Pharmacotherapy of paraphilias in the next millennium

✍ Scribed by Ariel Rösler; Eliezer Witztum

• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 146 KB
• Volume: 18
• Category: Article
• ISSN: 0735-3936
• DOI: 10.1002/(sici)1099-0798(200001/02)18:1<43::aid-bsl376>3.0.co;2-8

✦ Synopsis

Paraphilias are psychiatric disorders of abnormal sexual behavior whose prevalence has markedly increased during the last decade. Treatment modalities currently used fall into three categories: surgical castration, psychotherapy, and pharmacotherapy. The pharmacological interventions consist of antiandrogens that either completely reduce testosterone secretion and/or antagonize the action of testosterone at the level of the receptor, and psychotropic drugs, namely antidepressants. Cyproterone and medroxyprogesterone acetates are the two antiandrogens more commonly used. They are only eective in relatively high doses, but have a substantial number of severe side eects which has considerably limited their use. Psychotropic drugs may be eective solely in men with a de®nite obsessive± compulsive disorder component. Because of the erratic results and lack of permanent eradication of the paraphilic manifestations their use in paraphilias is highly controversial. Long-acting gonadotropin-releasing hormone (GnRH) agonist analogues are the most potent antiandrogens, and selectively abolish testosterone secretion in a totally reversible fashion. They are administered parenterally once every 1 to 3 months, and have the fewest side eects. Long-acting GnRH analogues, together with psychotherapy, are highly eective in controlling selected paraphilias ( pedophilia, exhibitionism, and voyeurism), and are the most promising mode of therapy in the next millennium. There is an urgent need for good methodological research; carefully designed double-blind controlled studies with a large number of subjects in order to validate or not the use of the various pharmacotherapies.