Kafka M P, Prentky R
Department of Psychiatry, Harvard Medical School, Boston, Mass.
J Clin Psychiatry. 1992 Oct;53(10):351-8.
Paraphilias (PAs) and non-paraphilic sexual addictions (NPSAs) may be behaviors that share a common perturbation of central serotonin neuroregulation as a component of their pathophysiology. Fluoxetine was selected as an agent that might mitigate these behaviors, based on the observations that PAs and NPSAs are associated with depression, compulsion, impulsivity, and disinhibited aggression.
Twenty men (PA, N = 10; NPSA, N = 10) recruited through newspaper advertisement were evaluated for depression and sexual behaviors at baseline and 4-week intervals while receiving fluoxetine pharmacotherapy in an open trial. Sixteen men completed the drug trial. Outcome was determined at 12 weeks using a single-factor, repeated-measures design and an analysis of variance. The general linear models procedure was used to test each of nine dependent measures.
Nineteen (95%) of 20 men met non-exclusionary DSM-III-R criteria for dysthymia and 11 men (55%) met criteria for current major depression. At baseline, the paraphilic and the nonparaphilic subgroups were comparable in most intergroup measures of sexual function except total sexual outlet. PAs shared extensive comorbidity with NPSAs (100%). At outcome, statistically significant effects (p < .05) of fluoxetine were found in both groups over time for all variables pertaining to depression and PA/NPSA sexual behaviors. Statistically significant reduction in PA/NPSA response was evident by Week 4, while conventional sexual behavior was not adversely affected by pharmacotherapy.
Men seeking treatment for PAs/NPSAs reported current depressive symptoms accompanied by a positive history of mood disorders, especially dysthymia and major depression. Fluoxetine selectively reduced both PA and NPSA behaviors in men reporting the presence of mild-severe depressive symptoms. Treatment response of PAs/NPSAs at outcome was independent of baseline depression score. Enhancement of central serotonin neurotransmission by fluoxetine may ameliorate symptoms of mood disorder, heightened sexual desire, and compulsivity/impulsivity associated with these conditions.
性偏好障碍（PAs）和非性偏好性成瘾行为（NPSAs）可能是一些行为，它们在病理生理学上有一个共同的特点，即中枢5-羟色胺神经调节受到干扰。基于PAs和NPSAs与抑郁、强迫、冲动和抑制解除性攻击相关的观察结果，氟西汀被选为一种可能减轻这些行为的药物。
通过报纸广告招募了20名男性（性偏好障碍组，N = 10；非性偏好性成瘾行为组，N = 10），在开放试验中接受氟西汀药物治疗期间，于基线及每隔4周对其抑郁和性行为进行评估。16名男性完成了药物试验。在12周时采用单因素重复测量设计和方差分析确定结果。使用一般线性模型程序对9项相关指标进行检验。
20名男性中有19名（95%）符合恶劣心境的非排除性DSM-III-R标准，11名男性（55%）符合当前重度抑郁症标准。在基线时，除总性释放量外，在大多数性功能组间测量中，性偏好障碍组和非性偏好性成瘾行为组具有可比性。性偏好障碍与非性偏好性成瘾行为有广泛的共病现象（100%）。在结果方面，随着时间推移，两组中氟西汀对所有与抑郁及性偏好障碍/非性偏好性成瘾行为相关的变量均有统计学显著效果（p < .05）。到第4周时，性偏好障碍/非性偏好性成瘾行为反应有统计学显著降低，而传统性行为未受到药物治疗的不利影响。
寻求性偏好障碍/非性偏好性成瘾行为治疗的男性报告目前有抑郁症状，并有心境障碍的阳性病史，尤其是恶劣心境和重度抑郁症。氟西汀选择性地减少了报告有轻至重度抑郁症状男性的性偏好障碍和非性偏好性成瘾行为。性偏好障碍/非性偏好性成瘾行为的治疗结果反应与基线抑郁评分无关。氟西汀增强中枢5-羟色胺神经传递可能改善与这些情况相关的心境障碍症状、性欲亢进以及强迫/冲动症状。
