inappropriate sexual behavior

Etiology

• life-long sexual misbehavior
• dementia, especially Pick's disease
• psychiatric disorder
• dopamine agonists
• urinary tract infection (frequent manual manipulation of genitals)

History

• obtain history from staff & family

Laboratory

• prostate-specific antigen in serum
• luteinizing hormone in serum
• testosterone in serum
• urinalysis
• liver function tests

Management

• behavioral management first line (cognitive behavioral therapy)
  • separation of victims from perpetrator
  • distraction, environmental modification
  • improvement or resolution of inappropriate sexual behavior in 72%, 21% without co-prescribed pharmacotherapy
• pharmaceuticals (none FDA-approved for this purpose)
  • cholinesterase inhibitors
  • serotonin reuptake inhibitors
    • sertraline 25-100 mg QD may reduce libido
    • paroxetine (potential anticholinergic effect impacting cognitive function)
  • mirtazapine may be useful if comorbidity of restless legs syndrome
  • clomipramine 25-100 mg QD if obsessive behavior
  • cimetidine may be helpful
  • antiandrogen compounds may also be helpful in men with sexual misbehavior
    • progesterone start 5 mg PO QD
      • leuprolide 5-10 mg IM monthly if behavior improves with progesterone
    • more effective than antipsychotics, antidepressants, or anticonvulsants

* see disinhibition for dosing

More general terms

• conduct disorder

Additional terms

• disinhibition