Actu Psychiatr Scund 1996: 93. 314-315 Printed in Uh' ull rights reserved

Cupyright 10 Munksgaard 1996 ACTA PSYCHIATRICA

SCANDINAVICA L S N ~ O O I - ~ ~ O O X

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Treatment of kleptomania with fluvoxamine

Chong SA, Low BL. Treatment of kleptomania with fluvoxamine. Acta Psychiatr Scand 1996: 93: 314-315. 0 Munksgaard 1996.

We report a patient fulfilling DSM-IV criteria for kleptomania who failed to respond to psychotherapy, behavioural therapy and pharmacotherapy with clomipramine, imipramine and lithium. He was successfully treated with the serotonergic agent fluvoxamine.

Kleptomania is thought to be a rare clinical condi- tion ( l ) , and there have been no controlled studies on its treatment. Case studies have suggested the possible effectiveness of behavioural therapy ( 2), psychoanalytic psychotherapy ( 3 ) and pharmaco- therapy with amitriptyline, imipramine, nortripty- line, fluoxetine and lithium (4-6). No other selective serotonin reuptake inhibitor (SSRI ) has been reported to be effective. This is a report of the successful use of another SSRI, fluvoxamine, in a case of kleptomania.

Case report

Mr A, a 38-year-old Chinese man, had suffered from compulsive checking and rumination since adolescence. He started stealing at around this time. Each act of theft was preceded by an unpleasant feeling of mounting tension which was relieved after he had stolen some object which he would either give away or discard. Despite several convictions for shoplifting (he had stolen even when on bail ) and one incident of physical assault by sales assist- ants, his stealing continued unabated.

He had been treated elsewhere with behavioural therapy, psychotherapy, and an adequate duration of clomipramine, imipramine and lithium adminis- tered singly at therapeutic dosages. However, there was no significant improvement in either his check- ing, rumination or stealing. When he was referred to this clinic, his stealing was occurring almost daily and he was out on bail for two charges of shoplifting.

A trial of fluvoxamine was started at 100 mg/day and subsequently increased to 200 mg/day. Within 2 weeks, the patient reported a lessening of his

S. A. Chong, B. L. low institute of Mental Health and Woodbridge Hospital, Singapore

Key words fluvoxamine; kleptomania

Siow Ann Chong, institute of Mental Health and Woodbridge Hospital, 10 Buangkok Green, Singapore 1953

Accepted for publication September 2. 1995

checking, rumination and urge to steal. Fluvoxamine was further increased to 300 mg/day. Although he would have the occasional urge to steal when he was out shopping, he had been able to control these urges easily. At the time of writing, he has been on fluvoxamine for 9 months and has not stolen during this period. The intensity of his rumination and checking has also significantly decreased.

Discussion

Kleptomania belongs to that group of disorders categorized in DSM-IV as impulse control dis- orders, not classified elsewhere. This group of dis- orders shares a core disturbance of impulsivity and compulsivity (7). McElroy et al. ( 8 ) commented that, while kleptomania does have many impulsive features (abrupt stealing without premeditation or consideration of the consequences), it could also have compulsive features (repetitive stealing to relieve discomfort). This was the case in the patient described here, who also had other obsessive- compulsive features. Because of this compulsive quality, kleptomania has been hypothesized to be a variant of obsessive-compulsive disorder ( 9 ). This hypothesis is supported by the high rates of obsess- ive-compulsive symptoms that are often associated with kleptomania ( X ) , and the higher than normal rate of obsessive-compulsive disorder in first-degree relatives of patients with kleptomania (6).

Remission or partial response of kleptomania to a broad range of thymoleptic agents has been reported. In this case, clomipramine, imipramine and lithium (a mood stabilizer) were ineffective, while the serotonergic agent fluvoxamine was clearly

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Treatment of kleptomania with fluvoxamine

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8. MCELROY SL, KECK PE, PHILIPS KA. Kleptomania, compuls- ive buying, and binge eating disorder. J Clin Psychiatry 1995:

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56 (Suppl. 4): 14-26.

effective. This suggests that disturbed central sero- tonergic neurotransmission may be important in the pathophysiology of kleptomania.

Ethical concerns (i.e. the potential for further stealing) prevented an ABAB triaI. However, the complete cessation of this patient’s stealing suggests that fluvoxamine should be considered as a treat- ment option for kleptomania, particularly when obsessive-compulsive symptoms are present. If its efficacy is also demonstrated by other clinicians, study of the mechanism of action of this drug in kleptomania may lead to a greater understanding of the pathophysiology of this condition.

References

1. GOLDMAN MJ. Kleptomania making sense of the nonsensical. Am J Psychiatry 1991: 148: 986-996.

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