A Case of Mental Retardation with Paraphilia Treated with Depot Leuprorelin

Abstract

Paraphilia is a psychiatric disease that has been difficult to cure. However, recently developed therapeutic methods hold promise. The patient was a 20-yr-old male with chief complaints of continuous masturbation, genital exposure, and aggressive behavior that started 2 yr ago. We administered leuprorelin 3.6 mg intramuscular injection per month, a depot gonadotrophin-releasing hormone analogue, to this patient who a severe mentally retardation with paraphilia. The clinical global impression (CGI)-severity, CGI-improvement and aberrant behavior checklist were performed. After one month, we observed significant improvement in symptoms, such as decreases of abnormal sexual behavior and sexual desire. The GnRH analogues are suggested to be used as an alternative or supplementary therapeutic method for sexual offenders after clinical studies.Graphical Abstract

Treatment of Paraphilic Disorders in Sexual Offenders or Men With a Risk of Sexual Offending With Luteinizing Hormone-Releasing Hormone Agonists: An Updated Systematic Review

“…The 1st studies indicating that LHRH agonists might be a useful treatment option not only in adult sexual offenders with a paraphilic disorder but also in adolescents and young adults, especially in those less susceptible to psychotherapeutic treatment (eg, with deficits in cognitive functioning), have been published. 77,78,80 In 2016, the WFSBP also published guidelines for the treatment of adolescent sexual offenders with paraphilic disorders. 81 Recognizing this and comparable to treatment guidelines of adults, psychological treatment is considered firstline treatment in all cases.…”

“…Park and Kim 77 and Fosdick and Mohiuddin 78 each reported on 1 patient who had an autistic disorder and mental retardation and was treated with LHRH agonists because of sexually aggressive behaviors. The patients in these 2 studies were not diagnosed with a paraphilic disorder.…”

“…The patients in these 2 studies were not diagnosed with a paraphilic disorder. The patient of Park and Kim 77 was described as showing a high frequency of masturbatory behavior (4e5 hours/day), repeated genital exposure, and sexually aggressive behavior against different family members beginning at 18 years of age. Treatment with valproate and olanzapine led to an initial improvement of symptoms but was accompanied by different side effects, especially weight gain.…”

Paraphilias

“…After cessation of chemical castration, the kinetics of serum testosterone recovery vary with treatment duration [31]. Although chemical castration is not considered the preferred treatment for paraphilia for ethical reasons, in some cases, such as mental retardation, the administration of antiandrogen medication may be used as an alternative therapeutic method [32]. Evidence concerning other biomedical treatment options for paraphilia is very scare, especially for individuals with comorbid psychiatric disorders.…”

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

“…In most cases, side effects were not reported. Park and Kim (2014) reported the efficacy of leuprolide acetate (1-month formulation) in a patient with exhibitionism, frotteurism, and severe mental retardation. Finally, Fosdick and Mohiuddin (2016) have described the case of a patient with autism and inappropriate sexual behavior towards children.…”