Kim S W, Grant J E, Adson D E, Shin Y C
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota 55454-1495, USA.
Biol Psychiatry. 2001 Jun 1;49(11):914-21. doi: 10.1016/s0006-3223(01)01079-4.
The authors' goal was to assess the efficacy and tolerability of naltrexone in the treatment of pathologic gambling disorder.
Eighty-three subjects who met criteria for DSM-IV pathologic gambling disorder were enrolled in a 1-week single-blind placebo lead-in followed by an 11-week double-blind naltrexone or placebo trial. Naltrexone was started at 25 mg/day and titrated upward until maximum symptom improvement or 250 mg/day was achieved. Gambling symptom change was assessed with the patient-rated Clinical Global Impression (PG-CGI-PT), clinician-rated CGI (PG-CGI-MD), and the Gambling Symptom Rating Scale (G-SAS). Side effects were monitored weekly and liver function tests biweekly.
Data from 45 patients were analyzed. Using random regression analysis, significant improvement was noted in all three gambling symptom measures: patient-rated Clinical Global Impression, p <.001; clinician-rated CGI, p <.001; Gambling Symptom Rating Scale, p <.019. At study end, 75% of subjects taking naltrexone were much or very much improved on both the PE-CEI PT and the PG-CGI-MD, compared with only 24% of those on placebo. Elevated liver enzymes occurred in four subjects who were taking analgesics concurrently. Nausea was common during the first week of treatment.
Results suggest that naltrexone is effective in reducing the symptoms of pathologic gambling. Until further studies corroborate the present findings, our report should be interpreted cautiously.
作者的目标是评估纳曲酮治疗病理性赌博障碍的疗效和耐受性。
83名符合DSM-IV病理性赌博障碍标准的受试者参加了为期1周的单盲安慰剂导入期，随后是为期11周的双盲纳曲酮或安慰剂试验。纳曲酮起始剂量为25毫克/天，然后逐渐增加剂量，直至症状得到最大改善或达到250毫克/天。使用患者自评的临床总体印象量表（PG-CGI-PT）、临床医生评定的CGI量表（PG-CGI-MD）和赌博症状评定量表（G-SAS）评估赌博症状的变化。每周监测副作用，每两周进行肝功能检查。
分析了45名患者的数据。采用随机回归分析，在所有三项赌博症状测量指标上均发现显著改善：患者自评的临床总体印象量表，p<.001；临床医生评定的CGI量表，p<.001；赌博症状评定量表，p<.019。在研究结束时，服用纳曲酮的受试者中75%在患者自评的临床总体印象量表和临床医生评定的CGI量表上有很大或非常大的改善，而服用安慰剂的受试者中这一比例仅为24%。4名同时服用镇痛药的受试者出现肝酶升高。恶心在治疗的第一周很常见。
结果表明纳曲酮在减轻病理性赌博症状方面有效。在进一步研究证实目前的发现之前，对本报告的解读应谨慎。
