Multidisciplinaire opvolging van androgeen deprivatie therapie bij mannen met een parafiele stoornis

Multidisciplinary follow-up of androgen deprivation therapy in men with a paraphilic disorder Background . Androgen deprivation therapy (ADT) is frequently used in the treatment of men with a paraphilic disorder. Due to ethical reluctance, there is a lack of randomized controlled trials in this target group to make evidence-based statements about somatic and psychiatric follow-up of ADT in Flanders and the Netherlands. Aim . Creating recommendations on the follow-up of ADT in men with a paraphilic disorder based on the experience of medical experts. Method . Using a modified Delphi method, 22 experts were questioned in three rounds about different aspects of the somatic and psychiatric follow-up of ADT. Results . Based on the degree of consensus between the experts recommendations were made concerning the somatic and psychiatric follow-up of ADT. The follow-up of ADT must be carried out by a multidisciplinary team, led by a forensic psychiatrist. High doses of cyproterone acetate (CPA) should be avoided, as a switch to a gonadotropin releasing hormone-agonist (GnRH agonist) is preferred. The expert opinion is very much in line with the influential WFSBP guideline, beyond some identified differences that rely on conflicting findings in existing research. Conclusion . The essence of the formulated recommendations is the necessity for a systematic assessment of the somatic and psychiatric condition of each patient with a paraphilic disorder undergoing ADT, in which cooperation between all multidisciplinary partners is important. The recommendations have the potential to reduce heterogeneity in clinical practice in Flanders and the Netherlands. Nevertheless, further research is required to clarify existing uncertainties and contradictions regarding certain follow-up parameters of ADT.