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THE URGE TO STEAL: DO MEDICATIONS HELP?
ABSTRACT
ESCITALOPRAM IN THE TREATMENT OF KLEPTOMANIA
Aboujaoude E, Gamel N, Koran L
Stanford University School of Medicine, Stanford, CA, USA
BACKGROUND: Kleptomania involves stealing items that are not needed or
have limited value from shops, strangers and acquaintances. Its prevalence is
estimated at 6 per 1000 U.S. adults. Kleptomania appears to account for 5% of
shoplifting. No controlled trials of pharmacotherapy for kleptomania have been
published. We are conducting the first controlled trial of a medication for
kleptomania. METHODS: We are enrolling adults aged 20 and older with
kleptomania of 1 year's duration, meeting DSM-IV criteria and marked by court
referral or stealing at least once per week. We exclude individuals with
psychotic disorders, alcohol or substance abuse, bipolar disorder or antisocial
personality disorder. Subjects receive open-label escitalopram 10 mg/day for 4
weeks and if not "much improved," take 20 mg/day for an additional 3 weeks. A
"responder" is a patient experiencing at least 50% decrease in the Y-BOCS-kleptomania
version (Y-BOCS-K) scale score and a CGI-I score of much or very much improved.
Responders are randomized double-blind to continue for four months on either
escitalopram or placebo. RESULTS: We have enrolled 13 patients of a
planned 24. Eleven completed the seven weeks of open-label escitalopram; two
discontinued. The 11 completers include 9 women with a mean age of 46 years.
Nine are employed full-time, one unemployed and one a student. Five are married,
three single, three divorced. Ten of the 11 received escitalopram 20 mg/day. The
completers' mean Y-BOCS-K score decreased from 23.1 (SD 5.1) to 8.6 (SD 7.8) at
end of week 7. On a 0-4 scale, the strength of urges to steal decreased from a
mean of 2.9 (SD 0.7) to 1.1 (SD 0.8). The mean number of weekly urges to steal
decreased from 3.0 (SD 0.6) to 1.6 (SD 1.1). Eight subjects were responders. Of
these eight, four relapsed during the 4-month double-blind, placebo-controlled
phase, but the blind remains unbroken. CONCLUSIONS: Early results suggest
a therapeutic effect for escitalopram in treating kleptomania
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