Use of Lithium for Sexual Obsessions in Asperger’s Disorder

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Back to table of contents Previous article Next article LettersFull AccessUse of Lithium for Sexual Obsessions in Asperger’s DisorderLokesh Shahani, M.D.Lokesh ShahaniDept. of Internal MedicineSIU School of MedicineSpringfield, ILSearch for more papers by this author, M.D.Published Online:1 Oct 2012https://doi.org/10.1176/appi.neuropsych.11090232AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Obsessional/repetitive behaviors are a core feature of autistic-spectrum disorders. Symptoms suggesting a DSM-IV diagnosis of obsessive compulsive disorder have been reported in 37% of the children with autism.1 Sexual obsessions have been commonly reported in these patients.2We report on a 17-year-old young man with a diagnosis of Asperger’s disorder who complained of having intrusive sexual thoughts and urges. He was masturbating 25–30 times per day, resulting in penile ulcers. These symptoms were associated with severe anxiety and frustration, leading to suicidal thoughts and self-injurious behavior, including stabbing his penis with tweezers. The patient denied any concomitant mood or psychotic symptoms. He denied any substance use, and his urine toxicology screen was negative. The patient was currently on sertraline 200 mg, clomipramine 225 mg, and aripiprazole 10 mg daily. He has had previous failed trials on citalopram, fluvoxamine, fluoxetine, clonazepam, quetiapine, and risperidone.Low serotonin levels have been associated with impulsive and aggressive behaviors,3 and enhancement of central serotonin neurotransmission could ameliorate heightened sexual desire and compulsivity associated with such sexual behaviors.4 Lithium has been shown to have some efficacy in similar behaviors associated with obsessive-compulsive features, such as pathological gambling.5 Hence, a trial of lithium was considered in this patient, and the dose was titrated up to 600 mg twice daily, with a lithium level of 0.56 mEq/L. The patient showed significant improvement in his sexual obsessions. He has not had a relapse in his obsessive symptoms and participates in cognitive-behavioral therapy to help with sustained remission.Lithium is known to increase serotonin levels in the cerebrospinal fluid by inducing serotonin synthesis.6 The particular pro-serotonergic action of lithium could be helpful in reducing the heightened sexual obsession and compulsive behavior. Further double-blind, placebo-controlled studies are needed to confirm the role of lithium as an augmentation agent for treatment of obsessive sexual behaviors.Dept. of Internal MedicineSIU School of MedicineSpringfield, ILCorrespondence: e-mail: [email protected]comReferences1 Leyfer OT, Folstein SE, Bacalman S, et al.: Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. J Autism Dev Disord 2006; 36:849–861Crossref, Medline, Google Scholar2 Zandt F, Prior M, Kyrios M: Repetitive behaviour in children with high-functioning autism and obsessive-compulsive disorder. J Autism Dev Disord 2007; 37:251–259Crossref, Medline, Google Scholar3 Cocarro EF, Kavoussi RJ: Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry 1998; 54:1081–1088Crossref, Google Scholar4 Stein DJ, Hollander E, Anthony DT, et al.: Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias. J Clin Psychiatry 1992; 53:267–271Medline, Google Scholar5 Pallanti S, Quercioli L, Sood E, et al.: Lithium and valproate treatment of pathological gambling: a randomized, single-blind study. J Clin Psychiatry 2002; 63:559–564Crossref, Medline, Google Scholar6 Lenox RH, Hahn CG: Overview of the mechanism of action of lithium in the brain: fifty-year update. J Clin Psychiatry 2000; 61(Suppl 9):5–15Medline, Google Scholar FiguresReferencesCited byDetailsCited byThe World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder17 November 2022 | Dialogues in Clinical Neuroscience, Vol. 24, No. 1Sexuality in autism: hypersexual and paraphilic behavior in women and men with high-functioning autism spectrum disorder1 April 2022 | Dialogues in Clinical Neuroscience, Vol. 19, No. 4 Volume 24Issue 4 Fall 2012Pages E17-E17 Metrics PDF download History Published online 1 October 2012 Published in print 1 October 2012