Elsevier

Biological Psychiatry

Volume 65, Issue 7, 1 April 2009, Pages 600-606
Biological Psychiatry

Archival Report
A Double-Blind, Placebo-Controlled Study of the Opiate Antagonist, Naltrexone, in the Treatment of Kleptomania

https://doi.org/10.1016/j.biopsych.2008.11.022Get rights and content

Background

Kleptomania is a rare psychiatric disorder characterized by recurrent stealing and for which there exists no empirically validated treatments. This study examined the efficacy and tolerability of the opioid antagonist naltrexone in adults with kleptomania who have urges to steal.

Methods

An 8-week, double-blind, placebo-controlled trial was conducted to evaluate the safety and efficacy of oral naltrexone for kleptomania. Twenty-five individuals with DSM-IV kleptomania were randomized to naltrexone (dosing ranging from 50 mg/day to 150 mg/day) or placebo. Twenty-three subjects (92%) completed the study. Subjects were assessed every 2 weeks with the Yale Brown Obsessive Compulsive Scale Modified for Kleptomania (K-YBOCS), the urge and behavior subscales of the K-YBOCS, the Kleptomania Symptom Assessment Scale (K-SAS), the Clinical Global Impressions Scale (CGI), and measures of depression, anxiety, and psychosocial functioning.

Results

Subjects assigned to naltrexone had significantly greater reductions in K-YBOCS total scores (p = .001), stealing urges (p = .032), and stealing behavior (p < .001) compared with subjects on placebo. Subjects assigned to naltrexone also had greater improvement in overall kleptomania severity (reflected in the CGI scores) (p < .001). The mean effective dose of naltrexone was 116.7 (±44.4) mg/day.

Conclusions

Naltrexone demonstrated statistically significant reductions in stealing urges and behavior in kleptomania. Naltrexone was well tolerated.

Section snippets

Subjects

Men and women aged 17 to 75 with a primary DSM-IV diagnosis of kleptomania were recruited by advertisements and referrals. All subjects met DSM-IV criteria for kleptomania using the clinician-administered Structured Clinical Interview for Kleptomania (SCI-K) (29) and were required to have had at least moderate urges to steal within the week prior to study entry (i.e., score ≥2 on the urge component of the Kleptomania Symptom Assessment Scale [K-SAS]) (25) and to have stolen something within 2

Subject Characteristics

Demographics of subjects at baseline are presented (Table 1). There were no statistically significant imbalances regarding age, gender, or marital status between groups. There were significant differences between groups regarding kleptomania severity at baseline with those assigned to naltrexone having more severe symptoms as reflected by the K-SAS and the CGI severity scales.

A total of 23 (92%) completed the 8-week study. Twelve (92.3%) of 13 subjects assigned to placebo and 11 (91.7%) of 12

Discussion

This randomized, double-blind, clinical trial found naltrexone to be superior to placebo in the treatment of kleptomania across a spectrum of illness-specific and global outcome measures. The results demonstrate that naltrexone treatment reduces the symptoms associated with kleptomania. In addition, this is the first double-blind pharmacological study in kleptomania and extends our previous open-label findings (25) by demonstrating that naltrexone is beneficial, safe, and well tolerated.

The

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