Leuprolide acetate for exhibitionism in huntington's disease

Rich, Stuart; Ovsiew, Fred

doi:10.1002/mds.870090317

Cited by 38 publications

(15 citation statements)

References 27 publications

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“…The treatment of hypersexuality and paraphilic disorder is primarily based on testosterone-lowering agents as medroxyprogesterone acetate, leuprolide (a gonadotropine-releasing hormone agonist),cyproterone acetate and serotonergic antidepressants (serotonin-specific reuptake inhibitors) [27,[51][52][53]. In addition, tiaprid and neuroleptics can lower hypersexual behavior by reducing sexual interest and libido.…”

Section: Discussionmentioning

confidence: 99%

“…Paraphilia, also referred as sexual deviation, is described as "persistent or repetitive sexually arousing fantasies of an unusual nature associated with either preference for or use of a nonhuman object for sexual arousal, repetitive sexual activity with human beings involving real or simulated suffering or humiliation, or repetitive sexual activity with non-consenting partners". The diagnosis of a paraphilic disorder is made if a person has acted on the urges or is markedly distressed by them and is an occasional feature of brain diseases [27].…”

Section: Introductionmentioning

confidence: 99%

“…Changed sexual interest and behavior and sexual dysfunctions are common problems in HD but do not only raise a problem for the patient himself [3][4][5][6][7][8][9][10][11][12][13]. Also spouses and children suffer from the socio-psychiatric consequences [14].…”

Section: Introductionmentioning

confidence: 99%

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Sexuality in Huntington's disease

Schmidt

Bonelli

2008

Wien Med Wochenschr

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Sexuality and partnership have an important influence on the quality of life of patients with chronic disorders. There are just a few studies in literature about sexuality in Huntington's disease which conclude that up to 85% men and up to 75% of women experience high levels of sexual problems, most of them having prevalent symptoms of a hypoactive sexual disorder but also increased sexual interest and paraphilia were found. There is no evidence that sexual dysfunction is mainly a specific symptom of HD and may be associated with the specific brain lesion itself or if it is chiefly related to the psychosocial factors caused by the steadily worsening of the disease. Further studies should focus on asymptomatic patients to explore sexual changes preceding neurological and motor symptoms and should incorporate partners to objectify sexual distinctive features. Investigations on the context of sexual dysfunction with depression, irritability and dementia symptoms are needed to better understand reasons for sexual changes in HD. Treatment options for HD patients with sexual disorder are only reported sporadically, guidelines can only be obtained from non-HD patients and further research is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sexuality in Huntington's disease

Schmidt

Bonelli

2008

Wien Med Wochenschr

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“…• There are no systematic studies that address treatment of hypoactive sexual interest in HD. Inappropriately heightened sexual activity has been treated with antiandrogens (medroxyprogesterone acetate), gonadatropin-releasing hormone agonists (leuprolide), and SSRIs, with a single report in Huntington's disease [39]. Such treatment is beyond the scope of this paper.…”

Section: Sexual Disordersmentioning

confidence: 95%

Huntington’s disease

Haskins

Harrison

2000

Curr Treat Options Neurol

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Huntington's disease is a neurodegenerative disorder inherited in an autosomal dominant fashion that results in involuntary movements, psychiatric symptoms, and cognitive dysfunction. The illness typically begins in midlife and progresses over 15 to 20 years, producing increasing disability. The diagnosis of Huntington's disease in an individual has implications for family members as well, whose at-risk status may be altered by the diagnosis. Genetic counseling and information about alternative approaches (eg, clinical diagnosis, DNA banking) should be provided and consent obtained before DNA testing in a symptomatic patient. Genetic counseling is essential for predictive testing in asymptomatic at-risk individuals. Although disease-modifying therapy is not yet available, a multidisciplinary approach to both pharmacologic and nonpharmacologic management can improve the motor and psychiatric symptoms of the illness and enhance function and quality of life for patients and their families. There have been few rigorous trials of treatments for Huntington's disease. The medications discussed in this article have been empirically found to be useful in the management of specific symptoms. Therapy for the movement disorder should focus on those symptoms that specifically limit function. The potential contribution of medication side effects to disability should be periodically reassessed and therapy adjusted as the disease progresses. Psychiatric symptoms are a substantial source of morbidity in this disorder and should be actively treated because they are often quite responsive to appropriate therapy. Both the motor and the psychiatric symptoms can be modified by environmental as well as pharmacologic strategies. Ongoing assessment of the need for adjunctive therapies by means of physical, occupational, and speech therapy is an important component of management, and social work intervention is often necessary to assist with the practical difficulties faced by patients and caregivers. Voluntary organizations are an important source of information and support for professionals caring for patients with Huntington's disease as well as for patients and their families.

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“…A small number of individual case reports have suggested a variety of hormonal treatments may be effective for sexually aggressive and disinhibited behaviors as well as agitation, including m e d r o x y p r o g e s t e r o n e , 1 8 7 conjugated estrogens, diethylstilbestrol, 188 cyproterone, 189 and leuprolide. 190,191 In a recent small randomized, placebo-controlled study, conjugated estrogens were more effective than placebo at reducing aggressive behaviour in 14 male and female patients with moderate to severe dementia. 192 Benefits were noted as early as the first week of treatment with 0.625 mg and the medication was welltolerated.…”

Section: Other Somatic Treatmentsmentioning

confidence: 99%

Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia

Herrmann

2001

Can. J. Neurol. Sci.

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Suppl. 1 -S96 serious problem that they encountered, rating it more frequently as a serious problem than the memory disturbance itself. The significance of BPSD was recently endorsed by both the United States A l z h e i m e r's A s s o c i a t i o n 6 and the International Psychogeriatric Association 1 as research priorities. The phenomenology and prevalence of BPSD have beenThe behavioral and psychological symptoms of dementia (BPSD) include delusions, hallucinations, misidentifications, agitation, wandering, pacing, restlessness, disinhibition, apathy, negativism, emotional lability, depression, anxiety, sleep disturbance and sexually inappropriate behaviours.1 While not included as diagnostic criteria for dementia by DSM-IV 2 or the NINCDS-ADRDA, 3 behaviours such as paranoia, depression, euphoria and apathy were recognized by Alzheimer in the initial description of the illness that bears his name. 4 Historically, the focus on BPSD began only recently, prompted by an early study by Rabins et al,5 who interviewed caregivers of patients with dementia. While these behaviours were noted in 50-90% of patients, caregivers considered physical aggression the most ABSTRACT: Background: The behavioral and psychological symptoms of dementia (BPSD) are common, serious problems that impair the quality of life for both patient and caregiver. In order to provide recommendations based upon the best available evidence, a qualitative literature review was performed. Methods: A search of the English language medical literature published between 1966 and 2000 was performed. The quality of the studies was assessed by considering the subjects, trial design, analysis and results. Final recommendations were based upon the quality of available evidence. Results: The management of BPSD begins with a thorough assessment to search for underlying causes of behaviour change. Concomitant medical illness should be treated and sensory impairment ameliorated. Nonpharmacological approaches should be instituted prior to medication use. These interventions include music, light, changes in level of stimulation and specific behavioral techniques. Antipsychotics are the best studied pharmacological intervention for agitation and aggression and have demonstrated modest but consistent efficacy. Antidepressants such as trazodone and selective serotonin re-uptake inhibitors, as well as anticonvulsants such as carbamazepine and valproic acid have also demonstrated efficacy. Benzodiazepines can be used for short-term treatment as p.r.n. agents when necessary. Pharmacotherapy must be monitored closely for both effectiveness and side effects, with consideration of medication withdrawal when appropriate. Conclusion: The management of BPSD can significantly improve the quality of life for the patient and caregiver. Their assessment and management are essential components of the treatment of dementia.RÉSUMÉ: Recommandations pour la prise en charge des symptômes comportementaux et psychologiques de la démence. Introduction: L e s symptômes comportementaux et ...

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Leuprolide acetate for exhibitionism in huntington's disease

Cited by 38 publications

References 27 publications

Sexuality in Huntington's disease

Sexuality in Huntington's disease

Huntington’s disease

Recommendations for the Management of Behavioral and Psychological Symptoms of Dementia

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