Solla Paolo, Bortolato Marco, Cannas Antonino, Mulas Cesare Salvatore, Marrosu Francesco
Movement Disorders Center, Department of Neurology, Institute of Neurology, University of Cagliari, Cagliari, Italy.
Mov Disord. 2015 Apr 15;30(5):604-13. doi: 10.1002/mds.26157. Epub 2015 Mar 11.
Paraphilias are intense urges or behaviors involving non-normative sexual interests. The newly approved diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have established that, although paraphilias should not be regarded as inherently pathological, they ought to be qualified as paraphilic disorders if resulting in distress, impairment, or harm to the affected individual or others. Recent evidence documents that both phenomena can emerge as relatively uncommon iatrogenic consequences in Parkinson's disease (PD) patients. To outline the clinical characteristics of paraphilias and paraphilic disorders in PD patients, we summarized the available evidence on these phenomena. The review encompasses all studies on paraphilias in PD patients identified by a search on the Pubmed and Scopus online databases through May 2014. Twenty-two case reports on a total of 31 PD patients with paraphilias or paraphilic disorders were identified. These phenomena were typically associated with dopaminomimetic treatment (with a mean levodopa-equivalent daily dose of 1,303 ± 823 mg/d) in male patients with motor complications, young age at PD onset, and long disease duration. Paraphilias were highly concomitant with impulse-control disorders or dopamine dysregulation syndrome. Although evidence on paraphilias and paraphilic disorders in PD patients remains anecdotal, available data point to these phenomena as likely sequelae of high-dose dopaminomimetic treatment. Accordingly, the intensity of paraphilic urges is typically attenuated by the reduction of dopaminomimetic doses, sometimes in association with atypical antipsychotics. Failure to recognize paraphilic disorders may significantly impair the relational functioning of the affected PD patients. Practitioners should routinely inquire about paraphilias during their clinical assessment of PD patients.
性偏好障碍是指涉及非规范性性兴趣的强烈冲动或行为。《精神疾病诊断与统计手册》第五版（DSM - 5）新批准的诊断标准规定，虽然性偏好障碍本身不应被视为病理性的，但如果对受影响个体或他人造成痛苦、损害或伤害，则应将其界定为性偏好障碍。最近有证据表明，这两种现象在帕金森病（PD）患者中可能作为相对罕见的医源性后果出现。为了概述PD患者中性偏好障碍和性偏好障碍的临床特征，我们总结了关于这些现象的现有证据。本综述涵盖了截至2014年5月通过在PubMed和Scopus在线数据库中检索所确定的所有关于PD患者性偏好障碍的研究。共确定了22篇病例报告，涉及31例患有性偏好障碍或性偏好障碍的PD患者。这些现象通常与运动并发症的男性患者、PD发病年龄较轻以及病程较长的患者使用拟多巴胺治疗（左旋多巴等效日剂量平均为1,303±823毫克/天）有关。性偏好障碍与冲动控制障碍或多巴胺调节异常综合征高度相关。虽然关于PD患者性偏好障碍和性偏好障碍的证据仍然是轶事性的，但现有数据表明这些现象可能是高剂量拟多巴胺治疗的后遗症。因此，性偏好冲动的强度通常会因拟多巴胺剂量的减少而减弱，有时还会联合使用非典型抗精神病药物。未能识别性偏好障碍可能会严重损害受影响的PD患者的人际关系功能。从业者在对PD患者进行临床评估时应常规询问性偏好障碍的情况。
