托吡酯治疗强迫性性行为：病例报告。
Topiramate in the treatment of compulsive sexual behavior: case report.
作者信息
Khazaal Yasser, Zullino Daniele Fabio
机构信息
Department of Psychiatry, Mood and Anxiety Disorders Unit, Echallens 9, 1004 Lausanne, Switzerland.
出版信息
BMC Psychiatry. 2006 May 23;6:22. doi: 10.1186/1471-244X-6-22.
BACKGROUND
Among the multiple mechanisms of action of topiramate, AMPA/kainate antagonism may be particularly interesting for the treatment of disorders characterized by conditioned cognitive and behavioral cue reactivity.
CASE PRESENTATION
We report the case of a patient consulting primarily for obesity and cue triggered snacking, who responded well on topiramate at doses up to 50 mg. Coincidentally he reported on an improvement of compulsive nonparaphilic sexual behaviors (consumption of prostitution), which was also strongly triggered by environmental cues. Both addictive behaviors (snacking and consumption of prostitution) reoccurred after discontinuation of topiramate and again responded reintroduction of the drug.
CONCLUSION
The present case report of topiramate's effect on comorbid obesity and nonparaphilic addiction could be interpreted as a further indication that topiramate acts on the common pathway underlying conditioned behaviors and seems to be a treatment of behavioral disorders associated with environmental cues.
背景
在托吡酯的多种作用机制中，α-氨基-3-羟基-5-甲基-4-异恶唑丙酸/海人藻酸（AMPA/kainate）拮抗作用对于治疗以条件性认知和行为线索反应为特征的疾病可能特别有意义。
病例报告
我们报告了一名主要因肥胖和线索触发的零食行为前来咨询的患者，该患者服用高达50毫克剂量的托吡酯后反应良好。巧合的是，他报告强迫性非恋物性性行为（嫖娼行为）有所改善，这种行为也受到环境线索的强烈触发。在停用托吡酯后，这两种成瘾行为（吃零食和嫖娼行为）再次出现，再次服用该药物后又有反应。
结论
本病例报告中托吡酯对合并的肥胖和非恋物性成瘾的作用，可被解释为进一步表明托吡酯作用于条件性行为的共同途径，似乎是一种治疗与环境线索相关的行为障碍的方法。
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