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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV1126

Combination treatment with aripiprazole, haloperidol, and quetiapine in a case of treatment-resistant pyromania: a case report

COMBINATION THERAPY WITH ARIPIPRAZOLE, HALOPERIDOL, AND QUETIAPINE IN A TREATMENT-REFRACTORY PATIENT WITH PYROMANIA: A CASE REPORT

In a case of pyromania unresponsive to multiple treatment trials, fire-setting behavior ceased completely with a triple antipsychotic regimen consisting of quetiapine, haloperidol, and aripiprazole.

The aim of this report is to describe the pharmacological management of a treatment-resistant case of pyromania characterized by recurrent deliberate fire-setting, in which comorbid paraphilias reinforced the behavioral impulse. The patient is a 46-year-old woman with a history of multiple psychiatric admissions, 11 documented incidents of arson, and a co-occurring sexual paraphilia. Previous treatment trials included valproate as a mood stabilizer; fluoxetine, sertraline, venlafaxine, and vortioxetine from the SSRI/SNRI group; and risperidone, olanzapine, paliperidone, and zuclopenthixol as antipsychotics, but behavioral stability was not achieved. During her most recent admission, a triple antipsychotic regimen was initiated comprising quetiapine 300 mg (broad receptor profile), haloperidol 10 mg (potent D2 blockade), and aripiprazole 15 mg (D2 partial agonism). Long-term stability was achieved after discharge, with complete cessation of fire-setting tendencies and paraphilic urges, and no fire-setting behavior occurred after discharge (0 incidents). The authors suggest that multilevel modulation of dopaminergic and serotonergic pathways—namely, the combination of potent D2 blockade, stabilizing partial agonism, and a broad receptor profile—may have suppressed impulsivity and paraphilic arousal where conventional polypharmacy had failed.

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