c




 
 




In a recent editorial in the New England Journal of Medicine ’

 
  



(á
 or á
î is an English-language peer-reviewed medical
journal published by the Massachusetts Medical Society. It is one of the most popular and
widely-read peer-reviewed general medical journals in the world. , this author decried the
need for government and pharmaceutical industry support for research in the treatment of
sexually deviant behavior (Bradford, 1998î. There are a number of reasons for this,
including the case of Kansas v. Hendricks (1997î where the U.S. Supreme Court upheld
the civil commitment of sexually violent predators for treatment as constitutional. This
means that the most seriously sexually deviant individuals are now to be held in
psychiatric hospitals or special facilities for the treatment of their sexual deviation prior
to their release. It is these individuals who need to be treated using a pharmacological
approach in addition to cognitive behaviourial therapy. Further, pedophilia
pedophilia, psychosexual disorder in which there is a preference for sexual activity with
prepubertal children. Pedophiles are almost always males. The children are more often of
the opposite sex (about twice as oftenî and are typically 13 years or age or younger;
alone is a very severe public health problem of staggering proportions, with between 6
and 62% of girls and 10 to 30% of boys being the victims of sexual abuse in childhood
according to various studies (Peters, Wyatt, & Finkelhor, 1986î. Furthermore, in the
United States the costs of incarcerating individuals convicted of sexually abusing
children is staggering, with more than two billion dollars spent in 1990, while at the same
time there is no evidence that the deterrence of incarceration Π
   


 
   
Police officers and other law enforcement officers are authorized by federal, state, and
local lawmakers to arrest and confine persons suspected of crimes. The judicial system is
authorized to confine persons convicted of crimes. has any impact on the problem
(Pithers et al., 1995î.
At this time, no one is certain of the cause of pedophilia and other sexual deviations. In
addition, the actual incidence and prevalence of the paraphilias is unknown. The level of
sexual abuse victimization victimization Social medicine The abuse of the
disenfranchised±eg, those underage, elderly, Ƃ, mentally retarded, illegal aliens, or other,
by coercing them into illegal activities±eg, drug trade, pornography, prostitution. of
children in the general population today is fairly consistent with that reported by Kinsey
(Gebhard & Johnson, 1979î. In a study completed in the 1940s, 24% of 4,000 females
surveyed disclosed a sexual interaction with a male at least five years older than them
when they were 14 years of age or younger (Gebhard & Johnson, 1979î. Sexual
intercourse occurred in 93% of cases, and in 31% of cases there was mild petting or
fondling without involvement of the genitals. A national survey by the Federal
Government of Canada on sexual violence against children and adolescents found that
18.1% of children (23.5% of females and 12.8% of malesî were victims of childhood
sexual abuse. In only 20% of cases were the perpetrators strangers, with friends,
acquaintances, parents, and other family members being the perpetrators in the majority
of cases (Federal Government of Canada, 1984î. The actual levels of the prevalence of
pedophilia in the general population is unknown, but it could be at least at the same levels
as obsessive compulsive disorder, or most likely even higher (Bradford, 1999î. Despite
this convincing evidence of a serious public health problem, the support for research into
the causes and treatment of pedophilia (and other sexual deviationsî is very weak, with
little or no pharmaceutical industry support and poor government support. In a study of
sexual fantasies by Crepault and Couture (1980î it was reported that over 60% of males
reported heterosexual pedophilic fantasies and 33% of males had rape fantasies. While
this may be a high estimate, even if this is partially accurate the prevalence of mild cases
of pedophilia in the general population is staggering. The onset of paraphilic sexual
fantasies and urges is usually well established by age 18 (Abel & Rouleau
rouleau /rou·leau/ (roo-lo´î pl.
  [Fr.] an abnormal group of red blood cells
adhering together like a roll of coins.

Y



pl.
  [Fr.] a roll of red blood cells resembling a pile of coins. , 1990î. This means
the risk of sexually acting out is present in late adolescence, yet there are only a few
programs dedicated to the treatment of sexual deviation in adolescence. Generally,
mental health professionals working

with this segment of the population are not aware of this serious problem, and therefore
not enough is being done to treat these conditions before they are well established. In
addition, there is considerable comorbidity between the various paraphilias (Bradford,
Boulet, & Pawlak, 1992î. This means that for a treatment to be successful it has to be
able to simultaneously reduce multiple paraphilic behaviours. All of these factors
strongly support a pharmacological treatment option as being the most important
intervention in the treatment of paraphilias.

The treatment of paraphilias using pharmacological agents is well established (Bradford,

1991, 1994, 1995î. It is a treatment approach that is effective in all types of sexual
deviations, including the simultaneous presence of multiple sexual deviations. In
addition, it is the treatment of choice for the most serious sexual deviations, such as
sexual sadism. The paraphilias or sexual deviations are deviant sexual behaviors that
have common clinical features, specifically sexual fantasies, leading to sexual urges and
then, ultimately, to the deviant sexual behavior. Ideally, if a treatment were to be
successful the sexually deviant behavior would be completely suppressed, while at the
same time nondeviant sexual behavior (normophilic behaviorî would remain intact or
would even be enhanced. As outlined later in this article various pharmacological
treatment approaches have been shown to have that capability. In addition an ideal
treatment would be one that was able to suppress the psychological component of sexual
deviation (sexual fantasiesî while at the same time having an impact on physiological
components of sexual deviation (sexual arousalî.

The success of any form of treatment is highly dependent on a detailed evaluation of the
behaviour and the establishment of the appropriate diagnosis. In the case of the
paraphilias, this is even more critical because of the comorbidity of the paraphilias and
the associated comorbidity with other psychiatric problems such as alcoholism. In the
author's sexual behaviors clinic (a research clinic that was established 20 years agoî,
 close to 3,000 individuals with paraphilias have been assessed and treated. In specialized
clinics such as this one there is a usually a standardized evaluation. This consists of a
psychiatric evaluation psychiatric evaluation The assessment of a person's mental, social,
psychologic functionality. See DSM-IV-table multiaxial assessment, Personality testing,
Psychiatric history, Psychiatric interview. with a detailed psychiatric history and mental
status examination to diagnose associated psychiatric and other medical conditions. The
assessment specific to sexual behaviors then consists of (aî a sex hormone profile, (bî
sexual questionnaires, and (cî physiological testing of sexual preference. Although it is
beyond the scope of this paper, a detailed evaluation is critical to establishing the
appropriate treatment intervention. In brief, the sex hormone profile is used to establish a
baseline level for possible future treatment with an antiandrogen
antiandrogen /an·ti·an·dro·gen/ (-an´dro-jenî any substance capable of inhibiting the
biological effects of androgens.

 
Y 
 , as well as screening for abnormal hormone levels. The sexual questionnaires consist of
computerized self-generated diagnosis based on DSM Ô
 - Data Structure Manager.

An object-oriented language by J.E. Rumbaugh and M.E. Loomis of GE, similar to C++. It is
used in implementation of CAD/CAE software. DSM is written in DSM and C and produces C
as output. criteria (American Psychiatric Association The Y   Y    
(APAî is the main professional organization of psychiatrists and trainee psychiatrists in the
United States, and the most influential world-wide. Its some 148,000 members are mainly
American but some are international. , 1994î, sexual history questionnaires, questionnaires to
measure cognitive distortions in relation to rape and coercive sexual traits as well as pedophilia,
questionnaires to measure types and levels of sexual fantasies, sexual drive measures as well as
measures of general sexual functioning, questionnaires on aggression and impulsivity, and
questionnaires on alcohol and drug abuse. Physiological measures of sexual arousal are used to
measure sexual preferences such as rape proneness, pedophilia and sexual sadism. Penile
penile /pe·nile/ (pe´nilî of or pertaining to the penis.
pe·nile
 
Of or relating to the penis.

 
of or pertaining to the penis. tumescence tumescence /tu·mes·cence/ (too-mes´ensî swelling.



Ô A swelling or an enlargement.
 A swollen condition.
 A swollen part or organ. techniques and visual reaction time are the physiological measures
used.

Sex is a basic biological drive, and understanding this helps to conceptualize con·cep·tu·al·ize
3  
 
,  
  ,  
 

3

To form a concept or concepts of, and especially to interpret in a conceptual way: the
pharmacological treatment approach to sexual deviation. In this framework the paraphilias are
similar to eating disorders eating disorders, in psychology, disorders in eating patterns that
comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia
nervosa is characterized by self-starvation to avoid obesity. , where a basic biological drive is
also involved. It is also well accepted how difficult it is to treat eating disorders. In eating
disorders there is a basic biological drive expressed as hunger and this drive can be disturbed,
leading to obesity if it is overactive o·ver·ac·tive
 
Active to an excessive or abnormal degree: an overactive child.

or anorexia if it is underactive. Thoughts of certain types of food can predominate these

disorders as a disturbed directional component to the drive, and the associated behaviour is very
difficult to control. It is obvious from the multi-million dollar diet industry in North America
how difficult it is for the average person to control their appetite. Sex is also a biological drive
with sexual drive the equivalent of hunger and where it can be disturbed both in intensity and
direction. Unlike hunger sex is not essential for survival, other than ensuring the procreation
PROCREATION. The generation of children; it is an act authorized by the law of nature: one of
the principal ends of marriage is the procreation of children. Inst. tit. 2, in pr. of the species.
Nonetheless the intensity of the sexual drive is similar to hunger. If this concept is considered in
relation to the sexual deviation, then the biomedical approach biomedical approach,
 medical framework that considers illness to be caused by identifiable agents. would involve
reducing sexual drive (the equivalent of hungerî and redirecting the drive toward normal sexual
behavior and away from deviant sexual interests. There is considerable scientific evidence that
the biological components of sexual drive are hormones and neurotransmitters (Bancroft, 1989î.
Using this knowledge the traditional pharmacological treatment approach has been aimed at sex
drive reduction using antiandrogens or hormonal agents. This has been closely related to other
biological interventions such as surgical castration surgical castration Urology Surgical removal
of testes±orchiectomy or ovaries±oophorectomy to stop sex hormone production, which slows
growth of certain cancers and stereotaxic stereotaxic /ster·eo·tax·ic/ (-tak´sikî
Ô stereotactic.
 pertaining to or exhibiting thigmotaxis (thigmotacticî.

Y  
1. neurosurgery neurosurgery /neu·ro·sur·gery/ (noor´o-sur?jer-eî surgery of the nervous system.


Y 
YY


Surgery on any part of the nervous system. . Stereotaxic neurosurgery is of only historical
interest. Surgical castration is of significant interest as it closely parallels antiandrogen
treatments which are aimed at reducing plasma testosterone (Bradford, 1985î. Surgical castration
involves removal of the testes 
or  
Male reproductive organs ( reproductive systemî. Humans have two oval-shaped testes 1.5±2
in. (4±5 cmî long that produce sperm and androgens (mainly testosteroneî, contained in a sac
(scrotumî behind the penis. and results in a significant reduction in plasma testosterone levels
(Bradford, 1985î. The effect of this intervention is seen in the long term outcome studies of
surgical castration. These studies, usually involving very serious sexual offenders (mostly
pedophiles and rapistsî who had already shown high rates of recidivism resulted in follow-up
rates of recidivism ranging from 1.3% to slightly over 10% with follow-up periods in some
studies being over 20 years (Bremer, 1959; Cornu, 1973; Heim & Hursch, 1979; Langeluddeke,
1963, Le Maire, 1956; Ortman 1980, 1984a; Sturup 1968, 1972î.

Testosterone is the principle androgen androgen (ăn`drԥjԥnî: see testosterone.


Y 

Any of a group of hormones that mainly influence the development of the male reproductive
system. produced by the testes of most animal species, and is also the most important androgen
in influencing male sexual behavior and, to a lesser extent, female sexual behavior (Davidson,
Smith, & Damassa, 1977î. As the mammalian species studied become more complex, there
appears to be a weakening of the direct influence of hormones on sexual behaviors, although in
the male sexual behavior tends to remain androgen dependent regardless of the species, including
man (Bancroft, 1989î. The effects of testosterone occurs through action on the intracellular
androgen receptors in various parts of the body (Liang, Tymoczko, Chan, Hung, & Liao, 1977î.
Testosterone may also be converted to estrogens Estrogens
Hormones produced by the ovaries, the female sex glands.

Mentioned in: Acne, Polycystic Ovary Syndrome

Y Y
 in the brain and then have an action on estrogen receptors, and in this way influence sexual
drive in both males and females (Naftolin, Ryan, & Petro, 1972î. It is these biological factors
that are the focus of pharmacological treatments targeting hormones.

More recently the neurochemistry of sexual behavior has been studied, and it is clear that central
serotonin metabolism also has a significant effect on sexual behavior (Greenberg & Bradford,
1997î. Decreased central serotonin levels in experimental animals are associated with an increase
in sexual drive. Contrastingly, increased serotonin levels reduce sexual drive. In humans the role
of serotonin in sexual behavior is extremely complex, and in addition there are a variety of
serotonin receptors that are present (Bradford, 1999; Greenberg & Bradford, 1997î.

Utilizing these factors, it has been possible to establish an algorithm for the treatment of the
paraphilias. This algorithm is also based on a classification of the severity of a given paraphilia
paraphilia /para·phil·ia/ (par?ah-fil´e-ahî a psychosexual disorder marked by sexual urges,
fantasies, and behavior involving objects, suffering or humiliation, or children or other
nonconsenting partners. . Although severity might vary according to the type of paraphilia, the
following classification covers most paraphilias. In order to establish the degree and severity of a
paraphilia, formal training in the assessment of treatment of the paraphilias is imperative. This
scheme follows the criteria for severity of manifestations of a specific paraphilia in DSM IIIR
IIIR Independent International Investment Research (UKî
IIIR Integration of Internet Information Resources , with the addition of additional category of
catastrophic as the highest category of severity. (DSM IIIR 1987î.

The paraphilias can be graded from mild to catastrophic as follows, based in part on the severity
criteria set forth in DSM IIIR (DSM IIIR 1987î.

Mild. "The person is markedly distressed by the recurrent paraphilic urges but has never acted on
them" (DSM IIIR 1987î. Mild cases would include deviant sexual fantasies and urges but no
history of any hands-on victimization. Deviant sexual preference as measured by sexual arousal
tests may show evidence of a deviation, but no evidence of severe paraphilias such as sexual
sadism. Most of the hands-off paraphilias such as exhibitionism exhibitionism /ex·hi·bi·tion·ism/
(ek?si-bish´in-izmî a paraphilia marked by recurrent sexual urges for and fantasies of exposing
one's genitals to an unsuspecting stranger.

    
 would be classified here. Hands-on paraphilias such as pedophilia would be limited to deviant
sexual fantasies and urges.

Moderate. "The person has occasionally acted on the paraphilic urges" (DSM IIIR 1987î. These
would be cases where victimization has occurred in terms of the hands-on paraphilias, although
the numbers of victims would remain low and the degree of victimization would be confined to
nonintrusive fondling (i.e., no penetrationî. A low number of victims would usually be classified
as less than three victims. Sexual arousal would show deviant sexual preference but no arousal to
coercive paraphilias or sexual sadism. The hands-off paraphilias would have problems
controlling their deviant sexual urges.

Severe. "The person has repeatedly acted on the paraphilic urges" (DSM IIIR 1987î. Severe
cases would involve greater than three victims and there would be an increased level of
intrusiveness in the victimization, where there would be penetration to some degree. Sexual
arousal tests would show deviant sexual arousal with a mild coercive component to it but no
frank evidence of sexual sadism. There may be mild sexually sadistic sa·dism

Ô The deriving of sexual gratification or the tendency to derive sexual gratification from
inflicting pain or emotional abuse on others.
 The deriving of pleasure, or the tendency to derive pleasure, from cruelty. fantasies present.
The hands-off paraphilias would have serious difficulties with control.

Catastrophic. There would be clear evidence of sexual sadism in terms of fantasies, urges,
history, and behavior in these cases. There may have been victimization and, if this was the case,
it would mean this is the highest level of risk in all categories. If there is no victimization, this
designation would result from evidence of predatory stalking behavior with sadistic urges,
homicidal hom·i·cid·al
 
Ô Of or relating to homicide.
 Capable of or conducive to homicide: a homicidal rage. urges, and urges to torture. It is
classified as catastrophic as any acting out would result in injury and/or death to the victim.
Sexual arousal testing would show evidence of sexual sadism, with high levels of arousal to
coercive stimuli.

THE AIMS OF PHARMACOLOGICAL TREATMENT:

The aims of treatment in all levels of severity would be the same: (aî to suppress deviant sexual
fantasies, (bî to suppress deviant sexual urges and behavior, and (cî to reduce the risk of further
victimization. The treatment algorithm would then be as follows:

ÔCognitive behaviourial treatment and relapse prevention treatment. This would always
be given regardless of the severity of the paraphilia.
 Pharmacological treatment would start with specific serotonin reuptake
reuptake /re·up·take/ (re-up´takî reabsorption of a previously secreted substance.
re·up·take
 inhibitors (SSRIsî and is indicated in most cases of mild paraphilias.
 If SSRIs are not effective in 4 to 6 weeks when at adequate dosage levels, then a small
dose of an antiandrogen would be added, such as Sertraline sertraline /ser·tra·line/ (ser´trah-lenî a
selective serotonin reuptake inhibitor used as the hydrochloride salt in the treatment of
depression, obsessive-compulsive disorder, and panic disorder. 200 mg daily and 50 mg of
Medroxyprogesterone Acetate med·rox·y·pro·ges·ter·one acetate

A progestin used to treat menstrual disorders and in hormone replacement therapy, often in
combination with estrogen. daily. This would be used in mild and moderate paraphilias.
 Full antiandrogen treatment or hormonal treatment given orally, e.g. 50 to 300 mg of
Medroxyprogesterone Acetate per day or 50 to 300 mg of Cyproterone cy·prot·er·one

A synthetic steroid that inhibits the secretion of androgens.

cyproterone

a synthetic steroid that inhibits the secretion of androgens. Acetate per day. This would be used
in moderate cases and in some cases of severe paraphilias.

 Full antiandrogen treatment or hormonal treatment given intramuscularly

in·tra·mus·cu·lar
 
Within a muscle: an intramuscular injection.

 , such as 300 mg of Medroxyprogesterone Acetate given intramuscularly per week or 200 mg

of Cyproterone Acetate given intramuscularly every, two weeks. This would be used in severe
cases of paraphilias.

  Complete androgen suppression and sex drive suppression by giving Cyproterone
intramuscularly, such as Cyproterone Acetate 200 to 400 mg intramuscularly given weekly or a
luteinizing hormone-releasing hormone agonist luteinizing hormone-releasing hormone
agonist LH-RH agonist Endocrinology Any substance that simulates LH-RH which, with time,
result in a Ļ sex hormone secretion. See H-RH. . This is for severe cases of paraphilia and the
only treatment in catastrophic cases.

The impact of this treatment algorithm on sexual behavior would be as follows:

1. Suppression of deviant sexual fantasies, urges, and behavior with a minor impact on sexual
drive occurring at Level 1 and Level 2.

2. Suppression of deviant sexual fantasies, urges, and behavior with a moderate reduction in
sexual drive. Normophilic behavior will occur but at a low level. This will be seen at Levels 2
and 3, but is dose dependent.

3. Suppression of deviant sexual fantasies, urges, and behavior with a severe reduction of sexual
drive, so that normophilic behavior occurs but at a very low level. This would be seen at Levels 4
and 5.

4. The complete suppression of sexual drive with no paraphilic or normophilic sexual behavior,
creating an asexual asexual /asex·u·al/ (a-sek´shoo-alî having no sex; not sexual; not pertaining
to sex.
a·sex·u·al
 
Ô Having no evident sex or sex organs; sexless.

 individual. This would be seen at Level 6.

In the case of the majority of paraphilias, Level 1 and Level 2 of the algorithm would be
sufficient for treatment. This would cover most of the hands-off paraphilias such as
exhibitionism, voyeurism Voyeurism Actaeon turned into stag for watching Artemis bathe. [Gk.
Myth.: Leach, 8]
elders of Babylon watch Susanna bathe. , and others where there is not a direct physical contact
involving a victim. Caution should prevail however, because of the high levels of comorbidity
and crossover between hands-off paraphilias and hands-on paraphilias. This emphasizes the
importance of a detailed evaluation prior to implementing treatment. In the case of hands-on
paraphilias involving direct physical contacts with victims, such as frotteurism
frotteurism /frot·teur·ism/ (fro-toor´izmî a paraphilia in which sexual arousal or orgasm is
achieved by actual or fantasized rubbing up against another person, usually in a crowded place
with an unsuspecting victim. and pedophilia, the treatment intervention would start at Levels 1
and 2, but would move quickly move to Levels 3 and 4 depending on the effectiveness of
treatment outcome. For example, in the cases of mild pedophilia Level 1 and Level 2 would be
sufficient treatment intervention. In contrast, for more severe cases of pedophilia Levels 3 and 4
of the algorithm would be the pharmacological treatment needed in order to reach adequate
control. More serious cases and cases involving sexual sadism of various degrees would start
with a Level 4 intervention would move through to Level 5 and Level 6 depending on the degree
of risk and the severity of the paraphilia.
This algorithm can only be used if there is a full understanding of the pharmacology of the
various agents used in the treatment. It is also important to think of the paraphilia and the type of
treatment as independent variables and that the final treatment outcome can be affected by a
variety of mediator variables. These mediator variables are various factors that could cause a
relapse of paraphilic behavior. These include (aî abuse of substances, specifically alcohol but
also nonprescription non·pre·scrip·tion
 
Sold legally without a physician's prescription; over-the-counter. drugs; (bî mood disorders,
specifically depression but any variation of mood disorder mood disorder

Any of a group of psychiatric disorders, including depression and bipolar disorder, characterized
by a pervasive disturbance of mood that is not caused by an organic abnormality. Also called


 3  

. can disinhibit dis·in·hib·it

3
   
,
    ,
   
To free from inhibitions. sexual behavior; (cî noncompliance noncompliance failure of the
owner to follow instructions, particularly in administering medication as prescribed; a cause of a
less than expected response to treatment.
noncompliance with pharmacological treatment; and (dî noncompliance with relapse prevention
interventions.

!"    ! áá
! á"! 

The most recent advance in the treatment of paraphilias has been the use of drugs that affect
serotonin (5HTî (Greenberg & Bradford, 1997î. By decreasing brain serotonin, animal research
has shown that the sexual behavior of animals is affected with an increased sexual drive and,
specifically, increased mounting behavior. It is also known that increasing the brain levels of
5HT would reduce sexual drive and behavior. Although sexual behavior in humans is always
regarded as being much more complicated than in animals, drugs affecting 5HT levels were seen
as possibly being useful in the treatment of sexually deviant behavior by suppressing sexual
drive (Greenberg & Bradford, 1997î. An early report by Bianchi (1990î described an
exhibitionist treated with fluoxetine hydrochloride flu·ox·e·tine hydrochloride

An oral antidepressant chemically unrelated to other antidepressants.

fluoxetine hydrochloride

Prozac, Prozac Weekly, Prozit (UKî, Sarafem

Ê    , and reported a reduction in paraphilic fantasy and urges. Other case
reports soon followed, mostly using fluoxetine hydrochloride as the pharmacological agent
(Emmanuel, Lydiard, & Ballenger 1991; Lorefice 1991; Perilstein, Lipper, & Friedman 1991;
Zohar, Kaplar, & Benjamin 1994î. Kafka (1991î studied four patients with nondeviant
hypersexuality hypersexuality

see mounting behavior. treated with fluoxetine hydrochloride and reported significant reductions
in sexual drive observed clinically. He also reported on three cases of sexual deviation treated
with Fluoxetine hydrochloride over a 3-month period and reported considerable improvement.
Kafka and Prentky (1992î completed an outpatient study (n = 16î, where 50% of the study
population suffered from a sexual deviation or paraphilia and the rest suffered from
nonparaphilic hypersexuality. All of the patients improved over a 12-week period with a mean
dose of 39 mg of fluoxetine hydrochloride per day. Stein et al. (1992î treated five paraphilic
males and in contrast reported that none had shown decreased sexual fantasies and urges or
masturbation to deviant sexual fantasies when treated with fluoxetine hydrochloride. Also,
Coleman, Cesnik, Moore, and Dwyer (1992î completed a retrospective study retrospective study,
a study in which a search is made for a relationship between one phenomenon or condition and
another that occurred in the past (e.g. of 13 paraphilic males and reported improvement in all
aspects of sexually deviant behavior when treated with fluoxetine hydrochloride. Kafka (1994î
reported on an open clinical trial of both men suffering from paraphilia (n = 13î and
nonparaphilic hypersexuality (n = 11î. The study showed a significant reduction in sexually
deviant fantasies, urges, masturbation, and sexual behavior. The specific serotonin reuptake
inhibitor was Sertraline and there was about a 50% clinical response rate. The nonresponders
were offered an alternative specific serotonin reuptake inhibitor, fluoxetine hydrochloride, and
two thirds showed some clinical improvement. The Sertraline was used for a mean duration of
treatment of 17.4 weeks (SD [+ or -] 18.6 weeksî and the mean dosage of Sertraline was
approximately 100 mg per day. The mean dosage of fluoxetine hydrochloride in the second
phase of the clinical study was 51.1 mg per day (SD [+ or -] 19.6î and the duration of treatment
was 30.5 weeks (SD [+ or -] 16.8 weeksî. Bradford, Greenberg, Gojer, Martindale, and Goldberg
(1995î reported on a 12-week open label dose titrated ti·trate


3  Y
,  Y ,  Y
To determine the concentration of (a solutionî by titration or perform the operation of titration.
study of pedophilia (n = 20î using Sertraline. The mean effective dosage of Sertraline was 131
mg per day. Eighty-six percent of patients completed the study and no patients were discontinued
due to an inadequate treatment response. Overall the severity of the pedophilia rated by the
physicians in the study decreased dramatically over and this was a statistically significant
decrease. A high proportion (86%î of patients were rated as responders. Various sexual
behaviors were significantly reduced over the duration of the study while heterosexual coitus
coitus /co·i·tus/ (ko´it-usî sexual connection per vaginam between male and female.co´ital.
 
  
 ,  
 YY

 actually showed a small increase during the study.
Physiological measures of sexual arousal showed decreases in pedophilic arousal and improved
or maintained normophilic arousal. Although this was an open label study, it did show evidence
of improvement or maintenance of normophilic behavior in the treatment of pedophilia, which
would be a highly desirable outcome. In another study Greenberg, Bradford, Curry, and
O'Rourke (1996î completed a retrospective study of the treatment of a variety of paraphilias
using three different serotonin reuptake inhibitors in a sample of paraphilic males (n = 58î. The
aim of the study was to see the relative efficacy of three different SSRIs in their ability to reduce
deviant sexual behavior. In this particular study, the three SSRIs, sertraline hydrochloride

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Holy Trinity University
Department of Nursing
Puerto Princesa City, Palawan


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