Shared psychotic disorder

Shared psychotic disorder, a rare and atypical psychotic disorder, occurs when an otherwise healthy person (secondary partner) begins believing the delusions of someone with whom they have a close relationship (primary partner) who is already suffering from a psychotic disorder with prominent delusions. This disorder is also referred to as "folie á deux."

In cases of shared psychotic disorder, the primary partner is most often in a position of strong influence over the other person. This allows them, over time, to erode the defenses of the secondary partner, forcing their strange belief upon them. In the beginning, the secondary partner is probably healthy, but has such a passive or dependent relationship with the primary partner that imposition of the delusional system is but a matter of time. Most of the time, this disorder occurs in a nuclear family. In fact, more than 95% of the cases reported involved people in the same family. Without regard to the number of persons within the family, shared delusions generally involve two people. There is the primary, most often the dominant person, and the secondary or submissive person. This becomes fertile ground for the primary (dominant) partner to press for understanding and belief by others in the family.

Shared psychotic disorder has also been referred to by other names such as psychosis of association, contagious insanity, infectious insanity, double insanity, and communicated insanity. There have been cases involving multiple persons, the most significant being a case involving an entire faamily of 12 people (folie á douze).

Symptoms 

The principal feature of shared psychotic disorder is the unwavering belief by the secondary partner in the dominant partner's delusion. The delusions experienced by both primary partners in shared psychotic disorder are far less bizarre than those found in schizophrenic patients; they are, therefore, believable. Since these delusions are often within the realm of possibility, it is easier for the dominant partner to impose his/her idea upon the submissive, secondary partner.

Diagnosis

A clinical interview is required to diagnose shared psychotic disorder. There are basically three symptoms required for the determination of the existence of this disorder:

• An otherwise healthy person, in a close relationship with someone who already has an established delusion, develops a delusion himself/herself.

• The content of the shared delusion follows exactly or closely resembles that of the established delusion.

• Some other psychotic disorder, such as schizophrenia , is not in place and cannot better account for the delusion manifested by the secondary partner.

Treatment

The treatment approach most recommended is to separate the secondary partner from the source of the delusion. If symptoms have not dissipated within one to two weeks, antipsychotic medications may be in order.

Once stabilized, psychotherapy should be undertaken with the secondary partner, with an eye toward integrating the dominant partner, once he/she has also received medical treatment and is stable.

Sleep terror disorder

Sleep terror disorder is sometimes referred to as pavor nocturnus when it occurs in children, and incubus when it occurs in adults. Sleep terrors are also sometimes called night terrors, though sleep terror is the preferred term, as episodes can occur during daytime naps as well as at night. Sleep terror is a disorder that primarily affects children, although a small number of adults are affected as well.

The symptoms of sleep terror are very similar to the physical symptoms of extreme fear. These include rapid heartbeat, sweating, and rapid breathing (hyperventilation). The heart rate can increase up to two to four times the person's regular rate. Sleep terrors cause people to be jolted into motion, often sitting up suddenly in bed. People sometimes scream or cry. The person's facial expression may be fearful.

People experiencing sleep terror disorder sometimes get out of bed and act as if they are fighting or fleeing something. During this time injuries can occur. Cases have been reported of people falling out of windows or falling down stairs during episodes of sleep terror.

People experiencing sleep terror are not fully awake. They are nearly impossible to bring to consciousness or comfort, and sometimes respond violently to attempts to console or restrain them. In many cases, once the episode is over the person returns to sleep without ever waking fully. People often do not have any recollection of the episode after later awaking normally, although they may recall a sense of fear.

Episodes of sleep terror usually occur during the first third of a person's night sleep, although they can occur even during naps taken in the daytime. The average sleep terror episode lasts less than 15 minutes. Usually only one episode occurs per night, but in some cases terror episodes occur in clusters. It is unusual for a person to have many episodes in a single night, although upwards of 40 have been reported. Most persons with the disorder have only one occurrence per week, or just a few per month.

Sleep terror is diagnosed most often in children when parents express concern to the child's pediatrician. A fact sheet from the American Academy of Child and Adolescent Psychiatry suggests that parents consult a child psychiatrist if the child has several episodes of sleep terror each night, if the episodes occur every night for weeks at a time, or if they interfere with the child's daytime activities. The diagnosis is usually made on the basis of the child's and parents' description of the symptoms. There are no laboratory tests for sleep terror disorder. In adults, the disorder is usually self-reported to the patient's family doctor. Again, the diagnosis is usually based on the patient's description of the symptoms.

Sleep terror is characterized by an abrupt arousal from sleep followed by symptoms of extreme fear. The symptoms often include screams, rapid heartbeat, heavy breathing, and sweating, as well as a subjective feeling of terror. According to the Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision ( DSM-IV-TR ), which is the standard reference work used by mental health professionals to diagnose mental disorders, people with sleep terror disorder do not respond to attempts to comfort or awaken them. In order to meet criteria for the diagnosis, the patients must not be able to recall their dreams, and they must not remember the episode itself. In addition, the episodes may not be attributed to a medical condition or drug use.

Sleep terror disorder is frequently confused with nightmare disorder . The two are similar in the sense that both are related to bad dreams. Nightmare disorder, however, involves a significantly smaller amount of physical movement than does sleep terror. Normally, people experiencing nightmare disorder do not get out of bed.

Moreover, people experiencing nightmare disorder often have problems going back to sleep because of the nature of their dream. Most people experiencing sleep terrors, however, go back to deep sleep without ever having fully awakened. People experiencing nightmares can generally remember their dreams and some of the events in the dream leading up to their awakening. People often awake from nightmares just as they are about to experience the most frightening part of a disturbing dream. People experiencing sleep terrors, however, can sometimes recall a sense of profound fear, but often do not remember the episode at all.

If sleep terror episodes are infrequent, then treatment may not be necessary as long as the episodes are not interfering significantly with the person's life. Some people may want to rearrange their bedroom furniture to minimize the possibility of hurting themselves or others if they get out of bed during a sleep terror episode. To keep children from becoming overly worried about their sleep terrors, experts suggest that parents avoid placing unnecessary emphasis on the episodes. Psychotherapy is often helpful for adults concerned about the specific triggers of sleep terror episodes.

Several different medications have been used to treat sleep terror disorder, with varying degrees of success. One of the most common is diazepam (Valium). Diazepam is a hypnotic (sleep-inducing medication), and is thought to be useful in the prevention of sleep terror episodes because it acts as a nervous system depressant. There are many different types of hypnotics, and choosing one for a patient depends on other drugs that the patient may be taking, any medical or psychological conditions, and other health factors. Most studies of medications as treatments for sleep terror disorder have been done on adult patients; there is little information available on the use of medications to treat the disorder in children.

Sleepwalking Disorder

Sleepwalking episodes usually occur during the first third of the night during the deepest phase of sleep. The episodes can last anywhere from a few minutes up to one hour, with five to 15 minutes being average. Sleepwalkers appear to be awake but are typically unresponsive to individuals who attempt to communicate with them. Persons who sleepwalk typically have no memory or awareness of their actions or movement upon waking.

There appears to be a genetic component for individuals who sleepwalk. The condition is 10 times more likely to occur in close relatives of known sleepwalkers than in the general public. These families also tend to be deep sleepers.

Sleepwalking may also be triggered by fever, which directly affects the nervous system, general illness, alcohol use, sleep deprivation, and emotional stress . Hormonal changes that occur during adolescence, menstruation, and pregnancy can be also be triggers for sleepwalking. Sleepwalking episodes are more likely during times of physiological or psychological stress.

Certain classes of medication have also been shown to precipitate sleepwalking episodes in some individuals. These include: Anti-anxiety or sleep-inducing drugs, antiseizure medications, stimulants, antihistamines, and anti-arrhythmic heart drugs.

Symptoms

• The DSM-IV-TR specifies six diagnostic criteria for sleepwalking disorder:
• Repeated episodes of rising from bed during sleep: These episodes may include sitting up in bed, looking around, and walking, and usually occur during the first third of the night.
• Is unresponsive to attempts at communication: During sleepwalking, the person typically has eyes open, dilated pupils, a blank stare, and does not respond to another's attempts at communication.
• Affected persons typically are only awakened with great difficulty.
• No recollection of the sleepwalking incident: Upon waking, the person typically has no memory of the sleepwalking events. If the individual does awaken from the sleepwalking episode, they may have a vague memory of the incident. Often, sleepwalkers will return to bed, or fall asleep in another place with no recall as to how they got there.
• No impairment of mental activity upon waking: If an individual awakens during a sleepwalking episode, there may be a short period of confusion or disorientation, but there is no impairment of mental activity or behavior.
• Causes significant distress to life situations: Sleepwalking causes significant disruption of social and occupational situations, or affects other abilities to function.
• Not due to substance use or abuse: Sleepwalking disorder is not diagnosed if the cause is related to drug abuse, medication, or a general medical condition.

The line that separates periodic sleepwalking from sleepwalking disorder is not clearly defined. Individuals or families most often seek professional help when the episodes of sleepwalking are violent, pose a risk for injury, or impair the person's ability to function. For a diagnosis of sleepwalking disorder to be made, the person must experience a significant amount of social, occupational, or other impairment related to the sleepwalking problem. Episodes that have a long history extending from childhood through adolescence and especially into adulthood are more likely to be diagnosed with sleepwalking disorder.

Since the individual cannot recall the sleepwalking activity, diagnosis by means of interview is of little benefit, unless it involves someone who has witnessed the sleepwalking behavior. The preferred method for accurate diagnosis is through polysomnography . This technique involves hooking electrodes to different locations on the affected person's body to monitor brain wave activity, heart rate, breathing, and other vital signs while the individual sleeps. Monitoring brain-wave patterns and physiologic responses during sleep can usually give sleep specialists an accurate diagnosis of the condition and determine the effective means of treatment, if any.

Sleepwalking disorder can be difficult to distinguish from sleep terror disorder . In both cases, the individual has motor movement, is difficult to awaken, and does not remember the incident. The primary difference is that sleep terror disorder typically has an initial scream and signs of intense fear and panic associated with the other behaviors.

Treatment 

Treatment for sleepwalking is often unnecessary, especially if episodes are infrequent and pose no hazard to the sleepwalker or others. If sleepwalking is recurrent, or daytime fatigue is suspected to result from disturbed sleep patterns, polysomnography may be recommended to determine whether some form of treatment may be helpful. If stress appears to trigger sleepwalking events in adults, stress management, biofeedback training, or relaxation techniques can be beneficial. Hypnosis has been used help sleepwalkers awaken once their feet touch the floor. Psychotherapy may help individuals who have underlying psychological issues that could be contributing to sleep problems.

Medications are sometimes used in the more severe cases with adults. Benzodiazepines—anti-anxiety drugs— such as diazepam (Valium) or alprazolam (Xanax) can be used to help relax muscles, although these may not result in fewer episodes of sleepwalking. When medications are used, they are typically prescribed in the lowest dose necessary and only for a limited period.

Somatization disorder

Somatization disorder is a psychiatric condition marked by multiple medically unexplained physical, or somatic, symptoms. In order to qualify for the diagnosis of somatization disorder, somatic complaints must be serious enough to interfere significantly with a person's ability to perform important activities, such as work, school or family and social responsibilities, or lead the person experiencing the symptoms to seek medical treatment.

Somatization disorder has long been recognized by psychiatrists and psychologists, and was originally called Briquet's syndrome in honor of Paul Briquet, a French physician who first described the disorder in the nineteenth century. It is included in the category of somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the professional handbook that aids clinicians in diagnosing patients' mental disorders. The term "somatoform" means that the physical symptoms have a psychological origin.

Individuals with somatization disorder suffer from a number of vague physical symptoms, involving at least four different physical functions or parts of the body. The physical symptoms that characterize somatization disorder cannot be attributed to medical conditions or to the use of drugs, and individuals with somatization disorder often undergo numerous medical tests (with negative results) before the psychological cause of their distress is identified. They often use impressionistic and colorful language to describe their symptoms, describing burning sensations, pains that move from place to place, strange tastes on the tongue, tingling, or tremors. While many symptoms resemble those associated with genuine diseases, some of the symptoms reported by people with somatization disorder are not. The individual usually visits many different physicians, but the information they provide about the patient's symptoms can be inconsistent. It is important to note that while the physical symptoms of somatization disorder frequently lack medical explanations, they are not intentionally fabricated. The typical person with somatization disorder has suffered from physical pain, discomfort, and dysfunction for an extended period of time and consulted several doctors; they are hopeful that they one can be found who can identify the cause of their illness and provide relief.

Somatization disorder can be dangerous, since patients may end up taking several different medications, thereby risking harmful drug interactions.

Symptoms 

Gastrointestinal (GI) complaints, such as nausea, bloating, diarrhea, and sensitivities to certain foods are common, and at least two different GI symptoms are required for the diagnosis. Sexual or reproductive symptoms, including pain during intercourse, menstrual problems, and erectile dysfunction are also necessary features for a diagnosis for somatization disorder. Other frequent symptoms are headaches, pain in the back or joints, difficulty swallowing or speaking, and urinary retention. To qualify for the diagnosis, at least one symptom must resemble a neurological disorder, such as seizures , problems with coordination or balance, or paralysis.

To receive a diagnosis of somatization disorder, the individual must have a history of multiple physical complaints that began before age 30 and that continued for several years ( DSM-IV-TR ). These symptoms must cause significant impairment to social, occupational or other areas of functioning—or lead the patient to seek medical treatment.

Each of the following four criteria must be met.

• The individual must report a history of pain affecting at least four different parts or functions of the body. Examples include headaches, back, joint, chest or abdominal pain, or pain during menstruation or sexual intercourse.
• A history of at least two gastrointestinal symptoms, such as nausea, bloating, vomiting, diarrhea, or food intolerance must be reported.
• There must be a history of at least one sexual or reproductive symptom, such as lack of interest in sex, problems achieving erection or ejaculation, irregular menstrual periods, excessive menstrual bleeding, or vomiting throughout pregnancy.
• One symptom must mimic a neurological condition. Examples include weakness, paralysis, problems with balance or coordination, seizures, hallucinations , loss of sensations such as touch, seeing, hearing, tasting, smelling—or difficulty swallowing or speaking, or amnesia and loss of consciousness. Pseudo-neurologic symptoms like these are the primary characteristics of another somatoform disorder known as "conversion disorder."

If a thorough medical evaluation reveals no evidence of an underlying medical- or drug- or medication-induced condition, the diagnosis of somatization disorder is likely. People with genuine medical conditions can qualify for the diagnosis if the level of functional impairment reported is more than would be expected based on medical findings. The symptoms must not be intentionally produced. If the patient is feigning symptoms, a diagnosis of factitious disorder or malingering would most likely be considered.

Treatments 

Cognitive behavior therapy

Cognitive-behavioral therapy (CBT) for somatization disorder focuses on changing negative patterns of thoughts, feelings, and behavior that contribute to somatic symptoms. The cognitive component of the treatment focuses on helping patients identify dysfunctional thinking about physical sensations. With practice, patients learn to recognize catastrophic thinking and develop more rational explanations for their feelings. The behavioral component aims to increase activity. Patients with somatization disorder have usually reduced their activity levels as a result of discomfort or out of fear that activity will worsen symptoms. CBT patients are instructed to increase activity gradually while avoiding overexertion that could reinforce fears. Other important types of treatment include relaxation training, sleep hygiene, and communication skills training. Preliminary findings suggest that CBT may help reduce distress and discomfort associated with somatic symptoms; however, it has not yet been systematically compared with other forms of therapy.

Medications

Antidepressant medications may help to alleviate symptoms of somatization disorder. According to one study, patients with somatization disorder who took the antidepressant nefazodone (Serzone) showed reductions in physical symptoms, increased activity levels, and lower levels of anxiety and depression at the end of treatment.

Trichotillomania

Trichotillomania (trik-o-til-o-MAY-ne-uh) is an irresistible urge to pull out hair from your scalp, eyebrows or other areas of your body. Hair pulling from the scalp often leaves patchy bald spots, which people with trichotillomania may go to great lengths to disguise.

For some people, trichotillomania may be mild and generally manageable. For others, the urge to pull hair is overwhelming and can be accompanied by considerable distress. Some treatment options have helped many people reduce their hair pulling or stop entirely.

Signs and symptoms of trichotillomania often include:

• Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but it can be from other body areas as well
• A strong urge to pull hair, followed by feelings of relief after the hair is pulled
• Patchy bald areas on the scalp or other areas of your body
• Sparse or missing eyelashes or eyebrows
• Chewing or eating pulled-out hair
• Playing with pulled-out hair
• Rubbing pulled-out hair across your lips or face

Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For some people, hair pulling is intentional and focused. They're aware that they're pulling their hair out and may even develop elaborate rituals for doing so. Other people pull their hair unconsciously. The same person may also do both, depending on the situation and mood. For example, focused hair pulling may occur when you're frustrated in the car. Or you may unconsciously pull hair when you're bored. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Your doctor will perform a thorough evaluation to determine if you have trichotillomania, which may include examining how much hair loss you have, having you fill out a questionnaire and eliminating other possible causes of hair pulling or hair loss. In some cases, your doctor may also take a biopsy of your hair or skin to try to pinpoint the problem.

To be diagnosed with trichotillomania, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

DSM criteria for the diagnosis of trichotillomania include:

• Repeatedly pulling out your hair, resulting in noticeable hair loss
• An increasing sense of tension before pulling, or when you try to resist pulling
• Pleasure or relief when pulling
• Your hair loss isn't attributed to another medical or dermatologic condition
• Hair pulling causes you significant distress

There is some debate among mental health providers — and people with trichotillomania — about these criteria, and they may change in the future.

Research on treatment of trichotillomania is limited. Current approaches focus on:

Psychotherapy. A form of psychotherapy called habit reversal training may be an effective treatment for trichotillomania. This type of therapy helps you learn how to recognize situations where you're likely to pull and how to substitute other behaviors instead, such as clenching your fists for a period to "freeze" the urge, or redirecting your hand from your hair to your ear. Sometimes elements of other therapies may be blended with habit reversal training. For instance, your care provider may use cognitive therapy to help you challenge and examine distorted beliefs you may have in relation to hair pulling. Another treatment, acceptance and commitment therapy (ACT), helps people learn to accept their hair-pulling urges while at the same time teaching them how to avoid acting on their impulses.

Medications. Your doctor may also recommend that you take an antidepressant, such as clomipramine (Anafranil).

Walking Corpse Syndrome

Cotard Syndrome is a rare and unusual mental affliction. It is a neuropsychiatric condition in which the person has a delusional belief that he is already dead and no longer exists. The sufferers of this condition think that they are zombies. They develop delusional belief that they are putrefying and can even smell the rotting flesh and that they have lost their internal organs and all the blood. Sometimes they also believe in the delusion of self immortality.

Jules Cotard, a French Neurologist first discovered this disorder and a patient suffering from it. He presented it in a lecture by false name Mademoiselle X in the year 1880.

Symptoms 

Neglect of own hygiene, constant withdrawal feeling, delusion of negation, sometimes delusion of immortality, depression and despair, distorted view of the world etc. Patient may also experience auditory and smell based hallucination.

Person suffering from it may not recognize his own face as well as his known ones. Patient can sometimes smell the odor of his own rotting flesh and feel that his internal organs and blood is lost.  Patient has many delusions and nihilistic delusion about one’s own body is the central one is this condition. Patient can exhibit less interest in society and reduced reaction to pleasurable experiences.

Jules Cotard mentions some symptoms of Cotard Syndrome like:

• anxious melancholy
• ideas of damnation or possession
• disposition towards suicide attempts and self-harm
• the idea that one is immortal and therefore can't die
• insensitivity to pain (analgesia)

Treatments

Medication like antidepressants, antipsychotics and mood stabilizers are used on the patients of Cotard Syndrome. Electroconvulsive therapy (ECT) is also used for the management of this condition. This treatment involves placing electrodes on the patient’s head and administering small electrical pulses. This treatment needs to be carried out in the presence of experienced Psychiatrist. Combination of the medication and the ECT seems to produce more positive effect than only a single method.

Insomnia

Insomnia is a disorder that can make it hard to fall asleep, hard to stay asleep, or both. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.

How much sleep is enough varies from person to person. Most adults need seven to eight hours a night. Many adults experience insomnia at some point, but some people have long-term (chronic) insomnia.

You don't have to put up with sleepless nights. Simple changes in your daily habits can help.

Insomnia symptoms may include:

• Difficulty falling asleep at night
• Awakening during the night
• Awakening too early
• Not feeling well rested after a night's sleep
• Daytime fatigue or sleepiness
• Irritability, depression or anxiety
• Difficulty paying attention or focusing on tasks
• Increased errors or accidents
• Tension headaches
• Gastrointestinal symptoms
• Ongoing worries about sleep

Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week.

When to see a doctor

If insomnia makes it hard for you to function during the day, see your doctor to determine what might be the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

In addition to asking you a number of questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks, if you haven't already done so.

Your doctor will do a physical exam to look for signs of other problems that may be causing insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that can cause insomnia.

If the cause of your insomnia isn't clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

Treatments

Changing your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people. Good sleep hygiene — simple steps such as keeping the same bedtime and arising time — promotes sound sleep and daytime alertness. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep.

Behavior therapies

Behavioral treatments teach you new sleep behaviors and ways to improve your sleeping environment. Behavior therapies are equally or more effective than are sleep medications. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.

Behavior therapies include:

Education about good sleeping habits. Sleep hygiene teaches habits that promote good sleep.

Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.

Cognitive behavioral therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive behavioral therapy can be taught through one-on-one counseling or in group sessions.

'Stimulus control.' This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.

Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.

Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside or get light via a medical-grade light box.

Medications

Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.

Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use. However, some of these medications are habit-forming.

If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone, doxepin or mirtazapine (Remeron).

Over-the-counter sleep aids

Sleep medications available over-the-counter contain antihistamines that can make you drowsy. But antihistamines may reduce the quality of your sleep, and they can cause side effects, such as daytime sleepiness, dry mouth and blurred vision. These effects may be worse in the elderly.

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Krabbe (KRAH-buh) disease | inherited disorder

DEFINITION

Krabbe (KRAH-buh) disease is an inherited disorder that destroys the protective coating (myelin) of nerve cells in the brain and throughout the nervous system.

In most cases, signs and symptoms of Krabbe disease develop in babies before 6 months of age, and the disease usually results in death by age 2. When it develops in older children and adults, the course of the disease can vary greatly.

There's no cure for Krabbe disease, and treatment focuses on supportive care. However, stem cell transplants have shown some success in infants who are treated before the onset of symptoms and in some older children and adults.

Krabbe disease affects about 1 in 100,000 people in the United States. It is also known as globoid cell leukodystrophy.

SYMPTOMS

In most cases, the signs and symptoms of Krabbe disease appear during the first few months of life. They begin gradually and progressively worsen.

Infants

Common signs and symptoms early in the course of the disease include the following:

• Feeding difficulties
• Unexplained crying
• Extreme irritability
• Fever with no sign of infection
• Declines in alertness
• Delays in typical developmental milestones
• Muscle spasms
• Loss of head control
• Frequent vomiting

As the disease progresses, signs and symptoms become more severe. They may include:

• Seizures
• Loss of developmental abilities
• Progressive loss of hearing and sight
• Rigid, constricted muscles
• Stiff, fixed posture
• Progressive loss of ability to swallow and breathe

Older children and adults

When Krabbe disease develops later in childhood or during adulthood, signs and symptoms can vary widely. They may include:

• Progressive loss of vision
• Difficulty walking (ataxia)
• Decline in thinking skills
• Loss of manual dexterity
• Muscles weakness

As a general rule, the younger the age that Krabbe disease occurs, the faster the disease progresses and the more likely it is to result in death.

Some people diagnosed during adolescence or adulthood may have less severe symptoms, with muscle weakness as a primary condition. They may have no impairment of their thinking skills.

When to see a doctor

The early signs and symptoms of Krabbe disease in infancy can indicate any number of diseases or developmental problems. Therefore, it's important to get a prompt and accurate diagnosis if your child is experiencing any signs or symptoms of the disease.

Signs and symptoms most often associated with older children and adults also are not specific to Krabbe disease and require a timely diagnosis.

CAUSES

Krabbe disease is caused when a person inherits two copies of an altered (mutated) gene — one copy from each parent.

A gene provides a kind of blueprint for producing proteins. If there is an error in this blueprint, then the protein product may not work properly. In the case of Krabbe disease, two mutated copies of a particular gene result in little or no production of an enzyme called galactocerebrosidase (GALC).

Enzymes, such as GALC, are responsible for breaking down certain substances in a cell's recycling center (lysosome). In Krabbe disease, the short supply of GALC enzymes results in the accumulation of certain types of fats called galactolipids.

Damage to nerve cells

Galactolipids normally exist in cells that produce and maintain the protective coating of nerve cells (myelin). However, an abundance of galactolipids has a toxic effect. Some galactolipids trigger myelin-forming cells to self-destruct.

Other galactolipids are taken up by specialized debris-eating cells in the nervous system called microglia. The process of cleaning up excessive galactolipids transforms these normally helpful cells into abnormal, toxic cells called globoid cells, which promote myelin-damaging inflammation.

The subsequent loss of myelin (demyelination) prevents nerve cells from sending and receiving messages.

RISK FACTORS

The gene mutation associated with Krabbe disease only causes the disease if two mutated copies of the gene are inherited. A disease resulting from two mutated copies is called an autosomal recessive disorder.

If each parent has one mutated copy of the gene, the risk for a child would be as follows:

• A 25 percent chance of inheriting two mutated copies, which would result in the disease
• A 50 percent chance of inheriting only one mutated copy, which would result in the child being a carrier of the mutation but would not result in the disease itself
• A 25 percent chance of inheriting two normal copies of the gene

Genetic testing

Genetic testing to understand the risk of having a child with Krabbe disease may be considered in certain situations:

• If one or both parents are likely carriers of a GALC gene mutation because of a known family history of Krabbe disease, a couple may want to have tests to understand the risks in their own family.
• If one child is diagnosed with Krabbe disease, a family may consider genetic tests to identify other children who could develop the disease later in life.
• If the parents are known carriers, they may request a prenatal genetic test to determine if their child is likely to develop the disease.
• Known carriers, who are using in vitro fertilization, may request a genetic test with fertilized eggs before implantation.

Genetic testing should be carefully considered. Ask your doctor about genetic counseling services that can help you understand the benefits, limits and implications of genetic testing.

COMPLICATIONS

A number of complications — including infections and respiratory difficulties — can develop in children with advanced Krabbe disease. In the later stages of the disease, children become incapacitated, are confined to their beds and eventually lapse into a vegetative state.

Most children who develop Krabbe disease in infancy die before the age of 2, most often from respiratory failure or complications of immobility and markedly decreased muscle tone. Children who develop the disease later in childhood may have a somewhat longer life expectancy, usually between two and seven years after diagnosis.

PREPARING FOR YOUR APPOINTMENT

In some cases, Krabbe disease is diagnosed in newborns with screening tests before symptoms appear. Conversations with your child's doctor and a specialist in nervous system disorders (neurologist) would begin as soon as a diagnosis is confirmed. In most cases, however, the onset of symptoms triggers an exploration of possible causes.

Well-baby visits

It's important to take your child to all regularly scheduled well-baby visits and annual appointments during childhood. These visits are an opportunity for your child's doctor to monitor your child's development in key areas, including:

• Growth
• Muscle tone
• Muscle strength
• Coordination
• Posture
• Age-appropriate motor skills
• Sensory abilities — vision, hearing and touch

Questions you should be prepared to answer during regular checkups might include the following:

• What concerns do you have about your child's growth or development?
• How well does he or she eat?
• How does your child respond to touch?
• Is your child reaching certain milestones in development, such as rolling over, pushing up, sitting up, crawling, walking or speaking?

Preparing for other doctor visits

If you're seeing your doctor because of the recent onset of symptoms, you'll likely start by seeing your general practitioner or your child's pediatrician. After an initial evaluation, your doctor may refer you to a neurologist.

Be prepared to answer the following questions about your symptoms or on your child's behalf:

• What signs or symptoms have you noticed? When did they begin?
• Have these signs or symptoms changed over time?
• Do you notice any changes in your child's attentiveness?
• Has your child had a fever?
• Have you noticed unusual or excessive irritability?
• Have you noticed changes in eating habits?

Questions especially for older children or adults may include:

• Has your child experienced any changes in school performance?
• Have you experienced difficulty with normal tasks or job-related work?
• Are you or is your child being treated for any other medical conditions?
• Have you or your child recently begun a new medication?

TESTS AND DIAGNOSIS

Your doctor will conduct a general physical exam and assess signs and symptoms that may indicate a neurological disease. A diagnosis of Krabbe disease is based on a series of tests, which may include the following.

Laboratory tests

A blood sample and small skin sample (biopsy) will be sent to a laboratory to assess the level of GALC enzyme activity. Very low or no GALC activity level may indicate Krabbe disease.

Although the results help a doctor make a diagnosis, they don't provide evidence of how quickly the disease may progress. For example, very low GALC activity doesn't always mean that the condition will advance rapidly.

Imaging tests

Your doctor may order one or more imaging tests that can detect the loss of myelin (demyelination) in affected regions of the brain. These may include:

• Magnetic resonance imaging (MRI), a technology that uses radio waves and a magnetic field to produce detailed 3-D images
• Computerized tomography (CT), a specialized X-ray technology that produces 2-D images

Nerve conduction study

A nerve conduction study assesses the rate at which nerves conduct a signal — essentially how quickly can they send a message. A special device measures the time it takes an electrical impulse to travel from one point on the body to another. When myelin is impaired, nerve conduction is slower.

Genetic testing

A genetic test may be done with a blood sample to confirm a diagnosis. There are variant forms of the mutated gene that results in Krabbe disease. The particular type of mutation may provide some clues regarding the expected course of the disease.

Newborn screening

In some states, a screening test for Krabbe disease is part of a standard set of assessments for newborns. The initial screening test measures GALC enzyme activity. If the enzyme activity is found to be low, follow-up GALC tests and genetic tests are conducted.

The use of newborn screening tests is relatively new. Researchers are still working to understand how best to use these tests, how well the tests lead to an accurate diagnosis and how well they predict the course of the disease.

TREATMENTS AND DRUGS

For infants who have already developed symptoms of Krabbe disease, there is currently no treatment that can change the course of the disease. Treatment, therefore, focuses on managing symptoms and providing supportive care. Interventions may include the following:

• Anticonvulsant medications to manage seizures
• Drugs to ease muscle spasticity and irritability
• Physical therapy to minimize deterioration of muscle tone
• Nutritional support, such as the use of a tube to deliver fluids and nutrients directly into the stomach (gastric tube)

Interventions for older children or adults with less severe forms of the disease may include:

• Physical therapy to minimize deterioration of muscle tone
• Occupational therapy to achieve as much independence as possible with daily activities

Stem cell transplantation

Hematopoietic stem cells are specialized cells that can develop into all of the different types of blood cells in the body. These stem cells are also the source of microglia, specialized debris-eating cells that take up residence in the nervous system. In Krabbe disease, microglia are transformed into toxic globoid cells.

In stem cell transplantation, donor stem cells are delivered into the recipient's bloodstream through a tube called a central venous catheter. The donor stem cells help the body produce healthy microglia that can populate the nervous system and deliver functioning GALC enzymes. This treatment may help restore some degree of normal myelin production and maintenance.

This therapy may improve outcomes in infants if treatment begins before the onset of symptoms — that is, when a diagnosis results from a newborn screening test.

Presymptomatic infants receiving a stem cell transplant have had slower disease progression, but these children still experience significant difficulties with speech, walking and other motor skills.

Older children and adults with mild symptoms also may benefit from this treatment.

Sources for hematopoietic stem cells include:

• Umbilical cord blood
• Donor bone marrow
• Donor circulating (peripheral) blood stem cells

LIFESTYLE AND HOME REMEDIES

Krabbe (KRAH-buh) disease is an inherited disorder that destroys the protective coating (myelin) of nerve cells in the brain and throughout the nervous system.

In most cases, signs and symptoms of Krabbe disease develop in babies before 6 months of age, and the disease usually results in death by age 2. When it develops in older children and adults, the course of the disease can vary greatly.

There's no cure for Krabbe disease, and treatment focuses on supportive care. However, stem cell transplants have shown some success in infants who are treated before the onset of symptoms and in some older children and adults.

Krabbe disease affects about 1 in 100,000 people in the United States. It is also known as globoid cell leukodystrophy.

Niemann-Pick disease

DEFINITION

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

SYMPTOMS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

CAUSES

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

RISK FACTORS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

COMPLICATIONS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

PREPARING FOR YOUR APPOINTMENT

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

TESTS AND DIAGNOSIS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

TREATMENTS AND DRUGS

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

LIFESTYLE AND HOME REMEDIES

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

TRYPOPHOBIA | Fear Of Holes

Definition 

TRYPOPHOBIA is a pathological fear of holes, particular those that are clustered together in a pattern. Trypophobia was coined in 2005 and derives its name from the Greek τρύπα (trýpa) “hole” and φόβος (phóbos) “fear”. According to Cole and Wilkins (2015) trypophobia is a “fear of holes” in which “Sufferers report aversion to visual stimuli comprising particular configuration of holes. The stimuli are usually clusters of holes of any variety that are almost always innocuous and seemingly pose no threat” . The phobia itself claims many sufferers although not currently recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), or any other scientific literature. 

Kleptomania | Impulse control disorder

DEFINITION

Kleptomania is the irresistible urge to steal items that you generally don't really need and that usually have little value. Kleptomania (klep-toe-MAY-knee-uh) is a serious mental health disorder that can cause much emotional pain to you and your loved ones if not treated.

Kleptomania is a type of impulse control disorder — a disorder in which you can't resist the temptation or drive to perform an act that's harmful to you or someone else. 

Many people with kleptomania live lives of secret shame because they're afraid to seek mental health treatment. Although there's no cure for kleptomania, treatment with medication or psychotherapy may be able to help end the cycle of compulsive stealing.

SYMPTOMS

Kleptomania symptoms may include:

• Powerful urges to steal items that you don't need 
• Feeling increased tension leading up to the theft 
• Feeling pleasure or gratification while stealing 
• Feeling terrible guilt or shame after the theft 

A powerful urge

Unlike typical shoplifters, people with kleptomania don't compulsively steal for personal gain. Nor do they steal as a way to exact revenge. They steal simply because the urge is so powerful that they can't resist it. This urge makes them feel uncomfortably anxious, tense or aroused. To soothe these feelings, they steal.

During the theft, they feel relief and gratification. Afterward, though, they may feel enormous guilt, remorse, self-loathing and fear of arrest. But the urge comes back, and the kleptomania cycle repeats itself.

Spontaneous occurrences and public places
Episodes of kleptomania generally occur spontaneously, without planning. Most people with kleptomania steal from public places, such as stores and supermarkets. Some may steal from friends or acquaintances, such as at a party. Often, the stolen items have no value to the person with kleptomania. The stolen items are usually stashed away, never to be used. Items may also be donated, given away to family or friends, or even secretly returned to the place from which they were stolen. 

When to see a doctor

If you can't stop shoplifting or stealing, seek medical advice. Many people who may have kleptomania don't want to seek treatment because they're afraid they'll be arrested or jailed. A mental health provider doesn't have to report your thefts to authorities, however. Getting treatment may help you gain control over your kleptomania.

If a loved one has kleptomania

If you suspect a close friend or family member may have kleptomania, gently raise your concerns with your loved one. Keep in mind that kleptomania is a mental health condition, not a character flaw, and approach your loved one without blame or accusation.

It may be helpful to emphasize the following points:

• You're concerned because you care about your loved one's health and well-being. 
• You're worried about the risks of compulsive stealing, such as being arrested, losing a job or damaging a valued relationship. 
• You understand that, with kleptomania, the urge to steal may be too strong to resist just by \"putting your mind to it.\" 
• Effective treatments are available to minimize the urge to steal and help your loved one live without addiction and shame. 

If you need help preparing for this conversation, talk with your doctor. He or she may refer you to a mental health provider who can help you plan a way of raising your concerns without making your loved one feel defensive or threatened.

CAUSES

The cause of kleptomania isn't known. There are several theories that suggest that changes in the brain may be at the root of kleptomania. Kleptomania may be linked to problems with a naturally occurring brain chemical (neurotransmitter) called serotonin. Serotonin helps regulate moods and emotions. Low levels of serotonin are common in people prone to impulsive behaviors.

Kleptomania also may be related to addictive disorders, and stealing may cause the release of dopamine (another neurotransmitter). Dopamine causes pleasurable feelings, and some people seek this rewarding feeling again and again.

Other research has found that kleptomania can occur after someone sustains a head injury. More research is needed to better understand all of these possible causes of kleptomania.

RISK FACTORS

Kleptomania is considered uncommon. However because many people with kleptomania never seek treatment, or they're simply jailed after repeated thefts, many cases of kleptomania may never be diagnosed. It's thought that fewer than 5 percent of shoplifters have kleptomania. Kleptomania often begins during adolescence or in young adulthood, but in rare cases it begins after 50 years of age.

Kleptomania risk factors may include:

• Family history. Having a first-degree blood relative, such as a parent or sibling, with kleptomania or obsessive-compulsive disorder may increase your risk of kleptomania. 
• Being female. Approximately two-thirds of people with known kleptomania are women. 
• Having another mental illness. People with kleptomania often have other mental illnesses, such as bipolar disorder, anxiety disorder, eating disorders, substance abuse or personality disorders. 
• Head trauma or brain injuries. People who've experienced a head trauma may develop kleptomania. 

COMPLICATIONS

Left untreated, kleptomania can result in severe emotional, legal and financial problems. For example, many people with known kleptomania have been arrested for shoplifting. Because you know stealing is wrong but you feel powerless to resist the impulse, you may be wracked by guilt, shame, self-loathing and humiliation. You may otherwise lead a moral, upstanding life and be confused and upset by your compulsive stealing.

Complications that kleptomania may cause or be associated with include:

• Arrest 
• Imprisonment 
• Depression 
• Alcohol and substance abuse 
• Eating disorders 
• Anxiety 
• Compulsive gambling or shopping 
• Suicidal thoughts or behavior 
• Social isolation 

PREPARING FOR YOUR APPOINTMENT

If you struggle with an irresistible urge to steal, call your doctor. Making that call will undoubtedly be scary, but trust that your doctor is interested in caring for your health, not in judging you. Your doctor may refer you to a mental health provider, such as a psychiatrist, with experience diagnosing and treating kleptomania.

Use the information below to prepare for your first appointment and learn what to expect from the mental health provider.

What you can do:

• Write down any symptoms you're experiencing, and for how long. It will help the mental health provider to know what kinds of events seem to trigger your urge to steal. 
• Write down key personal information,including traumatic events in your past and any current, major stressors. 
• Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications or supplements you're taking. 
• Take a trusted family member or friend along, if possible. It can be difficult to remember everything your mental health provider says, and a loved one can help remember the details. In addition, someone who has known you for a long time may be able to ask questions or share information with the mental health provider that you don't remember to bring up. 
• Write down questions to ask your mental health provider in advance so that you can make the most of your appointment. 

For kleptomania, some basic questions to ask your mental health provider include:

• Why can't I stop stealing? 
• What treatments are available? 
• What treatments are most likely to work for me? 
• How quickly will I stop stealing? 
• Will I still feel the urge to steal? 
• How often do I need therapy sessions, and for how long? 
• Would family therapy be helpful in my case? 
• Are there medications that can help? 
• What are the possible side effects of these medications? 
• I have these other health conditions. How can I best manage these conditions together? 
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting? 

What to expect from your mental health provider

The mental health provider will likely ask you a number of questions to better understand your symptoms and how they're affecting your life. The mental health provider may ask:

• At what age did you first experience an irresistible urge to steal? 
• How often do you experience the urge to steal? 
• Have you ever been caught or arrested for stealing? 
• How would you describe your feelings before, during and after you steal something? 
• What kinds of items do you steal? Are they things you need? 
• From whom do you steal? 
• What do you do with the items you steal? 
• Does anything in particular seem to trigger your urge to steal? 
• How would you say your urge to steal is affecting your life, including school, work and personal relationships? 
• Have any of your close relatives had a problem with compulsive stealing, or with other mental health conditions such as depression, addiction or obsessive-compulsive disorder? 
• Have you been treated for any other mental health problems, including eating disorders? If yes, what treatments were most effective? 
• Do you use alcohol or illegal drugs? How often? 
• Are you currently being treated for any other medical conditions? 

TESTS AND DIAGNOSIS

When you decide to seek treatment for symptoms of possible kleptomania, you may have both a physical and psychological evaluation. The physical exam can determine if there may be any physical causes triggering your symptoms.

There's no laboratory test to diagnose kleptomania. Instead, kleptomania is diagnosed based on your signs and symptoms. Kleptomania is a type of impulse control disorder. In addition to asking questions about your impulses and how they make you feel, your doctor may review a list of situations to see if they trigger kleptomania episodes. You may also fill out psychological questionnaires or self-assessments to help pinpoint a diagnosis.

To be diagnosed with kleptomania, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment. Criteria for a kleptomania diagnosis include:

• You have an inability to resist urges to steal objects that aren't needed for personal use or monetary value 
• You feel increasing tension leading up to the theft 
• You sense feelings of pleasure, relief or gratification during the act of stealing 
• The theft isn't committed as a way to exact revenge or to express anger, and isn't done while hallucinating or delusional 
• The stealing isn't related to manic episodes of bipolar disorder or other mental health disorders, such as antisocial personality disorder 

TREATMENTS AND DRUGS

Although fear, humiliation or embarrassment may make it difficult for you to seek treatment for kleptomania, it's important to get help. Kleptomania is difficult to overcome on your own. Treatment of kleptomania typically involves medications and psychotherapy, perhaps along with self-help groups. However, there's no standard kleptomania treatment, and researchers are still trying to understand what may work best. You may have to try several types of kleptomania treatment to find something that works well for your situation.

Medications

There's little solid scientific research about using psychiatric medications to treat kleptomania. However, certain medications may be helpful. Which medication is best for you depends on your overall situation and other conditions you may have, such as depression or obsessive-compulsive disorder. You may benefit from taking a combination of medications. Medications to consider include:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat kleptomania. These include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR), fluvoxamine (Luvox, Luvox CR) and others. 
• Mood stabilizers. These medications are meant to even out your mood so that you don't have rapid or uneven changes that may trigger urges to steal. One mood stabilizer used to treat kleptomania is lithium (Lithobid). 
• Anti-seizure medications. Although originally intended for seizure disorders, these medications have shown benefits in certain mental health disorders, possibly including kleptomania. Examples include topiramate (Topamax) and valproic acid (Depakene, Stavzor). 
• Addiction medications. Naltrexone (Revia, Vivitrol), known technically as an opioid antagonist, blocks the part of your brain that feels pleasure with certain addictive behaviors. It may reduce the urges and pleasure associated with stealing. 

You may have to try several different medications or combinations of medications to see what works best for you with the fewest side effects. Keep in mind that it may take several weeks to notice full benefits. Talk to your doctor or mental health provider if you're bothered by side effects. Under his or her guidance, you may be able to switch medications or change your dosage. Many side effects eventually go away.

Psychotherapy

Cognitive behavioral therapy has become the psychotherapy of choice for kleptomania. In general, cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Cognitive behavioral therapy may include these techniques to help you overcome kleptomania urges:

• Covert sensitization, in which you picture yourself stealing and then facing negative consequences, such as being caught 
• Aversion therapy, in which you practice mildly painful techniques, such as holding your breath until you become uncomfortable, when you get an urge to steal 
• Systematic desensitization, in which you practice relaxation techniques and picture yourself controlling urges to steal 

Other forms of therapy, such as psychodynamic therapy, family therapy or marriage counseling, also may be helpful.

Avoiding relapses

It's not unusual to have relapses of kleptomania. To help avoid relapses, be sure to stick to your treatment plan. If you feel urges to steal, contact your mental health provider or reach out to a trusted support group.

LIFESTYLE AND HOME REMEDIES

Kleptomania is the irresistible urge to steal items that you generally don't really need and that usually have little value. Kleptomania (klep-toe-MAY-knee-uh) is a serious mental health disorder that can cause much emotional pain to you and your loved ones if not treated.

Kleptomania is a type of impulse control disorder — a disorder in which you can't resist the temptation or drive to perform an act that's harmful to you or someone else.

Many people with kleptomania live lives of secret shame because they're afraid to seek mental health treatment. Although there's no cure for kleptomania, treatment with medication or psychotherapy may be able to help end the cycle of compulsive stealing.