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Psychiatr Clin North Am. 2014 Jun;37(2):173-81. doi: 10.1016/j.psc.2014.03.002. Epub 2014 Apr 18.

Pharmacologic treatment of paraphilias.

Author information

1
Department of Psychiatry, INCT-Medicina Molecular, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 Sala 240, Belo Horizonte, Minas Gerais, 30130-100, Brazil.
2
Department of Psychiatry, INCT-Medicina Molecular, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 Sala 240, Belo Horizonte, Minas Gerais, 30130-100, Brazil; INSERM U1073, Rouen University Hospital, Rouen University, 22 Boulevard Gambetta, Rouen Cx 76183, France. Electronic address: fredgarcia@ufmg.br.
3
Department of Psychiatry, INCT-Medicina Molecular, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 Sala 240, Belo Horizonte, Minas Gerais, 30130-100, Brazil; INSERM U1073, Rouen University Hospital, Rouen University, 22 Boulevard Gambetta, Rouen Cx 76183, France.
4
Institute of Mental Health Research, Brockville Mental Health Centre, University of Ottawa, 1804 Highway 2 East, Brockville, Ontario K6V 5W7, Canada.
5
Psychiatry and Addictive Disorders, University Hospital Cochin-Tarnier, 89 rue d'Assas, 75006 Paris, France; Department of Psychiatry and Addictive Disorders, Faculté de Médecine Paris V Descartes, 75000 Paris, France; INSERM U894, Centre des Neurosciences, 2 ter rue d'Alesia, 75000 Paris, France.

Abstract

The treatment of paraphilias remains a challenge in the mental health field. Combined pharmacologic and psychotherapeutic treatment is associated with better efficacy. The gold standard treatment of severe paraphilias in adult males is antiandrogen treatment with cognitive behavioral therapy. Selective serotonin reuptake inhibitors have been used in mild types of paraphilia and in cases of sexual compulsions and juvenile paraphilias. Antiandrogen treatments seem to be effective in severe paraphilic subjects committing sexual offenses. In particular, gonadotropin-releasing hormone analogs have shown high efficacy working in a similar way to physical castration but being reversible at any time. Treatment recommendations, side effects, and contraindications are discussed.

KEYWORDS:

Cyproterone acetate; Gonadotropin-releasing hormone analogue; Medroxyprogesterone acetate; Paraphilia; Pedophilia; Selective serotonin reuptake inhibitor; Sex offender

PMID:
24877704
DOI:
10.1016/j.psc.2014.03.002
[Indexed for MEDLINE]

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