Brief Report
Leuprolide acetate for exhibitionism in huntington's disease
Dr. Stuart S. Rich,
Fred Ovsiew,
Corresponding Author
Dr. Stuart S. Rich
Clinical Neuropsychiatry Service, Department of Psychiatry, University of Chicago, Chicago, Illinois, U.S.A.
Department of Psychiatry, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, U.S.A.Search for more papers by this authorFred Ovsiew
Clinical Neuropsychiatry Service, Department of Psychiatry, University of Chicago, Chicago, Illinois, U.S.A.
Search for more papers by this authorDr. Stuart S. Rich,
Fred Ovsiew,
Corresponding Author
Dr. Stuart S. Rich
Clinical Neuropsychiatry Service, Department of Psychiatry, University of Chicago, Chicago, Illinois, U.S.A.
Department of Psychiatry, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, U.S.A.Search for more papers by this authorFred Ovsiew
Clinical Neuropsychiatry Service, Department of Psychiatry, University of Chicago, Chicago, Illinois, U.S.A.
Search for more papers by this authorAbstract
We treated a patient with Huntington's disease and exhibitionism using leuprolide acetate (Lupron Depot, TAP Pharmaceuticals), a gonadotropin-releasing hormone agonist. The result was elimination of his deviant sexual behavior with few side effects. This regimen may be a safe and effective pharmacological treatment of the paraphilias. The occurrence of paraphilias in basal ganglia disorders is reviewed.
References
- 1 EM Stone, ed. American psychiatric glossary. Washington, DC: American Psychiatric Association, 1988.
- 2 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed, revised. Washington, DC: American Psychiatric Association, 1987: 567.
- 3 Epstein AW. Relationship of fetishism and transvestism to brain and particularly to temporal lobe dysfunction. J Nerv Ment Dis 1961; 133: 247–253.
- 4
Blumer D.
Hypersexual episodes in temporal lobe epilepsy.
Am J Psychiatry
1970;
126: 83–90.
10.1176/ajp.126.8.1099 Google Scholar
- 5 Kluver H, Bucy PC. Psychic blindness and other symptoms following bilateral lobectomy in rhesus monkeys. Am J Physiol 1937; 119: 352–353.
- 6 Janati A. Kluver-Bucy syndrome in Hungtington's chorea. J Nerv Ment Dis 1985; 173: 632–635.
- 7 Miller BL, Cummings JL, McIntyre H, Ebers G, Grode M. Hypersexuality or altered sexual preference following brain injury. J Neurol Neurosurg Psychiatry 1986; 49: 867–873.
- 8 Gorman DG, Cummings JL. Hypersexuality following septal injury. Arch Neurol 1992; 49: 308–310.
- 9 Nee LE, Caine ED, Polinsky RJ, Eldrighe R, Ebert UH. Gilles de la Tourette syndrome clinical and family study of 50 cases. Ann Neurol 1980; 7: 41–49.
- 10 Lishman WA. Organic psychiatry. 2nd ed. Oxford, England: Blackwell, 1987: 745.
- 11 Yik KY, Sullivan SN, Troster M. Neuropsychiatric disturbance due to occult occlusion of the portal vein. Can Med Assoc J 1982; 126: 50–52.
- 12 Huntington G. On chorea. In RH Wilkins, IA Brody, eds. Neurological classics. New York: Johnson Reprint Corporation, 1973 (originally printed in 1872): 3–5.
- 13 Critchley M. The history of Huntington's chorea. Psychol Med 1984; 14: 725–727.
- 14 Dewhurst K, Oliver JE, McKnight AL. Socio-psychiatric consequences of Huntington's disease. Br J Psychiatry 1970; 116: 255–258.
- 15 Lyon RL. Huntington's chorea in the Moray Firth area. Br Med J 1962; 1: 1301–1306.
- 16 Bolt JMW. Huntington's chorea in the West of Scotland. Br J Psychiatry 1970; 116: 259–270.
- 17 Fibiger HC, Nomikos GG, Pfaus JG, Damsma G. Sexual behavior, eating and mesolimbic dopamine. Clin Neuropharmacol 1992; 15(suppl 1, Pt. A): 566A–567A.
- 18 Alexander GE, Crutcher MD. Functional architecture of basal ganglia circuits neural substrates of parallel processing. Trends Neurosci 1990; 13: 266–271.
- 19 Kremer HPH, Roos RAC, Dingjan G, Marani E, Bots GTAM. Atrophy of the hypothalamic lateral tuberal nucleus in Huntington's disease. Neuropathol Exp Neurol 1990; 49: 371–382.
- 20 Kremer HPH, Roos RAC, Frolich M, et al. Endocrine functions in Huntington's disease a two-and-a-half years followup study. J Neurol Sci 1989; 90: 335–344.
- 21
Bradford JMW.
Organic treatments for the male sexual offender.
Behav Sci Law
1985;
3: 355–375.
10.1002/bsl.2370030404 Google Scholar
- 22 Berlin FS. Sex offenders a biomedical perspective and a status report on biomedical treatment. In: JR Greere, IR Sturat, eds. Sexual aggressor. New York: Van Nostrand Reinhold, 1983: 83–123.
- 23 Cooper AJ. Progestogens in the treatment of male sex offenders a review. Can J Psychiatry 1986; 31: 73–79.
- 24 Gagne P. Treatment of sex offenders with medroxyprogesterone acetate. Am J Psychiatry 1981; 138: 644–646.
- 25 Cooper AJ. Medroxyprogesterone acetate as a treatment for sexual acting out in organic brain syndrome. Am J Psychiatry 1988; 145: 1179–1180.
- 26 Money J. Treatment guidelines antiandrogen and counseling of paraphilic sex offenders. J Sex Marital Ther 1987; 13: (3): 219–223.
- 27 Rees HD, Bonsall RW, Michael RP. Preoptic and hypothalamic neurons accumulate tritiated medroxyprogesterone acetate in male cynomolgus monkeys. Life Sci 1986; 39: 1353–1359.
- 28 Chrisp P, Sorkin EM. Leuprorelin. A review of its pharmacology and therapeutic use in prostatic disorders. Drugs Aging 1991; 1: 487–509.
- 29 Santen RJ, Bourguignon J-P. Gonadotropin-releasing hormone physiological and therapeutic aspects, agonists and antagonists. Horm Res 1987; 28: 88–103.
- 30 Crayton H, Bohlmann T, Sufit R, Graziano F. Drug induced polymyositis secondary to leuprolide acetate (Lupron) therapy for prostate carcinoma. Clin Exp Rheumatol 1991; 9: 525–528.
- 31 Rousseau L, Coutre M, Dupont A, Labrie F, Couture N. Effect of combined androgen blockade with an LHRH agonist and flutamide in one severe case of male exhibitionism. Can J Psychiatry 1990; 35: 338–341.
- 32 Labrie F, Dupont A, Belanger A, et al. Treatment of prostate cancer with gonadotropin-releasing hormone agonists. Endocr Rev 1986; 7: 67–74.
- 33 Thibaut F, Kuhn JM, Colonna L. A possible antiaggressive effect of cyproterone acetate. Br J Psychiatry 1991; 159: 298–299.
