Saleh Fabian M, Niel Tracey, Fishman Marc J
University of Massachusetts Medical School, Department of Psychiatry, Worcester, MA, USA.
J Forensic Sci. 2004 Nov;49(6):1343-8.
Some juveniles who engage in sexual offenses may have a paraphilia, a psychiatric disorder characterized by a pervasive pattern of deviant and impairing sexual fantasies, thoughts, and/or behaviors. Though there is no known cure for these conditions, paraphilias can be effectively managed using a multimodal treatment approach. This may include the use of psychotherapeutic and pharmacological treatment interventions, including antiandrogen medications. One such agent, leuprolide acetate (leuprolide), a luteinizing hormone-releasing-hormone agonist, has been shown to be effective in reducing paraphilic symptoms in adult patients. To date, however, there is no published data on its use and effectiveness in adolescent and young adult paraphilic patients. This study consists of a case report series of six young adult patients treated with leuprolide. All subjects had been diagnosed with at least one paraphilia (i.e., Pedophilia, Sexual Sadism, Frotteurism, and Paraphilia Not Otherwise Specified). All subjects had been refractory to treatment in a residential program for adolescent sex offenders prior to initiation of leuprolide. All six subjects reported a reduction in sexually deviant symptoms following treatment with leuprolide. Clinicians rated four as much improved and two as moderately improved. The treatment was well tolerated in all six subjects. This preliminary case series supports the conclusion that leuprolide deserves further examination as a potentially safe and effective component in the treatment of young adult patients with paraphilia.
一些实施性犯罪的青少年可能患有性偏好障碍，这是一种精神疾病，其特征是存在普遍的异常且有害的性幻想、想法和/或行为模式。尽管这些病症尚无已知的治愈方法，但性偏好障碍可以通过多模式治疗方法得到有效控制。这可能包括使用心理治疗和药物治疗干预措施，包括抗雄激素药物。一种这样的药物，醋酸亮丙瑞林（亮丙瑞林），一种促黄体生成素释放激素激动剂，已被证明在减轻成年患者的性偏好症状方面有效。然而，迄今为止，尚无关于其在青少年和青年性偏好障碍患者中的使用及有效性的公开数据。本研究包括一系列六例接受亮丙瑞林治疗的青年成年患者的病例报告。所有受试者均被诊断患有至少一种性偏好障碍（即恋童癖、性施虐症、摩擦癖和未特定的性偏好障碍）。在开始使用亮丙瑞林之前，所有受试者在青少年性犯罪者住院治疗项目中对治疗均无反应。所有六名受试者报告称，使用亮丙瑞林治疗后性异常症状有所减轻。临床医生将四名评定为改善明显，两名评定为中度改善。所有六名受试者对该治疗耐受性良好。这个初步病例系列支持这样的结论：亮丙瑞林作为治疗青年成年性偏好障碍患者的一种潜在安全有效的成分，值得进一步研究。
