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Miyazaki K, Uchiyama M. An adolescent boy with kleptomania and attention-deficit hyperactivity disorder treated with methylphenidate and guanfacine: A case report. Neuropsychopharmacol Rep 2023; 43:650-653. [PMID: 37921065 PMCID: PMC10739163 DOI: 10.1002/npr2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/02/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
We present the case of a patient, a boy of 16 years of age at initial presentation, with kleptomania, an impulse disorder characterized by an impulse to steal unneeded items, and attention-deficit hyperactivity disorder (ADHD). The patient's parents reported that he would frequently impulsively steal items and money that he did not need. Cognitive and physical assessments revealed no abnormalities, and the patient had no history of substance abuse. The patient was diagnosed with kleptomania and ADHD. The patient was started on Osmotic Release Oral System Methylphenidate (OROS-MPH), a medication commonly used to treat ADHD, and experienced improvement in ADHD symptoms and stealing behavior. At 19 years of age, it was discovered that the patient's behavioral symptoms were uncontrolled during times of the day when the blood concentration of MPH was likely to have waned. After starting an additional dose of guanfacine at night, his symptoms during these times of day improved. While existing research is not definitive, there may be a connection between ADHD and kleptomania. Further, there are some reports that treatment of ADHD with MPH also reduced stealing behavior, aligning with our present findings. We discuss the potential mechanisms behind these improvements and further present the first evidence of the efficacy of guanfacine in the treatment of kleptomania.
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Affiliation(s)
- Kensuke Miyazaki
- Department of NeuropsychiatryHirosaki‐Aiseikai HospitalHirosaki‐shi, AomoriJapan
| | - Michiko Uchiyama
- Department of Hospital PharmacyHirosaki‐Aiseikai HospitalHirosaki‐shi, AomoriJapan
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Jannini TB, Lorenzo GD, Bianciardi E, Niolu C, Toscano M, Ciocca G, Jannini EA, Siracusano A. Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs). Curr Neuropharmacol 2022; 20:693-712. [PMID: 33998993 PMCID: PMC9878961 DOI: 10.2174/1570159x19666210517150418] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/22/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022] Open
Abstract
Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.
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Affiliation(s)
- Tommaso B. Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio D. Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy;,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | | | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy;,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy;,Address correspondence to this author at the Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; E-mail:
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Kleptomania Induced by Venlafaxine. Case Rep Psychiatry 2021; 2021:8470045. [PMID: 34540303 PMCID: PMC8448610 DOI: 10.1155/2021/8470045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/30/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction. Kleptomania is an impulse-control disorder that results in an irresistible urge to steal. It is often observed as a comorbidity in patients undergoing pharmacological treatment for Parkinson's disease. Recurrent shopliftings are also observed in the clinical course of frontotemporal dementia. Case Presentation. After successful treatment of severe depression with venlafaxine at a dose of 225 mg/day, a 54-year-old euthymic female patient exhibited recurrent stealing behavior. After the diagnostic exclusion of frontotemporal dementia, kleptomania induced by venlafaxine administration was suspected. The symptoms of kleptomania disappeared with the gradual decrease in the venlafaxine dosage to 37.5 mg/day. Discussion. Venlafaxine is a dual serotonin-norepinephrine reuptake inhibitor. We considered two possible mechanisms to explain the pathophysiology of kleptomania in the present case: (1) increased dopaminergic neural transmission due to the inhibited dopamine reuptake by the norepinephrine transporter with a high dose of venlafaxine or (2) enhanced serotonergic neural transmission by the inhibition of serotonin reuptake by venlafaxine. In past studies, five cases of impulse-control disorder induced by selective serotonin reuptake inhibitors have been reported. This is the fourth report of venlafaxine-induced kleptomania and highlights the importance of considering the possibility of a rare side effect of kleptomania induced by antidepressant.
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Kleptomania in a 15-year-old boy with ADHD – a case report. CURRENT PROBLEMS OF PSYCHIATRY 2019. [DOI: 10.2478/cpp-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Aim: The aim of the study was 1) to report the case of a 15-year-old boy who developed kleptomania symptoms during methylphenidate treatment and 2) to review the available therapeutic options for kleptomania based on a literature search of Medline and Google Scholar databases (2000–2018).
Case report: For the past seven years a 15-year-old boy had participated in counselling at a psychological counselling centre because of school problems and upbringing difficulties, and had a five-year history of psychiatric treatment for ADHD. He was admitted to the Department of Psychiatry because of recurrent stealing episodes that occurred during methylphenidate treatment. During the hospitalization, the patient did not observe the therapeutic contract – he stole items from other patients. Pharmacotheraputic and psychotherapeutic treatment resulted in a partial improvement in impulsive behaviour. At discharge, he spoke critically of his previous conduct and expressed readiness to continue treatment in an outpatient setting.
Conclusions:
Kleptomania has a very negative impact on a patient's overall well-being.
In the reported case, kleptomania developed during methylphenidate treatment.
Kleptomania should always be taken into account as a possible cause of stealing during a psychiatric examination, to avoid stigmatization of patients as criminals.
Pharmacotherapy and cognitive-behavioural psychotherapy focused on the development of strategies, which can help the patient to control the urge to steal, are important components of kleptomania treatment.
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Chee KT, Sim K, Lee TS, Ng BY. Making Sense of Kleptomania: Clinical Considerations. PROCEEDINGS OF SINGAPORE HEALTHCARE 2010. [DOI: 10.1177/201010581001900403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An understanding of the historical roots, clinical features and current diagnostic criteria of kleptomania would help in a better appreciation and assessment of this condition. One of the few psychiatric conditions that is defined by an illegal activity, kleptomania has been classified as one of the impulse control disorders under ICD-10 and DSM IV-TR. In terms of assessment, it is not sufficient merely to look at the operational criteria. One should take a complete history and probe for predisposing factors including childhood development and behaviour, previous relationships, losses, and habits. It is also necessary to detect current stressors and concomitant symptoms or disorders that may precipitate and perpetuate the condition. Some of the diagnostic criteria are based on subjective claim or report which may be unreliable. The use or value of the articles stolen is relative but may be easier to assess. As a guide, kleptomania should be a diagnosis by exclusion of other contributing disorders. When other contributing symptoms/disorders such as depression are present, care should be exercised before a diagnosis of kleptomania is made.
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Affiliation(s)
- Kuan Tsee Chee
- Department of General Psychiatry, Institute of Mental Health, Singapore
| | - Kang Sim
- Department of General Psychiatry, Institute of Mental Health, Singapore
| | | | - Beng Yeong Ng
- Department of Psychiatry, Singapore General Hospital, Singapore
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Grant JE, Odlaug BL. Cleptomania: características clínicas e tratamento. REVISTA BRASILEIRA DE PSIQUIATRIA 2007; 30 Suppl 1:S11-5. [PMID: 17713696 DOI: 10.1590/s1516-44462006005000054] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: A cleptomania, um transtorno incapacitante do controle dos impulsos, caracteriza-se pelo furto repetitivo e incontrolável de itens que são de pequena utilidade para a pessoa acometida por esse transtorno. Apesar de seu histórico relativamente longo, a cleptomania continua sendo pouco entendida pelo público geral, pelos clínicos e pelos que dela sofrem. MÉTODO: Este artigo revisa a literatura sobre o que se sabe a respeito das características clínicas, histórico familiar, neurobiologia e opções de tratamento para indivíduos com cleptomania. RESULTADOS: A cleptomania geralmente tem seu início no final da adolescência ou no início da vida adulta, e parece ser mais comum em mulheres. A comorbidade psiquiátrica ao longo da vida com outros transtornos de controle de impulsos (20-46%), de uso de substâncias (23-50%) e de humor (45-100%) é freqüente. Indivíduos com cleptomania sofrem de prejuízo significativo em sua capacidade de funcionamento social e ocupacional. A cleptomania pode responder ao tratamento com terapia cognitivo-comportamental e com várias farmacoterapias (lítio, antiepilépticos e antagonistas de opióides). CONCLUSÕES: A cleptomania é um transtorno incapacitante que resulta em uma vergonha intensa, bem como problemas legais, sociais, familiares e ocupacionais. São necessários estudos de tratamento em ampla escala.
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Affiliation(s)
- Jon E Grant
- Departmento de Psiquiatria, School of Medicine, University of Minnesota, Minnesota 55454, USA.
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Abstract
Kleptomania--the inability to resist the impulse to steal objects, not for personal use or monetary gain--is currently classified in psychiatric nomenclature as an impulse control disorder. However, some of the principle features of the disorder, which include repetitive intrusion thoughts, inability to resist the compulsion to perform the thievery and the relief of tension following the act, suggest that kleptomania may constitute an obsessive-compulsive spectrum disorder. Kleptomania is commonly under-diagnosed and is often accompanied by other psychiatric conditions, most notably affective, anxiety and eating disorders, and alcohol and substance abuse. Individuals with the disorder are usually referred for treatment due to the comorbid psychiatric complaints rather than kleptomanic behaviour per se. Over the past century there has been a shift from psychotherapeutic to psychopharmacological interventions for kleptomania. Pharmacological management using selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) and other antidepressants, mood stabilisers and opioid receptor antagonists, as adjuvants to cognitive-behavioural therapy, has produced promising results.
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Affiliation(s)
- R Durst
- Kfar Shaul Mental Health Center, Hebrew University, Hadassah Medical School, Jerusalem, Israel.
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