Biomedical subjects

R B Krueger

Publications and source records attributed to R B Krueger.

8 recordsLinked to original sources

PubMed2001

Depot-leuprolide acetate for treatment of paraphilias: a report of twelve cases.

A new class of antiandrogen medications, gonadotropin-releasing hormone agonists, offers promise in the treatment of the paraphilias, with substantially less side effects than medroxyprogesterone acetate or cyproterone acetate. This paper reports the results of treatment using a depot suspension of leuprolide acetate on 12 patients with paraphilic disorders or with sexual disorders not otherwise specified to suppress or help these individuals control their deviant sexual behavior or impulses. The method involved uncontrolled observations of individuals treated with depot-leuprolide acetate for various lengths of time, from 6 months to 5 years, with the follow-up intervals ranging from 6 months to 6 years. Leuprolide acetate resulted in a significant suppression of deviant sexual interests and behavior as measured by self-report and was well tolerated. However, the three patients who were on long-term therapy developed bone demineralization, suggesting that this is a significant side effect of prolonged therapy. Leuprolide acetate shows promise as a treatment for the paraphilias.

Adult↗

PubMed2001

The paraphilic and hypersexual disorders: an overview.

In this article, the first of a two-part series, the authors present reasons for considering the paraphilic and hypersexual disorders together and provide an overview of these disorders. The DSM-IV diagnostic criteria for paraphilias are reviewed, and proposed criteria for hypersexual disorders are presented. The question of whether the paraphilic and hypersexual disorders should be considered within the spectrum of obsessive-compulsive disorders is considered. The authors then review the epidemiology of these disorders, and discuss some implications of recent sexual predator legislation. The authors discuss the etiology of the paraphilias and hypersexual disorders, and consider the role of endocrinological function, findings from brain imaging and neuropsychological testing, findings from primate research, the monoamine hypothesis, the imprinting hypothesis, social learning theory, the concept of courtship disorder, the role of obsessive-compulsive elements, psychodynamic theories, and genetic factors. The phenomenology of the paraphilias and hypersexual disorders is discussed, including the tendency for multiple paraphilias to co-occur, the lack of a specific offender profile, the predominance of males among those with paraphilias, the incidence of a history of victimization in individuals with paraphilias and compulsive sexual disorders, the onset and course of both types of disorders, and the lack of internal motivation for change in individuals with paraphilias and hypersexual disorders. The authors then discuss disorders that commonly co-occur with paraphilias and compulsive sexual disorders, including mood disorders, substance abuse and dependence disorders, attention-deficit/hyperactivity disorder, anxiety and impulse control disorders, and personality disorders. The second article in the series will discuss the clinical assessment and the behavioral and psychopharmacological treatment of these disorders. A guide for clinicians and patients on where and how to find specialized clinicians and treatment resources in the United States will also be provided.

Journal Article↗

PubMed2000

Disorders of sexual impulse control in neuropsychiatric conditions.

This article reviews hypersexuality in individuals with neuropsychiatric disorders and its psychopharmacologic treatment. A brief review of the neurology, neuroendocrinology, and neuropharmacology of sexual behavior is presented. Literature describing the occurrence and treatment of hypersexuality in individuals with neuropsychiatric disorders is reviewed along with literature which discusses the pharmacologic treatment of individuals with hypersexual disorders in nonneuropsychiatric populations. Finally, a clinical algorithm for approaching and treating such disorders in a neuropsychiatric population is presented.

Androgen Antagonists↗

PubMed1998

Report from the Committee on Sex Offenders: the Abel Assessment for Sexual Interest--a brief description.

This article briefly reviews objective methods of assessing sexual interest and/or arousal and mentions some of the disadvantages of penile plethysmography. Literature that supports the use of viewing time as a measurement of sexual interest is reviewed. A detailed description of a new system of assessing sexual interest, called the Abel Assessment, which has both subjective and objective components, is presented. A critique of this assessment system is then offered.

Humans↗

PubMed1994

The significance of clinical EEG abnormalities in depressed patients treated with ECT.

Standard pretreatment clinical electroencephalograms (EEGs) were abnormal in 18.6% of 140 consecutive patients with Research Diagnostic Criteria (RDC) endogenous major depression. The patients were randomized to unilateral or bilateral and low- and high-dosage electroconvulsive therapy (ECT) conditions. Clinical features, short-term treatment response, and the rate and timing of relapse were contrasted in patients with normal and abnormal clinical EEG examinations. Psychotic depression was more common among abnormal EEG (61.5%) than normal EEG (38.9%) patients. Otherwise, the two groups were equivalent in a variety of demographic, clinical, and pharmacological variables. Patients with abnormal EEG findings tended to show a poorer rate of response to unilateral ECT, but a strong rate of response to bilateral ECT. Rates and timing of relapse were equivalent in the two groups. Other than the suggestion that bilateral ECT may be preferable in patients with clinical EEG abnormalities, little evidence was found that such abnormalities characterize discrete subgroups or have preductive utility with respect to ECT outcome.

Cross-Over Studies↗

PubMed1994

Acute cognitive effects of subconvulsive electrical stimulation.

Empirical titration procedures increasingly are being used to estimate initial seizure threshold. These procedures involve the administration of subconvulsive electrical stimulation. There has yet to be evaluation of the impact of such stimulation on the acute cognitive consequences of electroconvulsive therapy. In two studies we randomized depressed patients to right unilateral or bilateral ECT, with stimulus intensity maintained just above seizure threshold throughout the treatment course. These low dosage treatment groups received one or more subconvulsive stimuli in approximately 40% of treatment sessions, with a grand mal seizure also elicited at each session. Extensive neuropsychological evaluation was conducted at each session. We contrasted treatment sessions in which generalized seizures were preceded by subconvulsive stimulation with treatment sessions in which a single convulsive stimulation was applied. Across a variety of neuropsychological measures, there were no adverse cognitive consequences of subconvulsive stimulation.

Aged↗

PubMed1993

Does ECT permanently alter seizure threshold?

Recent research has raised the possibility that electroconvulsive therapy (ECT) results in a persistent elevation of seizure threshold among males. In this study, seizure threshold, quantified by the method of limits procedure, was assessed at the first and last treatments of 148 consecutive depressed patients. Patients with and without a prior history of ECT did not differ in seizure threshold at the first treatment, seizure duration at the first treatment or averaged across all treatments, or in the magnitude of the seizure threshold increase over the ECT course. No evidence was obtained that history of ECT was associated with alterations of seizure threshold or seizure duration.

Adult↗

PubMed1992

Pharmacological treatment of the cognitive side effects of ECT: a review.

Electroconvulsive therapy (ECT) is an extremely effective treatment for a variety of psychiatric syndromes. However, it is frequently associated with transient cognitive side effects. Recent research has shown that these effects are sensitive to a number of treatment parameters, such as electrode placement and stimulus dosage, that the clinician may manipulate. However there have been relatively few efforts to determine if these cognitive side effects may be reduced or prevented by psychopharmacological intervention. In animals electroconvulsive shock (ECS) has been used frequently to screen for compounds which may improve cognition and memory. This paper reviews basic research studies on such compounds, as well as clinical trials in the treatment of various cognitive disorders. Studies using such compounds to reduce the cognitive side effects of ECT are exhaustively reviewed. The compounds that have been examined include: opioids, vasopressin, adrenocorticotropic hormone, other neuropeptides, cholinergic agents, nootropic agents, ergoloid mesylates, calcium-channel blockers, dexamethasone, thyroid hormone, and stimulants.

Animals↗