QUETIAPINE FOR SEXUALLY INAPPROPRIATE BEHAVIOR IN DEMENTIA
Notice bibliographique
Résumé
To the Editor: The treatment of sexually inappropriate behavior by patients with dementia is largely a matter of trial and error.1 We wish to report an excellent response to an 4 atypical antipsychotic. The patient is an 85-year-old man whose wife described a slow cognitive decline for several years, followed by a perioperative stroke 3 years before our consultation. His cognition deteriorated abruptly at that time. Since the stroke he has continued in slow decline, though with periods of fluctuation, and he has also developed parkinsonism with rigidity and the characteristic posture and gait. Other conditions are atrial fibrillation and orthostatic hypotension. Medications at presentation were aspirin, betahistine, and dimenhydrinate for sleep (these last two were stopped). His Mini-Mental State Exam score was 18/30 On a daily basis, the patient attempted to have sexual relations with his wife, who resisted verbally. He was unsuccessful in these attempts and would then masturbate for several hours, to the point of self-injury. He was told by his physician that this behavior was unwelcome, and although his feelings were natural, his wife could no longer participate. Cyproterone 100 mg twice daily was tried for 2 weeks with no effect. Paroxetine 5 mg once daily was prescribed, but because of diarrhea only two doses were taken. Quetiapine 25 mg at bedtime was prescribed. Within 2 days the behavior had stopped, and it has not recurred in 2 months of follow-up. Drowsiness occurred when the dose was increased to 50 mg, so he has remained on 25 mg. His parkinsonism and orthostatic hypotension did not worsen. Quetiapine has been demonstrated to be safe in older people in open-label trials in psychotic disorders and in Parkinson's disease.2,3 Despite its effects on various receptors in the brain (e.g., D1, D2, H1, 5HT2a, alpha1, and others) quetiapine has the advantage (at both low and high doses) of relative selectivity for mesolimbic compared with mesostriatal dopaminergic neurons, making it an attractive choice for older adults with parkinsonism or Parkinson's disease.4 An important dosing consideration for quetiapine in older patients is that its clearance is decreased by approximately 40%. Low starting doses and slow dose titration are, therefore, necessary. Recognizing that anecdotes are the least favored form of evidence in the practice of medicine, our experience suggests that quetiapine in very small doses is safe and effective for this difficult problem of sexually inappropriate behavior.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,003 | 0,000 |
| Intégrité de la recherche | 0,011 | 0,011 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».