Hyperphagia and Inappropriate Sexual Behavior in a Patient with Dementia: A Case Report

在一位失智症病人呈現的多食及不恰當性行為：個案報告

林政曄(Cheng-Yeh Lin) ； 黃斯聖(Si-Sheng Huang)

《The Changhua Journal of Medicine》 15卷4期 (2017/12) Pp. 218-223

https://doi.org/10.6501/CJM.1504.006

摘要

Hyperphagia and inappropriate sexual behavior (ISB) are problematic behaviors in patients with dementia. Although these behaviors are not life-threatening, and therefore easily ignored, both are troublesome. Hyperphagia may lead to increased body weight and result in dangerous situations such as choking or poisoning, while hypersexuality can result in legal problems in certain circumstances. We describe the case of a 90-year-old man who presented with dementia syndrome with concomitant hyperphagia and hypersexuality. Paroxetine was prescribed and was partially effective in this patient. Reduction in levels of 5-hydroxytryptamine (5-HT) in the brain may lead to hyperphagia by directly affecting the central control mechanism that normally regulates food intake. Management of ISB should be initiated with nonpharmacological interventions. Classes of drugs that have been used include antipsychotics, serotonergics, anticonvulsants, antiandrogens, estrogens, and luteinizing hormone-releasing hormone analogs.

關鍵字

hyperphagia ； hypersexuality ； dementia ； selective serotonin reuptake inhibitor

並列摘要

多食及不恰當性行為在失智症病人中時常被忽略，但卻是令人困擾的問題行為。多食會造成體重增加，更甚者可能會造成飲食過程中發生窒息或食物中毒的結果。不恰當的性行為可能會衍生法律上的問題。本報告描述一位90歲合併多食及不恰當性行為的失智病人，對於paroxetine有部分療效的個案。報告中描述病人之行為精神症狀並以文獻回顧探究多食及不恰當性行為之相關的機轉及治療方式。處理此類行為問題建議先嘗試以非藥物的處遇治療。針對多食，藥物治療可考慮血清素再回收抑制劑；而不恰當性行為之藥物治療有多種類可選擇，如抗精神病藥物、血清素再回收抑制劑、抗癲癇藥物、荷爾蒙類藥物，但是缺乏大型臨床研究實證支持。

並列關鍵字

多食 ； 不恰當性行為 ； 失智症 ； 血清素再回收抑制劑