Kleptomania and pyromania — structured clinical viva

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]