Grant Jon E, Kim Suck Won, Hartman Boyd K
Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN 55454, USA.
J Clin Psychiatry. 2008 May;69(5):783-9. doi: 10.4088/jcp.v69n0511.
Pathological gambling (PG) is a disabling disorder experienced by approximately 1% of adults and for which few empirically validated treatments exist. This study examined the efficacy and tolerability of the opioid antagonist naltrexone in adults with PG who have urges to gamble.
An 18-week, double-blind, placebo-controlled trial was conducted to evaluate the safety and efficacy of 3 doses of oral naltrexone for PG. Seventy-seven individuals with DSM-IV-TR PG were randomly assigned to naltrexone (50 mg/day, 100 mg/day, or 150 mg/day) or placebo. Subjects were assessed with the Pathological Gambling Adaptation of the Yale-Brown Obsessive Compulsive Scale (PG-YBOCS), the urge and behavior subscales of the PG-YBOCS, the Gambling Symptom Assessment Scale (G-SAS), the Clinical Global Impressions-Severity of Illness scale (CGI-S), and measures of depression, anxiety, and psychosocial functioning. Data were collected from September 2002 to June 2005.
Outcomes did not significantly differ between the various doses of naltrexone. Subjects assigned to naltrexone had significantly greater reductions in PG-YBOCS total scores (p = .0094), gambling urges (p = .0053), and gambling behavior (p = .0134) compared to subjects assigned to placebo. Subjects assigned to naltrexone also had greater improvement in overall gambling severity (reflected in the CGI-S scores) (p = .0080) and in psychosocial functioning (p = .0177) than subjects assigned to placebo. A complete analysis (N = 49) demonstrated significantly greater improvement on all variables for subjects assigned to naltrexone. A sex analysis demonstrated that men and women did not differ significantly in their response to naltrexone.
Subjects assigned to naltrexone demonstrated statistically significant reductions in gambling urges and behavior in PG. Low-dose naltrexone (50 mg/day) appeared as efficacious as higher doses (100 mg/day and 150 mg/day), and all doses were well tolerated.
病理性赌博（PG）是一种使约1%的成年人深受其害的疾病，而针对该病的经实证验证的治疗方法很少。本研究考察了阿片类拮抗剂纳曲酮对有赌博冲动的成年PG患者的疗效和耐受性。
开展了一项为期18周的双盲、安慰剂对照试验，以评估3种剂量口服纳曲酮治疗PG的安全性和疗效。77名符合《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）PG诊断标准的个体被随机分配至纳曲酮组（50毫克/天、100毫克/天或150毫克/天）或安慰剂组。使用耶鲁-布朗强迫量表病理性赌博适应性版本（PG-YBOCS）、PG-YBOCS的冲动和行为分量表、赌博症状评估量表（G-SAS）、临床总体印象-疾病严重程度量表（CGI-S）以及抑郁、焦虑和社会心理功能测量工具对受试者进行评估。数据收集时间为2002年9月至2005年6月。
不同剂量的纳曲酮之间的结果没有显著差异。与分配至安慰剂组的受试者相比，分配至纳曲酮组的受试者在PG-YBOCS总分（p = 0.0094）、赌博冲动（p = 0.0053）和赌博行为（p = 0.0134）方面有显著更大程度的降低。与分配至安慰剂组的受试者相比，分配至纳曲酮组的受试者在总体赌博严重程度（反映在CGI-S评分中）（p = 0.0080）和社会心理功能（p = 0.0177）方面也有更大改善。一项完整分析（N = 49）表明，分配至纳曲酮组的受试者在所有变量上的改善都显著更大。一项性别分析表明，男性和女性对纳曲酮的反应没有显著差异。
分配至纳曲酮组的受试者在PG中的赌博冲动和行为有统计学上的显著降低。低剂量纳曲酮（50毫克/天）似乎与高剂量（100毫克/天和150毫克/天）一样有效，且所有剂量的耐受性都良好。
