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Kelly G, Simpson G. The Behaviour Support Elements Checklist: Profiling intervention elements in community-based behaviour support for sexualised behavior after acquired brain injury. Brain Inj 2023; 37:551-561. [PMID: 36867020 DOI: 10.1080/02699052.2023.2184494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND The challenges associated with behavior dysregulation post acquired brain injury (ABI) are well documented. In a previous publication, we described a case series in which sexualized behavior post-ABI was reduced using multi-element behavior support interventions. In this publication, we describe the intervention elements used, as summarized using a one-page recording tool: The Behavior Support Elements Checklist (BSEC). INSTRUMENT The BSEC contains three categories indicating the target for change: the individual with ABI, their support network members, or other environmental aspects. Each category lists a number of elements being used in the routine practice of a community-based behavior support service. RESULTS In total, 173 intervention elements were recommended, averaging seven per participant. Elements from all three categories were routinely incorporated into interventions, but changes to the (category) environment were rated by clinicians as most effective in changing behavior; some elements (e.g., meaningful activities) were considered more effective than others (e.g., ABI education). CONCLUSIONS The BSEC could assist service agencies and researchers to record and analyze clinician practices to improve service delivery, detect professional development needs, and steer resource allocation. Although the BSEC reflects the context in which it was constructed, it could readily be adapted to other service contexts.
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Affiliation(s)
- Glenn Kelly
- Private practice, Melbourne, Australia.,Concept Psychology Services, Melbourne, Australia
| | - Grahame Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney LHD, Sydney, Australia.,Sydney School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. METHODS An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. RESULTS Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. CONCLUSIONS An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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Fraser EE, Downing MG, Haines K, Bennett L, Olver J, Ponsford JL. Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines. J Clin Med 2022; 11:jcm11123525. [PMID: 35743597 PMCID: PMC9225377 DOI: 10.3390/jcm11123525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted.
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Affiliation(s)
- Elinor E. Fraser
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, VIC 3121, Australia
- Correspondence:
| | - Marina G. Downing
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, VIC 3121, Australia
| | - Kerrie Haines
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
| | - Linda Bennett
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
| | - John Olver
- Rehabilitation Medicine, Epworth HealthCare, Richmond, VIC 3121, Australia;
| | - Jennie L. Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia; (M.G.D.); (K.H.); (L.B.); (J.L.P.)
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Richmond, VIC 3121, Australia
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Kelly G, Brown S, Gillett L, Descallar J, Simpson GK. Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series ( N = 24). Neuropsychol Rehabil 2020; 32:407-428. [PMID: 33081575 DOI: 10.1080/09602011.2020.1830807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Inappropriate sexual behaviours (ISX) are challenging clinical sequelae of acquired brain injury (ABI). Limited evidence exists about treatment approaches, with few case studies published to date. This study reports an exploratory clinical trial of community-based behaviour support interventions as a treatment approach to ISX after ABI. From routine referrals to a state-wide service specializing in challenging behaviours after ABI, a cohort (n = 24) displaying ISXs were selected. The interventions addressed multiple behavioural domains, and used a variety of approaches including environmental change, psychoeducation, and specific behavioural techniques. These approaches targetted change in the person with ABI, support personnel, or other environmental domains. Behaviour data were collected using the Overt Behaviour Scale (OBS) at baseline, closure and follow-up. Visual inspection and multilevel models were used to analyse the data. For the sample as a whole, there was a significant decline in ISXs from baseline to closure that was maintained at follow-up. Results at an individual level are also presented. Specificity of the intervention was demonstrated by comparison with concurrent challenging behaviours (aggression, perseveration, absconding) which showed no significant change over the same three time points. The results demonstrate the potential efficacy of community-based behaviour support interventions in treating ISXs after ABI.
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Affiliation(s)
| | | | - Lauren Gillett
- Department of Neurology, Liverpool Hospital, Sydney, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, UNSW Australia, Liverpool, Australia
| | - Grahame K Simpson
- Ingham Institute for Applied Medical Research, Sydney, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Sydney, Australia
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Plantier D, Luauté J. Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice. Ann Phys Rehabil Med 2016; 59:42-57. [PMID: 26797170 DOI: 10.1016/j.rehab.2015.10.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE There are no handbook or recommendations for the use of pharmacological agents to treat neurobehavioral disorders after traumatic brain injury (TBI). This work proposes a systematic review of the literature and a user guide on neuroleptics, antidepressants, beta-blockers, mood stabilizers and other medications for irritability, aggressiveness, agitation, impulsivity, depression, apathy… METHOD Steering, working and reading groups (62 people) were formed under the control of the French High Authority for Health (HAS) in collaboration with the SOFMER scientific society (French Society of Physical and Rehabilitation Medicine). Articles were searched by HAS officers in the Medline database from 1990 to 2012, crossing TBI and pharmacological agents. The HAS method to select, read and analyze papers is close to the PRISMA statements. RESULTS Out of 772 references, 89 were analyzed, covering a total of 1306 people with TBI. There is insufficient evidence to standardize drug treatments for these disorders. There are however some elements to establish consensus recommendations for good clinical practice. Propranolol can improve aggression (B grade). Carbamazepine and valproate seem effective on agitation and aggression and are recommended as first line treatment (Expert Consensus [EC]). There is no evidence of efficacy for neuroleptics. Their prescription is based on emergency situation for a crisis (loxapine) but not for long-term use (EC). Antidepressants are recommended to treat depression (EC) with a higher standard of proof for Selective Serotonin Reuptake Inhibitors (SSRI, grade B). Other products are described. CONCLUSION The choice of treatment depends on the level of evidence, target symptoms, custom objectives, clinical experience and caution strategies.
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Affiliation(s)
- D Plantier
- Department of Physical Medicine and Rehabilitation (PM&R), Neurological Rehabilitation, Renée-Sabran Hospital, University Hospital of Lyon, boulevard Édouard-Herriot, 83400 Hyères, France.
| | - J Luauté
- Physical Medicine and Rehabilitation, Neurological Rehabilitation, Henry-Gabrielle Hospital, University Hospital of Lyon, 69230 Saint-Genis-Laval, France; Neuroscience Research Center of Lyon (CRNL) IMPACT team, Inserm U1028, CNRS, UMR5292, 69500 Bron, France
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Deepmala, Agrawal M. Use of Propranolol for Hypersexual Behavior in an Adolescent With Autism. Ann Pharmacother 2014; 48:1385-8. [DOI: 10.1177/1060028014541630] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To report a case of an adolescent with autism with clinically significant hypersexual behaviors in whom a trial of low-dose propranolol led to major clinical improvement. Case Summary: This case report describes a 13-year-old boy with a history of autism who presented to the outpatient psychiatric clinic for hypersexual behaviors that started at the onset of puberty. The behaviors affected his functioning both at school and home. A trial of low-dose propranolol, 0.3 mg/kg/d (10 mg twice a day), targeting hypersexual behavior led to remarkable clinical improvement. The behaviors remained stable on this dose of propranolol for 1 year. Discussion: Hypersexual behavior exhibited by adolescent patients with autism can be a big challenge to manage. The literature on pharmacological options to manage these behaviors in children and adolescents with autism is limited. Clinical data of propranolol use are novel. Conclusion: To our knowledge, this is the first case report of low-dose propranolol leading to clinically significant improvement in hypersexual behaviors in an adolescent with autism. Propranolol use may expand the choice of treatment option in this patient population.
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Affiliation(s)
- Deepmala
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mayank Agrawal
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Prevalence, Clinical Features, and Correlates of Inappropriate Sexual Behavior After Traumatic Brain Injury. J Head Trauma Rehabil 2013; 28:202-10. [DOI: 10.1097/htr.0b013e31828dc5ae] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ter Mors BJ, van Heugten CM, van Harten PN. Evaluation of electrical aversion therapy for inappropriate sexual behaviour after traumatic brain injury: a single case experimental design study. BMJ Case Rep 2012; 2012:bcr-02-2012-5932. [PMID: 22922913 DOI: 10.1136/bcr-02-2012-5932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Inappropriate sexual behaviour after acquired brain injury is a severe complication. Evidence for effective treatment is not available. Electrical aversion therapy (EAT) is a behavioural therapeutic option used in persons with intellectual disabilities, which might be suitable for brain-injured individuals for whom other therapies are not effective. The effect of EAT in brain injury has not been investigated previously. A single case experimental design was used. In an ABBA (baseline-treatment-treatment-withdrawal) design the frequency of the target behaviour (ie, inappropriate sexual behaviour) in a 40-year-old man was measured daily. A total of 551 measurements were recorded. A significant reduction of the target behaviour was seen after the first treatment phase (baseline 12.18 (2.59) vs 3.15 (3.19) mean target behaviours daily); this reduction remained stable over time. We conclude that EAT was effective in this patient with inappropriate sexual behaviour due to severe brain injury. EAT can therefore be considered in therapy resistant inappropriate sexual behaviour in brain-injured patients.
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Affiliation(s)
- Bert Jan Ter Mors
- Department of Brain Injury, Huize Padua, GGZ Oost Brabant, Boekel, The Netherlands.
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Reid RC, Garos S, Carpenter BN, Coleman E. A surprising finding related to executive control in a patient sample of hypersexual men. J Sex Med 2011; 8:2227-36. [PMID: 21595837 DOI: 10.1111/j.1743-6109.2011.02314.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, and poor judgment as well as deficits in emotion regulation and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. Exploring relationships between dysregulated sexual behavior and executive deficits will enhance our understanding of hypersexuality. AIM This study sought to assess whether patients seeking help for hypersexual behavior exhibit executive deficits as measured by standardized neuropsychological tests of executive functioning when compared with healthy controls. METHODS Executive deficits were assessed in a sample of male patients (N = 30) seeking help for hypersexual behavior compared with a nonhypersexual community sample of men (N = 30) using neuropsychological tests of executive functioning. Using multivariate statistics, differences between the groups were examined. MAIN OUTCOME MEASURES Sexual activity measured by the Hypersexual Behavior Inventory and the Compulsive Sexual Behavior Inventory. Executive functions measured through neuropsychological testing using several subtests of Delis-Kaplan Executive Function System: Color-Word Interference Test, the Tower Test, the Trail Making Test, the Verbal Fluency Test, as well as the Wisconsin Card Sorting Test. Psychopathology was assessed using the Mini International Neuropsychiatric Interview, and cognitive ability was assessed using the Wechsler Adult Intelligence Scale. RESULTS Significant differences on measures of hypersexuality were observed. However, the groups failed to exhibit significant differences across neuropsychological tests of executive functioning even after controlling for cognitive ability. CONCLUSIONS These results contradict a previous finding of executive deficits among hypersexual men measured by self-report. The lack of executive deficits suggests that this population may exhibit domain-specific aspects of impulsivity, poor judgment, and risky behavior that are not generalizable to other domains of life. Furthermore, our findings fail to support a conceptualization of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, proposed hypersexual disorder based on models of executive dysfunction. .
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Affiliation(s)
- Rory C Reid
- Department of Psychology, Brigham Young University, Provo, UT, USA.
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Reid RC, Karim R, McCrory E, Carpenter BN. Self-reported differences on measures of executive function and hypersexual behavior in a patient and community sample of men. Int J Neurosci 2010; 120:120-7. [PMID: 20199204 DOI: 10.3109/00207450903165577] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients seeking help for hypersexual behavior often exhibit features of impulsivity, cognitive rigidity, poor judgment, deficits in emotion regulation, and excessive preoccupation with sex. Some of these characteristics are also common among patients presenting with neurological pathology associated with executive dysfunction. These observations led to the current investigation of differences between a group of hypersexual patients (n = 87) and a non-hypersexual community sample (n = 92) of men using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and the Hypersexual Behavior Inventory (HBI). Significant differences between the groups emerged on eight subscales and all of the general indices of executive functioning with the most dramatic differences on BRIEF-A's Shift, Emotional Control, Initiate, and Plan/Organize subscales. Hypersexual behavior was positively correlated (r = .37, p < .01) with global indices of executive dysfunction and several subscales of the BRIEF-A. These findings provide preliminary evidence supporting the hypothesis that executive dysfunction may be implicated in hypersexual behavior.
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Affiliation(s)
- Rory C Reid
- Brigham Young University, University of California, Los Angeles, California, USA.
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Deb S, Crownshaw T. Review of subjectThe role of pharmacotherapy in the management of behaviour disorders in traumatic brain injury patients. Brain Inj 2009; 18:1-31. [PMID: 14660233 DOI: 10.1080/0269905031000110463] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this paper was to systematically review the research published in English language on the effectiveness of drugs for the treatment of neurobehavioural disorders in patients with traumatic brain injury (TBI). A literature search using Medline, Pre-Medline, Embase, Psychlit and Cochrane Library databases between 1990 and January 2003 as well as a hand search of Brain Injury since 1996 were carried out. Phrases such as 'head injury', 'brain injury', 'drug treatment', 'drug trials' and 'randomized controlled trials' were used. Sixty-three papers were selected for data synthesis. Of these, 13 were randomized controlled trials, eight were prospective observational studies, four were retrospective studies, 25 were case series and 13 were single case studies. There was a dearth of type I-III evidence. There was no strong evidence either way to suggest that drugs are effective in the treatment of behaviour disorders in patients with TBI. However, there was weak evidence, primarily based on case studies that psychostimulants are effective in the treatment of apathy, inattention and slowness; high dose beta-blockers in the treatment of agitation and aggression; anti-convulsants and anti-depressants (particularly SSRIs) in the treatment of agitation and aggression, particularly in the context of an affective disorder; and possibly a specific neuroleptic methotrimeprazine in the treatment of agitation in the post-acute stage of Acquired Brain Injury. Some drugs that are effective in some patients have been shown to be ineffective in others. Some drugs, particularly lithium and dopaminergic drugs could cause adverse effects and deterioration in some patients.
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Affiliation(s)
- Shoumitro Deb
- Division of Neuroscience, Department of Psychiatry, University of Birmingham, UK.
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Johnson C, Knight C, Alderman N. Challenges associated with the definition and assessment of inappropriate sexual behaviour amongst individuals with an acquired neurological impairment. Brain Inj 2009; 20:687-93. [PMID: 16809200 DOI: 10.1080/02699050600744137] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The subject of Inappropriate Sexual Behaviour (ISB) amongst clients with neurological impairment, specifically Acquired Brain Injury (ABI) and dementia, has received limited coverage to date within the literature. This paper discusses some of the problems encountered in the definition and quantification of ISB, in particular the absence of standardized measurement tools to record ISB within an inpatient setting. Whilst ISB is reported to be less prevalent than other behavioural sequelae of brain injury or dementia, it is suggested that its impact on patients and carers can be significant. Ill-defined terminology and the absence of relevant assessment tools add to the specific challenges of understanding and managing ISB within a care or rehabilitation setting. As a result, it is argued that the subjective attitudes of staff and the culture of an institution can dominate the approach taken to dealing with ISB for these client groups.
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Affiliation(s)
- C Johnson
- Townsend and Kemsley Division, St Andrew's Hospital, Northampton, UK
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Guay DR. Drug treatment of paraphilic and nonparaphilic sexual disorders. Clin Ther 2009; 31:1-31. [DOI: 10.1016/j.clinthera.2009.01.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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Knight C, Alderman N, Johnson C, Green S, Birkett-Swan L, Yorstan G. The St Andrew's Sexual Behaviour Assessment (SASBA): Development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment. Neuropsychol Rehabil 2008; 18:129-59. [DOI: 10.1080/09602010701822381] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Crowe SF, Ponsford J. The role of imagery in sexual arousal disturbances in the male traumatically brain injured individual. Brain Inj 1999; 13:347-54. [PMID: 10367145 DOI: 10.1080/026990599121539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Over 50% of individuals who suffer traumatic brain injury (TBI) demonstrate a decrease in sexual arousal post-injury. This study investigated the basis of this loss and hypothesized that it occurred as a consequence of the effect of the injury on cognition: specifically, diminution of the ability to form and manipulate sexually arousing imagery. The study compared 14 male participants who identified themselves as having alteration in sexual functioning following traumatic brain injury with a further 14 non-brain injured participants, case matched to them for age and education. All TBI participants were assessed after 2 years following injury, and had had a loss of consciousness of 3 days or greater. The results indicated that the two groups differed in terms of their performance on the Bett's QMI Scale, the Gordon Test of Visual Imagery Control, the Vividness of Sexual Imagery Scale of the Imaginal Processes Inventory, the State Trait Anxiety Inventory, and the Beck Depression Inventory. After correction for the level of depression by analysis of covariance, the TBI participants still featured lower levels of performance on the Sexual Imagery sub-scale of the Imaginary Processes Inventory. The results indicate that sexual arousal disturbances may exist above and beyond the disturbances to affect associated with the psychosocial effects of the TBI.
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Affiliation(s)
- S F Crowe
- School of Psychological Sciences, La Trobe University, Bundoora, Australia
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