Pharmacotherapy for inappropriate sexual behaviors in dementia: A systematic review of literature

American Journal of Alzheimer's Disease and other Dementias

Volumn 23, Issue 4, 2008, Pages 344-354

  Ozkan, Banu ^a   Wilkins, Kirsten ^a   Muralee, Sunanda ^a   Tampi, Rajesh R ^a  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Behavioral disturbances in dementia; Hypersexuality; Inappropriate sexual behaviors; Neuropsychiatric symptoms of dementia

Indexed keywords

ADRENALIN; ANTIDEPRESSANT AGENT; BENZODIAZEPINE DERIVATIVE; CARBAMAZEPINE; CHLORPROMAZINE; CIMETIDINE; CLOMIPRAMINE; DONEPEZIL; ESTROGEN; GABAPENTIN; GALANTAMINE; HALOPERIDOL; LAMOTRIGINE; LORAZEPAM; MEDROXYPROGESTERONE ACETATE; MEMANTINE; MESORIDAZINE; MOOD STABILIZER; NEUROLEPTIC AGENT; PAROXETINE; PINDOLOL; PIPAMPERONE; QUETIAPINE; RIVASTIGMINE; SEROTONIN UPTAKE INHIBITOR; THIORIDAZINE; TIOTIXENE; TRAZODONE; UNINDEXED DRUG; VALPROIC ACID;

ABDOMINAL PAIN; ABSENCE OF SIDE EFFECTS; AKATHISIA; AMINOTRANSFERASE BLOOD LEVEL; ANTICHOLINERGIC EFFECT; ANXIETY; ARTHRALGIA; ARTICLE; ASTHENIA; ATAXIA; BLOOD DYSCRASIA; BRADYCARDIA; CARDIOVASCULAR DISEASE; COCHRANE LIBRARY; CONFUSION; CONGESTIVE HEART FAILURE; CONSTIPATION; DELUSION; DEMENTIA; DEPRESSION; DIABETES MELLITUS; DIARRHEA; DIZZINESS; DROWSINESS; DRUG DOSE INCREASE; DRUG DOSE REDUCTION; DRUG DOSE TITRATION; DRUG EFFICACY; DRUG INDUCED DISEASE; DRUG SUBSTITUTION; DRUG WITHDRAWAL; EDEMA; EJACULATION; EMBASE; FALLING; FATIGUE; FLUID RETENTION; GALACTORRHEA; GASTROINTESTINAL SYMPTOM; GYNECOMASTIA; HAIR LOSS; HALLUCINATION; HEADACHE; HOT FLUSH; HUMAN; HYPERSEXUALITY; HYPERTENSION; HYPOTENSION; IMPOTENCE; INCREASED APPETITE; INSOMNIA; IRRITABILITY; LIBIDO; MASTALGIA; MEDLINE; NAUSEA; ORTHOSTATIC HYPOTENSION; PARKINSONISM; PELVIS PAIN SYNDROME; PERIPHERAL EDEMA; PRIAPISM; PSYCINFO; RASH; SEDATION; SEXUAL DEVIATION; SEXUAL DYSFUNCTION; SIDE EFFECT; SOMNOLENCE; SPERMATOZOON COUNT; SWEATING; SYSTEMATIC REVIEW; TARDIVE DYSKINESIA; THROMBOEMBOLISM; TREMOR; VOMITING; WEIGHT CHANGE; WEIGHT GAIN; XEROSTOMIA;

EID: 49249099724     PISSN: 15333175     EISSN: None     Source Type: Journal    
DOI: 10.1177/1533317508318369     Document Type: Article

References (74)

1. Mortimer JA Alzheimer's disease and senile dementia: prevalence and incidence. In: Reisberg B, ed. Alzheimer's Disease: The Standard Reference. New York, NY: Free Press; 1983: 141-148.
2. Aggarwal NT, Decarli C. Vascular dementia: emerging trends. Semin Neurol. 2007 ; 27: 66-77.
3. Bharucha AJ, Rosen J., Mulsant BH, Pollock BG Assessment of behavioral and psychological symptoms of dementia. CNS Spectr. 2002 ; 7: 797-802.
4. Black B., Muralee S., Tampi RR Inappropriate sexual behaviors in dementia. J Geriatr Psychiatry Neurol. 2005 ; 18: 155-162.
5. Kamel HK, Hajjar RR Sexuality in the nursing home, part 2: managing abnormal behavior-legal and ethical issues. J Am Med Dir Assoc. 2004 ; 5 (suppl 2). S48 - S52.
6. Burns A., Jacoby R., Levy R. Psychiatric phenomena in Alzheimer's disease. IV: disorders of behaviour. Br J Psychiatry. 1990 ; 157: 86-94.
7. Szasz G. Sexual incidents in an extended care unit for aged men. J Am Geriatr Soc. 1983 ; 31: 407-411.
8. Levitsky AM, Owens NJ Pharmacologic treatment of hypersexuality and paraphilias in nursing home residents. J Am Geriatr Soc. 1999 ; 47: 231-234.
9. Tsai SJ, Hwang JP, Yang CH, et al. Inappropriate sexual behaviors in dementia: a preliminary report. Alzheimer Dis Assoc Disord. 1999 ; 13: 60-62.
10. Alagiakrishnan K., Lim D., Brahim A., et al. Sexually inappropriate behaviour in demented elderly people. Postgrad Med J. 2005 ; 81: 463-466.
11. Bradford JM The neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour. Can J Psychiatry. 2001 ; 46: 26-34.
12. Meston CM, Frohlich PF The neurobiology of sexual function. Arch Gen Psychiatry. 2000 ; 57: 1012-1030.
13. Bradford JM The paraphilias, obsessive compulsive spectrum disorder, and the treatment of sexually deviant behaviour. Psychiatr Q. 1999 ; 70: 209-219.
14. Potocnik F. Successful treatment of hypersexuality in AIDS dementia with cyproterone acetate. S Afr Med J. 1992 ; 81: 433-434.
15. Huws R., Shubsachs AP, Taylor PJ Hypersexuality, fetishism and multiple sclerosis. Br J Psychiatry. 1991 ; 158: 280-281.
16. Cooper AJ Medroxyprogesterone acetate (MPA) treatment of sexual acting out in men suffering from dementia. J Clin Psychiatry. 1987 ; 48: 368-370.
17. Persinger MA Maintained hypersexuality between male rats following chronically induced limbic seizures: implications for bisexuality in complex partial epileptic seizures. Psychol Rep. 1994 ; 74: 647-652.
18. Lilly R., Cummings JL, Benson DF, Frankle M. The human Kluver-Bucy syndrome. Neurology. 1983 ; 33: 1141-1145.
19. Monga TN, Monga M., Raina MS, et al. Hypersexuality in stroke. Arch Phys Med Rehabil. 1986 ; 67: 415-417.
20. Blustein J., Seeman MV Brain tumors presenting as functional psychiatric disturbances. Can Psychiatr Assoc J. 1972 ; 17 (suppl 2). SS59 - SS63.
21. Bear DM, Fedio P. Quantitative analysis of interictal behavior in temporal lobe epilepsy. Arch Neurol. 1977 ; 34: 454-467.
22. Miller BL, Cummings JL, McIntyre H., et al. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry. 1986 ; 49: 867-873.
23. Mendez MF, Chow T., Ringman J., et al. Pedophilia and temporal lobe disturbances. J Neuropsychiatry Clin Neurosci. 2000 ; 12: 71-76.
24. Chae BJ, Kang BJ Quetiapine for hypersexuality and delusional jealousy after stroke. J Clin Psychopharmacol. 2006 ; 26: 331-332.
25. Kerbeshian J., Burd L. Tourette syndrome and recurrent paraphilic masturbatory fantasy. Can J Psychiatry. 1991 ; 36: 155-157.
26. Janati A. Kluver-Bucy syndrome in Huntington's chorea. J Nerv Ment Dis. 1985 ; 173: 632-635.
27. Comings DE, Comings BG A case of familial exhibitionism in Tourette's syndrome successfully treated with haloperidol. Am J Psychiatry. 1982 ; 139: 913-915.
28. Akil M., Brewer GJ Psychiatric and behavioral abnormalities in Wilson's disease. Adv Neurol. 1995 ; 65: 171-178.
29. Bowers MB Jr, Van Woert M., Davis L. Sexual behaviors during L-dopa treatment for Parkinsonism. Am J Psychiatry. 1971 ; 127: 1691-1693.
30. Brown E., Brown GM, Kofman O., Quarrington B. Sexual function and affect in parkinsonian men treated with L-dopa. Am J Psychiatry. 1978 ; 135: 1552-1555.
31. Mc Lean PD Special award lecture: new findings on brain function and sociosexual behavior. In: Zubin J, Money J, eds. Contemporary Sexual Behaviors: Critical Issues in the 1970s. Baltimore, MD: Johns Hopkins University Press ; 1973: 53-74.
32. Huang YS, Guilleminault C., Kao PF, et al. SPECT findings in the Kleine-Levin syndrome. Sleep. 2005 ; 28: 955-960.
33. Hashmi FH, Krady AL, Qayum F., Grossberg GT Sexually disinhibited behavior in the cognitively impaired elderly. Clin Geriatr. 2000 ; 8: 631-637.
34. Aja A., Self D. Alternate methods of changing nursing home staff attitudes towards sexual behavior in the aged. J Sex Educ Ther. 1986 ; 12: 37-41.
35. Young RC, Gyulai L., Mulsant BH, et al. Pharmacotherapy of bipolar disorder: review and recommendations. Am J Geriatr Psychiatry. 2001 ; 12: 342-357.
36. Lonergan ET, Cameron M., Luxenberg J. Valproate preparation for agitation in dementia [review]. Cochrane Database Syst Rev. 2004 ;( 4 ):CD003945. 10.1002/14651858.CD003945.pub2.
37. Sheldon LJ, Ancill RJ, Holliday SG Gabapentin in geriatric psychiatry patients. Can J Psychiatry. 1998 ; 43: 422-423.
38. Alkhalil C., Tanvir F., Alkhalil B., Lowenthal DT Treatment of sexual disinhibition in dementia: case reports and review of the literature. Am J Ther. 2004 ; 11: 231-235.
39. Miller LJ Gabapentin for treatment of behavioral and psychological symptoms of dementia. Ann Pharmacother. 2001 ; 35: 427-431.
40. Alkhalil C., Hahar N., Alkhalil B., Zavros G., Lowenthal DT Can gabapentin be a safe alternative to hormonal therapy in the treatment of inappropriate sexual behavior in demented patients ? Int Urol Nephrol. 2003 ; 35: 299-302.
41. Freymann N., Michael R., Dodel R., Jessen F. Successful treatment of sexual disinhibition in dementia with carbamazepine-a case report. Pharmacopsychiatry. 2005 ; 38: 144-145.
42. Aziz R., Lorberg B., Tampi RR Treatments for late-life bipolar disorder. Am J Geriatr Pharmacother. 2006 ; 4: 347-364.
43. Tampi RR, van Dyck CH In: Miao-Kun Sun, ed. Chapter 11; Behavioral and Psychological Symptoms of Alzheimer's Disease. Research Progress in Alzheimer's Disease and Dementia. Hauppauge, NY: Blanchette Rockefeller Neuro-sciences Institute, Nova Publishers ; 2006: 251-272.
44. Konovalov S., Muralee S., Tampi RR Anticonvulsants for the treatment of behavioral and psychological symptoms of dementia: a literature review. Int Psychogeriatr. 2008 ; 20: 293-308.
45. Death AK, McGrath KC, Handelsman DJ Valproate is an anti-androgen and anti-progestin. Steroids. 2005 ; 70: 946-953.
46. Cummings JL Use of cholinesterase inhibitors in clinical practice: evidence-based recommendations. Am J Geriatr Psychiatry. 2002 ; 11: 131-145.
47. Alagiakrishnan K., Sclater A., Robertson D. Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman. J Am Geriatr Soc. 2003 ; 51: 1326.
48. Chemali Z. Donepezil and hypersexuality: a report of two cases. Prim Psychiatry. 2003 ; 10: 78-79.
49. Areosa SA, Sherriff F., McShane R. Memantine for dementia [review]. Cochrane Database Syst Rev. 2005 ;(18). CD003154. 10.1002/14651858.CD003154. pub5.
50. Simpson DM, Foster D. Improvement in organically disturbed behavior with trazodone treatment. J Clin Psychiatry. 1986 ; 47: 191-193.
51. Leo RJ, Kim KY Clomipramine treatment of paraphilias in elderly demented patients. J Geriatr Psychiatry Neurol. 1995 ; 8: 123-124.
52. Perilstein RD, Lipper S., Friedman LJ Three cases of paraphilias responsive to fluoxetine treatment. J Clin Psychiatry. 1991 ; 52: 169-170.
53. McElroy SL, Phillip KA, Keck PE Obsessive compulsive spectrum disorder J Clin Psychiatry. 1994 ; 55 (suppl): 33-53.
54. Guidotti A., Costa E. Can the antidysphoric and anxiolytic profiles of selective serotonin reuptake inhibitors be related to their ability to increase brain 3-alfa and 5-alfa-tetrahydroprogesterone (allopregnelone) availability ? Biol Psychiatry. 1998: 44: 865-873.
55. Stewart JT, Shin KJ Paroxetine treatment of sexual disinhibition in dementia. Am J Psychiatry. 1997 ; 154: 1474.
56. Raji M., Dongjie L., Wallace D. Sexual aggressiveness in a patient with dementia: sustained clinical response to citalopram. Ann Long Term Care. 2000 ; 8: 81-83.
57. Mania I., Evcimen H., Mathews M. Citalopram treatment for inappropriate sexual behavior in a cognitively impaired patient. Prim Care Companion J Clin Psychiatry. 2006 ; 8: 106.
58. Nagaratnam N., Gayagay G. Hypersexuality in nursing care facilities-a descriptive study. Arch Gerontol Geriatr. 2002 ; 35: 195-203.
59. Maixner SM, Mellow AM, Tandon R. The efficacy, safety, and tolerability of antipsychotics in the elderly. J Clin Psychiatry. 1999 ; 60 (suppl 8). 29-41.
60. Macknight C., Rojas-Fernandez C. Quetiapine for sexually inappropriate behavior in dementia. J Am Geriatr Soc. 2000 ; 48: 707.
61. Kobayashi T. Effect of haloperidol on a patient with hypersexuality following frontal lobe injury. Psychogeriatrics. 2004 ; 4: 49-52.
62. Cooper AJ Progestogens in the treatment of male sex offenders: a review. Can J Psychiatry. 1986 ; 31: 73-79.
63. Mellor CS, Farid NR, Craig DF Female hypersexuality treated with cyproterone acetate. Am J Psychiatry. 1988 ; 145: 1037.
64. Light SA, Holroyd S. The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia. J Psychiatry Neurosci. 2006 ; 31: 132-134.
65. Weiner MF, Denke M., Williams K., Guzman R. Intramuscular medroxyprogesterone acetate for sexual aggression in elderly men. Lancet. 1992 ; 339: 1121-1122.
66. Lothstein LM, Fogg-Waberski J., Reynolds P. Risk management and treatment of sexual disinhibition in geriatric patients. Conn Med. 1997 ; 612: 609-618.
67. Kyomen HH, Noble KW, Wei JY The use of estrogen to decrease aggressive physical behavior in elderly men with dementia. J Am Geriatr Soc. 1991 ; 39: 1110-1112.
68. Ott BR Leuprolide treatment of sexual aggression in a patient with dementia and Kluver-Bucy syndrome. Clin Neuropharmacol. 1995 ; 18: 443-447.
69. Rich SS, Ovsiew F. Leuprolide acetate for exhibitionism in Huntington's disease. Mov Disord. 1994 ; 9: 353-357.
70. Wiseman SV, McAuley JW, Freidenberg GR, Freidenberg DL Hypersexuality in patients with dementia: possible response to cimetidine. Neurology. 2000 ; 54: 2024.
71. Brunton LL, Lazo JS, Parker KL Goodman & Gilman's Pharmacological Basis of Therapeutics. http://www.accessmedicine.com/content.aspx?aID=946438. Accessed February 2, 2008.
72. Jensen CF Hypersexual agitation in Alzheimer's disease. J Am Geriatr Soc. 1989 ; 37: 917.
73. Cohen RF, Swanwick GR, O'Boyle CA, Coakley D. Behaviour disturbance and other predictors of carer burden in Alzheimer's disease. Int J Geriatr Psychiatry. 1997 ; 12: 331-336.
74. O'Donnell BF, Drachman DA, Barnes HJ, et al. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol. 1992 ; 5: 45-52.