Pharmacological management of inappropriate sexual behaviours: a review of its evidence, rationale and scope in relation to men with intellectual disabilities.
BACKGROUND
The management of inappropriate sexual behaviours (ISB) including sexual offending is difficult, especially when the person treated has intellectual disabilities (ID). Psychological therapies are the accepted first line of treatment. Pharmacological treatments have also been advocated, particularly for people who have committed serious sexual offences. There is limited information on available drugs and evidence of their efficacy in the treatment of ISBs, in particular for people with ID.


METHODS
A literature search of electronic databases was undertaken. Pharmaceutical companies were contacted for unpublished information. Trials that included people with ID were systematically reviewed for the benefits and outcome in that population.


RESULTS
Androgen depleting drugs (cyproterone acetate, medroxyprogesterone acetate and luteinising hormone releasing hormone agonists) and psychotropic drugs (serotonin specific reuptake inhibitors and antipsychotics) are the two major categories of medications used in the treatment of ISBs. The majority of studies identified were open trials and most relied on self-report measures. Trials that included people with ID were few in number. Most trials indicated beneficial effects including reduction in sexually deviant fantasies and behaviours.


CONCLUSIONS
The quality of evidence base for the use of pharmacological agents in the treatment of ISBs is inadequate to justify their use in routine clinical practice. If used, they should only be a part of a comprehensive treatment programme and closely monitored. In addition, there are several clinical, ethical and legal issues to be addressed before considering pharmacological treatment of ISBs in people with ID.
Olive Mount Mansion, Merseycare NHS Trust, Liverpool, UK. sajithsg@yahoo.com
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D000726:Androgen Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D008607:Intellectual Disability / Q000188:drug therapy* / Q000523:psychology; D008297:Male; D010262:Paraphilic Disorders / Q000188:drug therapy* / Q000523:psychology; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012742:Sex Offenses / Q000517:prevention & control* / Q000523:psychology; D012725:Sexual Behavior / Q000187:drug effects*
D000726:Androgen Antagonists; D014150:Antipsychotic Agents; D007987:Gonadotropin-Releasing Hormone; D011619:Psychotropic Drugs; D017367:Selective Serotonin Reuptake Inhibitors