A 36-year-old woman with kleptomania continues to steal despite psychotherapy. Which medication, acting through blockade of the endogenous opioid reward system, has randomised controlled trial evidence for reducing stealing urges in this disorder?
- A Lithium carbonate
- B Naltrexone ✓
- C Topiramate
- D Olanzapine
Correct answer: B. Naltrexone
Explanation
Naltrexone, a mu-opioid receptor antagonist, blocks the pleasure and relief that follows stealing, thereby weakening the urge-reward loop, and controlled trials support its use in kleptomania. This same mechanism explains its benefit in gambling disorder, which shares the impulsivity-reward pathway. Lithium, topiramate and olanzapine lack specific trial evidence in kleptomania and are reserved for comorbid conditions.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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