Sex Hormones, Neurotransmitters, and Psychopharmacological Treatments in Men with Paraphilic Disorders

Saleh, Fabian M.; Berlin, Fred S.

doi:10.1300/j070v12n03_09

Cited by 29 publications

(25 citation statements)

References 67 publications

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“…Thus the choice of MPA has seemed to withstand the test of time, although newer agents may still be developed in the future. For reviews of the use of pharmacological agents to reduce sexual drive in offenders, see Maletzky and Field (2003) and Saleh and Berlin (2004).…”

mentioning

confidence: 99%

The Oregon depo-Provera Program: A Five-Year Follow-Up

Maletzky

Tolan²,

McFarland

2006

Sex Abuse

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In 1999, the Oregon State Legislature, concerned about the risk certain sexual offenders might pose to their communities upon release from prison, enacted House Bill 2500. This bill required selected offenders to be evaluated prior to their release to determine whether medical treatment with medroxyprogesterone acetate (MPA), also known by its trade name of depo-Provera, was indicated to reduce their risk. The present study reviewed the first 275 men to be evaluated under this program from the years 2000 through 2004. Data were collected on diagnoses and outcome on three groups: men judged to need MPA who eventually went on to actually receive it; men recommended to receive MPA who, for a variety of reasons, did not receive the medication; and men deemed not to need MPA. Outcome measures included recidivism data, including reoffenses, parole violations, and reincarcerations, and whether these were sexual in nature. Data were also collected on employment and whether supervising officers believed the men in each group were doing well. Significant differences emerged among these three groups, with men actually receiving depo-Provera committing no new sexual offenses and also committing fewer overall offenses and violations compared to the other two groups. In addition, almost one third of men judged to need medication but who did not receive it committed a new offense and almost 60% of these were sexual in nature. While generalizations from these types of retrospective and partially subjective findings are inherently limited, the present study lends credence to the belief that, in selected offenders, anti-androgenic medication can be a valuable, if time-limited, addition to a cognitive and behavioral treatment program. Suggestions for more practical and far-reaching implementation of this adjunctive approach are offered.

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confidence: 99%

The Oregon depo-Provera Program: A Five-Year Follow-Up

Maletzky

Tolan²,

McFarland

2006

Sex Abuse

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“…SSRIs have been reported to reduce both libido and impulsivity, but can also delay or entirely prevent ejaculation (e.g., Corona et al, 2009), leading men to seek greater stimulation to trigger orgasm. Endocrinological agents (anti-androgens) also reduce libido—potentially more effectively than do SSRIs—but have a less tolerable side-effect profile (for a review, see Saleh & Berlin, 2003). “Chemical castration” with such agents is rarely recommended outside a forensic context.…”

Section: Types Of Hypersexuality Referralmentioning

confidence: 99%

A Treatment-Oriented Typology of Self-Identified Hypersexuality Referrals

et al. 2013

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Men and women have been seeking professional assistance to help control hypersexual urges and behaviors since the nineteenth century. Despite that the literature emphasizes that cases of hypersexuality are highly diverse with regard to clinical presentation and comorbid features, the major models for understanding and treating hypersexuality employ a “one size fits all” approach. That is, rather than identify which problematic behaviors might respond best to which interventions, existing approaches presume or assert without evidence that all cases of hypersexuality (however termed or defined) represent the same underlying problem and merit the same approach to intervention. The present article instead provides a typology of hypersexuality referrals that links individual clinical profiles or symptom clusters to individual treatment suggestions. Case vignettes are provided to illustrate the most common profiles of hypersexuality referral that presented to a large, hospital-based sexual behaviors clinic, including: (1) Paraphilic Hypersexuality, (2) Avoidant Masturbation, (3) Chronic Adultery, (4) Sexual Guilt, (5) the Designated Patient, and (6) better accounted for as a symptom of another condition.

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“…Although they consequently lack the volume of empirical study (and support) associated with antiandrogens, 37 SSRIs have been used with some success for some types of sex-offending behavior. 44,45,50 Unlike antiandrogens, which act on a hormone directly connected to sexual behavior, the mechanism of action of SSRIs in com-bating sexual behavior is uncertain. The increase in prolactin and decrease in libido found with SSRIs, which is usually viewed as a negative side effect, may explain the efficacy in some cases.…”

Section: Pharmacological and Biological Treatmentsmentioning

confidence: 99%

The Management of Sex Offenders: Perspectives for Psychiatry

Saleh

Grudzinskas²,

Malin³

et al. 2010

Harvard Review of Psychiatry

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In the effort to identify and manage sex offenders, the differences between legal and medical/psychiatric terminology and approaches are readily apparent. This article discusses the different definitions and approaches of the two fields and considers both the behaviors that create risk to others and the strategies for reducing that risk. Particular attention is paid to the subcategory of paraphilic sex offenders. Treatment goals, modalities, and efficacies are discussed, as are evolving legal strategies for risk control and the need for interaction between law and medicine/psychiatry in order to accomplish common goals of risk management.

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Sex Hormones, Neurotransmitters, and Psychopharmacological Treatments in Men with Paraphilic Disorders

Cited by 29 publications

References 67 publications

The Oregon depo-Provera Program: A Five-Year Follow-Up

The Oregon depo-Provera Program: A Five-Year Follow-Up

A Treatment-Oriented Typology of Self-Identified Hypersexuality Referrals

The Management of Sex Offenders: Perspectives for Psychiatry

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