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Naltrexone promising for treating urges and behavior in kleptomania.

HOLLYWOOD, FLA. -- The opioid antagonist naltrexone significantly reduced stealing urges and behaviors associated with kleptomania, compared with placebo in a small, randomized, double-blind study.

Brian Odlaug and his associates at the University of Minnesota, Minneapolis, conducted a study to see whether a behavioral addiction such as kleptomania could be managed with an agent used to treat alcoholism and substance abuse.

The idea came in part from a previous study of patients with a different behavioral addiction. "We've done studies in gambling addiction and found naltrexone very beneficial for gambling addiction," Mr. Odlaug said (J. Clin. Psychiatry 2008;69:783-9).

People with gambling addiction and kleptomania report similar urges, said Mr. Odlaug, a research coordinator and public health graduate student at the University of Minnesota.

In the current study, he, lead author Dr. Jon E. Grant, and their associates enrolled 25 people who met DSM-IV criteria for kleptomania. They randomized them to 50 mg/day up to 150 mg/day naltrexone (mean effective dose, 117 mg/day) or placebo. A total of 23 participants completed the 8-week study. Mr. Odlaug and his coauthors had no relevant financial disclosures.

The treatment group experienced significantly lower total scores on the Yale Brown Obsessive Compulsive Scale Modified for Kleptomania (K-YBOCS), compared with placebo, the primary study outcome. The K-YBOCS total score decreased from 20.08 at baseline to 3.83 at 8 weeks with naltrexone. At the same time, the score in the placebo group decreased from 15.69 to 11.46. Results were presented as a poster at a meeting of the New Clinical Drug Evaluation Unit sponsored by the National Institute of Mental Health and published in Biologic Psychiatry (2009;65:600-6).

In addition, treated patients had significantly fewer stealing urges and stealing behaviors at 8 weeks, compared with placebo, as well as greater improvements in kleptomania severity on the self-reported Kleptomania Symptom Assessment Scale and the Clinical Global Impressions scale.

The naltrexone group showed a trend toward significant improvement in scores for the Sheehan Disability Scale, which measures psychosocial functioning disturbances over a 7-day period. "I just wanted to point that out, that improvements in other types of functioning [work/school, social life, and family/home responsibilities] were also noted in the naltrexone group along with improvements in their overall kleptomania symptoms," Mr. Odlaug said in a follow-up interview.

Naltrexone was well tolerated--four patients reported nausea, one reported dry mouth, and one reported insomnia. In the placebo group, one patient each reported headache, nausea, or diarrhea.

No significant changes were found in mood on the Hamilton Depression and Hamilton Anxiety scales, "so [naltrexone] really targeted the urges and behavior," Mr. Odlaug said. "Comorbid conditions are the rule, not the exception, with these folks. They have a lot of depression, anxiety, and suicidal ideation. They experience shame and embarrassment [and are] extremely impulsive by nature."

Duration of treatment with naltrexone "is a big question," Mr. Odlaug said. Generally, after 1 year of maintenance, most people can taper off the agent if they have changed their behaviors.

"It is very, very promising," Mr. Odlaug said. However, he acknowledged the small sample size and said further research is warranted.

The study was internally funded and not supported by industry.
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Author:McNamara, Damian
Publication:Clinical Psychiatry News
Article Type:Clinical report
Date:Oct 1, 2009
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