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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
- 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 [2]
- 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
* see disinhibition for dosing
Related
disinhibition
General
conduct disorder
References
- Annals of Long-Term Care
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Geriatric Review Syllabus, 11th edition (GRS11)
Harper GM, Lyons WL, Potter JF (eds)
American Geriatrics Society, 2022