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Lievesley R, Swaby H, Winder B, Norman C, Hocken K. "One a Day Keeps the Prison Away": Understanding the Experiences of Individuals Convicted of Sexual Offences Receiving Anti-Androgens for the Treatment of Problematic Sexual Arousal. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2141-2158. [PMID: 38594464 PMCID: PMC11176105 DOI: 10.1007/s10508-024-02847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
Problematic sexual arousal (PSA) is an umbrella term to describe a range of clinical presentations related to excessive sexual thinking (e.g., sexual preoccupation) and sexual behavior (e.g., hypersexuality). Although such concepts are known to affect sexual recidivism among individuals convicted of sexual offences, PSA is not routinely or directly targeted in offending behavior programs in England and Wales. However, in recent years, there have been moves to incorporate pharmacological interventions for addressing this among people with sexual offence histories. Although some work to understand the experiences of those taking SSRI medication for this purpose has emerged, little is known about the experiences of service users taking anti-androgen medication. In this study, we interviewed all individuals in prison taking anti-androgens for the treatment of problematic sexual arousal following convictions for sexual offences in England at the time of data collection (N = 10). Using a phenomenologically oriented thematic analysis, we established themes pertaining to "Differing needs: Motivations for treatment," "Medication as a risk management strategy," and how the medication helped the men in their pursuit of "Discovering a 'new me'." This work contributes important knowledge to inform the development of ethical and effective prescribing of anti-androgen medication with this population and offer recommendations for both future research and the development of clinical practice.
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Affiliation(s)
- Rebecca Lievesley
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK.
| | - Helen Swaby
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Belinda Winder
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Christine Norman
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, UK
| | - Kerensa Hocken
- Midlands Psychology Services, His Majesty's Prison and Probation Service, Nottingham, UK
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Harada T, Nomura K, Shimada H, Kawakami N. Development of a risk assessment tool for Japanese sex offenders: The Japanese Static-99. Neuropsychopharmacol Rep 2023; 43:496-504. [PMID: 36915995 PMCID: PMC10739125 DOI: 10.1002/npr2.12330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
In Japan, sexual offending, especially paraphilic sexual offending, has become a major problem, and approximately 3000 people are arrested for frotteuristic and voyeuristic behavior each year. Considering the repetitive nature of such behaviors, determining the recidivism risk is imperative. Globally, Static-99 is one of the most widely used actuarial risk assessment tools to predict recidivism among sex offenders. However, sexual offending is largely influenced by social and cultural backgrounds, and whether risk factors identified in the West are applicable to other countries is unknown. Therefore, we developed a Japanese version of the Static-99 and examined its reliability and validity with 167 Japanese paraphilic sex offenders. The results showed good internal consistency (Cronbach's alpha coefficient = 0.88) and predictive accuracy (area under the curve = 0.76). The results indicate that the Japanese Static-99 can be used with Japanese sex offenders. Moreover, risk factors identified in the Western context are applicable to Japanese sex offenders despite the different nature and manifestations of their offending.
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Affiliation(s)
- Takayuki Harada
- Faculty of Human SciencesUniversity of TsukubaTokyoJapan
- University of TokyoTokyoJapan
| | - Kazutaka Nomura
- School of Allied Health Sciences, Kitasato UniversityKanagawaJapan
| | | | - Norito Kawakami
- Department or Digital Mental HealthGraduate School of Medicine, The University of TokyoTokyoJapan
- Junpukai FoundationOkayamaJapan
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Ågmo A, Laan E. The Sexual Incentive Motivation Model and Its Clinical Applications. JOURNAL OF SEX RESEARCH 2023; 60:969-988. [PMID: 36378887 DOI: 10.1080/00224499.2022.2134978] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sexual motivation (desire) requires the simultaneous presence of an active central motive state and a stimulus with sexual significance. Once activated, sexual motivation leads to visceral responses and approach behaviors directed toward the emitter of the sexual stimulus. In humans, such behaviors follow cognitive evaluation of the context, including predictions of the approached individual's response. After successful approach and establishment of physical contact, manifest sexual activities may be initiated. Sexual interaction is associated with and followed by a state of positive affect in most animals, whereas aversive consequences may be experienced by humans. The affective reactions may become associated with stimuli present during sexual interaction, and these stimuli may thereby alter their incentive properties. Here we show how the incentive motivation model can be used to explain the origins and possible treatments of sexual dysfunctions, notably disorders of desire. We propose that associations formed between negative outcomes of sexual interaction and the salient stimuli, for example, the partner, underlies hypoactive desire disorder. Highly positive outcomes of sexual interaction enhance the incentive value of the stimuli present, and eventually lead to hyperactive sexual desire. Treatments aim to alter the impact of sexual incentives, mainly by modifying cognitive processes.
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Affiliation(s)
- Anders Ågmo
- Department of Psychology, University of Tromsø
| | - Ellen Laan
- Department of Sexology and Psychosomatic Gynaecology, Amsterdam UMC, University of Amsterdam
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Perrotta G. The Concept of "Hypersexuality" in the Boundary between Physiological and Pathological Sexuality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105844. [PMID: 37239570 DOI: 10.3390/ijerph20105844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The concept of hypersexuality belongs to modern parlance, according to a predominantly clinical meaning, and is understood as a psychological and behavioural alteration as a result of which sexually motivated stimuli are sought in inappropriate ways and often experienced in a way that is not completely satisfactory. METHODS Literature up to February 2023 was reviewed, with 25 searches selected. RESULTS Forty-two articles were included in the review. CONCLUSION Hypersexuality is a potentially clinically relevant condition consisting of one or more dysfunctional and pathological behaviours of one's sexual sphere and graded according to the severity of impairment of subjective acting out; for this reason, the Perrotta Hypersexuality Global Spectrum of Gradation (PH-GSS) is suggested, which distinguishes high-functioning forms (pro-active and dynamic hypersexuality) from those of attenuated and corrupted functioning (dysfunctional and pathological hypersexuality of grades I and II). Future research is hoped to address the practical needs of this condition, such as the exact etiopathology, the role of oxytocin in dopaminergic hypotheses (and its ability to attenuate the symptomatology suffered by the patient in terms of manic drive), the best structural and functional personality framing of the subject, and the appropriate therapy to pursue.
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Affiliation(s)
- Giulio Perrotta
- Istituto per lo Studio delle Psicoterapie-ISP, Via San Martino Della Battaglia n. 31, 00185 Rome, Italy
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Páv M, Sebalo I, Brichcín S, Perkins D. Outcome Evaluation of a Treatment Program for Men with Paraphilic Disorders Convicted of Sexual Offenses: 10-Year Community Follow-up. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023:306624X231165416. [PMID: 37157822 DOI: 10.1177/0306624x231165416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Evidence concerning specific paraphilia treatment effectiveness is limited. We present observation data of 127 men convicted of paraphilic sexual offenses who attended inpatient and outpatient follow-up treatment in Czechia. We collected participants' sociodemographic and treatment-related information, including STATIC-99R scores, and used proportional hazards models to analyze variables' effect on recidivism risk. Within the observation period, the general recidivism and sexual recidivism rates were 33.1% and 16.5%, respectively, and the sexual contact recidivism rate was 4.7%. The total STATIC-99 score for those who re-offended was 5.65 (SD = 2.11) and for those who did not was 3.98 (SD = 2.02). Recidivism risk was 7.52 times higher for those diagnosed with exhibitionism than with pedophilia, sadomasochism, or antisocial personality disorder. General recidivism is comparable to others' findings. We attribute the lower sexual contact recidivism rate to the combined effects of psychological and pharmacological treatment, and higher numbers of non-contact offenses to limited antidepressant use.
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Affiliation(s)
- Marek Páv
- Psychiatric Hospital Bohnice, Prague, Czech Republic
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Vayısoğlu S. Symptoms of exhibitionism that regress with bupropion: A case report. Front Psychiatry 2022; 13:1079863. [PMID: 36684014 PMCID: PMC9846203 DOI: 10.3389/fpsyt.2022.1079863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023] Open
Abstract
Exhibitionistic Disorder, one of the paraphilic disorders, is a disease with an unknown etiology and causes significant distress and loss of function in the patient's life. Serotonergic antidepressants are generally preferred in the treatment of this Disorder. However, in this case, we report a patient who did not respond to serotonergic antidepressants but bupropion, an antidepressant with dopaminergic and noradrenergic activity. Therefore, bupropion should be considered a medical treatment alternative in case serotonergic antidepressants do not work efficiently in the treatment of Exhibitionism.
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Self-Medication of Paraphilic Ideation Contributing to a Pulmonary Embolism: A Case Report. J Acad Consult Liaison Psychiatry 2021; 62:456-459. [PMID: 34210405 DOI: 10.1016/j.jaclp.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 11/23/2022]
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Thibaut F, Cosyns P, Fedoroff JP, Briken P, Goethals K, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020; 21:412-490. [PMID: 32452729 DOI: 10.1080/15622975.2020.1744723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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 (1990-2018 for SSRIs) (1969-2018 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.
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Affiliation(s)
- Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
| | - Paul Cosyns
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - John Paul Fedoroff
- Division of Forensic Psychiatry, The Royal Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and University Forensic Centre, Antwerp University Hospital, Antwerp, Belgium
| | - John M W Bradford
- The Royal Institute of Mental Health Research, University of Ottawa, McMaster University, Ottawa & Hamilton, ON, Canada
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Abstract
PURPOSE OF REVIEW We reviewed recent data on sexual addiction and its treatment. We examined the different definitions of this disorder, related to the pathophysiological mechanisms. We addressed the pharmacological treatment of sexual addiction. RECENT FINDINGS Hypersexual behavior can be considered an addictive disorder. Sexual addiction is accompanied by significant psychiatric and addictive comorbidities and is responsible for life impairment. A comprehensive and efficient treatment must be proposed. Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.
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Affiliation(s)
- Leo Malandain
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France.
| | - Jean-Victor Blanc
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florian Ferreri
- Department of Adult Psychiatry and Medical Psychology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Florence Thibaut
- University Hospital Cochin (site Tarnier), Paris University, AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
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Yasin W, Ahmed SI, Gouthro RV. Does Bupropion Impact More than Mood? A Case Report and Review of the Literature. Cureus 2019; 11:e4277. [PMID: 31157138 PMCID: PMC6529042 DOI: 10.7759/cureus.4277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sexual side effects are often an unintended consequence of antidepressant treatment. Given antidepressants of different classes are frequently paired together in order to improve therapeutic response, understanding their interplay in regards to sexual functioning is important. Bupropion is an atypical antidepressant which is often used as a Selective Serotonin Reuptake Inhibitors adjunct in the treatment of depression, as well as in the amelioration of decreased libido. The following case highlights the importance of understanding antidepressant medications and their combined potential effect on sexual function to prevent unnecessary complications in cases involving the history of paraphilic disorders and hypersexuality.
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Affiliation(s)
- Waqas Yasin
- Psychiatry, Medical College of Wisconsin, Green Bay, USA
| | - Syed Ijlal Ahmed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
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Combined hormonal influence of cyproterone acetate and nomegestrol acetate on meningioma: a case report. Acta Neurochir (Wien) 2019; 161:589-592. [PMID: 30666456 DOI: 10.1007/s00701-018-03782-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/18/2018] [Indexed: 12/13/2022]
Abstract
Cyproterone acetate (CPA) is an antiandrogenic drug which has recently been recognized to promote the occurrence and growth of intracranial meningiomas. Nomegestrol acetate (NOMAC) is a widely used progestin-like drug that could be suggested as an alternative for patients taking CPA. We report a case of CPA-related meningioma for which relay from CPA to NOMAC led to further tumor growth and cessation of NOMAC-induced tumor shrinkage. We suggest NOMAC can have a similar effect than CPA on meningiomas. The use of NOMAC as replacement for CPA in the presence of a meningioma should be discouraged until further evidence becomes available on the role of NOMAC in such instances.
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Winder B, Fedoroff JP, Grubin D, Klapilová K, Kamenskov M, Tucker D, Basinskaya IA, Vvedensky GE. The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence. Int Rev Psychiatry 2019; 31:159-168. [PMID: 31184226 DOI: 10.1080/09540261.2019.1577223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper provides an international perspective on the use of medications to treat problematic sexual interests, paraphilic disorders, and sexual preoccupation in men who have committed a sexual offence. Experts from Canada, the Czech Republic (CR), Russia, the United Kingdom, and the United States met in Prague, CR in May 2017 to review and compare their treatment approaches. This report is a summary of their discussions, including empirical data from CR and Russia which have not previously been published in the English language. All participants agreed that continuing international collaboration would be very useful for the development of ethical international prescribing guidelines, as well as pooling data from studies on the efficacy and utility of pharmacological and other biological treatments for people who have committed sexual offences.
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Affiliation(s)
- Belinda Winder
- a Sexual Offences, Crime and Misconduct Research Unit , Nottingham Trent University , Nottingham , UK
| | - J Paul Fedoroff
- b Sexual Behaviours Clinic , The Royal and University of Ottawa , Ottawa , Canada
| | - Don Grubin
- c Emeritus Professor of Forensic Psychiatry , Newcastle University , Newcastle upon Tyne , UK
| | - Kateřina Klapilová
- d Head of Laboratory of Evolutionary Sexology and Psychopathology , National Institute of Mental Health , Klecany , Czech Republic.,e Faculty of Humanities , Charles University , Prague , Czech Republic
| | - Maxim Kamenskov
- f V.P. Serbsky National Medical Research Center of Psychiatry and Narcology , Moscow , Russia
| | - Douglas Tucker
- g Department of Psychiatry, San Francisco School of Medicine, Program in Psychiatry and the Law , University of California , Moraga , CA , USA
| | - Irina A Basinskaya
- h FSI "Oryol Mental Health Facility with Intensive Care" , Ministry of Public Health , Oryol , Russia
| | - Georgy E Vvedensky
- f V.P. Serbsky National Medical Research Center of Psychiatry and Narcology , Moscow , Russia
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Stark R, Klucken T, Potenza MN, Brand M, Strahler J. A Current Understanding of the Behavioral Neuroscience of Compulsive Sexual Behavior Disorder and Problematic Pornography Use. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0162-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lewis A, Grubin D, Ross CC, Das M. Gonadotrophin-releasing hormone agonist treatment for sexual offenders: A systematic review. J Psychopharmacol 2017; 31:1281-1293. [PMID: 28661259 DOI: 10.1177/0269881117714048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sexual offending is a significant international issue causing long-term consequences for victims, perpetrators and society. AIMS The purpose of this study was to review the existing research data assessing the efficacy of gonadotrophin-releasing hormone agonists for treating adult, male, sexual offenders. METHOD The method of this review involved the examination of studies involving participants prescribed at least one month of a gonadotrophin-releasing hormone agonist for the purposes of reducing sexual drive related to offending. The primary outcome measures were recidivism rates and sexual functioning. Secondary outcome measures included assessment of side effects and effects on interpersonal/psychiatric functioning. Studies in the English language that were dated 1969-2015 were included. RESULTS Twelve eligible studies (323 participants) were identified. A reduction in a variety of measures of sexual functioning and/or risk was found in all studies. Robust recidivism data was limited. Medication was rarely described as ineffectual. All studies reported side effects. Reduction in bone density and potential long-term reduction in fertility in some subjects were issues of concern. CONCLUSION Whilst identified studies showed promising results with respect to sexual functioning, challenges in performing randomised control trials in this subject group meant that included studies were methodologically limited. This review recommends that future research must be performed before the effectiveness and tolerability of gonadotrophin-releasing hormone agonists in this population can be confirmed.
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Affiliation(s)
| | - Don Grubin
- 2 Newcastle University, Newcastle upon Tyne, UK
| | | | - Mrigendra Das
- 3 Broadmoor Hospital, Crowthorne, UK.,4 Top End Mental Health Service, Darwin, Australia
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Prevalence of sexual dysfunctions and other sexual disorders in adults with attention-deficit/hyperactivity disorder compared to the general population. ACTA ACUST UNITED AC 2017; 10:87-96. [DOI: 10.1007/s12402-017-0237-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/07/2017] [Indexed: 11/25/2022]
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Taktak Ş, Yılmaz E, Karamustafalıoglu O, Ünsal A. Characteristics of paraphilics in Turkey: A retrospective study-20years. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:22-30. [PMID: 27180212 DOI: 10.1016/j.ijlp.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study is carried out to research the frequency of occurrence and the characteristics of paraphilic cases in Turkey and forensic aspects of them and to explain forensic psychiatric studies of people show paraphilic actions and assess them from legal aspects. METHOD This research is done by studying a total of 101,208 cases who were sent to Istanbul Forensic Medicine Institute (FMI) by the judicial organs of 4th Specialization Board between 1984 and 2004 to decide whether they show paraphilic actions or not. When choosing the cases of pedophilic actions, incest incidents were excluded and 307 incidents were taken into assessment. RESULTS The male subjects are 97.4%, 39.7% of them are 19-29years old, 10% of them are over age 60, 59% of the subjects are single, 36.5% of them are unemployed, 71.7% of the incidents have no physical disorder. The subjects who were imprisoned before were 20.2% and 22.1% of them had undergone psychiatric treatment before the incident. Twenty separate diagnosis are determined by the FMI for the subjects. There were mental retardation, schizophrenia and various personality disorders on the top the diagnosis list. The paraphilia type of the incidents are pedophilia (60.3%), exhibitionism (8.1%), pedophilia and exhibitionism (7.5%) and fetishism (5.9%). It was determined that there were more than one paraphilia type in 40 incidents (13%). FMI decided that 54.7% of them have criminal responsibility, 25.1% of them have no criminal responsibility, and 20.2% of them have reduced criminal responsibility. CONCLUSION There were 20 separate type of diagnosis for the incidents. It is understood that paraphilic incidents do not seek for help although they have the symptoms of disorder and they are exposed to psychiatric assessment only when they face a criminal inquiry. This suggests that there are more paraphilic incidents in the society than what we encounter.
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Affiliation(s)
- Şafak Taktak
- Psychiatry and Forensic Medicine Departments, Ahi Evran University Education and Research Hospital, Turkey.
| | - Ebru Yılmaz
- Forensic Medicine Department, Forensic Medicine Institution, Istanbul, Turkey
| | | | - Ayla Ünsal
- Nursing Department, School of Health, Ahi Evran University, Turkey
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Fosdick C, Mohiuddin S. Case Report: Resolution of Severe Sexual Aggression in a Developmentally Disabled Adolescent During Leuprolide Acetate Use. J Autism Dev Disord 2016; 46:2267-2269. [DOI: 10.1007/s10803-016-2739-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Paraphilic disorders are characterized by atypical sexual interests, fantasies, and behaviors that are subjectively distressing to patients or pose a risk of harm to others. By their very nature, some paraphilic disorders may predispose an individual to commit sexual offenses. The biological treatment of paraphilic disorders, then, is of paramount importance for psychiatry and society at large. Three categories of pharmacologic agents commonly used to treat paraphilic disorders are selective serotonin reuptake inhibitors, synthetic steroidal analogs, and gonadotropin-releasing hormone analogs. Each medication uses a different mechanism of action and has different effects on the physiological and psychological features of paraphilic disorders. In general, these medications have limited high-quality research to support their use. Despite this, some authors have proposed treatment algorithms for individuals with paraphilic disorders of varying severity. These guidelines offer clinicians potentially useful, rational approaches to assessing treatment need in individuals with paraphilic disorders. Recent neuroimaging research suggests that functional magnetic resonance imaging may offer further promise in effectively assessing paraphilic disorders to help direct treatment options.
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Affiliation(s)
- Brian J Holoyda
- Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, 2230 Stockton Blvd., Sacramento, CA, 95817, USA.
| | - Denise C Kellaher
- Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine, 2230 Stockton Blvd., Sacramento, CA, 95817, USA.
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Nair M. Pharmacotherapy for Sexual Offenders. SEXUAL OFFENDING 2016. [DOI: 10.1007/978-1-4939-2416-5_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kingston DA. Hypersexuality Disorders and Sexual Offending. SEXUAL OFFENDING 2016. [DOI: 10.1007/978-1-4939-2416-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Knott V, Impey D, Fisher D, Delpero E, Fedoroff P. Pedophilic brain potential responses to adult erotic stimuli. Brain Res 2015; 1632:127-40. [PMID: 26683083 DOI: 10.1016/j.brainres.2015.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 11/27/2015] [Accepted: 12/02/2015] [Indexed: 11/24/2022]
Abstract
Cognitive mechanisms associated with the relative lack of sexual interest in adults by pedophiles are poorly understood and may benefit from investigations examining how the brain processes adult erotic stimuli. The current study used event-related brain potentials (ERP) to investigate the time course of the explicit processing of erotic, emotional, and neutral pictures in 22 pedophilic patients and 22 healthy controls. Consistent with previous studies, early latency anterior ERP components were highly selective for erotic pictures. Although the ERPs elicited by emotional stimuli were similar in patients and controls, an early frontal positive (P2) component starting as early as 185 ms was significantly attenuated and slow to onset in pedophilia, and correlated with a clinical measure of cognitive distortions. Failure of rapid attentional capture by erotic stimuli suggests a relative reduction in early processing in pedophilic patients which may be associated with relatively diminished sexual interest in adults.
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Affiliation(s)
- Verner Knott
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada.
| | - Danielle Impey
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Derek Fisher
- Department of Psychology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Emily Delpero
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Paul Fedoroff
- Forensic Research Unit, University of Ottawa, Institute of Mental Health Research, Ottawa, ON, Canada
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Thibaut F, Bradford JMW, Briken P, De La Barra F, Häßler F, Cosyns P. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders. World J Biol Psychiatry 2015; 17:2-38. [PMID: 26595752 PMCID: PMC4743592 DOI: 10.3109/15622975.2015.1085598] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 01/12/2023]
Abstract
The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment of adolescents with paraphilic disorders who are also sexual offenders or at-risk of sexual offending. Psychotherapeutic and psychosocial treatments were also reviewed. Adolescents with paraphilic disorders specifically present a different therapeutic challenge as compared to adults. In part, the challenge relates to adolescents being in various stages of puberty and development, which may limit the use of certain pharmacological agents due to their potential side effects. In addition, most of the published treatment programmes have used cognitive behavioural interventions, family therapies and psychoeducational interventions. Psychological treatment is predicated in adolescents on the notion that sexually deviant behaviour can be controlled by the offender, and that more adaptive behaviours can be learned. The main purposes of these guidelines are to improve the quality of care and to aid physicians in their clinical decisions. These guidelines brought together different expert views and involved an extensive literature research. Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for efficacy, safety, tolerability and feasibility. An algorithm is proposed for the treatment of paraphilic disorders in adolescent sexual offenders or those who are at risk.
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Affiliation(s)
- Florence Thibaut
- University Hospital Cochin, Faculty of Medicine Paris Descartes, INSERM U 894 CPN,
Paris,
France
| | - John M. W. Bradford
- University of Ottawa, Institute of Mental Health Research, Division of Forensic Psychiatry, Queen’s University, Clinical Director, Forensic Treatment Unit, Brockville Mental Health Centre, Royal Ottawa Health Care Group,
Brockville,
Ontario,
Canada
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf,
Hamburg,
Germany
| | - Flora De La Barra
- East Psychiatry and Mental Health Department, University of Chile,
Clinica Las Condes,
Chile
| | - Frank Häßler
- Clinic for Child and Adolescent Psychiatry, University of Medicine of Rostock,
Rostock,
Germany
| | - Paul Cosyns
- University Forensic Centre (University Hospital of Antwerp),
Belgium
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Khan O, Ferriter M, Huband N, Powney MJ, Dennis JA, Duggan C. Pharmacological interventions for those who have sexually offended or are at risk of offending. Cochrane Database Syst Rev 2015; 2015:CD007989. [PMID: 25692326 PMCID: PMC6544815 DOI: 10.1002/14651858.cd007989.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sexual offending is a serious social problem, a public health issue, and a major challenge for social policy. Victim surveys indicate high incidence and prevalence levels and it is accepted that there is a high proportion of hidden sexual victimisation. Surveys report high levels of psychiatric morbidity in survivors of sexual offences.Biological treatments of sex offenders include antilibidinal medication, comprising hormonal drugs that have a testosterone-suppressing effect, and non-hormonal drugs that affect libido through other mechanisms. The three main classes of testosterone-suppressing drugs in current use are progestogens, antiandrogens, and gonadotropin-releasing hormone (GnRH) analogues. Medications that affect libido through other means include antipsychotics and serotonergic antidepressants (SSRIs). OBJECTIVES To evaluate the effects of pharmacological interventions on target sexual behaviour for people who have been convicted or are at risk of sexual offending. SEARCH METHODS We searched CENTRAL (2014, Issue 7), Ovid MEDLINE, EMBASE, and 15 other databases in July 2014. We also searched two trials registers and requested details of unidentified, unpublished, or ongoing studies from investigators and other experts. SELECTION CRITERIA Prospective controlled trials of antilibidinal medications taken by individuals for the purpose of preventing sexual offences, where the comparator group received a placebo, no treatment, or 'standard care', including psychological treatment. DATA COLLECTION AND ANALYSIS Pairs of authors, working independently, selected studies, extracted data, and assessed the risk of bias of included studies. We contacted study authors for additional information, including details of methods and outcome data. MAIN RESULTS We included seven studies with a total of 138 participants, with data available for 123. Sample sizes ranged from 9 to 37. Judgements for categories of risk of bias varied: concerns were greatest regarding allocation concealment, blinding of outcome assessors, and incomplete outcome data (dropout rates in the five community-based studies ranged from 3% to 54% and results were usually analysed on a per protocol basis).Participant characteristics in the seven studies were heterogeneous, but the vast majority had convictions for sexual offences, ranging from exhibitionism to rape and child molestation.Six studies examined the effectiveness of three testosterone-suppressing drugs: cyproterone acetate (CPA), ethinyl oestradiol (EO), and medroxyprogesterone acetate (MPA); a seventh evaluated two antipsychotics (benperidol and chlorpromazine). Five studies were placebo-controlled; in two, MPA was administered as an adjunctive treatment to a psychological therapy (assertiveness training or imaginal desensitisation). Meta-analysis was not possible due to heterogeneity of interventions, comparators, study designs, and other issues. The quality of the evidence overall was poor. In addition to methodological issues, much evidence was indirect. PRIMARY OUTCOME recividism. Two studies reported recidivism rates formally. One trial of intramuscular MPA plus imaginal desensitisation (ID) found no reports of recividism at two-year follow-up for the intervention group (n = 10 versus one relapse within the group treated by ID alone). A three-armed trial of oral MPA, alone or in combination with psychological treatment, reported a 20% rate of recidivism amongst those in the combined treatment arm (n = 15) and 50% of those in the psychological treatment only group (n = 12). Notably, all those in the 'oral MPA only' arm of this study (n = 5) dropped out immediately, despite treatment being court mandated.Two studies did not report recidivism rates as they both took place in one secure psychiatric facility from which no participant was discharged during the study, whilst another three studies did not appear directly to measure recividism but rather abnormal sexual activity alone. SECONDARY OUTCOMES The included studies report a variety of secondary outcomes. Results suggest that the frequency of self reported deviant sexual fantasies may be reduced by testosterone-suppressing drugs, but not the deviancy itself (three studies). Where measured, hormonal levels, particularly levels of testosterone, tended to correlate with measures of sexual activity and with anxiety (two studies). One study measured anxiety formally; one study measured anger or aggression. Adverse events: Six studies provided information on adverse events. No study tested the effects of testosterone-suppressing drugs beyond six to eight months and the cross-over design of some studies may obscure matters (given the 'rebound effect' of some hormonal treatments). Considerable weight gain was reported in two trials of oral MPA and CPA. Side effects of intramuscular MPA led to discontinuation in some participants after three to five injections (the nature of these side effects was not described). Notable increases in depression and excess salivation were reported in one trial of oral MPA. The most severe side effects (extra-pyramidal movement disorders and drowsiness) were reported in a trial of antipsychotic medication for the 12 participants in the study. No deaths or suicide attempts were reported in any study. The latter is important given the association between antilibidinal hormonal medication and mood changes. AUTHORS' CONCLUSIONS We found only seven small trials (all published more than 20 years ago) that examined the effects of a limited number of drugs. Investigators reported issues around acceptance and adherence to treatment. We found no studies of the newer drugs currently in use, particularly SSRIs or GnRH analogues. Although there were some encouraging findings in this review, their limitations do not allow firm conclusions to be drawn regarding pharmacological intervention as an effective intervention for reducing sexual offending.The tolerability, even of the testosterone-suppressing drugs, was uncertain given that all studies were small (and therefore underpowered to assess adverse effects) and of limited duration, which is not consistent with current routine clinical practice. Further research is required before it is demonstrated that their administration reduces sexual recidivism and that tolerability is maintained.It is a concern that, despite treatment being mandated in many jurisdictions, evidence for the effectiveness of pharmacological interventions is so sparse and that no RCTs appear to have been published in two decades. New studies are therefore needed and should include trials with larger sample sizes, of longer duration, evaluating newer medications, and with results stratified according to category of sexual offenders. It is important that data are collected on the characteristics of those who refuse and those who drop out, as well as those who complete treatment.
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Affiliation(s)
- Omer Khan
- The Priory GroupChadwick Lodge, Chadwick DriveEaglestoneMilton KeynesBuckinghamshireUKMK6 5LS
| | - Michael Ferriter
- Nottinghamshire Healthcare NHS TrustForensic DivisionThe Clair Chilvers CentreRampton HospitalWoodbeckNottinghamshireUKDN22 0PD
| | - Nick Huband
- University of NottinghamInstitute of Mental HealthTriumph RoadNottinghamUKNG7 2TU
| | - Melanie J Powney
- The University of ManchesterDepartment of Clinical Psychology2nd Floor, Zochonis BuildingBrunswick StreetManchesterUKM13 9PL
| | - Jane A Dennis
- Queen's University Belfastc/o Cochrane Developmental, Psychosocial and Learning Problems GroupICCR6 College ParkBelfastUK
| | - Conor Duggan
- University of NottinghamInstitute of Mental HealthTriumph RoadNottinghamUKNG7 2TU
- Partnerships in Care2 Imperial PlaceMaxwell RoadBorehamwoodHertfordshireUKWD6 1JN
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Turner D, Basdekis-Jozsa R, Dekker A, Briken P. Which factors influence the appropriateness of testosterone-lowering medications for sex offenders? A survey among clinicians from German forensic-psychiatric institutions. World J Biol Psychiatry 2014; 15:472-8. [PMID: 24219802 DOI: 10.3109/15622975.2013.839052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Although testosterone-lowering medications (TLM) are a frequently used addition to psychotherapy in sex offender treatment, discord still seems to exist amongst clinicians as to in which cases administering TLM is justified. The depo-Provera scale (DPS), which was published by Maletzky and Field (Aggress Violent Behav 2003;8:391), assesses the appropriateness of TLM administration in sex offender treatment. METHODS The DPS was sent to all forensic psychiatric institutions in Germany. The clinical directors of these institutions were asked to rate the importance of each item of the DPS on a six-point Likert scale. RESULTS Twenty-nine clinicians participated. The most important reason selected for the prescription of TLM for sex offender treatment was a "history of sexual offender treatment failure". The least important item was "deviant sexual interest, by plethysmograph or Abel Screen" (neither plethysmograph nor Abel Screen is used in Germany). CONCLUSIONS Clinicians' attitudes towards the DPS correspond to the suggestions made in the current WSFBF-guidelines for the pharmacological treatment of sex offenders (Thibaut et al. 2010 ; World J Biol Psychiatry 11:604-655). Use of the DPS could therefore contribute to a more structured approach towards helping clinicians come to a decision about whether or not to treat a sex offender with TLM.
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Affiliation(s)
- Daniel Turner
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Electroencephalographic activity during sexual behavior: A novel approach to the analysis of drug effects on arousal and motivation relevant for sexual dysfunctions. Pharmacol Biochem Behav 2014; 121:158-69. [DOI: 10.1016/j.pbb.2014.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 01/16/2014] [Accepted: 02/05/2014] [Indexed: 11/17/2022]
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Abstract
Paraphilias are recurrent, persistent, and intense sexual interests in atypical objects or activities. The most commonly encountered paraphilias in sexological or forensic settings are pedophilia, sexual sadism, exhibitionism, and voyeurism. Paraphilias are often comorbid with other sexual, mood, and personality disorders. Assessment and diagnosis require an integration of multiple sources of clinical information, given the limits and biases of self-report (through clinical interview or questionnaires). Clinicians ideally have access to more objective assessment methods, such as phallometric testing of sexual arousal. The accurate assessment and diagnosis of paraphilias is essential to effective treatment and management.
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Affiliation(s)
- Michael C Seto
- Royal Ottawa Health Care Group, uOttawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada.
| | - Drew A Kingston
- Royal Ottawa Health Care Group, uOttawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada
| | - Dominique Bourget
- Royal Ottawa Health Care Group, uOttawa Institute of Mental Health Research, 1145 Carling Avenue, Ottawa, Ontario K1Z 7K4, Canada
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Jordan K, Fromberger P, Laubinger H, Dechent P, Müller JL. Changed processing of visual sexual stimuli under GnRH-therapy--a single case study in pedophilia using eye tracking and fMRI. BMC Psychiatry 2014; 14:142. [PMID: 24885644 PMCID: PMC4036749 DOI: 10.1186/1471-244x-14-142] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 04/30/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Antiandrogen therapy (ADT) has been used for 30 years to treat pedophilic patients. The aim of the treatment is a reduction in sexual drive and, in consequence, a reduced risk of recidivism. Yet the therapeutic success of antiandrogens is uncertain especially regarding recidivism. Meta-analyses and reviews report only moderate and often mutually inconsistent effects. CASE PRESENTATION Based on the case of a 47 year old exclusively pedophilic forensic inpatient, we examined the effectiveness of a new eye tracking method and a new functional magnetic resonance imaging (fMRI)-design in regard to the evaluation of ADT in pedophiles. We analyzed the potential of these methods in exploring the impact of ADT on automatic and controlled attentional processes in pedophiles. Eye tracking and fMRI measures were conducted before the initial ADT as well as four months after the onset of ADT. The patient simultaneously viewed an image of a child and an image of an adult while eye movements were measured. During the fMRI-measure the same stimuli were presented subliminally. Eye movements demonstrated that controlled attentional processes change under ADT, whereas automatic processes remained mostly unchanged. We assume that these results reflect either the increased ability of the patient to control his eye movements while viewing prepubertal stimuli or his better ability to manipulate his answer in a socially desirable manner. Unchanged automatic attentional processes could reflect the stable pedophilic preference of the patient. Using fMRI, the subliminal presentation of sexually relevant stimuli led to changed activation patterns under the influence of ADT in occipital and parietal brain regions, the hippocampus, and also in the orbitofrontal cortex. We suggest that even at an unconscious level ADT can lead to changed processing of sexually relevant stimuli, reflecting changes of cognitive and perceptive automatic processes. CONCLUSION We are convinced that our experimental designs using eye tracking and fMRI could prospectively add additional and valuable information in the evaluation of ADT in paraphilic patients and sex offenders. But with respect to the limited significance of this single case study, these first results are preliminary and further studies have to be conducted with healthy subjects and patients.
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Affiliation(s)
- Kirsten Jordan
- Department of Forensic Psychiatry and Psychotherapy, Georg-August-University Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
| | - Peter Fromberger
- Department of Forensic Psychiatry and Psychotherapy, Georg-August-University Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
| | - Helge Laubinger
- Asklepios Forensic Psychiatric Hospital of Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
| | - Peter Dechent
- Department of Cognitive Neurology, Georg-August-University Göttingen, Robert-Koch-St. 40, Göttingen 37075, Germany
| | - Jürgen L Müller
- Department of Forensic Psychiatry and Psychotherapy, Georg-August-University Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
- Asklepios Forensic Psychiatric Hospital of Göttingen, Rosdorfer Weg 70, Göttingen 37081, Germany
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Abstract
Emotional and behavioral dyscontrol are relatively common neuropsychiatric sequelae of traumatic brain injury and present substantial challenges to recovery and community participation. Among the most problematic and functionally disruptive of these types of behaviors are pathologic laughing and crying, affective lability, irritability, disinhibition, and aggression. Managing these problems effectively requires an understanding of their phenomenology, epidemiology, and clinical evaluation. This article reviews these issues and provides clinicians with brief and practical suggestions for the management of emotional and behavioral dyscontrol.
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Affiliation(s)
- David B Arciniegas
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA; Neuropsychiatry Service, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Hal S Wortzel
- Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Neuropsychiatry Service, Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA; VISN 19 MIRECC, Denver Veterans Medical Center, Denver, CO, USA
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30
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Treatment outcomes of chemical castration on Korean sex offenders. J Forensic Leg Med 2013; 20:563-6. [DOI: 10.1016/j.jflm.2013.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/28/2013] [Accepted: 06/04/2013] [Indexed: 11/24/2022]
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[Deviant sexual behaviors, paraphilias, perversions]. Prog Urol 2013; 23:793-803. [PMID: 23830274 DOI: 10.1016/j.purol.2012.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 10/29/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To know the new concept of paraphilias, their clinical presentation and their link with a personality disorder as perversion, the French legislation concerning them and the different therapeutic options. MATERIAL AND METHODS Review of guidelines published on this subject in the Medline database and a reflexion from our own clinical experience, especially in the judicial expertise. RESULTS Deviant sexual behavior is, in current classifications, known as paraphilia. This clinical entity corresponds to any sexual behavior considered "abnormal" compared with sexual acts in the society where the person lives. It means precisely, firstly, suffering caused by this disorder or deterioration of social, professional, or family life. Paraphilia such as pedophilia have strict age limits. The victim must be aged below 16 years, with an age difference of at least 5 years with the author of the act. Sexual acts which are illegal are crimes or offences according to the degree, and are sanctioned by the law. In ordinary terms, they are known as perverts, committing perversions. This concept is different from that of paraphilia, a pervert can have, or not have, paraphiliac behavior. In order to diagnose a personality disorder such as perversion, all the criteria must be included: narcissism, use of a person as an object for pleasure, with, primarily, mechanisms of denial and a split personality which removes any feeling of guilt from the perpetrator. CONCLUSION Medical treatment of paraphilia alone is not satisfactory for the denial mechanism is such that only the sex drive is affected with a high risk of recurrence. Only psychotherapy can modify the pathological element of a perverted personality.
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Abstract
OBJECTIVE To understand the societal evolution of sexuality with a reflection on its possible consequences on the therapeutic management of sexual disorders. MATERIAL AND METHODS Synthesis of key points from articles or books selected according to their scientific relevance, and epidemiologic studies published on this subject. RESULTS Far from the classic framework of marriage and parallely to the social empowerment of women, relationships evolve in an increasingly short-lived way. The development of social networks leads to an externalization of owns intimacy. Adolescents are prematurely exposed to the easily accessible pornographic models through Internet. The development of internet encounters, this virtual sexuality, can lead to excessive behavior, at most a cyber addiction, with sometimes a major impact on the real relationship. The diktats of fashion, performance and youth are ever-present and broadly conveyed by the medias. CONCLUSIONS The therapist must be aware of the societal evolution of sexuality, mainly orchestrated by the net and medias, to be able to adapt his management of the sexual disorders. He will ensure to protect each one's individuality, without anxiety, in our normative society.
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Affiliation(s)
- F Cour
- Service d'urologie, hôpital Foch, université de Versailles Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
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Rosenberg KP, Carnes P, O'Connor S. Evaluation and treatment of sex addiction. JOURNAL OF SEX & MARITAL THERAPY 2013; 40:77-91. [PMID: 23790248 DOI: 10.1080/0092623x.2012.701268] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There have been several diagnostic labels for persistent, excessive sexual behaviors, often referred in the popular media as sex addiction. Two related diagnoses, Internet addictive disorder and hypersexual disorder, were considered for, but not included in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. However, most clinicians, even those trained in sexual disorders or addiction medicine, have little to no training in treating sexual compulsivity and cybersex addiction. The authors present the historical context, proposed diagnostic criteria, evaluation protocols, comorbid disorders, speculations about the neuroscience, and treatment recommendations.
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MESH Headings
- Adult
- Behavior, Addictive/diagnosis
- Behavior, Addictive/physiopathology
- Behavior, Addictive/psychology
- Behavior, Addictive/therapy
- Brain/physiopathology
- Comorbidity
- Diagnosis, Differential
- Disruptive, Impulse Control, and Conduct Disorders/diagnosis
- Disruptive, Impulse Control, and Conduct Disorders/physiopathology
- Disruptive, Impulse Control, and Conduct Disorders/psychology
- Disruptive, Impulse Control, and Conduct Disorders/therapy
- Humans
- Internet
- Male
- Motivation/physiology
- Nerve Net/physiology
- Object Attachment
- Obsessive-Compulsive Disorder/diagnosis
- Obsessive-Compulsive Disorder/physiopathology
- Obsessive-Compulsive Disorder/psychology
- Obsessive-Compulsive Disorder/therapy
- Psychometrics/statistics & numerical data
- Reproducibility of Results
- Sexual Behavior/psychology
- Surveys and Questionnaires
- Treatment Outcome
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Garcia FD, Delavenne HG, Assumpção ADFA, Thibaut F. Pharmacologic treatment of sex offenders with paraphilic disorder. Curr Psychiatry Rep 2013; 15:356. [PMID: 23572328 DOI: 10.1007/s11920-013-0356-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sexual offending is both a social and a public health issue. Evidence demonstrates that a combination of pharmacological and psychotherapeutic approaches may reduce or even eliminate deviant sexual behavior in sex offenders with paraphilic disorders. In this article, we will review pharmacological treatment options for sex offenders with paraphilias. Both serotonin selective reuptake inhibitors (SSRIs) and antiandrogen treatments have been used with reported success in decreasing recidivism. SSRIs have been used in mild types of paraphilias and juvenile paraphilias. Antiandrogen treatments seem to be effective in severe sex offenders with paraphilic disorders in order to reduce victimization. Combined pharmacological and psychotherapeutic treatment is associated with better efficacy. Imaging studies may improve the knowledge of paraphilic disorders and the mechanisms of action of current treatments. In spite of existing evidence, there is a need for independent, large-scale and good quality studies assessing the long-term efficacy and tolerance of treatments.
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Affiliation(s)
- Frederico Duarte Garcia
- Department of Psychiatry, INCT - de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Turner D, Basdekis‐Jozsa R, Briken P. Prescription of Testosterone‐Lowering Medications for Sex Offender Treatment in German Forensic‐Psychiatric Institutions. J Sex Med 2013; 10:570-8. [DOI: 10.1111/j.1743-6109.2012.02958.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Balon R. Controversies in the diagnosis and treatment of paraphilias. JOURNAL OF SEX & MARITAL THERAPY 2013; 39:7-20. [PMID: 23152966 DOI: 10.1080/0092623x.2012.709219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Richard Balon
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA.
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Aroudj S, Baratta A. Paraphilie, castration chimique et neuropathie optique : à propos d’un cas clinique. ANNALES MEDICO-PSYCHOLOGIQUES 2012. [DOI: 10.1016/j.amp.2012.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jordan K, Fromberger P, Stolpmann G, Müller JL. The Role of Testosterone in Sexuality and Paraphilia—A Neurobiological Approach. Part II: Testosterone and Paraphilia. J Sex Med 2011; 8:3008-29. [DOI: 10.1111/j.1743-6109.2011.02393.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Karila L, Lafaye G, Reynaud M. Poppers dependence: The mask behind hypersexuality. Presse Med 2011; 40:976-9. [DOI: 10.1016/j.lpm.2011.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/21/2011] [Accepted: 05/04/2011] [Indexed: 11/16/2022] Open
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Abstract
Concerns about paraphilia and its treatment have grown in the past few years. Although the aetiology of paraphilia disorder is still not completely understood, pharmacological treatments have been proposed for this disorder. Paraphilias are a major burden for patients and society; nevertheless, only a few individuals with paraphilias voluntarily seek treatment. Antidepressants have been used in the treatment of certain types of mild (e.g. exhibitionism) and juvenile paraphilias. Antilibidinal hormonal treatments, such as steroidal antiandrogens and gonadotrophin-releasing hormone (GnRH) analogues, have also been studied and they seem to be effective in paraphilic disorders, although caution should be taken in the prescription of these treatments in order to avoid or minimize adverse effects and the risk of victimization. The combination of psychotherapy and pharmacological therapy is associated with better efficacy compared with either treatment as monotherapy. Paraphilia is a chronic disorder and a minimal duration of treatment of 3-5 years is highly recommended for severe paraphilia with a high risk of sexual violence. In conclusion, this review of the literature provides suggestive evidence that paraphilias are well characterized disorders marked by pathological dimensions. Although further research is necessary to confirm treatment efficacy and to improve our knowledge of long-term tolerance, available data on the use of selective serotonin reuptake inhibitors, steroidal antiandrogens and GnRH analogues strongly suggest the efficacy of these treatments for paraphilic disorders.
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Affiliation(s)
- Frederico D Garcia
- ADEN Laboratory EA4311, Rouen University Hospital, Biomedical Research Institute, IFR 23, Rouen, France
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Kasperk C. Das Osteoporoserisiko der antiandrogenen Therapie des Mannes. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2010. [DOI: 10.1007/s11757-010-0053-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Eher R. Die antiandrogene Behandlung von Sexualstraftätern vor dem Hintergrund der aktuellen Wirksamkeitsforschung und der kriminologischen Realität. FORENSISCHE PSYCHIATRIE PSYCHOLOGIE KRIMINOLOGIE 2010. [DOI: 10.1007/s11757-010-0055-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Treatment of a Patient With Dementia and Inappropriate Sexual Behaviors With Citalopram. Alzheimer Dis Assoc Disord 2010; 24:402-3. [DOI: 10.1097/wad.0b013e3181ec16ec] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yang FW, Liang CS. Paraphilias in schizophrenia: differential diagnosis and treatment with selective serotonin reuptake inhibitors. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1126-7. [PMID: 20403404 DOI: 10.1016/j.pnpbp.2010.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 04/10/2010] [Accepted: 04/14/2010] [Indexed: 11/16/2022]
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Garcia FD, Thibaut F. Sexual Addictions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:254-60. [DOI: 10.3109/00952990.2010.503823] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thibaut F, De La Barra F, Gordon H, Cosyns P, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias. World J Biol Psychiatry 2010; 11:604-55. [PMID: 20459370 DOI: 10.3109/15622971003671628] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions. METHODS The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990-2009 for SSRIs) (1969-2009 for antiandrogen 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. CONCLUSIONS An algorithm was proposed with six levels of treatment for different categories of paraphilias.
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Affiliation(s)
- Florence Thibaut
- Faculty of Medicine, Rouen University Hospital Ch. Nicolle, University of Rouen, Rouen, France.
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Haasen C. Comorbidity of paraphilia and depression in Mexico. Ment Illn 2010; 2:e8. [PMID: 25478091 PMCID: PMC4253343 DOI: 10.4081/mi.2010.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 06/08/2010] [Accepted: 06/08/2010] [Indexed: 11/23/2022] Open
Abstract
The comorbidity of paraphilia-related disorders and other psychiatric disorders is high, but the paraphilia-related disorder often remains untreated until patients seek help for the comorbid disorder. A case of a patient in Mexico with comorbid paraphilia and depressive disorder, who was effectively treated with antidepressive medication and psychotherapy, is reported. The effect of stigmatization of homosexuality on the access to care of persons with sexual disorders is discussed.
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Affiliation(s)
- Christian Haasen
- Department of Psychiatry, University Medical Center Eppendorf, Hamburg, Germany and Psicoterapia al Alcance de Todos (PAAT), Cuernavaca, Mexico
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Abstract
Over the last 20 years, Ray Blanchard, Ph.D., with a variety of coauthors and collaborators, has proposed a theory that links the sexual orientation of male-to-female transsexuals with the presence or absence of autogynephilia (erotic arousal by the thought or image of "himself" as a woman). Blanchard's Autogynephilia Theory suggests that the association between sexual orientation and autogynephilia among male-to-female transsexuals is clinically important and the association is always (or almost always) present. Although the theory has been criticized by clinicians, researchers, and transsexuals themselves, it has not been critiqued in a peer-reviewed article previously. This article will attempt to fill that gap. Key studies on which the theory is based will be analyzed and alternative interpretations of the data presented. I conclude that although autogynephilia exists, the theory is flawed.
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Affiliation(s)
- Charles Moser
- Department of Sexual Medicine, Institute for Advanced Study of Human Sexuality, San Francisco, California, USA
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