QUETIAPINE FOR SEXUALLY INAPPROPRIATE BEHAVIOR IN DEMENTIA
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.003 | 0.000 |
| Research integrity | 0.011 | 0.011 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".