Antilibidinal Drugs and Mental Retardation: A Review

Abstract

A minority of people with mental retardation have sexual behaviour which is socially unacceptable or which brings them into conflict with the law. Such behaviour may be the result of ignorance about sexual matters, often best managed by counselling or by a behavioural approach. There are a small number of men with mental retardation and aberrant sexual behaviour who benefit from the prescription of an antilibidinal drug. Treatment with an antilibidinal drug alone reduces the intensity of sexual drive but does not alter its direction; concurrent sexual counselling or psychotherapy is often indicated. The various antilibidinal medications available are reviewed, with particular attention to reports which have described the treatment of people with mental retardation. Of the antilibidinals currently used, medroxyprogesterone acetate and cyproterone acetate are those for which there is most evidence of efficacy. Cyproterone acetate is preferable because it has a specific antiandrogenic action and fewer adverse effects. There is a need for controlled studies of antilibidinal drugs, with clearly defined inclusion criteria and adequate measures of both behavioural and attitudinal change.

Leuprolide Acetate Suppresses Pedophilic Urges and Arousability

“…Sexual thoughts, fantasies, and feelings were inhibited more consistently and to a greater degree than the subject's sexual orientation (Bradford, 1983;Clarke, 1989;Cooper, 1986).…”

Offenders with intellectual disability: the size of the problem and therapeutic outcomes

“…There were no clinical trials of these preparations available in the literature on offenders with ID. Recent reviews have summarized the therapeutic and medico‐legal issues pertinent to the use of these preparations in offenders with ID (Clarke 1989; Cooper 1995; Sherak 2000).…”

Pharmacological management of inappropriate sexual behaviours: a review of its evidence, rationale and scope in relation to men with intellectual disabilities

“…This generalised response highlights the impact of a reduction in sexual arousal, which may not have been abnormal in its degree prior to treatment, in reducing inappropriate or deviant sexual behaviour. A small reduction in sexual drive may be sufficient to enable a patient to avoid acting on an impulse that would otherwise have led to unacceptable behaviour (Clarke 1989). More recent treatments like SSRIs and LHRH agonists hold promise although controlled trials are yet to happen.…”

“…The recommended daily dose of benperidol in the treatment of ISBs is 0.25–1.5 mg in divided doses (Murray et al. 1975; Clarke 1989).…”