The aim of this study is to systematically review the published literature on pharmacotherapy for inappropriate sexual behaviors in dementia. Literature search of the 5 databases (PubMed, MEDLINE, EMBASE, PsychINFO, and COCHRANE collaboration) and the analysis of the data available for the pharmacotherapeutic treatments of inappropriate sexual behaviors in dementia were carried out.There are no published randomized controlled trials of pharmacotherapy for inappropriate sexual behaviors in dementia, but available data from uncontrolled trials, case series, and individual case reports suggest efficacy for antidepressants, antipsychotics, mood stabilizers, hormonal agents, cimetidine, and pindolol for the treatment of these behaviors. Although there are no controlled data for the treatment of inappropriate sexual behaviors in dementia, available data suggest efficacy for some commonly used pharmacotherapeutic agents.
Mortimer JAAlzheimer's disease and senile dementia: prevalence and incidence . In: Reisberg B, ed. Alzheimer's Disease: The Standard Reference. New York, NY: Free Press;1983:141-148.
Bharucha AJ, Rosen J., Mulsant BH, Pollock BGAssessment of behavioral and psychological symptoms of dementia. CNS Spectr. 2002;7:797-802.
4.
Black B., Muralee S., Tampi RRInappropriate sexual behaviors in dementia. J Geriatr Psychiatry Neurol. 2005; 18:155-162.
5.
Kamel HK, Hajjar RRSexuality in the nursing home, part 2: managing abnormal behavior-legal and ethical issues. J Am Med Dir Assoc. 2004 ;5(suppl 2):S48-S52.
6.
Burns A., Jacoby R., Levy R.Psychiatric phenomena in Alzheimer's disease. IV: disorders of behaviour. Br J Psychiatry.1990;157:86-94.
7.
Szasz G.Sexual incidents in an extended care unit for aged men. J Am Geriatr Soc. 1983;31:407-411.
8.
Levitsky AM, Owens NJPharmacologic treatment of hypersexuality and paraphilias in nursing home residents. J Am Geriatr Soc. 1999;47:231-234.
9.
Tsai SJ, Hwang JP, Yang CH, et al . Inappropriate sexual behaviors in dementia: a preliminary report . Alzheimer Dis Assoc Disord. 1999;13:60-62.
10.
Alagiakrishnan K., Lim D., Brahim A., et al. Sexually inappropriate behaviour in demented elderly people. Postgrad Med J. 2005 ;81:463-466.
11.
Bradford JMThe neurobiology, neuropharmacology, and pharmacological treatment of the paraphilias and compulsive sexual behaviour. Can J Psychiatry . 2001;46:26-34.
12.
Meston CM, Frohlich PFThe neurobiology of sexual function. Arch Gen Psychiatry . 2000;57:1012-1030.
13.
Bradford JMThe paraphilias, obsessive compulsive spectrum disorder, and the treatment of sexually deviant behaviour. Psychiatr Q. 1999;70:209-219.
14.
Potocnik F.Successful treatment of hypersexuality in AIDS dementia with cyproterone acetate. S Afr Med J. 1992;81:433-434.
15.
Huws R., Shubsachs AP, Taylor PJHypersexuality, fetishism and multiple sclerosis. Br J Psychiatry . 1991;158: 280-281.
16.
Cooper AJMedroxyprogesterone acetate (MPA) treatment of sexual acting out in men suffering from dementia. J Clin Psychiatry. 1987;48:368-370.
17.
Persinger MAMaintained hypersexuality between male rats following chronically induced limbic seizures: implications for bisexuality in complex partial epileptic seizures. Psychol Rep. 1994;74:647-652.
18.
Lilly R., Cummings JL, Benson DF, Frankle M.The human Kluver-Bucy syndrome. Neurology. 1983;33:1141-1145.
19.
Monga TN, Monga M., Raina MS, et al. Hypersexuality in stroke. Arch Phys Med Rehabil . 1986;67:415-417.
20.
Blustein J. , Seeman MVBrain tumors presenting as functional psychiatric disturbances. Can Psychiatr Assoc J.1972;17(suppl 2):SS59-SS63.
21.
Bear DM, Fedio P.Quantitative analysis of interictal behavior in temporal lobe epilepsy . Arch Neurol. 1977; 34:454-467.
22.
Miller BL, Cummings JL, McIntyre H., et al. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry. 1986 ;49: 867-873.
23.
Mendez MF, Chow T., Ringman J., et al. Pedophilia and temporal lobe disturbances. J Neuropsychiatry Clin Neurosci. 2000;12:71-76.
24.
Chae BJ, Kang BJQuetiapine for hypersexuality and delusional jealousy after stroke. J Clin Psychopharmacol. 2006;26:331-332.
25.
Kerbeshian J., Burd L.Tourette syndrome and recurrent paraphilic masturbatory fantasy. Can J Psychiatry. 1991 ; 36:155-157.
26.
Janati A.Kluver-Bucy syndrome in Huntington's chorea. J Nerv Ment Dis . 1985;173:632-635.
27.
Comings DE, Comings BGA case of familial exhibitionism in Tourette's syndrome successfully treated with haloperidol. Am J Psychiatry. 1982;139:913-915.
28.
Akil M., Brewer GJPsychiatric and behavioral abnormalities in Wilson's disease. Adv Neurol. 1995;65:171-178.
29.
Bowers MB Jr, Van Woert M., Davis L.Sexual behaviors during L-dopa treatment for Parkinsonism. Am J Psychiatry. 1971;127:1691-1693.
30.
Brown E., Brown GM, Kofman O., Quarrington B.Sexual function and affect in parkinsonian men treated with L-dopa . Am J Psychiatry. 1978;135:1552-1555.
31.
Mc Lean PDSpecial award lecture: new findings on brain function and sociosexual behavior . In: Zubin J, Money J, eds. Contemporary Sexual Behaviors: Critical Issues in the 1970s. Baltimore, MD: Johns Hopkins University Press; 1973:53-74.
32.
Huang YS, Guilleminault C., Kao PF, et al. SPECT findings in the Kleine-Levin syndrome. Sleep. 2005;28:955-960.
33.
Hashmi FH, Krady AL, Qayum F., Grossberg GTSexually disinhibited behavior in the cognitively impaired elderly . Clin Geriatr. 2000;8:631-637.
34.
Aja A., Self D.Alternate methods of changing nursing home staff attitudes towards sexual behavior in the aged. J Sex Educ Ther. 1986 ;12:37-41.
35.
Young RC, Gyulai L., Mulsant BH, et al. Pharmacotherapy of bipolar disorder: review and recommendations . Am J Geriatr Psychiatry. 2001;12:342-357.
36.
Lonergan ET , Cameron M., Luxenberg J.Valproate preparation for agitation in dementia [review]. Cochrane Database Syst Rev.2004 ;(4):CD003945. 10.1002/14651858 .CD003945.pub2.
37.
Sheldon LJ, Ancill RJ, Holliday SGGabapentin in geriatric psychiatry patients. Can J Psychiatry . 1998;43:422-423.
38.
Alkhalil C. , Tanvir F., Alkhalil B., Lowenthal DTTreatment of sexual disinhibition in dementia: case reports and review of the literature . Am J Ther. 2004;11:231-235.
39.
Miller LJGabapentin for treatment of behavioral and psychological symptoms of dementia . Ann Pharmacother. 2001;35:427-431.
40.
Alkhalil C. , Hahar N., Alkhalil B., Zavros G., Lowenthal DTCan gabapentin be a safe alternative to hormonal therapy in the treatment of inappropriate sexual behavior in demented patients ? Int Urol Nephrol. 2003;35: 299-302.
41.
Freymann N. , Michael R., Dodel R., Jessen F.Successful treatment of sexual disinhibition in dementia with carbamazepine-a case report. Pharmacopsychiatry . 2005; 38:144-145.
42.
Aziz R., Lorberg B., Tampi RRTreatments for late-life bipolar disorder. Am J Geriatr Pharmacother . 2006;4: 347-364.
43.
Tampi RR, van Dyck CH In: Miao-Kun Sun, ed. Chapter 11; Behavioral and Psychological Symptoms of Alzheimer's Disease. Research Progress in Alzheimer's Disease and Dementia. Hauppauge, NY: Blanchette Rockefeller Neuro-sciences Institute, Nova Publishers ; 2006:251-272.
44.
Konovalov S. , Muralee S., Tampi RRAnticonvulsants for the treatment of behavioral and psychological symptoms of dementia: a literature review. Int Psychogeriatr. 2008; 20:293-308.
45.
Death AK, McGrath KC, Handelsman DJValproate is an anti-androgen and anti-progestin. Steroids . 2005;70: 946-953.
46.
Cummings JLUse of cholinesterase inhibitors in clinical practice: evidence-based recommendations . Am J Geriatr Psychiatry. 2002;11:131-145.
47.
Alagiakrishnan K., Sclater A., Robertson D.Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman . J Am Geriatr Soc. 2003;51:1326.
48.
Chemali Z.Donepezil and hypersexuality: a report of two cases. Prim Psychiatry. 2003;10:78-79.
49.
Areosa SA, Sherriff F., McShane R.Memantine for dementia [review]. Cochrane Database Syst Rev.2005;(18): CD003154. 10.1002/14651858.CD003154.pub5.
50.
Simpson DM, Foster D.Improvement in organically disturbed behavior with trazodone treatment . J Clin Psychiatry. 1986;47:191-193.
51.
Leo RJ, Kim KYClomipramine treatment of paraphilias in elderly demented patients . J Geriatr Psychiatry Neurol. 1995;8:123-124.
52.
Perilstein RD, Lipper S., Friedman LJThree cases of paraphilias responsive to fluoxetine treatment. J Clin Psychiatry. 1991;52:169-170.
Guidotti A. , Costa E.Can the antidysphoric and anxiolytic profiles of selective serotonin reuptake inhibitors be related to their ability to increase brain 3-alfa and 5-alfa-tetrahydroprogesterone (allopregnelone) availability ? Biol Psychiatry. 1998:44:865-873.
55.
Stewart JT, Shin KJParoxetine treatment of sexual disinhibition in dementia. Am J Psychiatry. 1997;154:1474.
56.
Raji M., Dongjie L., Wallace D.Sexual aggressiveness in a patient with dementia: sustained clinical response to citalopram. Ann Long Term Care. 2000;8:81-83.
57.
Mania I., Evcimen H., Mathews M.Citalopram treatment for inappropriate sexual behavior in a cognitively impaired patient. Prim Care Companion J Clin Psychiatry. 2006; 8:106.
58.
Nagaratnam N., Gayagay G.Hypersexuality in nursing care facilities-a descriptive study. Arch Gerontol Geriatr. 2002;35:195-203.
59.
Maixner SM, Mellow AM, Tandon R.The efficacy, safety, and tolerability of antipsychotics in the elderly . J Clin Psychiatry. 1999;60(suppl 8):29-41.
60.
Macknight C. , Rojas-Fernandez C.Quetiapine for sexually inappropriate behavior in dementia. J Am Geriatr Soc. 2000;48:707.
61.
Kobayashi T.Effect of haloperidol on a patient with hypersexuality following frontal lobe injury. Psychogeriatrics. 2004;4:49-52.
62.
Cooper AJProgestogens in the treatment of male sex offenders: a review. Can J Psychiatry. 1986;31:73-79.
63.
Mellor CS, Farid NR, Craig DFFemale hypersexuality treated with cyproterone acetate. Am J Psychiatry. 1988; 145:1037.
64.
Light SA, Holroyd S.The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia. J Psychiatry Neurosci . 2006;31:132-134.
65.
Weiner MF, Denke M., Williams K., Guzman R.Intramuscular medroxyprogesterone acetate for sexual aggression in elderly men. Lancet. 1992;339:1121-1122.
66.
Lothstein LM , Fogg-Waberski J., Reynolds P.Risk management and treatment of sexual disinhibition in geriatric patients. Conn Med. 1997;612:609-618.
67.
Kyomen HH, Noble KW, Wei JYThe use of estrogen to decrease aggressive physical behavior in elderly men with dementia. J Am Geriatr Soc. 1991;39:1110-1112.
68.
Ott BRLeuprolide treatment of sexual aggression in a patient with dementia and Kluver-Bucy syndrome. Clin Neuropharmacol. 1995;18:443-447.
69.
Rich SS, Ovsiew F.Leuprolide acetate for exhibitionism in Huntington's disease. Mov Disord. 1994;9:353-357.
70.
Wiseman SV, McAuley JW, Freidenberg GR, Freidenberg DLHypersexuality in patients with dementia: possible response to cimetidine . Neurology. 2000;54:2024.
71.
Brunton LL, Lazo JS, Parker KLGoodman & Gilman's Pharmacological Basis of Therapeutics. http://www.accessmedicine.com/content.aspx?aID=946438. Accessed February 2, 2008.
72.
Jensen CFHypersexual agitation in Alzheimer's disease. J Am Geriatr Soc. 1989;37:917.
73.
Cohen RF, Swanwick GR, O'Boyle CA, Coakley D.Behaviour disturbance and other predictors of carer burden in Alzheimer's disease. Int J Geriatr Psychiatry. 1997;12:331-336.
74.
O'Donnell BF , Drachman DA, Barnes HJ, et al. Incontinence and troublesome behaviors predict institutionalization in dementia. J Geriatr Psychiatry Neurol. 1992;5:45-52.
