Voyeuristic Disorder and Internet Pornography Addiction: A Case Report

@#With the availability of the Internet, pornographic materials are readily accessible. Pornographic materials may have a link to addiction and other deviant sexual behaviour. In this case report, we highlighted a link between voyeuristic disorder and internet sex addiction. Mr. SK is a 22-year-old single gentleman who was referred for psychiatric assessment due to voyeuristic acts. He had been watching pornographic materials since 16 years old and became addicted to it.

Increased sexual arousal in patients with movement disorders / Exacerbação do impulso sexual em pacientes com distúrbios do movimento

ABSTRACT Increased of sexual arousal (ISA) has been described in different neurological diseases. The purpose of this study was present a case series of ISA in patients with movement disorders. Method Fifteen patients with different forms of movement disorders (Parkinson’s disease, Huntington’s disease, Tourette´s syndrome, spinocerebellar ataxia type 3), were evaluated in the Movement Disorders Unit of the Federal University of Paraná. Results Among Parkinson’s disease patients there were seven cases with different forms of ISA due to dopaminergic agonist use, levodopa abuse, and deep brain stimulation (DBS). In the group with hyperkinetic disorders, two patients with Huntington’s disease, two with Tourette’s syndrome, and four with spinocerebellar ataxia type 3 presented with ISA. Conclusions ISA in this group of patients had different etiologies, predominantly related to dopaminergic treatment or DBS in Parkinson’s disease, part of the background clinical picture in Huntington’s disease and Tourette’s syndrome, and probably associated with cultural aspects in patients with spinocerebellar ataxia type 3.

RESUMO A exacerbação do impulso sexual (EIS) tem sido descrita em diversas doenças neurológicas. O objetivo deste estudo foi apresentar uma série de casos de EIS em pacientes com distúrbios do movimento. Métodos Quinze pacientes com diferentes formas de distúrbios do movimento (Doença de Parkinson, doença de Huntington, síndrome de Tourette, ataxia espinocerebellar tipo 3), foram avaliados na Unidade de Distúrbios de Movimento-Universidade Federal do Paraná. Resultados Entre os pacientes com doença de Parkinson houve sete casos com diferentes formas de EIS devido ao uso de agonista dopaminérgico, abuso de levodopa ou estimulação cerebral profunda (DBS). No grupo com distúrbios hipercinéticos, dois pacientes com doença de Huntington, dois com síndrome de Tourette, e quatro com ataxia espinocerebelar tipo 3 apresentaram EIS. Conclusões EIS nesses pacientes decorreu de diferentes etiologias, relacionadas com o tratamento dopaminérgico ou DBS na doença de Parkinson, parte do quadro clinico na doença de Huntington e síndrome de Tourette, e provavelmente relacionado com aspectos culturais em pacientes com ataxia espinocerebelar tipo 3.

Dementia and inappropriate sexualbehavior (ISB): What we know andwhat we need to know

Traditionally, there has been no place for sexuality in older age. However, research has shown that sexuality plays an important role in older people’s life, even in situations such as dementia. The goal of the article is to review the scientific literature regarding the inappropriate sexual behavior that these kind of patients might present. In order to do so, we will firstly address the definition of inappropriate sexual behavior or, more precisely, its multiple definitions. After that, we will deal with other issues such as its prevalence, factors that can cause its appearance, its consequences and some of the available therapeutic options. Finally, in the last section some recommendations for future research will be provided, such as the need to clarify the concept of inappropriate sexual behavior, to find more efficient ways to address this problem, and the desirability of considering sexuality as a human dimension with a high adaptive potential in old age.

La vejez es una etapa del ciclo vital en la que, tradicionalmente, no tênia cabida la sexualidad. No obstante, la investigación mostrado que la sexualidad desempeña un importante papel en la vida de los mayores, incluso en situaciones comola demencia. El objetivo del artículo es revisar la literatura científica en relación a los comportamientos sexualmente inapropiados (CSI) que este tipo de pacientes pueden manifestar. Para ello, se abordará, en primer lugar, la cuestión de su definición o, más bien dicho, de sus múltiples definiciones, y luego se ahondará en otros aspectos tales como su prevalencia, los posibles factores que pueden desencadenarlos, sus consecuencias, y algunas de las alternativas terapéuticas de las que se dispone. Finalmente, en el último apartado ofreceremos algunas recomendaciones para investigación futura, como son la necesidad de solventar la ambigüedad que gira alrededor del concepto de CSI y de encontrar las formas más eficientes de abordar terapéuticamente esta problemática, así como la conveniencia de considerar la sexualidad como una dimensión humana con un gran potencial adaptativo en la vejez.

Hypersexuality in dementia: a case report

This case report highlights the issue of hypersexuality in persons with dementia and outlines the possible etiology and challenges associated with interventions of inappropriate sexual behaviors in dementia. Methods: We report a 75-year-old male with vascular dementia who developed hypersexuality and aggression towards his wife. The management plans are elaborated in this paper. Results: A combination of pharmacological and psychosocial intervention lead to the resolution of his inappropriate sexual behavior and improvement in his relationships with his wife and children. Conclusion: Inappropriate sexual behaviors need to be recognized and managed without compromising the fulfillment of the human’s basic need of sexuality.

Two Cases of Hypersexuality Probably Associated with Aripiprazole

Sexual dysfunction is a common side effect in patients treated with antipsychotics but significant differences exist across different compounds. We report hypersexuality symptoms in two female patients with schizophrenia who were receiving treatment with aripiprazole. The patients experienced more frequent sexual desire and greater sexual preoccupation after taking aripiprazole. We discuss the potential neuro-chemical mechanisms for this and argue that aripiprazole's unique pharmacological profile, partial agonism with high affinity at dopamine D2-receptor, may have contributed to the development of these symptoms.

Demencia y comportamientos sexualmente inapropiados (CSI): Qué sabemos y qué necesitamos saber / Dementia and inappropriate sexual behavior: What we know and what we need to know

La vejez es una etapa del ciclo vital en la que, tradicionalmente, no tenía cabida la sexualidad. No obstante, la investigación mostrado que la sexualidad desempeña un importante papel en la vida de los mayores, incluso en situaciones como la demencia. El objetivo del artículo es revisar la literatura científica en relación a los comportamientos sexualmente inapropiados (CSI) que este tipo de pacientes pueden manifestar. Para ello, se abordará, en primer lugar, la cuestión de su definición o, más bien dicho, de sus múltiples definiciones, y luego se ahondará en otros aspectos tales como su prevalencia, los posibles factores que pueden desencadenarlos, sus consecuencias, y algunas de las alternativas terapéuticas de las que se dispone. Finalmente, en el último apartado ofreceremos algunas recomendaciones para investigación futura, como son la necesidad de solventar la ambigüedad que gira alrededor del concepto de CSI y de encontrar las formas más eficientes de abordar terapéuticamente esta problemática, así como la conveniencia de considerar la sexualidad como una dimensión humana con un gran potencial adaptativo en la vejez...

Traditionally, there has been no place for sexuality in older age. However, research has shown that sexuality plays an important role in older people’s life, even in situations such as dementia. The goal of the article is to review the scientific literature regarding the inappropriate sexual behavior that these kind of patients might present. In order to do so, we will firstly address the definition of inappropriate sexual behavior or, more precisely, its multiple definitions. After that, we will deal with other issues such as its prevalence, factors that can cause its appearance, its consequences and some of the available therapeutic options. Finally, in the last section some recommendations for future research will be provided, such as the need to clarify the concept of inappropriate sexual behavior, to find more efficient ways to address this problem, and the desirability of considering sexuality as a human dimension with a high potential for adaptation in old age...

Síndrome de Kleine-Levin: caso clínico e dificuldades de diagnóstico / Kleine-Levin syndrome: clinical case and diagnosis difficulties

Os autores descrevem a síndrome de Kleine-Levin e referem as dificuldades de seu diagnóstico. Apresentam um caso clínico de um rapaz de 16 anos de idade, que tiveram a ocasião de diagnosticar e de acompanhar e que, embora manifestando a trilogia clássica (hipersônia, hiperfagia e hipersexualidade), é ilustrativo dessas dificuldades sob várias formas clínicas. Discutem as causas e as conseqüências colocadas pelas dificuldades de diagnóstico, prestando uma atenção especial aos aspectos de diagnóstico diferencial.

The authors describe the Kline-Levin Syndrome (KLS) and point out the difficulties regarding its diagnosis. A clinical case of a 16-year-old boy diagnosed and followed by the authors is presented. Although having the classic trilogy (hypersomnolence; hyperphagia; hypersexuality), this is an illustrative case of such difficulties under several distinct clinical forms. Causes and consequences raised by diagnostic difficulties are discussed, with special attention to aspects concerning differential diagnosis.

Sexual Problems of Healthy and Dementic Elderly in Korea / 신경정신의학

OBJECTIVES: The aging process can influence sexual functions by physiological, pathological, behavioral and psychosocial changes. Studies on sex among elderly are scarce. However, sexual activities remain throughout life in different forms. The aim of this study was to identify sexual problems and dysfunctions among dementia patients and compare with healthy aged persons. METHODS: The sexual problems and affecting factors were evaluated by structured interview and sexual problem screening instruments for 46 dementia patients according to DSM-IV and 60 healthy Koreans aged over 60. RESULTS: 1) Frequency of erection was less than once a day in 68.0% of controls, while more than once a day in 47.6% of dementia. Trouble in attaining erection was found in 50.0% of dementia as compared with 65.4% of controls. Awake with erection was less than once a week in 37.8% of controls, while less than once a week in 22.2% and more than once a week in 10.0% of dementia. Maintaining erection was better in controls (92.0%) as compared with dementia (55.0%)(pactivity). Satisfaction in sex life (41.7%), partner's satisfaction (31.8%), satisfaction with partner (45.5%) and men's interest in sex decline with age (54.5%) were higher in dementia (p<0.001, respectively). 2) The recognition of sexual problems was higher in healthy elderly (74.1%). Most of sexual dysfunctions except sexual desire disorder (83.3% in controls vs 40.0% in dementia) was higher in demetia, that is, erectile disorder (30.0%), premature ejaculation (20.0%), and orgasmic disorder (10.0%). The duration over 5 years of sexual problems was the most in both (46.7% in controls vs 53.3% in dementia). 3) Problematic sexual behaviors seen among dementia patients were obscene remarks/sexual hallucination (30.8%, respectively), public exposure (15.4%), inappropriate contact/physical contact with others/sexual seduction toward other patients (1.7%, respectively) in that order. Appea-rance time of sexual problems was over 1 year of dementia (50.0%), within 1 year of dementia (32.4%), and with the initiation of dementia (17.6%). The frequency was more than once a week in 60.0% and less than once a week in 40.0% of dementia. Place of sexual misbehavior was one's own room (68.6%), other place (22.9%), toilet (5.7%), activity therapy room (2.9%) in that order. Targets of sexual misbehavior were other patients (40.0%), caregivers (31.4%), medical personnel/others (14.3%, respectively) in that order. For the management of sexual misbehavior, most of the doctors chose non-pharmacological methods (83.9%). CONCLUSION: The sexual activity among Korean elderly with age over 60 was more active in healty controls than dementic patients, while sexual dysfunction except sexual desire disorder was more in dementic patients than healthy controls. Therefore, special interest and proper management was needed toward hypersexuality as well as sexual hypoactivity, and most of all, conceptual changes of doctors and caregivers toward sexual problems in the elderly must be preceded.

Hypersexuality in Dementia

PURPOSE: Hypersexual behavior such as increased libido, change in sexual orientation or disinhibition had been reported in dementia. Mechanism and treatment measures were reviewed. METHOD: A medline search was undertaken for papers written by English since 1970. RESULTS: Careful evaluation of past medical and sexual history should be undertaken as well as review of medication. SSRIs may be the first line because they are relatively safe. And then antiandrogens, estrogens or gonadotropin releasing hormone analogues can be tried. Effect of atypical antipsychotics or acetylcholinesterase inhibitors were also suggested. CONCLUSIONS: Symptoms of hypersexuality in dementia often cause feelings of embarrasment and become immense burden to relatives and healthworkers. Some pharmacological agents were promising. For example, combination of cimetidine or spironolactone and a cholinesterase inhibitor can be useful.

Hypersexuality and Obsessive-Compulsive Behaviors in a Stroke Patient with the Left Mesial Frontal Cortex and Both Basal Ganglia Lesion

Hyposexuality after stroke has been frequently observed, but hypersexuality as a sequela of stroke has not been commonly documented. We report a patient who exhibited hypersexuality and obsessive-compulsive behaviors after stroke in the region of the left mesial frontal cortex and both basal ganglia. At 2 months after stroke, he visited psychiatric unit due to these symptoms. His motor function was almost full recovered. He was treated with fluvoxamine and perphenazine, With two-month medication, his hypersexuality and obsessive-compulsive behavior disappeared. This case may indicate that basal ganglia-thalamocortical circuit plays an important role in the mediation of sexual behavior and obsessive-compulsive behavior. Since changes in sexual activity may not be spontaneously reported, a systemic inquiry into patient's sexual functioning after infarction in frontal lobe or basal ganglia is warranted.