Kafka M P, Hennen J
Department of Psychiatry, Harvard Medical School, Boston, USA.
J Clin Psychiatry. 2000 Sep;61(9):664-70. doi: 10.4088/jcp.v61n0912.
We describe an open trial of psychostimulants (primarily methylphenidate sustained release [SR]) added to selective serotonin reuptake inhibitors (SSRIs; primarily fluoxetine) during the course of pharmacologic treatment of men with paraphilias and paraphilia-related disorders (PRDs).
Twenty-six men with paraphilias (N = 14) or PRDs (N = 12) were assessed for life-time mood disorders and attention-deficit/hyperactivity disorder (ADHD) as defined by DSM-IV. All men were assessed at baseline for total sexual outlet and average time per day associated with paraphilia/PRD sexual behaviors. The indications for the addition of a psychostimulant to a stable dose of SSRI included the retrospective diagnosis of ADHD with persistent adult symptoms despite pharmacotherapy with an SSRI (N = 17); residual paraphilia/PRD fantasies, urges, and activities despite SSRI pharmacotherapy (N = 16); the persistence or presence of residual depressive symptoms despite SSRI pharmacotherapy (N = 6); relapse or loss of SSRI efficacy during the treatment of sexual impulsivity disorders (N = 4); and treatment of SSRI-induced side effects (N = 4).
SSRI pharmacotherapy (mean +/- SD duration = 8.8+/-11.1 months) had statistically significant effects in diminishing paraphilia/PRD-related total sexual outlet (p < .001) and average time/day spent in paraphilia/PRD sexual behavior (p < .001). Addition of methylphenidate SR (mean dose = 40 mg/day; mean +/- SD duration = 9.6+/-8.2 months) was associated with additional statistically significant effects on paraphilia/PRD-related total sexual outlet (p = .003) and average time per day (p = .04) in addition to improvement of putative residual ADHD and depressive symptoms.
Methylphenidate SR can be cautiously and effectively combined with SSRI antidepressants to ameliorate paraphilias and paraphilia-related disorders for the indications listed above.
我们描述了一项开放试验，即在患有性偏好障碍和性偏好障碍相关疾病（PRD）的男性药物治疗过程中，在选择性5-羟色胺再摄取抑制剂（SSRI，主要为氟西汀）基础上加用精神兴奋剂（主要是哌甲酯缓释剂[SR]）。
对26名患有性偏好障碍（n = 14）或PRD（n = 12）的男性进行评估，以确定其是否患有DSM-IV定义的终生心境障碍和注意力缺陷多动障碍（ADHD）。所有男性在基线时均接受评估，以确定总的性发泄情况以及每天与性偏好障碍/PRD性行为相关的平均时间。在稳定剂量的SSRI基础上加用精神兴奋剂的指征包括：尽管使用SSRI进行药物治疗，但仍有持续性成人症状的ADHD回顾性诊断（n = 17）；尽管进行了SSRI药物治疗，但仍有残留的性偏好障碍/PRD幻想、冲动和行为（n = 16）；尽管进行了SSRI药物治疗，但仍有残留的抑郁症状持续存在或出现（n = 6）；在治疗性冲动障碍期间SSRI疗效复发或丧失（n = 4）；以及治疗SSRI引起的副作用（n = 4）。
SSRI药物治疗（平均±标准差疗程 = 8.8±11.1个月）在减少与性偏好障碍/PRD相关的总性发泄（p <.001）和每天花费在性偏好障碍/PRD性行为上的平均时间（p <.001）方面具有统计学显著效果。加用哌甲酯缓释剂（平均剂量 = 40毫克/天；平均±标准差疗程 = 9.6±8.2个月）除改善假定的残留ADHD和抑郁症状外，还对与性偏好障碍/PRD相关的总性发泄（p =.003）和每天平均时间（p =.04）产生了额外具有统计学显著意义的影响。
对于上述指征，哌甲酯缓释剂可谨慎且有效地与SSRI抗抑郁药联合使用，以改善性偏好障碍和性偏好障碍相关疾病。
