Rosh Psychiatry Board Practice Exam

Which medication is considered first-line therapy for males with pedophilic disorder?

1. Bupropion PO

2. Fluoxetine PO

3. Methylprednisolone IM

4. Medroxyprogesterone IM

The correct answer is: Medroxyprogesterone IM

Medroxyprogesterone acetate, administered intramuscularly, is recognized as a first-line therapy for males with pedophilic disorder due to its efficacy in reducing sexual drive and impulsive behaviors associated with paraphilic disorders. This medication is a progestin that acts by lowering circulating testosterone levels, effectively diminishing libido. The reduction in testosterone is crucial in managing pedophilic urges, helping to mitigate the risk of acting on these impulses. The use of medroxyprogesterone for this purpose is well supported in clinical guidelines and literature, making it a preferred choice in the treatment of such disorders. In contrast, bupropion and fluoxetine are antidepressants that may have indications in the treatment of mood disorders or anxiety but do not specifically target the underlying sexual drives associated with pedophilic disorder. Methylprednisolone, a corticosteroid, is more suitable for inflammatory or autoimmune conditions rather than for managing paraphilic disorders. Therefore, medroxyprogesterone stands out as the most appropriate option for effectively addressing the specific symptoms of pedophilic disorder in males.