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Clinical Atlas Prestige · Evidence-first

Psych VivasGeneral adult psychiatry — impulse control

Psych Vivas · General adult psychiatry — impulse control

Kleptomania and pyromania — structured clinical viva

Fellowship viva covering DSM-5-TR criteria for kleptomania and pyromania, instrumental crime exclusions, Grant naltrexone RCT, Koran escitalopram nuance, CBT, and multi-agency risk.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A 29-year-old woman with repeated unneeded shoplifting and post-arrest despair is referred. The consultant also asks you to teach a junior how to separate pyromania from arson. Discuss criteria, differentials, evidence-based management including naltrexone, and risk formulation.

Interpretation

Reveal interpretation

Kleptomania criteria. Operationalise: unneeded objects, tension before, pleasure/relief at theft, exclusions (anger/vengeance, delusion/hallucination, CD/mania/ASPD better explanation). Clinical series show high comorbidity and shame; many have prior arrests.[3][6]

Is medication useful? No labelled cure. Naltrexone has double-blind RCT evidence reducing urges and stealing versus placebo; practical start 50 mg oral daily after LFTs and opioid clearance; off-label counselling required; always pair with CBT/stimulus control.[1][6] Escitalopram open-label then failed double-blind discontinuation — do not overclaim SSRI maintenance for the drive itself; still treat depression.[4]

Pyromania versus arson. Fire-setting = behaviour; arson = legal charge; pyromania = rare diagnosis with fascination/tension-relief and a long exclusion list (money, ideology, concealment, anger/vengeance, impaired judgment, CD/mania/ASPD). Most arson is not pyromania.[2][5]

Risk formulation. Static: prior arrests, early onset if present, prior fire-setting. Dynamic: current legal crisis, substance use, untreated depression, access to cues/accelerants, non-engagement. Protective: motivation, family support, treatment engagement. Explicitly assess suicide after shame/arrest and public safety for fire risk. Multi-agency when needed.[5][6]

Expected probes

  1. State the “object not needed” criterion precisely.
  2. List at least four pyromania exclusions.
  3. Name Grant naltrexone RCT and Koran escitalopram discontinuation nuance.
  4. What baseline checks before naltrexone?
  5. Why is pyromania uncommon among arson defendants?
  6. How do you manage post-arrest suicide risk?
[1] [2] [4] [5]

Pass criteria

  • Accurate operational criteria without inventing thresholds
  • Clear behaviour vs charge vs diagnosis language for fire-setting
  • Evidence-based yet humble plan (CBT + off-label naltrexone with safety checks)
  • Explicit suicide and public-safety risk work
  • No nihilism and no overclaim of cure
[1] [3] [5] [6]

References

  1. [1]Grant JE, Kim SW, Odlaug BL A double-blind, placebo-controlled study of the opiate antagonist, naltrexone, in the treatment of kleptomania Biol Psychiatry, 2009.PMID 19217077
  2. [2]Grant JE, Won Kim S Clinical characteristics and psychiatric comorbidity of pyromania J Clin Psychiatry, 2007.PMID 18052565
  3. [3]McElroy SL, Pope HG Jr, Hudson JI, et al. Kleptomania: a report of 20 cases Am J Psychiatry, 1991.PMID 2018170
  4. [4]Koran LM, Aboujaoude EN, Gamel NN Escitalopram treatment of kleptomania: an open-label trial followed by double-blind discontinuation J Clin Psychiatry, 2007.PMID 17388713
  5. [5]Burton PRS, McNiel DE, Binder RL Firesetting, arson, pyromania, and the forensic mental health expert J Am Acad Psychiatry Law, 2012.PMID 22960918
  6. [6]Schreiber L, Odlaug BL, Grant JE Impulse control disorders: updated review of clinical characteristics and pharmacological management Front Psychiatry, 2011.PMID 21556272