the object/content of individual behaviours; d) the psychodynamic profile of the patient, on the basis of his disorder (if present) or of the simple behavioural manifestation of a paraphiliac matrix; e) categorisation by intensity, severity and content. 7) The present research work has therefore demonstrated the reliability of the psychodiagnostic instrument, also noting that the highest percentage of a diagnostic error on the subject of sexual behaviour is present in both males and females in the 25-35 age band, followed by the 14-24 age band, for an overall total of 40.7% in males and 37% in females. It would appear that diagnostic errors are less frequent in the older and more mature age groups. In relation then to the MMPI-II and the PICI-1 it proved particularly functional with the latter, in order to proceed to the therapeutic contract with the patient and therefore to the implementation of the necessary strategies in support, assistance and therapy.