치매 환자에서의 부적절한 성행동
Inappropriate Sexual Behavior in Patients with Dementia
1
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
치매 환자의 부적절한 성행동은 환자의 치료 환경에 있어 대단히 중요한 증상이지만 지금껏 과소평가되거나 무시되었다. 부적절한 성행동에 대한 정확한 정의를 위해서 행동 속에 내포된 의미나 당시 환경을 포괄적으로 이해하는것과 행동을 범주 별로 정확히 기술하는 것이 중요하다. 부적절한 성행동의 원인은 다양하며 환자의 뇌영역의 interconnectivity나호르몬의 변화로 인해 발생된다고 생각된다. 이러한 뇌의 변화 외에도 환자의 대인관계의 친밀감이나 지루한 환경 등 심리적인 요소도 원인이 될 수 있다. 치매환자의 부적절한 성행동을 평가할 때에는 환자의 행동이성적 의도를 가지고 있는가와 당시 환경과 상황에 적절한지 평가하는 것이 중요하다. 부적절한 성행동에 치료에는 우선적으로 비약물적인 치료가 필요하다. 이때, 치료진의 도덕적 규범에 의하여 왜곡되지 않는 문제해결식 접근이 중요하다. 이를 위해 치료진의 병동 회의나 교육이 필요하다. 비약물적 요법에는 환경변화, stimulus technique, 행동제한 등이 있다. 약물치료는 우선적으로는 세로토닌 계열의항우울제, 항안드로겐 약물, LHRH 효현제나 에스트로겐제제와 같은 약물을 단계적으로 사용할 수 있으며 추가적으로 항정신병약물이나 항경련제 등 여러 가지 약제를 추가할 수 있다. 특히 약물치료 중 호르몬치료는 화학적 거세논란이 있으므로 시행 전 반드시 보호자에게 치료에 대한설명과 서면 동의를 구하여야 한다.
Abstract
Research about Inappropriate Sexual Behavior (ISB) among patients with dementia is not abundant although its impact on patients and carers can be significant. There are many reasons for this relative neglect. In particular, notable is a problem encountered in the inconsistency of definition and assessment of ISB as well as stigma of sexuality in patients with dementia. This article reviews the literature concerning sexually inappropriate behavior in demented patients. Behavioral and pharmacological treatment approaches are explored and the recommendations and guidelines offered by other researchers are described.
참고문헌 (40)
- Korean Association for Geriatric Psychiatry, "Geriatric Psychiatry 2nd edition", 393~ (2004)
- Johnson C, "Challenges associated with the definition and assessment of inappropriate sexual behaviour amongst individuals with anacquired neurological impairment", Brain Inj, 20, pp.687~693 (2006)
- Haddad PM, "Sexual problems associated with dementia:Part 2. Aetiology, assessment and treatment", international Journal of Geriatric Psychiatry, 8, pp.631~637 (1993)
- Harris L, "Inappropriate sexual behavior in dementia; a review of the treatment literature", Sexuality and Disability, 16, pp.205~217 (1998)
- Nagaratnam N, "Hypersexuality in nursing care facilities-a descriptive study", Archives of Gerontology and Geriatrics, 25, pp.195~203 (2002)
- Britton KR, "Medroxyprogesterone in the treatment of aggressive hypersexual behavior in traumatic brain injury", Brain Injury, 12, pp.703~707 (1998)
- Ryden MB, "Aggressive behavior in cognitively impaired nursing home residents", Research in Nursing and Health, 14, pp.87~95 (1991)
- Kolanowski AM, "The relation of premorbid factors to aggressive physical bebaviour in dementia", Journal of Neuroscience Nursing, 31, pp.278~284 (1999)
- Zeiss AM, "An observational study of sexual behavior in demented male patients", J Gerontol A Biol Sci Med Sci, 51, pp.M325~329 (1996)
- Ehrenfeld M, "Sexuality among institutionalized elderly patients with dementia", Nurs Ethics, 6, pp.144~149 (1999)
- de Medeiros K, "Improper sexual behaviors in elders with dementia living in residential care", Dement Geriatr Cogn Disord, 26, pp.370~377 (2008)
- Utti RJ, "Hypersexuality with antiparkin-sonian therapy", Clin Neuropharmacol, 12, pp.375~383 (1989)
- Lesser JM, "Sexually inappropritate behaviors.Assessment necessitates careful medical and psychological evaluation and sensitivity", Geriatrics, 60, pp.34~ (2005)
- Guay DR, "Inappropriate sexual behaviors in cognitively impaired older individuals", Am J Geriatr Pharmacother, 6, pp.269~288 (2008)
- Ryden MB, "Aggressive behaviour in persons with dementia who live in the community", Alzheimer Disease and Associated Disorders, 2, pp.342~355 (1988)
- Cohen-Mansfiled J, "A decription of agitation in a nursing home", Journal of Gerontology, 44, pp.77~84 (1989)
- Tucker I, "Management of inappropriate sexual behaviors in dementia:a literature review", Int Psychogeriatr, 15, pp.1~10 (2010)
- Ducharme S, "Sexual values, training and professional roles", Journal of Head Trauma Rehabilitation Nursing, 5, pp.38~45 (2004)
- Hashmi FH, "Sexually disinhibited behavior in the cognitively impaired elderly", Clinical Geriatrics, 8, pp.61~68 (2000)
- Lawrie B, "Assessing and addressing inappropriate sexual behavior in brain injured clinents", Rehabilitation Nursing, 29, pp.9~13 (2004)
- Zencius A, "Managing hypersexual disorders in brain-injured clients", Brain Inj, 4, pp.175~181 (1990)
- Kamel HK, "sexuality in the nursing home. Part: managing abnormal behavior-legal and ethical issues", Jam Md Dir Assoc, 4, pp.203~206 (2003)
- MoleyJE, "Aging and sexuality, in Facts and Research in Gerontology", pp.157~165 (1992), Springer
- Stewart JT, "Paroxetine treatment of sexual disinhibition in dementia", Am J Psychiatry, 154, pp.1474~ (1997)
- Anneser JM, "Inappropriate sexual behaviour in a case of ALS and FTD: successful treatment with sertraline", Amyotroph Lateral Scler, 8, pp.189~190 (2007)
- Leo RJ, "Clomipramine treatment of paraphilias in elderly demented patients", Geriatry Psychiatry Neurol, 8, pp.123~124 (1995)
- Simpson DM, "Improvement in organically disturbed behavior with trazodone treatment", Clin Psychiatry, 47, pp.191~193 (1986)
- Unger HR, "Cyproterone and hypersexulaity", N Z Med J, 86, pp.39~40 (1977)
- Light SA, "The use of medroxyprogesterone acetate for the treatment of sexually inappropriate behaviour in patients with dementia", J Psychiatry Neurosci, 31, pp.132~134 (2006)
- Sennello LT, "Single-dose pharmacokinetics of leuprolide in humans following intravenous and subcutaneous administration", J Pharm Sci, 75, pp.158~160 (1986)
- Muller FO, "Pharmacokinetics of triptorelin afterintravenous bolus administration in healthy males and in males with renal or hepatic insufficiency", Br J Clin Pharmacol, 44, pp.335~341 (1997)
- Kyomen HH, "Estrogen therapy decreases physically aggressive behaviors in elderly long-term care facility dementia patients:Results from a double-blind, placebo-controlled clinical trial", Neuropsychiatry Clin Neurosci, 9, pp.174~ (1997)
- MacKnight C, "Quetiapine for sexually inappropriate behavior in dementia", J Am Geriatric soc, 48, pp.707~ (2000)
- Freymann N, "Successful treatment of sexual disinhibition in dementia with carbamazepine-a case report", Pharmacopsychiatry, 38, pp.144~145 (2005)
- Alkhalil C, "Can gabapentin be a safe alternative to hormonal therapy in the treatment of inappropriate sexual behavior in demented patients?", Int Urol Nephrol, 35, pp.299~302 (2003)
- Tiller JWG, "Short-term buspirone treatment in disinhibition with dementia", Lancet, 2, pp.510~ (1998)
- Alagiakrishnan K, "Role of cholinesterase inhibitor in the management of sexual aggression in an elderly demented woman", J Am Geriatr Soc, 51, pp.1326~ (2003)
- Wiseman SV, "Hypersexuality in patients with dementia: Possible response to cimetidine", Neurology, 54, pp.2024~ (2000)
- Weinberger LE, "The impact of surgical castration on sexual recidivism risk among sexually violent predatory offenders", J Am acad Psychiatry Law, 22, pp.16~36 (2005)
- Choi SH, "The Korean Version of the Neuropsychiatric Inventory: A Scoring Tool for Neuropsychiatric Disturbance in Dementia Patients", Journal of Korean Medical Science, 15, pp.609~615 (2000)
