Grant Jon E, Kim Suck Won, Odlaug Brian L
Department of Psychiatry, University of Minnesota School of Medicine, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
Biol Psychiatry. 2009 Apr 1;65(7):600-6. doi: 10.1016/j.biopsych.2008.11.022. Epub 2009 Feb 12.
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.
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.
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.
Naltrexone demonstrated statistically significant reductions in stealing urges and behavior in kleptomania. Naltrexone was well tolerated.
偷窃癖是一种罕见的精神障碍，其特征为反复偷窃，且目前尚无经实证验证的治疗方法。本研究考察了阿片类拮抗剂纳曲酮对有偷窃冲动的成年偷窃癖患者的疗效和耐受性。
进行了一项为期8周的双盲、安慰剂对照试验，以评估口服纳曲酮治疗偷窃癖的安全性和疗效。25名符合《精神疾病诊断与统计手册》第四版（DSM-IV）偷窃癖诊断标准的个体被随机分为纳曲酮组（剂量范围为50毫克/天至150毫克/天）或安慰剂组。23名受试者（92%）完成了研究。每2周使用针对偷窃癖修改的耶鲁布朗强迫量表（K-YBOCS）、K-YBOCS的冲动和行为分量表、偷窃癖症状评估量表（K-SAS）、临床总体印象量表（CGI）以及抑郁、焦虑和社会心理功能测量指标对受试者进行评估。
与安慰剂组受试者相比，纳曲酮组受试者的K-YBOCS总分（p = 0.001）、偷窃冲动（p = 0.032）和偷窃行为（p < 0.001）有显著更大程度的降低。纳曲酮组受试者在偷窃癖总体严重程度方面（反映在CGI评分中）也有更大改善（p < 0.001）。纳曲酮的平均有效剂量为116.7（±44.4）毫克/天。
纳曲酮在统计学上显著降低了偷窃癖患者的偷窃冲动和行为。纳曲酮耐受性良好。
