Hypersexuality As a Neuropsychiatric Disorder: The Neurobiology and Treatment Options.
Hypersexuality refers to abnormally increased or extreme involvement in any sexual activity. It is clinically challenging, presents trans-diagnostically and there is extensive medical literature addressing the nosology, pathogenesis and neuropsychiatric aspects in this clinical syndrome. Classification includes deviant behaviours, diagnosable entities related to impulsivity, and obsessional phenomena. Some clinicians view an increase in sexual desire as 'normal' i.e. psychodynamic theorists consider it as egodefensive at times alleviating unconscious anxiety rooted in intrapsychic conflicts. We highlight hypersexuality as multi-dimensional involving an increase in sexual activity that is associated with distress and functional impairment. The aetiology of hypersexuality is multi-factorial with differential diagnoses that include major psychiatric disorders (e.g. bipolar disorder), adverse effects of treatments (e.g. levodopatreatment), substance-induced disorders (e.g. amphetamine substance use), neuropathological disorders (e.g. frontal lobe syndrome), among others. Numerous neurotransmitters are implicated in its pathogenesis, with dopamine and noradrenaline playing a crucial role in the neural reward pathways and emotionally- regulated limbic system neural circuits. The management of hypersexuality is determined by the principle of de causa effectu evanescent, if the causes are treated, the effect may disappear. We aim to review the role of pharmacological agents causing hypersexuality and centrally acting agents treating the associated underlying medical conditions. Bio-psycho-social determinants are pivotal in embracing the understanding and guiding management of this complex and multi-determined clinical syndrome.
Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
Muna
M
Asiff
Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
Hatta
H
Sidi
Department of Psychiatry, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
Ruziana
R
Masiran
Department of Physiology, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
Jaya
J
Kumar
Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
Srijit
S
Das
School of Medicine, Medical University of Galway, Galway, Ireland.
Nurul Hazwani
NH
Hatta
Department of Psychiatry, Columbia University Medical Center, 262 Central Park West, Suite # 1B, New York, NY 10024, United States.
Cesar
C
Alfonso
D000679:Amygdala / Q000503:physiopathology; D000726:Androgen Antagonists / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007989:Libido; D008032:Limbic System / Q000503:physiopathology; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy*; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009422:Nervous System Diseases / Q000175:diagnosis / Q000188:drug therapy*; D017397:Prefrontal Cortex / Q000503:physiopathology; D012725:Sexual Behavior; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000188:drug therapy*
D000726:Androgen Antagonists; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D006062:Gonadotropins; D009292:Narcotic Antagonists
Hypersexuality; bio psychological treatment; libido; neurobiology; neuropsychiatry; normality.