Pharmacotherapy for Inappropriate Sexual Behaviors in Dementia: A Systematic Review of Literature
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.American Journal of Alzheimer s Disease and Other Dementias (Impact Factor: 1.63). 06/2008; 23(4):344-54. DOI: 10.1177/1533317508318369
The aim of this study is to systematically review the published literature on pharmacotherapy for inappropriate sexual behaviors in dementia. Literature search of the 5 databases (PubMed, MEDLINE, EMBASE, PsychINFO, and COCHRANE collaboration) and the analysis of the data available for the pharmacotherapeutic treatments of inappropriate sexual behaviors in dementia were carried out. There are no published randomized controlled trials of pharmacotherapy for inappropriate sexual behaviors in dementia, but available data form uncontrolled trials, case series, and individual case reports suggest efficacy for antidepressants, antipsychotics, mood stabilizers, hormonal agents, cimetidine, and pindolol for the treatment of these behaviors. Although there are no controlled data for the treatment of inappropriate sexual behaviors in dementia, available data suggest efficacy for some commonly used pharmacotherapeutic agents.
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- "A less common behavior observed in dementia is extreme sexual behavior    . Examples of extreme sexual behavior are sexual comments, public masturbation, public exposing of the breasts or genitals, and approaching attendants or fellow residents for sexual contact    . The impact of extreme sexual behavior can cause severe distress and disturbance to the patients themselves, to their relatives, and * Correspondence to: Dr. Susan van Hooren, Zuyd University of Applied Sciences, KenVak, 6400 AN Heerlen, The Netherlands. "
ABSTRACT: In nursing homes, extreme sexual behavior is one of the most challenging behaviors in dementia. Despite this, however, there is no conformity in the literature regarding how to label and define this type of behavior. Examples of labels used include inappropriate sexual behavior, improper sexual behavior, sexually disinhibited behavior, or hyper sexuality. According to recent theoretical perspectives, extreme sexual behavior may be regarded as a part of disinhibited behavior or could be considered as an independent neuropsychiatric symptom. In this multicenter study, it was investigated whether there is a relationship between extreme sexual behavior and the typical neuropsychiatric symptoms seen in dementia. In 179 residents diagnosed with dementia, extreme sexual behavior was measured using an observation scale. Twelve neuropsychiatric symptoms were measured by the Neuropsychiatric Inventory. Multivariate analysis of covariance with gender showed that residents with observed extreme sexual behavior (n = 43) only showed a higher score on neuropsychiatric symptom 'disinhibition', as compared to residents with non-observed sexual behavior (n = 136). In addition, the effect size was large. These findings indicate that among residents with dementia, extreme sexual behaviors should not be considered as an independent neuropsychiatric symptom. Instead, disinhibition may be an important underlying mechanism for extreme sexual behavior and thus validates the label 'sexually disinhibited behavior'.
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ABSTRACT: This paper reviews published literature on the pharmacological and non-pharmacological treatment of inappropriate sexual behavior in dementia. A literature search of Psychinfo and Cochrane databases was performed and data from case reports and case series were analyzed. No randomized controlled trials exist for any treatment of sexual disinhibition in dementia and there are no trials comparing different pharmacological agents. Case reports and case series report a wide range of pharmacotherapies as efficacious in the treatment of inappropriate sexual behaviors in dementia. There is only one case report of non-pharmacological strategies to manage inappropriate sexual behavior. Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.
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ABSTRACT: Inappropriate sexual behaviors (ISBs) associated with dementias and their treatment have not been commonly reported in the medical literature. This report presents an elderly male patient with moderately severe dementia and incident onset of ISBs who was treated with citalopram (20-mg daily) and subsequently displayed a reduction in ISBs. A review of the literature suggests that ISBs may be underrecognized and undertreated, and therefore should be actively monitored and treated.
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