個案報告──重度憂鬱與偷竊癖共病個案的之治療策略探討

A Case Report: Exploring Treatment Strategies for a Comorbid Case of Major Depression and Kleptomania

【目的】本報告分析一名同時患有偷竊癖與重度憂鬱症的成年女性患者，旨在探討偷竊癖的影響及可能的介入策略，以期為行為矯正或臨床治療提供參考。【方法】本個案報告以一場有關偷竊癖的個案討論會為基礎，並回顧相關文獻，以深入瞭解偷竊癖患者的臨床特徵、疾病進程、神經生理機制及診斷標準，亦參考現有研究中可行的治療方式。報告最後總結出具實證基礎與可行性的治療策略。【結果】個案重複住院14次，過去在出院期間與本院住院期間重複出現偷竊行為。相隔10年後再次住院，依舊在病房中偷竊。個案最近一次再住院期間，除了常規憂鬱症藥物治療之外，採取認知行為治療策略，給予說明竊盜行為的法律責任、訂定行為約定後，於三個月住院期間未再有偷竊行為。【結論】竊盜行為可能與複雜神經生理機制有關，應詳加評估，不宜只視為一般竊盜罪而給予判刑。本案例在住院時所面臨的內外在困境有助於轉化學習，可提高治療配合度與改變動機。在未來的住院治療中，非藥物干預將在治療計劃中發揮重要作用。除了加強家庭支持外，還將考慮認知行為療法（包括厭惡療法和隱藏敏感化）等心理治療策略。搭配輔助療法，如體能活動、冷暴露和園藝療法，可以進一步促進情緒調節，減少衝動，並增強整體心理健康，並降低復發風險。

[Purpose] This report analyzes an adult female patient who suffers from both kleptomania and major depression, aiming to explore the psychological mechanisms, impacts, and possible intervention strategies of kleptomania, to provide a reference for behavioral correction or clinical treatment. [Methods] This case report is based on a case conference on kleptomania. It includes a review of relevant literature to understand the clinical characteristics, disease progression, neurophysiological mechanisms, and diagnostic criteria of individuals with kleptomania. Research on feasible treatment options is also referenced. The report concludes with a summary of evidence-based and practical treatment strategies. [Results] The patient's initial diagnosis was major depression, and the co-morbid diagnosis was kleptomania because of repetitive stealing. She has been hospitalized 14 times, and in the past, she has been repeatedly stealing during his discharge from the hospital and during his stay in this hospital. She was hospitalized again after 10 years and continued to steal in the ward. During the case's most recent hospitalization, in addition to routine depression medication treatment, cognitive behavioral therapy strategies were used. During the three-month hospitalization, there was no further theft. [Conclusion] Theft may be related to complex neurophysiological mechanisms and should be carefully evaluated. It is not appropriate to simply treat it as a general theft crime and impose a sentence. In this case, the internal and external dilemmas encountered during hospitalization facilitated transformational learning, which in turn enhanced treatment compliance and increased motivation for change. In future hospitalizations, nonpharmacological interventions will play an important role in the treatment plan. In addition to strengthening family support, psychotherapeutic strategies such as cognitive-behavioral therapy（including aversion therapy and covert sensitization）will be considered. Such practices as exercise, cold exposure, and horticultural therapy may promote emotional regulation, reduce impulsivity, enhance overall mental health, and decrease the risk of relapse.