"Evolution of Sexual Symptoms in Paraphilic Sexual Offenders With/Without Antiandrogen or SSRI Treatment"

The ISDSS assesses three domains of sexual functioning during the past month:

Sexual interest and desire (score 0-8; higher = stronger desire)

Sexual thoughts and fantasies (score 0-8; higher = more frequent/intense fantasies)

Frequency of paraphilic sexual activities per week (e.g., masturbation, sexual activity leading to orgasm; reported as count).

The mean score of the three domains (range 0-8) will be calculated. Higher scores indicate worse outcome (greater intensity/frequency of paraphilic sexual behavior).

Number of participants with sexual relapse (recurrence of deviant sexual behavior) during the 36-month follow-up, recorded at each 3-month visit via participant report, third-party notifications, or official records.

Categorical diagnosis (present/absent) of psychiatric comorbidities assessed at baseline and 36 months using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.

Outcome: Change from baseline in treatment adherence score at 36 months. Measurement: Measured every 3 months using the Brief Adherence Rating Scale (BARS, range 0-6; higher scores indicate better adherence).

Number of participants with treatment-related adverse events during the 36-month follow-up, documented by type, frequency, onset time, and severity, as reported by the treating physician or participant.

Binary assessment (present/absent) of gynecomastia at baseline and every 3 months.

Outcome: Total score on the Trauma History Questionnaire (THQ). Measurement: THQ is a self-report questionnaire assessing the presence and frequency of traumatic events over the lifetime.

Scale: The French version used in the study includes a series of items scored from 0 (no occurrence) to a maximum determined by the number of events endorsed (higher scores indicate a greater number of traumatic events).

Scoring interpretation: Higher scores reflect a worse outcome, meaning greater exposure to traumatic life events.

Number of participants whose comorbidity profile changes during the 36-month follow-up.

Measurement: Recorded at each 3-month visit, based on DSM-5 diagnosis status (present/absent for each condition

Number of participants with changes in clinical management due to treatment-related adverse events.

Measurement: Recorded at each 3-month visit; events classified by type, severity, and relationship to treatment (CTCAE v4.0).

Outcome: Change from baseline in sexual symptom scores leading to a modification of clinical management.

Measurement: Difference in scores from validated sexual symptoms scales (libido, fantasies, sexual activity), measured every 3 months over 36 months.

Outcome: Change from baseline in serum testosterone concentration at 36 months in participants receiving SSRIs or antiandrogens.

Measurement: Measured in ng/dL at baseline and when non-adherence is suspected; lower levels are expected in adherent participants on antiandrogen treatment.

The PDQ-4+ assesses personality disorder traits. Score range 0-100; higher scores indicate more personality disorder traits (worse outcome).

The BIS-11 is a self-report questionnaire of impulsivity. Score range 30-120; higher scores indicate greater impulsivity (worse outcome).

Mean systolic and diastolic blood pressure values measured at baseline and every 3 months.

Mean weight measured at baseline and every 3 months.

Description: Molest Scale score, range [min-max to be specified], higher scores indicate greater aggression (worse outcome).

Rape Scale score, range [min-max], higher scores indicate higher risk of sexual violence (worse outcome).

Range [min-max], higher scores indicate greater empathy (better outcome).

Range [min-max], higher scores indicate greater denial (worse outcome).

AUDIT total score (0-40). Higher scores indicate more hazardous or harmful drinking (worse outcome).

Self-reported consumption of illicit drugs (type, grams/day, duration). Reported at baseline and every 3 months.

PATHOS score range 0-5, PEACCE [specify range]. Higher scores indicate higher risk of hypersexuality (worse outcome).

CSBI score range [min-max], higher scores indicate greater compulsive sexual behavior (worse outcome).

STATIC-99 score range 0-12; higher scores indicate greater risk of sexual violence recidivism (worse outcome).

STABLE-2007 score range 0-26; higher scores indicate greater dynamic risk factors for sexual recidivism (worse outcome).

MoCA score range 0-30; higher scores indicate better cognitive function.

Stroop performance (reaction time in seconds and number of errors). Longer reaction times and more errors indicate worse cognitive function.