A seven year and two month old female patient was brought by her mother to the outpatient clinic of child psychiatry with a complaint of stretching by flexing the legs and rubbing on objects. According to the information acquired from the mother, this behaviour started first when she was 3 years of age. Previously, she was rubbing on her bed and then falling asleep. Later, she started rubbing on objects during the day, especially the edge of her seat. Without intervention, it continued for 3-5 minutes and she sweated and the frequency of her respiration increased at the same time. She started doing it when she was alone in her room so as not to be exposed to the mother’s warnings and punitive attitudes. In the last year, she has been masturbating in crowded environments by stretching her legs to create pubic pressure. The frequency and duration of the complaint have increased in the last 6 months and she has performed it during the day, when she has been out of stimuli in the last 2 months. According to the mother’s statement, she has repeated this behavior 15-20 times in a day. The family had to taket the child out of school, because she was conducting this behavior during the lessons. The family was seen by a pediatrician for this complaint. She was directed to a neurologist because the laboratory investigations for probable diagnosis were within normal ranges. Her neurological examination and EEG were evaluated as normal. An adult psychiatrist was consulted and 1 mg/day risperidone was started because of the excessive masturbation behavior. No prominent decrease in complaints was noted at the follow-up examination after 2 weeks and risperidone was increased to 1.5 mg/day. According to the statements from the family, risperidone was regularly administered for 1 week at a dose of 1.5 mg/day. There was a little decrease in masturbation behavior but the drug was discontinued due to excessive sleepiness and fatigue. In the mental evaluation, she was a girl who appeared to be her age and dressed appropriately for her socioeconomic status; she had the ability to speak compatible with her age and gave short purposeful responses. There was no effort to talk spontaneously or to maintain the relationship. Reactions from the environment against her behavior and concerns related to the inability to go to school were present in her thought content. Her general knowledge was compatible with her age; she gave the impression of normal intelligence. No symptoms were discovered in support of perception disorder or obsessive compulsive disorder. During observation in the examination room, she was masturbating by stretching her legs to create pubic pressure. When the history taken from the family as well as clinical observation and medical investigations were evaluated together, the patient was diagnosed as excessive childhood masturbation. The family was informed about the causes, the course and treatment of the situation. Behavioral suggestions were made. Because the patient experienced marked sedation with partial benefit from risperidone treatment, 2.5 mg/day aripiprazole oral solution was started after receiving the consent of the family. In the follow-up examination after 10 days, it was stated that there had been a reduction in her complaint; she had been masturbating 5-6 times in a day and therefore the dose was increased to 4 mg because she reported no significant adverse effects. Her complaint decreased significantly with an increase in the dose and there was no complaint after the 3 month follow-up; the medication was reduced by tapering the dose. Her complaint showed no recurrence in follow-up examinations performed after stopping the medication.
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Özetle:
7 yaşındaki kız çocuğu günde 15-20 defa çeşitli eşyalara sürtünerek veya kaslarını sıkarak masturbasyon yapıyor. İlk tedavisinde Risperidon başlanıyor; fakat şikayetlerde çok bir azalma olmamasına karşın yan etkilerine dayanılmadığı için ilaç kesiliyor. Ardından Aripiprazol başlanıyor ve durum düzeliyor. İlaç kesildikten sonra da nüksetmiyor.
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