Briken Peer, Hill Andreas, Berner Wolfgang
Institute of Sex Research and Forensic Psychiatry, Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany.
J Clin Psychiatry. 2003 Aug;64(8):890-7. doi: 10.4088/jcp.v64n0806.
In addition to psychotherapy, pharmacotherapy is an important treatment option for paraphilias, especially in sexual offenders. Cyproterone acetate (CPA) and medroxyprogesterone acetate (MPA) are commonly used but can have serious side effects. Selective serotonin reuptake inhibitors (SSRIs) may also be effective in less severe cases. Recent research shows that luteinizing hormone-releasing hormone (LHRH) agonists may offer a new treatment option for treatment of paraphilic patients.
MEDLINE was searched for clinical trials, case-control studies, case reports, and other clinically and theoretically important literature published between 1980 and November 2002 on the treatment of paraphilia with LHRH agonists. Keywords included LHRH agonists, GnRH- agonists, antiandrogens, paraphilia, pedophilia, and sex offenders.
We found 4 case reports, 1 case- control study, 7 open uncontrolled studies, and 1 study comparing patients receiving CPA with those receiving LHRH agonist treatment in forensic hospitals. In total, the studies reported on a sample of 118 treated patients with different forms of paraphilias (sadism, pedophilia, exhibitionism, voyeurism). Nearly all of the studies used self-reports to measure the effects of medication. Duration of follow-up was between 6 months and 7 years and revealed that there were no relapses if patients remained under treatment. Patients previously treated with other agents like CPA, MPA, or SSRIs reported better effects when taking LHRH agonists.
Although there is a need for further research, LHRH agonists offer a treatment option for patients with severe paraphilia. We propose a differentiated pharmacologic treatment regarding side effects, symptomatology, and severity.
除心理治疗外，药物治疗是性偏好障碍的重要治疗选择，尤其是对性犯罪者而言。醋酸环丙孕酮（CPA）和醋酸甲羟孕酮（MPA）是常用药物，但可能会有严重副作用。选择性5-羟色胺再摄取抑制剂（SSRI）在不太严重的病例中可能也有效。最近的研究表明，促黄体生成素释放激素（LHRH）激动剂可能为治疗性偏好障碍患者提供一种新的治疗选择。
检索MEDLINE数据库，查找1980年至2002年11月期间发表的关于使用LHRH激动剂治疗性偏好障碍的临床试验、病例对照研究、病例报告以及其他具有临床和理论重要性的文献。关键词包括LHRH激动剂、GnRH激动剂、抗雄激素、性偏好障碍、恋童癖和性犯罪者。
我们发现了4篇病例报告、1篇病例对照研究、7篇开放性非对照研究以及1篇在法医医院比较接受CPA治疗的患者与接受LHRH激动剂治疗的患者的研究。这些研究总共报告了118例接受不同形式性偏好障碍（施虐癖、恋童癖、露阴癖、窥阴癖）治疗的患者样本。几乎所有研究都使用自我报告来衡量药物疗效。随访时间为6个月至7年，结果显示如果患者持续接受治疗则无复发情况。先前接受过CPA、MPA或SSRI等其他药物治疗的患者在服用LHRH激动剂时报告疗效更佳。
尽管需要进一步研究，但LHRH激动剂为重度性偏好障碍患者提供了一种治疗选择。我们建议根据副作用、症状和严重程度进行差异化药物治疗。
