Kleptomania and Pyromania

Introduction

Definition

Impulse control disorders such as kleptomania and pyromania are psychiatric disorders or conditions characterized by extreme and/or harmful desire and behavior. These disorders lead to significant damage or impairment in one’s social and professional life.

Included diagnoses:

• Intermittent explosive disorder Intermittent Explosive Disorder Intermittent explosive disorder (IED) is an impulse-control disorder characterized by abrupt episodes of recurrent, severe, angry outbursts with normal mood maintained between the outbursts. Intermittent Explosive Disorder
• Conduct disorder Conduct Disorder Conduct disorder (CD) is a pediatric mental disorder characterized by a recurrent behavior in which patients do not comply with social norms and rules or the basic rights of others. Examples include violence, destruction, theft, lying, and serious breaking of rules present over ≥ 1 year. Conduct Disorder
• Kleptomania
• Pyromania

Stages of impulsivity Impulsivity Attention Deficit Hyperactivity Disorder

Impulse behavior is fast, insensitive, and unrestrained. There are 5 stages:

• Rising impulse
• Increase in internal tension
• Acting on impulse brings pleasure.
• Sense of relief after action
• Guilt or remorse substitute for pleasure and relief.

Pathophysiology

• Thought to be due to changes in parts of the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification:
  • Limbic system Limbic system The limbic system is a neuronal network that mediates emotion and motivation, while also playing a role in learning and memory. The extended neural network is vital to numerous basic psychological functions and plays an invaluable role in processing and responding to environmental stimuli. Limbic System: Anatomy: responsible for memory Memory Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. Psychiatric Assessment and emotions
  • Frontal lobe Frontal lobe The part of the cerebral hemisphere anterior to the central sulcus, and anterior and superior to the lateral sulcus. Cerebral Cortex: Anatomy: responsible for decision-making
• Increase in level of testosterone Testosterone A potent androgenic steroid and major product secreted by the leydig cells of the testis. Its production is stimulated by luteinizing hormone from the pituitary gland. In turn, testosterone exerts feedback control of the pituitary LH and FSH secretion. Depending on the tissues, testosterone can be further converted to dihydrotestosterone or estradiol. Androgens and Antiandrogens (responsible for aggressive behavior)
• Related to dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS neurotransmitter (controls feelings of pleasure and satisfaction): Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship undergoing dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS agonist therapy are at increased risk of developing an impulse control disorder.

Kleptomania

Definition

Kleptomania is the impulse to steal without the need to (e.g., items stolen are free, have no value, the person doesn’t need them or could afford them), accompanied by a feeling of relief or relaxation after the theft.

• Thefts are unintentional, not planned.
• Items stolen are usually disposed of or never used.
• Symptoms often occur during times of stress.
• Exclude the following disorders:
  • Conduct disorder Conduct Disorder Conduct disorder (CD) is a pediatric mental disorder characterized by a recurrent behavior in which patients do not comply with social norms and rules or the basic rights of others. Examples include violence, destruction, theft, lying, and serious breaking of rules present over ≥ 1 year. Conduct Disorder
  • Manic episode
  • Antisocial personality disorder Antisocial Personality Disorder A personality disorder whose essential feature is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. The individual must be at least age 18 and must have a history of some symptoms of conduct disorder before age 15. Cluster B Personality Disorders

Epidemiology

• Incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency of 0.3%–0.6% (compared with lifetime prevalence Prevalence The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency of shoplifting of 11.3% in the United States)
• Women:men incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency: 3:1.
• High rates of comorbidity with mood and anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorders

Management

Psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy:

• CBT: main treatment; helps patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship identify triggers and how to cope with them
• Insight-oriented psychotherapy Psychotherapy Psychotherapy is interpersonal treatment based on the understanding of psychological principles and mechanisms of mental disease. The treatment approach is often individualized, depending on the psychiatric condition(s) or circumstance. Psychotherapy: systematic desensitization Systematic desensitization A behavior therapy technique in which deep muscle relaxation is used to inhibit the effects of graded anxiety-evoking stimuli. Psychotherapy and aversion conditioning

Medication:

• Opioid Opioid Compounds with activity like opiate alkaloids, acting at opioid receptors. Properties include induction of analgesia or narcosis. Constipation antagonists (e.g., naltrexone Naltrexone Derivative of noroxymorphone that is the n-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. Opioid Analgesics) thought to work on altering dopaminergic pathways
• Antidepressants (e.g., selective serotonin reuptake inhibitors Selective Serotonin Reuptake Inhibitors Serotonin Reuptake Inhibitors and Similar Antidepressants ( SSRIs SSRIs Serotonin Reuptake Inhibitors and Similar Antidepressants) such as paroxetine Paroxetine A serotonin uptake inhibitor that is effective in the treatment of depression. Serotonin Reuptake Inhibitors and Similar Antidepressants) and mood stabilizers (e.g., topiramate Topiramate A sulfamate-substituted fructose analog that was originally identified as a hypoglycemic agent. It is used for the treatment of epilepsy and migraine disorders, and may also promote weight loss. Second-Generation Anticonvulsant Drugs) may be indicated with comorbid psychiatric conditions.

Pyromania

Definition

Pyromania is fire setting that is impulsive, recurrent, and intentional without secondary gain (e.g., insurance payoff or revenge), preceded by tension or anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder and followed by relief or excitement once the fire has been set.

• Fires are usually set in random locations.
• Can inadvertently cause harm, although this is not the goal
• Exclude the following disorders:
  • Conduct disorder Conduct Disorder Conduct disorder (CD) is a pediatric mental disorder characterized by a recurrent behavior in which patients do not comply with social norms and rules or the basic rights of others. Examples include violence, destruction, theft, lying, and serious breaking of rules present over ≥ 1 year. Conduct Disorder
  • Manic episode
  • Antisocial personality disorder Antisocial Personality Disorder A personality disorder whose essential feature is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. The individual must be at least age 18 and must have a history of some symptoms of conduct disorder before age 15. Cluster B Personality Disorders

Epidemiology

• Men > women
• > 40% under the age of 18 
• Comorbid conditions:
  • Mild intellectual disability Disability Determination of the degree of a physical, mental, or emotional handicap. The diagnosis is applied to legal qualification for benefits and income under disability insurance and to eligibility for social security and workman’s compensation benefits. ABCDE Assessment
  • Anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorder
  • Depression

Management

Behavioral therapies:

• CBT helps patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship understand the tension preceding fire starting and find other ways to release it.
• Family therapy Family therapy A form of group psychotherapy. It involves treatment of more than one member of the family simultaneously in the same session. Psychotherapy is indicated for juvenile offenders.
• Recurrent offenders may need supervision and even incarceration Incarceration Inguinal Canal: Anatomy and Hernias.

Medications:

• No FDA-approved treatments 
• Can include SSRIs SSRIs Serotonin Reuptake Inhibitors and Similar Antidepressants and potentially mood-stabilizing medications

Differential Diagnosis

• Bipolar Bipolar Nervous System: Histology disorder: psychiatric illness characterized by periods of depression and  mania Mania A state of elevated excitement with over-activity sometimes accompanied with psychotic symptoms (e.g., psychomotor agitation, inflated self esteem and flight of ideas). It is often associated with mental disorders (e.g., cyclothymic disorder; and bipolar diseases). Bipolar Disorder/ hypomania Hypomania Bipolar Disorder. Part of the disorder’s symptomatology Symptomatology Scarlet Fever includes the impulse to seek pleasure or engage in dangerous activities regardless of consequences. Careful history taking must be completed to rule out the manic phase of bipolar Bipolar Nervous System: Histology disorder before kleptomania or pyromania can be diagnosed. 
• Conduct disorder Conduct Disorder Conduct disorder (CD) is a pediatric mental disorder characterized by a recurrent behavior in which patients do not comply with social norms and rules or the basic rights of others. Examples include violence, destruction, theft, lying, and serious breaking of rules present over ≥ 1 year. Conduct Disorder: mental disorder characterized by recurrent behavior in which patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship do not comply with basic rights of others for duration of 1+ year. This disorder differs from stealing or fire-setting behaviors of kleptomania or pyromania as those are not done to cause personal harm. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with kleptomania or pyromania experience uncontrollable urges prior to their actions.