Response of pyromania to biological treatment in a homeless person

Randolph W Parks, Russell DJ Green, Sobhi Girgis, Michael D Hunter, Peter WR Woodruff, Sean A Spence

Academic Clinical Psychiatry, University of Sheffield School of Medicine, Sheffield, UK

Abstract: Pyromania has been associated with abnormalities of impulsivity, social estrangement, cognitive flexibility, and executive function. We aim to investigate whether psychopharmacological interventions increase cognitive test performance and decrease frequency of serious clinical incidents during inpatient admission for pyromania. This is a case study of a 20-year-old homeless male who met DSM-IV criteria for pyromania. Neuropsychological testing was administered on psychiatric admission and repeated 5-months later following psychopharmacological treatment with olanzapine and sodium valproate. Baseline neuropsychological assessment revealed impairments in attention, verbal/visual memory, and executive functions, whereas visuospatial skills were intact. Five-month follow-up neuropsychological assessment showed substantial improvement on cognitive tests, while visuospatial skills remained within the normal range. A decrease in frequency of serious clinical incidents occurred during the course of inpatient admission. Fire-setting behavior abated. Psychopharmacological treatment may have facilitated improvement in cognitive test performance, social-adaptive functioning, and decreased aggressive behavior. It might have a more specific role in the treatment of mental disorders characterized by impulsive dangerousness.

Keywords: pyromania, olanzapine, sodium valproate, neuropsychological assessment, psychopharmacological treatment, homelessness, executive function